终末期心力衰竭患者核素显像“反向不匹配”表现1例  

One case of"reverse mismatch"in nuclear imaging of end-stage heart failure patient

作　　者：李潇雅 刘建营 孙奔 赵修义 邵亚辉 LI Xiaoya;LIU Jianying;SUN Ben;ZHAO Xiuyi;SHAO Yahui(Nuclear Medicine,The Third Affiliated Hospital of Shandong First Medical University,Jinan 250031,China;Nuclear Medicine,Jinan Central Hospital,Jinan 250013,China)

机构地区：[1]山东第一医科大学第三附属医院核医学科,山东济南250031 [2]济南市中心医院核医学科,山东济南250013

出　　处：《老年医学研究》2025年第1期56-59,共4页Geriatrics Research

摘　　要：患者因“反复出现胸闷、憋喘”入院。体格检查发现双肺湿啰音及心脏杂音,双下肢水肿。根据2021ESC急慢性心力衰竭诊断和治疗指南,通过核素显像、心脏超声、冠脉造影及实验室检查等,明确冠状动脉粥样硬化性心脏病、心力衰竭(终末期)诊断。患者经过经皮冠状动脉介入治疗(PCI)及药物处理后效果不佳,2个月后死亡。该患者核素心肌灌注图像显示轻至中度的灌注减低区却出现了重度甚至近于缺损的18F-FDG代谢,相异于常见的缺血但存活心肌的灌注代谢“图像不匹配”以及梗死心肌的灌注代谢“图像匹配”,呈现“反向不匹配”。这提示该部分心肌处于严重的濒死状态,现有的治疗效果不佳或心肌恢复功能所需时间较长。该病例提示,在心肌活性判定中存活心肌FDG代谢减低的程度可以反映心肌损伤的严重程度,可能也是影响预后的重要因素之一。The patient was admitted to hospital due to"recurrent chest tightness and shortness of breath".Physical ex-amination indicated bilateral pulmonary rales and heart murmurs,as well as bilateral lower extremities edema.According to the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,through radioactive nuclide imaging,echocardiography,coronary angiography,and laboratory results,the patient's diagnosis of coronary heart disease and end-stage heart failure was confirmed.Despite percutaneous coronary intervention(PCI)and drugs,the patient's con-dition did not improve and she died two months later.The radionuclide myocardial perfusion images of this patient showed mild to moderate perfusion reduction areas,but there was severe or nearly defect-like 18F-FDG metabolism,which was dif-ferent from the common"image mismatch"of ischemic but viable myocardium and the"image match"of infarcted myocardi-um in terms of perfusion and metabolism,presenting a"reverse mismatch".This suggests that this part of the myocardium is in a severe near-death state,that existing treatments do not respond well,or that it takes a long time for the myocardium to recover function.This case suggests that the degree of FDG metabolism reduction in viable myocardium can reflect the severity of myocardial injury and may also be an important factor affecting prognosis.

关 键 词：心肌灌注显像 心肌代谢显像 心力衰竭 经皮冠状动脉介入治疗 

分 类 号：R817.4[医药卫生—影像医学与核医学]