^(99)Tc^(m)-PYP SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变与肥厚型心肌病  

Performance of^(99)Tc^(m)-PYP scintigraphy in differentiation of transthyretin-related cardiac amyloidosis and hypertrophic cardiomyopathy

作　　者：虢红辉 张昕璐 向馨 安荣臣 房智慧 叶千春[1] 董楚宁 尹璇 马晓伟 王云华[1] Guo Honghui;Zhang Xinlu;Xiang Xin;An Rongchen;Fang Zhihui;Ye Qianchun;Dong Chuning;Yin Xuan;Ma Xiaowei;Wang Yunhua(Department of Nuclear Medicine,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院核医学科,长沙410011

出　　处：《中华核医学与分子影像杂志》2024年第11期668-672,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^(99)Tc^(m)-焦膦酸盐(PYP)SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变(ATTR-CA)与肥厚型心肌病(HCM)的效能。方法回顾性分析2020年6月至2023年3月于中南大学湘雅二医院经心外活组织检查和心脏超声明确诊断为ATTR-CA[35例(男28例,女7例);年龄62.5(58.6,64.3)岁]或HCM[14例(男13例,女1例);年龄60.5(57.3,68.7)岁]的患者资料。所有患者在注射370~720 MBq^(99)Tc^(m)-PYP后1 h行平面显像和SPECT断层显像;对显像图进行视觉评分(0~1分为阴性,2~3分为阳性),计算心脏与对侧肺摄取比值(H/CL);采用χ^(2)检验比较ATTR-CA和HCM组间视觉评分差异,计算视觉评分法的诊断效能;行Mann-Whitney U检验比较组间H/CL差异;采用ROC曲线分析H/CL鉴别诊断ATTR-CA和HCM的效能。结果ATTR-CA组34例视觉评分≥2分,1例视觉评分<2分;HCM组6例视觉评分为2分,8例视觉评分<2分;视觉评分诊断ATTR-CA的灵敏度为97.1%(34/35),特异性为8/14;ATTR-CA与HCM组间视觉评分差异有统计学意义(χ^(2)=16.20,P<0.001)。ATTR-CA组H/CL明显高于HCM组[2.08(1.97,2.20)与1.26(1.17,1.35);z=-5.09,P<0.001];ROC曲线分析示H/CL最佳截断值为1.45[AUC:0.980(95%CI:0.946~1.000),P<0.001],H/CL鉴别诊断HCM和ATTR-CA的灵敏度为97.1%(34/35),特异性为14/14。结论^(99)Tc^(m)-PYP SPECT显像有助于鉴别诊断ATTR-CA和HCM,H/CL鉴别诊断这2种疾病的最佳截断值为1.45。Objective To investigate the efficacy of^(99)Tc^(m)-pyrophosphate(PYP)SPECT imaging for the differential diagnosis of transthyretin-related cardiac amyloidosis(ATTR-CA)and hypertrophic cardiomyopathy(HCM).Methods Data of patients who were definitively diagnosed with ATTR-CA(35 patients(28 males,7 females);age 62.5(58.6,64.3)years)or HCM(14 patients(13 males,1 female);age 60.5(57.3,68.7)years)by extracardiac biopsy and echocardiography in the Second Xiangya Hospital of Central South University between June 2020 and March 2023 were retrospectively analyzed.All patients underwent planar and SPECT imaging 1 h after injection of 370-720 MBq^(99)Tc^(m)-PYP.Visual scoring was performed(0-1 was negative,2-3 was positive),and heart-to-contralateral lung uptake ratio(H/CL)was calculated based on planar images.Theχ^(2)test was used to compare the difference in visual scores between ATTR-CA and HCM groups,and the diagnostic efficacy of the visual score was calculated.The H/CL differences between ATTR and HCM groups were compared with Mann-Whitney U test,and the ROC curve was used to analyze the efficacy of H/CL for the differential diagnosis of ATTR-CA and HCM.Results There were 34 patients with visual scores≥2 and 1 patient with visual score<2 in the ATTR-CA group,6 patients with visual scores=2 and 8 patients with visual scores<2 in HCM group,and there were significant differences between the 2 groups(χ^(2)=16.20,P<0.001).The diagnostic sensitivity of the visual score was 97.1%(34/35),and the specificity was 8/14.The H/CL in the ATTR-CA group was significantly higher than that in the HCM group(2.08(1.97,2.20)vs 1.26(1.17,1.35),z=-5.09,P<0.001).The ROC curve analysis suggested that the optimal cut-off value was 1.45(AUC:0.980,95%CI:0.946-1.000;P<0.001);the sensitivity of H/CL differential diagnosis between HCM and ATTR-CA was 97.1%(34/35),and the specificity was 14/14.Conclusion^(99)Tc^(m)-PYP SPECT imaging is useful in differentiation of ATTR-CA and HCM,and the optimal cut-off value of H/CL for differential diagnosis o

关 键 词：淀粉样神经病 家族性 心肌病 肥厚性 99m锝焦磷酸盐 放射性核素显像 体层摄影术 发射型计算机 单光子 

分 类 号：R542.2[医药卫生—心血管疾病] R817.4[医药卫生—内科学]