Mody F V, Brunken R C, Stevenson L W, Nienaber C A, Phelps M E, Schelbert H R
Department of Radiological Sciences, University of California-Los Angeles.
J Am Coll Cardiol. 1991 Feb;17(2):373-83. doi: 10.1016/s0735-1097(10)80102-0.
To determine if imaging of blood flow (using N-13 ammonia) and glucose metabolism (using F-18 2-deoxyglucose) with positron emission tomography can distinguish cardiomyopathy of coronary artery disease from nonischemic dilated cardiomyopathy, 21 patients with severe left ventricular dysfunction who were evaluated for cardiac transplantation were studied. The origin of left ventricular dysfunction had been previously determined by coronary angiography to be ischemic (11 patients) or nonischemic (10 patients). Images were visually analyzed by three observers on a graded scale in seven left ventricular segments and revealed fewer defects in dilated cardiomyopathy compared with ischemic cardiomyopathy for N-13 ammonia (2.7 +/- 1.6 versus 5 +/- 0.6; p less than 0.03) and F-18 deoxyglucose (2.8 +/- 2.1 versus 4.6 +/- 1.1; p less than 0.03). An index incorporating extent and severity of defects revealed more homogeneity with fewer and less severe defects in subjects with nonischemic than in those with ischemic cardiomyopathy as assessed by imaging of flow (2.8 +/- 1.8 versus 9.2 +/- 3; p less than 0.001) and metabolism (3.8 +/- 3.3 versus 8.5 +/- 3.6; p less than 0.005). Diagnostic accuracy for distinguishing the two subgroups by visual image analysis was 85%. Using previously published circumferential count profile criteria, patients with dilated cardiomyopathy had fewer ischemic segments (0.4 +/- 0.8 versus 2.5 +/- 2 per patient; p less than 0.01) and infarcted segments (0.1 +/- 0.3 versus 2.4 +/- 1.4 per patient; p less than 0.001) than did patients with cardiomyopathy of coronary artery disease. The sensitivity for differentiating the two clinical subgroups using circumferential profile analysis was 100% and the specificity 80%. An index incorporating both number and severity of defects derived from circumferential profile analysis was significantly lower in subjects with dilated cardiomyopathy than in ischemic cardiomyopathy (0.3 +/- 0.8 versus 2.7 +/- 2.4; p less than 0.005). Thus, noninvasive positron emission tomographic imaging with N-13 ammonia and F-18 deoxyglucose is helpful in distinguishing patients with severe left ventricular dysfunction secondary to coronary artery disease from those with nonischemic cardiomyopathy, and a semiquantitative index such as circumferential profile analysis is superior to that of visual analysis alone.
为了确定使用正电子发射断层扫描进行血流成像（使用N-13氨）和葡萄糖代谢成像（使用F-18 2-脱氧葡萄糖）能否区分冠状动脉疾病所致心肌病与非缺血性扩张型心肌病，对21例接受心脏移植评估的严重左心室功能障碍患者进行了研究。左心室功能障碍的病因先前已通过冠状动脉造影确定为缺血性（11例患者）或非缺血性（10例患者）。由三名观察者对七个左心室节段的图像进行视觉分级分析，结果显示，对于N-13氨（2.7±1.6对5±0.6；p<0.03）和F-18脱氧葡萄糖（2.8±2.1对4.6±1.1；p<0.03），扩张型心肌病的缺损比缺血性心肌病更少。一项综合缺损范围和严重程度的指数显示，与缺血性心肌病患者相比，非缺血性心肌病患者的缺损数量更少、程度更轻，血流成像（2.8±1.8对9.2±3；p<0.001）和代谢成像（3.8±3.3对8.5±3.6；p<0.005）评估的结果更均匀。通过视觉图像分析区分这两个亚组的诊断准确率为85%。使用先前公布的圆周计数轮廓标准，扩张型心肌病患者的缺血节段（每位患者0.4±0.8对2.5±2；p<0.01）和梗死节段（每位患者0.1±0.3对2.4±1.4；p<0.001）比冠状动脉疾病所致心肌病患者更少。使用圆周轮廓分析区分这两个临床亚组的敏感性为100%，特异性为80%。由圆周轮廓分析得出的一项综合缺损数量和严重程度的指数在扩张型心肌病患者中显著低于缺血性心肌病患者（0.3±0.8对2.7±2.4；p<0.005）。因此，使用N-13氨和F-18脱氧葡萄糖进行的无创正电子发射断层扫描成像有助于区分冠状动脉疾病继发的严重左心室功能障碍患者与非缺血性心肌病患者，并且像圆周轮廓分析这样的半定量指数优于单纯的视觉分析。
