一体化PET/MR对缺血性心脏病心肌活性的评估价值  

Assessment of myocardial viability in ischemic heart disease by integrated PET/MR

作　　者：崔亚东 郑冲 谷珊珊 崔碧霄[1] 司瑾[3] 肖克令 李静[3] 卢洁[1] Cui Yadong;Zheng Chong;Gu Shanshan;Cui Bixiao;Si Jin;Xiao Keling;Li Jing;Lu Jie(Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Nuclear Medicine,Civil Aviation General Hospital,Beijing 100123,China;Department of Geriatrics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院放射与核医学科,北京100053 [2]民航总医院核医学科,北京100123 [3]首都医科大学宣武医院老年医学综合科,北京100053

出　　处：《中华核医学与分子影像杂志》2023年第9期513-517,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82130058)。

摘　　要：目的探讨一体化PET/MR在评估缺血性心脏病心肌活性中的应用价值。方法回顾性纳入2020年9月至2021年12月于首都医科大学宣武医院行PET/MR心脏检查的39例缺血性心脏病患者[男28例、女11例,年龄(60.1±12.0)岁]。所有患者行13N-NH3·H2O和18F-FDG心脏PET/MR检查,MRI扫描包括钆对比剂延迟增强(LGE)序列。对PET和MRI图像进行分析,按照美国心脏协会17节段法评估各节段心肌活性,测得PET和MRI梗死心肌范围。应用加权Kappa检验评估PET和MRI对心肌活性一致性评价。PET和MRI测得梗死心肌范围比较采用配对t检验,采用Pearson相关分析探讨两者的相关性。结果PET和MRI评价心肌活性结果一致性中等,Kappa值为0.532(P<0.001),符合率为69.83%(463/663)。PET与MRI测得梗死心肌范围差异无统计学意义[(23.89±14.23)%与(23.55±11.90)%;t=-0.24,P=0.809],二者呈强相关(r=0.79,P<0.001)。在PET显示正常心肌节段中,22.52%(100/444)在MRI显示存在心肌梗死。在MRI显示不存活心肌节段中,39.89%(73/183)在PET显示正常或存活。结论一体化PET/MR能够充分发挥PET和MRI的互补优势,实现对心肌活性的全面精确评价。Objective To evaluate the value of integrated PET/MR in assessing myocardial viability in ischemic heart disease.Methods A total of 39 patients(28 males,11 females;age(60.1±12.0)years)diagnosed with ischemic heart disease in Xuanwu Hospital,Capital Medical University were retrospectively enrolled from September 2020 to December 2021.All patients underwent cardiac 13N-NH3·H2O and 18F-FDG PET/MR examinations.Late gadolinium enhancement(LGE)sequence was included in MRI scan.PET and MRI images were analyzed and myocardial viability of each myocardial segment was evaluated according to the American Heart Association(AHA)17 segment method.The extent of left ventricular infarcted myocardium was measured based on PET and MRI images.Weighted Kappa test was used to evaluate the agreement of PET and MRI in assessing myocardial viability.The extent of infarcted myocardium measured by PET and MRI was compared by paired-t test,and Pearson correlation analysis was used to assess the correlation between them.Results There was a moderate agreement between PET and MRI in assessing myocardial viability(Kappa=0.532,P<0.001),with the agreement rate of 69.83%(463/663).There was no significant difference but strong correlation between the extents of infarcted myocardium measured by PET and MRI((23.89±14.23)%vs(23.55±11.90)%;t=-0.24,P=0.809;r=0.79,P<0.001).In segments with normal perfusion and metabolism on PET,22.52%(100/444)showed abnormal enhancement on MRI.On the other hand,39.89%(73/183)of the segments classified as non-viable on MRI showed normal or viable on PET.Conclusion Integrated PET/MR is able to take full advantage of the complementary nature of PET and MRI,achieving the comprehensive and accurate evaluation of myocardial viability.

关 键 词：心肌缺血 组织存活 心肌灌注显像 氨 正电子发射断层显像术 氟脱氧葡萄糖F18 磁共振成像 钆 

分 类 号：R541[医药卫生—心血管疾病]