多排 CT 与 F-18-FDG-PET 和 SPECT 在评估心肌梗死后心肌存活中的比较：一项初步研究。

Comparison of multidetector CT with F-18-FDG-PET and SPECT in the assessment of myocardial viability in patients with myocardial infarction: a preliminary study.

机构信息

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.

出版信息

Eur J Radiol. 2009 Dec;72(3):401-5. doi: 10.1016/j.ejrad.2008.09.001. Epub 2008 Oct 11.

DOI:10.1016/j.ejrad.2008.09.001

PMID:18849129

Abstract

OBJECTIVE

To evaluate the ability of MDCT to detect a nonviable myocardium in patients with myocardial infarction (MI).

METHODS AND MATERIAL

This study included 17 patients with MI in the acute (n=13) or chronic stage (n=4). MDCT, SPECT, and F-18-FDG-PET were performed in 10 patients during the acute stage and in 2 during the chronic stage of MI. MDCT and SPECT were performed in 13 patients with acute stage and in 4 with chronic stage of MI. Sixteen-slice MDCT was performed 10 min after injection of 120 mL of nonionic contrast media. MDCT, SPECT and PET images were analyzed using a 17-segment model. The depth of hyperenhancement >2/3 was defined as nonviable at MDCT.

RESULTS

MDCT and SPECT were concordant in localizing the MI in 84.2% (272/323 segments) and were discordant in 15.8% (51/323). MDCT and PET were concordant in localizing MI in 89.2% (182/204) and discordant in 10.8% (22/204). The sensitivity, specificity and diagnostic accuracy of MDCT in determining the nonviable segments were 70.4%, 85.3%, 81.4% as compared with PET, respectively, and 69.4%, 81.8%, 79.9% compared with SPECT, respectively, and 73.5%, 79.4%, 78.4% compared with combined PET and SPECT, respectively. MDCT findings suggested nonviability in additional 16 segments (5.0%) and 7 segments (3.4%) where MI was not detected on SPECT and FDG-PET, respectively.

CONCLUSION

MDCT is useful for determining myocardial viability in patients with myocardial infarction and more sensitive than SPECT and FDG-PET in detecting a nonviable myocardium.

摘要

目的

评估 MDCT 检测心肌梗死后（MI）患者心肌是否存活的能力。

方法与材料

本研究纳入了 17 名 MI 患者，其中急性期 13 例，慢性期 4 例。10 例患者在急性期，2 例在慢性期进行了 MDCT、SPECT 和 F-18-FDG-PET 检查。13 例急性 MI 患者进行了 MDCT 和 SPECT 检查，4 例慢性 MI 患者进行了这两种检查。16 层 MDCT 在注射 120ml 非离子型造影剂 10 分钟后进行。采用 17 节段模型对 MDCT、SPECT 和 PET 图像进行分析。MDCT 上增强程度大于 2/3 的深度定义为无活性。

结果

MDCT 和 SPECT 在定位 MI 方面的一致性为 84.2%（272/323 节段），不一致性为 15.8%（51/323）。MDCT 和 PET 在定位 MI 方面的一致性为 89.2%（182/204），不一致性为 10.8%（22/204）。MDCT 在确定无活性节段的敏感性、特异性和诊断准确性分别为 70.4%、85.3%和 81.4%，与 PET 相比，分别为 69.4%、81.8%和 79.9%，与 SPECT 相比，分别为 73.5%、79.4%和 78.4%，与联合 PET 和 SPECT 相比，分别为 73.5%、79.4%和 78.4%。MDCT 结果提示在 SPECT 和 FDG-PET 分别未检测到 MI 的情况下，另外 16 个节段（5.0%）和 7 个节段（3.4%）存在无活性。