13N-NH3·H20 PET/C T显像血流储备测定对冠状动脉微血管疾病的诊断价值  

Diagnostic value of blood flow reserve measurement with 13N-NH3·H2O PET/CT imaging in patients with coronary microvascular disease

作　　者：彭琨 陈卫强[2] 王永德[2] 张健[2] 李剑明[1] Peng Kun;Chen Weiqiang;Wang Yongde;Zhang Jian;Li Jianming(Department of Nuclear Mediciney TEDA International Cardiovascular Hospital and Tianjin Medical University Cardiovascular Clinical Institute,Tianjin 300457,China;Department o f Cardiologyf TEDA International Cardiovascular Hospital and Tianjin Medical University Cardiovascular Clinical Institute,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院、天津医科大学心血管病临床学院核医学科,300457 [2]泰达国际心血管病医院、天津医科大学心血管病临床学院心内科,300457

出　　处：《中华核医学与分子影像杂志》2019年第12期708-713,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：天津市滨海新区卫生计生委科技项目(2017BWKY010);天津市滨海新区科技项目(BHXQKJXM-SF-2018-06)。

摘　　要：探讨13N-NH3·H2O PET/CT显像测定的冠状动脉血流储备(CFR)对可疑冠状动脉微血管疾病(CMVD)患者的诊断价值。方法回顾性分析2017年9月至2018年9月泰达国际心血管病医院共54例临床疑诊CMVD的患者(男22例、女32例,年龄25~77岁),行13N-NH3·H2O PET/CT显像测定左心室整体CFR(LV-CFR),并据其将患者分成CMVD组(LV-CFR<2.5)和非CMVD组(LV-CFR≥2.5)。比较2组患者PET/CT心肌灌注显像(MPI)半定量参数[负荷总积分(SSS)、静息总积分(SRS)、总积分差(SDS)和一过性缺血性扩张(TID)]和左心室功能参数[静息和负荷显像左心室射血分数(LVEF)、静息和负荷舒张末期容积(EDV)、收缩末期容积(ESV)]。另外分析和比较静息、负荷状态下左心室整体心肌血流量(LV-MBF)及CMVD组三支冠状动脉区域CFR分布的情况。采用两独立样本t检验、Mann-Whitney U检验和Pearson相关分析数据。结果CMVD组左心室整体静息MBF高于非CMVD组[(0.74±0.16)与(0.63±0.09)ml·g-1·min-1],而左心室整体负荷MBF低于非CMVD组[(1.52±0.36)与(1.89±0.22)ml·g-1·min-1;t值:2.925和-4.503,均P<0.05];余半定量参数在2组间的差异均无统计学意义(t值:-1.430~1.400,U值:286.0~338.5,均P>0.05)。CMVD组左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)的CFR之间有较好的相关性(r值:0.798~0.836,均P<0.01)。结论PET/CT显像CFR测定的诊断能力优于MPI的半定量分析,为冠状动脉造影或动脉CT阴性、疑诊CMVD的患者提供了无创、客观的诊断和评价依据。ObjectiveTo evaluate the diagnostic value of coronary flow reserve(CFR)on 13N-NH3·H2O PET/CT imaging for patients with suspected coronary microvascular disease(CMVD).MethodsFrom September 2017 to September 2018,54 clinical suspected CMVD patients(22 males,32 females;age:25-77 years)in TEDA International Cardiovascular Hospital were retrospectively analyzed.All patients underwent 13N-NH3·H2O PET/CT imaging to measure left ventricle CFR(LV-CFR),and were divided into CMVD group(LV-CFR<2.5)and non-CMVD group(LV-CFR≥2.5).Semi-quantitative parameters of PET/CT myocardial perfusion imaging(MPI),including summed stress score(SSS),summed rest score(SRS),summed difference score(SDS)and transient ischemic dilation(TID),as well as left ventricular function parameters,such as rest and stress imaging left ventricular ejection fraction(LVEF),end-diastolic volume(EDV),and end-systolic volume(ESV)were compared between two groups.Besides,rest and stress LV-myocardial blood flow(MBF)and CFR distribution of the CMVD group in the region of three coronary arteries was also analyzed and compared.Independent-sample t test,Mann-Whitney U test and Pearson correlation analysis were used to analyze the data.ResultsRest LV-MBF of CMVD group was higher than that of non-CMVD group((0.74±0.16)vs(0.63±0.09)ml·g-1·min-1)and stress LV-MBF was lower((1.52±0.36)vs(1.89±0.22)ml·g-1·min-1;t values:2.925,-4.503,both P<0.05).There was no significant difference between the two groups in other semi-quantitative parameters(t values:from-1.430 to 1.400,U values:286.0-338.5,all P>0.05).Positive correlations were found in CFR among left anterior descending(LAD),left circumflex(LCX)and right coronary artery(RCA)(r values:0.798-0.836,all P<0.01).ConclusionCFR measured with PET/CT imaging is better than semi-quantitative parameters in MPI,which provides noninvasive and objective diagnosis and evaluation information for patients without obvious epicardial coronary artery stenosis and suspected with CMVD.

关 键 词：冠状动脉疾病 微血管性心绞痛 血流储备分数 心肌 心肌灌注显像 正电子发射断层显像术 体层摄影术 X线计算机 氨 

分 类 号：R54[医药卫生—心血管疾病]