冠状动脉 FDG 显像的可行性：急性冠脉综合征与稳定型心绞痛的比较。
Feasibility of FDG imaging of the coronary arteries: comparison between acute coronary syndrome and stable angina.
机构信息
Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
JACC Cardiovasc Imaging. 2010 Apr;3(4):388-97. doi: 10.1016/j.jcmg.2010.01.004.
OBJECTIVES
This study tested the hypothesis that fluorodeoxyglucose (FDG) uptake within the ascending aorta and left main coronary artery (LM), measured using positron emission tomography (PET), is greater in patients with recent acute coronary syndrome (ACS) than in patients with stable angina.
BACKGROUND
Inflammation is known to play an important role in atherosclerosis. Positron emission tomography imaging with (18)F-FDG provides a measure of plaque inflammation.
METHODS
Twenty-five patients (mean age 57.9 +/- 9.8 years, 72% male, 10 ACS, and 15 stable angina) underwent cardiac computed tomographic angiography and PET imaging with (18)F-FDG after invasive angiography. Images were coregistered, and FDG uptake was measured at locations of interest for calculation of target-to-background ratios (TBR). Additionally, FDG uptake was measured at the site of the lesion deemed clinically responsible for the presenting syndrome (culprit) by virtue of locating the stent deployed to treat the syndrome.
RESULTS
The FDG uptake was higher in the ACS versus the stable angina groups in the ascending aorta (median [interquartile ranges] TBR 3.30 [2.69 to 4.12] vs. 2.43 [2.00 to 2.86], p = 0.02), as well as the LM (2.48 [2.30 to 2.93] vs. 2.00 [1.71 to 2.44], p = 0.03, respectively). The TBR was greater for culprit lesions associated with ACS than for lesions stented for stable coronary syndromes (2.61 vs. 1.74, p = 0.02). Furthermore, the TBR in the stented lesions (in ACS and stable angina groups) correlated with C-reactive protein (r = 0.58, p = 0.04).
CONCLUSIONS
This study shows that in patients with recent ACS, FDG accumulation is increased both within the culprit lesion as well as in the ascending aorta and LM. This observation suggests inflammatory activity within atherosclerotic plaques in acute coronary syndromes and supports intensification of efforts to refine PET methods for molecular imaging of coronary plaques.
目的
本研究旨在验证以下假设，即使用正电子发射断层扫描（PET）测量的急性冠状动脉综合征（ACS）患者升主动脉和左主干冠状动脉（LM）内的氟脱氧葡萄糖（FDG）摄取量高于稳定型心绞痛患者。
背景
炎症在动脉粥样硬化中起着重要作用。用（18）F-FDG 进行正电子发射断层扫描成像可提供斑块炎症的测量指标。
方法
25 名患者（平均年龄 57.9±9.8 岁，72%为男性，10 名 ACS 患者，15 名稳定型心绞痛患者）在有创性血管造影后进行心脏计算机断层扫描血管造影和（18）F-FDG 的 PET 成像。对图像进行配准，并测量感兴趣部位的 FDG 摄取量，以计算靶-背景比（TBR）。此外，还测量了病变部位的 FDG 摄取量，该病变部位通过定位用于治疗综合征的支架来确定为导致当前综合征的临床责任病变（罪犯）。
结果
ACS 组的 FDG 摄取量高于稳定型心绞痛组，升主动脉（中位数[四分位数范围] TBR 3.30[2.69 至 4.12] 与 2.43[2.00 至 2.86]，p=0.02）和 LM（2.48[2.30 至 2.93] 与 2.00[1.71 至 2.44]，p=0.03）。与稳定型冠状动脉综合征相关的 ACS 罪犯病变的 TBR 大于支架治疗的病变（2.61 与 1.74，p=0.02）。此外，支架病变（ACS 和稳定型心绞痛组）的 TBR 与 C 反应蛋白呈正相关（r=0.58，p=0.04）。
结论
本研究表明，在近期 ACS 患者中，不仅在罪犯病变内，而且在升主动脉和 LM 内 FDG 蓄积均增加。这一观察结果表明，急性冠状动脉综合征中存在动脉粥样斑块的炎症活性，并支持加强努力，以改进用于冠状动脉斑块分子成像的 PET 方法。
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