^(18)F-FDG PET/CT联合^(99m)Tc-MIBI G-MPI双核素显像对冠状动脉旁路移植术前存活心肌的评估价值  

Assessment value of ^(18)F-FDG PET/CT combined with ^(99m)Tc-MIBI G-MPI dual-nuclide imaging in evaluating viable myocardium before coronary artery bypass grafting

作　　者：张淼[1] 王超[1] 郭睿[1] 潘昱[1] 林晓珠[1] 张一帆[1] 李彪[1] ZHANG Miao;WANG Chao;GUO Rui;PAN Yu;LIN Xiaozhu;ZHANG Yifan;LI Biao(Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《山东医药》2019年第13期15-18,共4页Shandong Medical Journal

基　　金：国家青年科学基金资助项目(30900375);上海市申康促进医院临床技能与临床创新能力三年行动计划项目(16CR3110B)

摘　　要：目的探讨18氟-脱氧葡萄糖正电子发射型计算机断层显像(^(18)F-FDG PET/CT)联合^(99m)锝-甲氧基异丁基异腈(^(99m)Tc-MIBI)门控心肌灌注显像(G-MPI)对冠状动脉旁路移植(CABG)术前存活心肌的评估价值。方法选择冠状动脉病变患者28例,CABG术前2周均行^(18)F-FDG PET/CT联合^(99m)Tc-MIBI G-MPI双核素显像检查,测算灌注-代谢积分差值(SDS)、代谢-灌注不匹配范围、左心室射血分数(LVEF)、治疗前后LVEF差值(ΔLVEF)。术后随访6～12个月复查G-MPI。用Pearson相关分析不匹配范围与LVEF、SDS的相关性。结果 28例患者中有22例完成手术及术后随访。根据SDS将22例患者分为三组,A组(4例) SDS≥0、B组(10例)-5≤SDS <0、C组(8例) SDS <-5。A组术前心肌存活范围较小,CABG术后LVEF未改善(P> 0. 05); B组术前存活心肌范围中等,术后LVEF改善(P <0. 05); C组患者术前存活心肌范围较大,术后LVEF改善(P <0. 01)。术前SDS比较A组> B组> C组,术前不匹配范围比较A组<B组<C组,差异均有统计学意义(P均<0. 05)。不匹配范围与ΔLVEF呈正相关(r=0. 478,P <0. 05),与SDS呈负相关(r=-0. 671,P <0. 05)。结论 CABG术前采用^(18)F-FDG PET/CT联合^(99m)Tc-MIBI G-MPI双核素显像可有效评估患者存活心肌范围,从而预测其预后。Objective To investigate the value of 18F-deoxyglucose-positron emission tomo graphy(18 F-FDG PET/CT)combined with 99m Tc-methoxyisobutylisonitrile(99m Tc-MIBI)gated myocardial perfusion imaging(G-MPI)dual nuclide imaging in evaluating the viable myocardium before coronary artery bypass grafting(CABG).Methods Twenty-eight patients with coronary artery disease were selected.All patients underwent 18 F-FDG PET/CT combined with 99m Tc-MIBI G-MPI dual-nuclide imaging 2 weeks before CABG.The difference of perfusion-metabolism score(SDS),mismatch range of perfusion metabolism,left ventricular ejection fraction(LVEF),and LVEF difference before and after treatment(ΔLVEF)were calculated.G-MPI was reexamined after 6-12 months of follow-up.The correlation between mismatch range and LVEF,SDS was analyzed by Pearson correlation.Results Of 28 patients,22 completed the operation and follow-up.According to SDS,22 patients were divided into three groups:group A(4 cases)with SDS≥0,group B(10 cases)with-5≤SDS<0,and group C(8 cases)with SDS<-5.The survival myocardial range of preoperative assessment in the group A was small,the LVEF did not improve after CABG(P>0.05).The LVEF of group B was improved after CABG,and ischemic myocardium survived(P<0.05).In the group C,the survival myocardial range of preoperative assessment was larger,and the postoperative LVEF was significantly improved(P<0.01).The mismatch range was positively correlated withΔLVEF(r=0.478,P<0.05)and was negatively correlated with SDS(r=-0.671,P<0.05).Conclusion 18 F-FDG PET/CT combined with 99m Tc-MIBI G-MPI dual-nuclide imaging before CABG can effectively assess the range of viable myocardium and predict the prognosis of patients.

关 键 词：冠状动脉旁路移植术 18氟-脱氧葡萄糖正电子发射型计算机断层显像 99m锝-甲氧基异丁基异腈门控心肌灌注显像 存活心肌 

分 类 号：R445[医药卫生—影像医学与核医学]