99mTc-甲氧基异丁基异腈心肌单光子发射计算机断层显像（SPECT）与18F-氟代脱氧葡萄糖正电子发射断层显像（PET）联合应用评估心肌存活的临床价值

Evaluation of the clinical value of combination of 99mTc-MIBI myocardial SPECT and 18F-FDG PET in assessing myocardial viability.

作者信息

Zhang X, Liu X, Shi R, Wu Q, Gao R, Liu Y, Hu S, Guo S, Xie F, Li Y

机构信息

Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Radiat Med. 1999 May-Jun;17(3):205-10.

PMID:10440109

Abstract

PURPOSE

To evaluate the value of 18F-FDG PET metabolic imaging and 99mTc-MIBI SPECT in the identification of myocardial viability in patients with previous myocardial infarction and left ventricular dysfunction.

METHODS

18F-FDG PET (made in China) and 99mTc-MIBI SPECT were performed in 60 patients (pts) (age 54+/-9 yr) with myocardial infarction before revascularization. Before and after revascularization, LVEF and wall motion were measured with echocardiography in 36 pts (Group A), and myocardial perfusion was evaluated in 24 pts (Group B).

RESULTS

According to the interpretation of perfusion and metabolic images, myocardial segments were classified into mismatch (MM): reduced myocardial perfusion and normal FDG uptake or match (M): reduced perfusion and FDG uptake. Out of 264 segments with hypoperfusion, 145 (54.9%) were MM, suggesting viable myocardium (G-A1 and G-B1), 119 (45.1%) were M, suggesting necrosis (G-A2 and G-B2). After revascularization, LVEF was increased in G-A1 (49+/-15% vs. 59+/-7%, p<0.05), and in G-B1 (50+/-8% vs. 59+/-12%, p<0.05), but was not improved in G-A2 and G-B2. LVEDD was decreased in G-A1 and G-B1 (p<0.05) and was unchanged in G-A2 and G-B2. The positive predictive value (PPV) of FDG PET for improvement of regional wall motion after revascularization was 88%, and the negative predictive value (NPV) was 72.6%. The PPV for improvement of perfusion was 84.1%, NPV was 85%, and accuracy was 84.4%.

CONCLUSION

18F-FDG imaging with Chinese PET has clinical value for assessing myocardial viability and identifying patients who will benefit from revascularization.

摘要

目的

评估18F-FDG PET代谢成像和99mTc-MIBI SPECT在识别既往心肌梗死和左心室功能障碍患者心肌存活情况中的价值。

方法

对60例（年龄54±9岁）心肌梗死患者在血运重建前进行18F-FDG PET（中国制造）和99mTc-MIBI SPECT检查。在36例患者（A组）血运重建前后，用超声心动图测量左室射血分数（LVEF）和室壁运动，在24例患者（B组）评估心肌灌注。

结果

根据灌注和代谢图像的判读，心肌节段分为不匹配（MM）：心肌灌注降低但FDG摄取正常，或匹配（M）：灌注和FDG摄取均降低。在264个灌注减低节段中，145个（54.9%）为MM，提示存活心肌（A1组和B1组），119个（45.1%）为M，提示坏死（A2组和B2组）。血运重建后，A1组LVEF升高（49±15%对59±7%，p<0.05），B1组也升高（50±8%对59±12%，p<0.05），但A2组和B2组未改善。A1组和B1组左室舒张末期内径（LVEDD）减小（p<0.05），A2组和B2组无变化。FDG PET对血运重建后局部室壁运动改善的阳性预测值（PPV）为88%，阴性预测值（NPV）为72.6%。对灌注改善的PPV为84.1%，NPV为85%，准确性为84.4%。