慢性血栓栓塞性肺动脉高压患者核素肺通气/灌注分布异质性的初步定量研究  

Preliminary quantitative analysis of the distribution heterogeneity of lung ventilation/perfusion in patients with chronic thromboembolic pulmonary hypertension

作　　者：马荣政 王蒙 方纬[1] 张宗耀[1] 汪蕾[1] Ma Rongzheng;Wang Meng;Fang Wei;Zhang Zongyao;Wang Lei(Department of Nuclear Medicine,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院核医学科,100037

出　　处：《国际放射医学核医学杂志》2020年第5期291-297,共7页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的研究核素肺通气/灌注(V/Q)SPECT显像在慢性血栓栓塞性肺动脉高压(CTEPH)分布异质性中的应用,探讨分布异质性定量指标与肺动脉压力之间的相关性。方法收集中国医学科学院阜外医院2018年2月至12月经右心导管及肺动脉造影确诊的CTEPH患者20例(CTEPH组),其中男性12例、女性8例,年龄(48.75±14.07)岁;13名正常健康者作为对照组,其中男性7名、女性6名,年龄(54.46±8.56)岁。CTEPH组患者和对照组健康者均行肺V/Q SPECT显像及同床位低剂量CT扫描,CTEPH患者在一周内行超声心动检查,估测肺动脉收缩压(PASP)。通过图像重建和分析,获得肺V/Q放射性分布异质性指标LogSDV、LogSDQ和LogSDVQR(SD为标准差;V、Q、VQR分别为通气、灌注的放射性计数及二者的比值)。在CT图像上采用肺CT阈值的方法自动勾画左肺、右肺和全肺的感兴趣区,并将之复制于肺灌注图像上,获得左肺、右肺和全肺的标准化摄取值(SUV),包括SUV的峰值(SUVpeak)、最大值(SUVmax)、最小值(SUVmin)、平均值(SUVmean)和标准差(SUVSD),其中SUVSD代表肺灌注放射性分布的异质性。2组之间的比较采用t检验,分布异质性指标与PASP的相关性采用Pearson相关性分析。结果健康对照组的肺V/Q放射性分布曲线呈对称性单峰状分布,而CTEPH组的肺V/Q放射性分布曲线呈非对称性的多峰分布。与健康对照组相比,CTEPH组的LogSDV、LogSDVRQ、全肺灌注的SUVpeak、SUVmax、SUVSD均明显升高,且差异均有统计学意义(LogSDV:0.56±0.16对0.31±0.11,t=4.91,P=0.000;LogSDVQR:0.61±0.15对0.40±0.14,t=3.89,P=0.001;SUVpeak:19.12±7.94对10.81±4.05,t=3.48,P=0.002;SUVmax:20.19±8.30对11.44±4.33,t=3.49,P=0.001;SUVSD:3.54±1.44对2.42±0.91,t=2.50,P=0.018);而2组的LogSDQ、SUVmean和SUVmin的差异均无统计学意义。CTEPH组的PASP为(72.80±0.15)mmHg,LogSDVQR与PASP呈中等程度相关(R=0.544,P=0.013)。结论核素肺V/Q显像可定量评估CTEPH患者肺V/Q放射性分布�Objective To quantitatively assess the distribution heterogeneity of lung ventilation/perfusion(V/Q)in patients with chronic thromboembolic pulmonary hypertension(CTEPH)and to evaluate the correlation between distribution heterogeneity parameters and pulmonary artery pressure.Methods Twenty CTEPH patients,comprising twelve males and eight females(age,48.75±14.07 years old),who were hospitalized in Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from February 2018 to December 2018,were confirmed to have CTEPH by means of right heart catheterization and pulmonary angiography.Thirteen controls,comprising seven males and six females(age,54.46±8.56 years old),were also enrolled.Patients and controls underwent V/Q san and low-dose CT,and echocardiography was performed within 1 week to estimate pulmonary artery systolic pressure(PASP).The heterogeneity indexes of lung V/Q distribution include LogSDV,LogSDQ,and LogSDVQR(V and Q and V/Q are the radioactivity count of ventilation and perfusionand,and its ratio).SD is the standard deviation.The abovementioned indexes were obtained by image reconstruction and analysis.Then,on CT images,the lung CT threshold was used to automatically delineate the boundary of the left lung,the right lung,and the whole lung as the volume of interest,and it was replicated on the pulmonary perfusion images to acquire the standardized uptake value(SUV),including peak of SUV(SUVpeak),maximum of SUV(SUVmax),minimum of SUV(SUVmin),mean of SUV(SUVmean),and standard deviation of SUV(SUVSD).SUVSD represents the heterogeneity of perfusion distribution.The comparation of two groups by utilising t-test.Using Pearson correlation to analyse distribution heterogeneity parameters and PASP correlation.Results The distribution of lung V/Q in the healthy control patients presented a symmetrical unimodal distribution,whereas the distribution curve of lung V/Q in patients with CTEPH presented an asymmetric multi-peak distribution.Compared with the control group,LogSDV,LogSDVQR

关 键 词：通气-灌注显像 高血压 肺性 肺栓塞 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 异质性 

分 类 号：R544.1[医药卫生—心血管疾病] R817.4[医药卫生—内科学]