SPECT/CT显像在评估缺血性心肌病患者的存活心肌中的应用价值  

Application of SPECT/CT imaging in the evaluation of viable myocardium in patients with ischemic cardiomyopathy

作　　者：赵守松 孙文杰 牟兴宇 陆路 张蕾 秦杰 付巍[1] ZHAO Shousong;SUN Wenjie;MOU Xingyu;LU Lu;ZHANG Lei;QIN Jie;FU Wei(Department of Nuclear Medicine,Affiliated Hospital of Guilin Medical College,Guilin 541001,Guangxi,China)

机构地区：[1]桂林医学院附属医院核医学科,广西桂林541001

出　　处：《中国现代医生》2023年第29期33-38,共6页China Modern Doctor

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2020111)。

摘　　要：目的 以2-氟-18-氟-2-脱氧-D-葡萄糖(^(18)F-fluorodeoxyglucose,^(18)F-FDG)PET/CT心肌代谢显像为金标准,探讨锝-99m-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(technetium-99m labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime,^(99m)Tc-HL91)SPECT/CT乏氧显像结合锝-99m-甲氧基异丁基异腈(technetium-99m labeled sestamibi,^(99m)Tc-MIBI)SPECT/CT心肌灌注显像评估缺血性心肌病(ischemic cardiomyopathy,ICM)患者不同缺血程度及不同冠状动脉供血区存活心肌的价值。方法 纳入66例ICM患者,于^(99m)Tc-MIBI心肌灌注显像当日行^(99m)Tc-HL91乏氧显像、次日行^(18)F-FDG心肌代谢显像。将左心室心肌分为17个节段,分析^(99m)Tc-MIBI心肌灌注显像与^(99m)Tc-HL91乏氧显像的放射性分布情况,根据结果将ICM患者缺血心肌节段分为存活心肌节段和坏死心肌节段,并与金标准对比。采用四格表法计算^(99m)Tc-HL91乏氧显像对ICM患者不同缺血程度及不同冠状动脉供血区存活心肌的诊断效能。结果 66例ICM患者共1122个心肌节段,^(99m)Tc-MIBI心肌灌注显像提示,正常心肌节段304个,缺血心肌节段818个。^(99m)Tc-HL91乏氧显像提示,存活心肌节段514个,坏死心肌节段304个;^(18)F-FDG心肌代谢显像提示,存活心肌节段641个,坏死心肌节段177个。^(99m)Tc-HL91乏氧显像在轻中度缺血组、重度缺血伴梗死组间诊断的敏感度、准确率差异均有统计学意义(P均<0.001),特异性差异无统计学意义(P=1.000)。^(99m)Tc-HL91乏氧显像诊断敏感度、准确率在左前降支组、左回旋支组组间比较,差异均无统计学意义(P分别为0.121、0.653),在左前降支组、右冠状动脉组组间(P均<0.001)或左回旋支组、右冠状动脉组组间比较,差异均有明显统计学意义(P均<0.001),特异性在各组间差异均无统计学意义(P均为1.000)。结论 ^(99m)Tc-HL91乏氧显像结合^(99m)Tc-MIBI心肌灌注显像可判断缺血心肌的存活状态,对于存在�Objective ^(18)F-fluorodeoxyglucose(^(18)F-FDG) PET/CT myocardial metabolic imaging was used as the gold standard,to investigate the value of technetium-99m labeled 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime(^(99m)Tc-HL91)single-photon emission computed tomography/computed tomography(SPECT/CT) hypoxia imaging combined with technetium-99m labeled sestamibi(^(99m)Tc-MIBI) SPECT/CT myocardial perfusion imaging in the evaluation of viable myocardium with different degrees of ischemia and different coronary blood supply areas in patients with ischemic cardiomyopathy(ICM).Methods ^(99m)Tc-HL91 hypoxia imaging was performed on the same day as ^(99m)Tc-MIBI myocardial perfusion imaging,and ^(18)F-FDG myocardial metabolism imaging was performed the next day in 66 patients with ICM.The left ventricular myocardium was divided into 17 segments.The radioactivity distribution of ^(99m)Tc-MIBI and ^(99m)Tc-HL91 was analyzed.According to the results,ischemic myocardial segments were divided into viable segments and necrotic segments,and the results were compared with gold standard.The diagnostic efficacy of ^(99m)Tc-HL91 hypoxia imaging in the evaluation of different degrees of ischemia and different coronary blood supply areas in patients with ICM was calculated by four-grid method.Results There were a total of 1122 myocardial segments in 66 patients with ICM were analyzed.^(99m)Tc-MIBI myocardial perfusion imaging showed 304 normal and 818 ischemic myocardial segments.Of these,^(99m)Tc-HL91 hypoxia imaging showed 514 viable myocardial segments and 304 necrotic myocardial segments,and ^(18)F-FDG myocardial metabolism imaging showed 641 viable myocardial segments and 177 necrotic myocardial segments.There were statistically significant differences in diagnostic sensitivity and accuracy between the mild to moderate ischemia group and severe ischemia with infarction group(all P<0.001),but there were no statistical difference in specificity between the two groups(P=1.000).There were no statistical differences in sens

关 键 词：乏氧显像 心肌灌注显像 心肌代谢显像 缺血性心肌病 存活心肌 

分 类 号：R81[医药卫生—放射医学]