^(99m)Tc-MIBI SPECT/CT门控心肌血流灌注显像在乳腺癌术后放疗致放射性心脏损伤诊断中的应用价值  

Application value of ^(99m)Tc-MIBI SPECT/CT gated myocardial perfusion imaging in diagnosis of radiation-inducedheart damage caused by radiotherapy for postoperative breast cancer

作　　者：王雪霁 刘医辉 李海霞[1] 张荣[1] 梁瑞 张雪燕 杨勇[1] 王静[1] WANG Xueji;LIU Yihui;LI Haixia;ZHANG Rong;LIANG Rui;ZHANG Xueyan;YANG Yong;WANG Jing(Department of Nuclear Medicine,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Radiotherapy,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院核医学科,宁夏银川750002 [2]宁夏回族自治区人民医院放疗科,宁夏银川750002

出　　处：《宁夏医学杂志》2024年第7期568-572,共5页Ningxia Medical Journal

基　　金：宁夏自然科学基金项目(2022AAC03355)。

摘　　要：目的探讨高锝酸盐标记甲氧基异丁基异腈单光子发射计算机断层扫描门控心肌血流灌注显像(^(99m)Tc-MIBI SPECT/CT GMPI)在乳腺癌术后放疗致放射性心脏损伤(RIHD)诊断中的应用价值。方法收集接受放疗的乳腺癌患者72例。所有患者均于放疗前及放疗结束后行两日法静息+运动^(99m)Tc-MIBI SPECT/CT GMPI检查,比较放疗前后心肌灌注显像半定量参数及左心功能评价指标间的差异。结果72例患者放疗前有14例患者存在心肌缺血,占比为19.4%,放疗后心肌缺血患者共43例,占比为59.7%,放疗后心肌缺血人数较放疗前明显增加,差异有统计学意义(P<0.05)。放疗后心肌灌注显像半定量参数(SSS)、静息灌注总评分(SRS)、总差值(SDS=SRS-SSS)及总灌注缺损(TPD)平均值均高于放疗前,差异有统计学意义(P<0.05)。放疗后SRS、SSS、SDS及TPD与患者年龄呈正相关,差异有统计学意义(P<0.05);与患者身体质量指数呈负相关,差异有统计学意义(P<0.05)。肿瘤位于左侧及手术方式为根治术的患者SSS、SRS、SDS及TPD平均值明显大于肿瘤位于右侧及手术方式为保乳术的患者,差异有统计学意义(P<0.05)。放疗前心脏彩超检查左心功能参数舒张末期容积(EDV)、收缩末期容积(ESV)及左心室射血分数(LVEF)与静息GMPI左心功能参数比较,差异无统计学意义(P>0.05)。放疗后心脏彩超与静息状态下GMPI左心功能参数EDV、ESV比较,差异无统计学意义,(P>0.05)。但放疗后GMPI检查所得LVEF值低于心脏彩超检查,差异有统计学意义(P<0.05)。结论^(99m)Tc-MIBI SPECT/CT GMPI不仅可以根据视觉及半定量指标判断放疗后心肌缺血范围及严重程度,而且还可以通过EDV、ESV及LVEF评价放疗后左心室功能,其可作为乳腺癌放疗后评估放疗所致心脏损伤的一项重要检查方式。Objective To investigate the value of^(99m)Tc-MIBI SPECT/CT GMPI in the diagnosis of radiation-induced heart disease(RIHD)after breast cancer surgery.Methods 72 patients with breast cancer who received radiotherapy in the department of Radiotherapy of our hospital were collected.All patients underwent 2-day resting and exercise ^(99m)Tc-MIBI SPECT/CT GMPI before and after radiotherapy.The semi-quantitative parameters of GMPI and left ventricular function evaluation indexes before and after radiotherapy were compared.Results 19.4%patients had myocardial ischemia before radiotherapy.59.7%patients were found to have myocardial ischemia after radiotherapy.The number of patients was significantly higher than that before radiotherapy,and the difference was statistically significant(P<0.05).The semiquantitative parameters SRS,SSS,SDS and TPD of MPI after radiotherapy were higher than those before radiotherapy,the differences were statistically significant(P<0.05).After radiotherapy,SRS,SSS,SDS and TPD were significantly correlated with the age of patients,and were positively correlated,and the differences were statistically significant(P<0.05).There was a significant and negative correlation with body mass index(P<0.05).The mean values of SSS,SRS,SDS and TPD in patients with tumor located on the left side and radical operation were significantly higher than those in patients with tumor located on the right side and breast conserving operation,and the differences were statistically significant(P<0.05).There was no significant difference between left ventricular function parameters EDV,ESV,LVEF and resting GMPI before radiotherapy(P>0.05).There was no significant difference in left ventricular function parameters EDV and ESV of GMPI after radiotherapy compared with those at rest(P>0.05).However,the LVEF value obtained by GMPI after radiotherapy was lower than that by Cardiac color Doppler ultrasound and the difference was statistically significant(P<0.05).Conclusion ^(99m)Tc-MIBI SPECT/CT GMPI can not only judge the exten

关 键 词：乳腺癌 放疗 高锝酸盐标记甲氧基异丁基异腈 单光子发射计算机断层扫描仪 门控心肌血流灌注显像 放射性心脏损伤 

分 类 号：R737.9[医药卫生—肿瘤]