对比增强磁共振成像与（18）F-FDG正电子发射断层显像/201Tl单光子发射计算机断层扫描在功能失调心肌中的比较：与慢性缺血性心脏病外科血运重建术后早期功能转归的关系
Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease.
作者信息
Wu Yen-Wen, Tadamura Eiji, Yamamuro Masaki, Kanao Shotaro, Marui Akira, Tanabara Keiichi, Komeda Masashi, Togashi Kaori
机构信息
Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan.
出版信息
J Nucl Med. 2007 Jul;48(7):1096-103. doi: 10.2967/jnumed.106.038596.
UNLABELLED
Revascularization of viable myocardial segments has been shown to improve left ventricular (LV) function and long-term prognosis; however, the surgical risk is comparatively higher in patients with a low ejection fraction (EF). We compared contrast-enhanced MRI with (18)F-FDG PET/(201)Tl SPECT for myocardial viability and prediction of early functional outcome in patients with chronic coronary artery disease (CAD).
METHODS
Forty-one patients with chronic CAD and LV dysfunction (mean age +/- SD, 66 +/- 10 y; 32 men; mean EF +/- SD, 38% +/- 13%) referred for (18)F-FDG PET, (201)Tl-SPECT and MRI within 2 wk were included. Twenty-nine subjects underwent coronary artery bypass grafting (CABG), and LV function was reassessed by MRI before discharge (17 +/- 7 d after surgery). Two were excluded from outcome analysis (1 death due to sepsis; 1 perioperative myocardial infarction). The extent of viable myocardium by (18)F-FDG PET/(201)Tl SPECT was defined by the metabolism-perfusion mismatch or ischemia, in comparison with the extent of delayed enhancement (DE) on MRI in a 17-segment model. Segmental functional recovery was defined as improvement in the wall motion score of > or =1 on a 4-point scale. EF and LV volume change were used as global functional outcome.
RESULTS
Three hundred ninety-four dysfunctional segments were compared, and the extent of DE on MRI correlated negatively with the viability on (18)F-FDG PET. Of 252 dysfunctional segments that were successfully revascularized, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/SPECT were 60.2%, 98.7%, 76.6%, and 96.7% and of MRI were 92.2%, 44.9%, 72.4%, and 78.6% using the cutoff value of 50% DE on MRI, without significant differences in overall accuracies. In 18 subjects who underwent isolated CABG, improvement of EF (> or =5%) and reverse LV remodeling (> or =10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on (18)F-FDG/SPECT predicted a poor early functional outcome (all P < 0.001).
CONCLUSION
Accurate prediction of early functional outcome by PET/SPECT and contrast-enhanced MRI is possible.
未标注
已证实对存活心肌节段进行血运重建可改善左心室（LV）功能和长期预后；然而，射血分数（EF）较低的患者手术风险相对较高。我们比较了对比增强磁共振成像（MRI）与（18）F - 氟代脱氧葡萄糖正电子发射断层显像（PET）/（201）铊单光子发射计算机断层显像（SPECT）在慢性冠状动脉疾病（CAD）患者心肌存活情况及早期功能结局预测方面的差异。
方法
纳入41例慢性CAD且左心室功能不全的患者（平均年龄±标准差，66±10岁；32例男性；平均EF±标准差，38%±13%），在2周内接受了（18）F - FDG PET、（201）Tl - SPECT和MRI检查。29例患者接受了冠状动脉旁路移植术（CABG），出院前（术后17±7天）通过MRI重新评估左心室功能。2例被排除在结局分析之外（1例因败血症死亡；1例围手术期心肌梗死）。在17节段模型中，与MRI上延迟强化（DE）范围相比，（18）F - FDG PET/（201）Tl SPECT显示的存活心肌范围通过代谢 - 灌注不匹配或缺血来定义。节段性功能恢复定义为4分制壁运动评分改善≥1分。EF和左心室容积变化用作整体功能结局指标。
结果
比较了394个功能障碍节段，MRI上DE范围与（18）F - FDG PET显示的存活情况呈负相关。在252个成功进行血运重建的功能障碍节段中，PET/SPECT的敏感性、特异性、阳性预测值和阴性预测值分别为60.2%、98.7%、76.6%和96.7%，MRI的分别为92.2%、44.9%、72.4%和78.6%（以MRI上DE为50%作为截断值），总体准确率无显著差异。在18例接受单纯CABG的患者中，MRI上无DE对EF改善（≥5%）和左心室逆向重构（左心室大小缩小≥10%）的预测最佳，（18）F - FDG/SPECT显示有大量无存活心肌的患者早期功能结局较差（所有P < 0.001）。
结论
PET/SPECT和对比增强MRI能够准确预测早期功能结局。
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