^(99)Tc^(m)-PYP延迟及断层显像诊断转甲状腺素蛋白相关心脏淀粉样变的应用价值  

Application value of delay-phase ^(99)Tc^(m)-PYP scintigraphy and SPECT imaging for diagnosis of transthyretin-related cardiac amyloidosis

作　　者：任超 任静芸 杜延荣 田庄 何山 王雪竹 郝志鑫 丁洁 张抒扬 李方 霍力 Ren Chao;Ren Jingyun;Du Yanrong;Tian Zhuang;He Shan;Wang Xuezhu;Hao Zhixin;Ding Jie;Zhang Shuyang;Li Fang;Huo Li(Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine State Key Laboratory of Complex Severe and Rare Diseases(Peking Union Medical College Hospital),Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences State Key Laboratory of Complex Severe and Rare Diseases(Peking Union Medical College Hospital),Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院北京协和医院核医学科、核医学分子靶向诊疗北京市重点实验室、疑难重症及罕见病国家重点实验室(北京协和医院),北京100730 [2]中国医学科学院、北京协和医学院北京协和医院心内科、疑难重症及罕见病国家重点实验室(北京协和医院),北京100730

出　　处：《中华核医学与分子影像杂志》2022年第1期1-6,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家重点研发计划(2016YFC0901500,2016YFC0901501);中国医学科学院医学与健康科技创新工程(2018-I2M-3-001)。

摘　　要：目的:探讨^(99)Tc^(m)-焦膦酸盐(PYP)不同采集方法在心脏淀粉样变(CA)诊断与病理分型中的应用。方法:回顾性分析2018年12月至2019年12月间北京协和医院31例临床怀疑CA的患者资料,其中男22例、女9例,年龄21~81(57.2±13.4)岁。患者注射^(99)Tc^(m)-PYP后不同时间行平面显像[早期显像(注射后1 h)、延迟显像(注射后2~3 h)]和断层显像(注射后1 h)。以临床诊断为标准,分别采用视觉评分法(≥2分为阳性)和半定量法[心脏与对侧肺摄取比值(H/CL)≥1.5诊断为阳性]分析^(99)Tc^(m)-PYP不同采集方法获得的CA及非CA患者的影像学特点。采用单因素方差分析和Bonferroni检验分析数据。结果:根据临床诊断,CA组15例[转甲状腺素蛋白相关CA(ATTR-CA)5例、轻链型CA(AL-CA)10例],非CA组16例。5例ATTR-CA患者双时相显像和SPECT/CT显像均为阳性;10例AL-CA患者中3例早期显像阳性,延迟显像和SPECT/CT显像阴性;16例非CA患者双时相显像和SPECT/CT显像均为阴性。延迟期平面显像及断层显像灵敏度均为5/5,特异性均为10/10,阳性预测值均为5/5,阴性预测值均为10/10,准确性均为15/15。31例患者中,转甲状腺素蛋白相关(TTR)突变基因患者16例,其中4例为家族性突变型(ATTRv),表现为^(99)Tc^(m)-PYP显像阳性;12例诊断为非CA,表现为显像阴性。ATTR-CA组与AL-CA组早期显像H/CL(2.11±0.24与1.31±0.07)与延迟显像H/CL(2.02±0.19与1.30±0.05)差异均有统计学意义(F值:75.41和87.15,Bonferroni检验,均P<0.01)。结论:早期平面显像对CA分型存在误诊现象,延迟期平面显像及断层显像结果一致性好,可准确诊断ATTR-CA。^(99)Tc^(m)-PYP显像有助于发现TTR突变基因患者是否合并CA。Objective To investigate the application of different imaging methods of ^(99)Tc^(m)-pyrophosphate(PYP)in the diagnosis and pathological classification of cardiac amyloidosis(CA).Methods A total of 31 patients(22 males,9 females,age 21-81(57.2±13.4)years)with suspected CA who underwent ^(99)Tc^(m)-PYP dual-phase scintigraphy(early-phase:1 h,delay-phase:2-3 h)and SPECT/CT(1 h)between December 2018 and December 2019 in Peking Union Medical College Hospital were retrospectively included.Taking clinical diagnosis as the standard,the results of visual score(≥2,positive)and semi-quantitative values(heart to contralateral lung(H/CL)≥1.5,positive)of ^(99)Tc^(m)-PYP uptake in dual-phase scintigraphy and SPECT/CT imaging were analyzed.One-way analysis of variance and Bonferroni test were used to analyze the data.Results Among 31 patients with suspected CA,15 were clinically diagnosed as CA(5 patients with transthyretin-related CA(ATTR-CA)and 10 patients with light chain CA(AL-CA))and 16 were diagnosed as non-CA.All 5 patients with ATTR-CA had positive dual-phase scintigraphy and SPECT/CT imaging results.Three out of 10 patients with AL-CA had positive early-phase scintigraphy whereas negative delay-phase scintigraphy and SPECT/CT imaging results.Sixteen patients who were clinically diagnosed as non-CA had negative dual-phase scintigraphy and SPECT/CT imaging results.The sensitivity(5/5),specificity(10/10),positive predictive value(5/5),negative predictive value(10/10)and accuracy(15/15)of delay-phase scintigraphy and SPECT/CT imaging were the same.Among 31 patients,16 patients carried transthyretin-related(TTR)gene mutation,and 4 of them who clinically diagnosed as variant ATTR(ATTRv)had positive image findings while 12 of them who not clinically diagnosed as CA had negative image findings.There were significant differences in H/CL between ATTR-CA group and AL-CA group in early-phase(2.11±0.24 vs 1.31±0.07)and delay-phase(2.02±0.19 vs 1.30±0.05;F values:75.41 and 87.15,Bonferroni test,both P<0.01).Conclusions ^(99

关 键 词：淀粉样变性 心肌 放射性核素显像 体层摄影术 发射型计算机 单光子 99m锝焦磷酸盐 

分 类 号：R541[医药卫生—心血管疾病] R817.4[医药卫生—内科学]