SPECT/CT的简易Z-score影像系统在评估颈动脉内膜切除术对颈动脉狭窄的治疗效果中的价值  

Value of easy Z-score imaging system of SPECT/CT in evaluating the therapeutic effect of carotid endarterectomy on carotid artery stenosis

作　　者：张志婷 王萱 孙丹阳[1] 李玮[1] Zhang Zhiting;Wang Xuan;Sun Danyang;Li Wei(Department of Nuclear Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Nuclear Medicine,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津医科大学总医院核医学科,天津300052 [2]天津市胸科医院核医学科,天津300222

出　　处：《国际放射医学核医学杂志》2024年第6期343-350,共8页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：天津市科技人才培育项目(KJ20059);天津医科大学总医院青年孵育基金(ZYYFY2019027)。

摘　　要：目的探讨SPECT/CT的简易Z-score影像系统(eZIS)在评估颈动脉内膜切除术(CEA)对颈动脉狭窄的治疗效果中的价值,并分析其与磁共振血管成像(MRA)的一致性。方法回顾性分析2018年6月至2021年1月在天津医科大学总医院常规行99Tcm-双半胱乙酯脑血流灌注SPECT/CT显像及MRA检查的18例颈动脉狭窄(单侧或双侧)患者的临床资料,根据是否行CEA,将患者分为手术治疗组和非手术治疗组,其中,手术治疗组7例,包括男性5例、女性2例,年龄(58.4±7.6)岁,这7例患者均于术前及术后6个月内行SPECT/CT显像和MRA检查;非手术治疗组11例,包括男性8例、女性3例,年龄(62.6±11.1)岁,这11例患者均接受常规药物治疗,并于治疗前及治疗后行SPECT/CT显像和MRA检查,且所有检查均于6个月内完成。测量患者病变部位局部脑血流量并通过eZIS计算出治疗前后Z-score的变化。对2组患者治疗前后Z-score及颈动脉狭窄程度的比较采用配对样本t检验。对MRA与SPECT/CT的eZIS结果的一致性行Kappa检验。结果手术治疗组患者术后Z-score(0.54±2.71)较术前(-1.34±2.68)明显升高,且差异有统计学意义(t=3.899,P=0.008),而非手术治疗组患者治疗后Z-score(-0.33±2.58)较治疗前(1.84±2.62)明显下降,且差异有统计学意义(t=4.618,P=0.001)。手术治疗组患者术后颈动脉狭窄程度较术前明显减轻,且差异有统计学意义(t=3.063,P=0.022);非手术治疗组患者治疗后颈动脉狭窄程度较治疗前明显加重,且差异有统计学意义(t=4.820,P=0.001)。MRA和SPECT/CT的eZIS对颈动脉狭窄治疗前后病情评估的一致性较好(Kappa值=0.766,P<0.001)。结论SPECT/CT的eZIS能够无创、可视化评估CEA对颈动脉狭窄的治疗效果,其方法简便且结果与MRA具有较好的一致性。Objective To explore the value of easy Z-score imaging system(eZIS)in the evaluation of carotid endarterectomy(CEA)in the treatment of carotid artery stenosis and to analyze its consistency with magnetic resonance angiography(MRA).Methods The clinical data of 18 patients with carotid artery stenosis(unilateral or bilateral)who underwent 99Tcm-ethylcysteinate dimer cerebral blood flow perfusion SPECT/CT imaging and MRA examination at Tianjin Medical University General Hospital from June 2018 to January 2021 were retrospectively analyzed.Whether CEA was performed or not,the patients were divided into the surgical treatment group and non-surgical treatment group.The surgical treatment group consisted of 7 patients,including 5 males and 2 females,aged(58.4±7.6)years.All 7 patients underwent SPECT/CT imaging and MRA examination before and within 6 months after surgery.On the contrary,the non-surgical treatment group consisted of 11 patients,including 8 males and 3 females,aged(62.6±11.1)years.All 11 patients received routine drug treatment and underwent SPECT/CT imaging and MRA examination before and after treatment,all of which were completed within 6 months.The local cerebral blood flow at the lesion site of the patients was measured,and the changes in Z-score before and after treatment were calculated by using eZIS.A paired sample t-test was used to verify the change in Z-score and carotid artery stenosis degree in the two groups before and after treatment.The consistency of MRA and SPECT/CT eZIS results was analyzed by conducting the Kappa test.Results The postoperative Z-score(0.54±2.71)in the surgical treatment group was remarkably higher than that before surgery(−1.34±2.68),and the difference was statistically significant(t=3.899,P=0.008).The Z-score(−0.33±2.58)of patients in the non-surgical treatment group decreased remarkably after treatment compared with that before treatment(1.84±2.62),and the difference was statistically significant(t=4.618,P=0.001).The degree of carotid artery stenosis in the s

关 键 词：颈动脉狭窄 颈动脉内膜切除术 脑血流灌注显像 磁共振血管造影术 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 简易Z-score影像系统 

分 类 号：R651.12[医药卫生—外科学]