用 82Rb 正电子发射断层扫描术定量心肌血流：用 15O-水进行临床验证。
Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water.
机构信息
Nuclear Medicine Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
出版信息
Eur J Nucl Med Mol Imaging. 2012 Jun;39(6):1037-47. doi: 10.1007/s00259-012-2082-3. Epub 2012 Mar 8.
PURPOSE
Quantification of myocardial blood flow (MBF) with generator-produced (82)Rb is an attractive alternative for centres without an on-site cyclotron. Our aim was to validate (82)Rb-measured MBF in relation to that measured using (15)O-water, as a tracer 100% of which can be extracted from the circulation even at high flow rates, in healthy control subject and patients with mild coronary artery disease (CAD).
METHODS
MBF was measured at rest and during adenosine-induced hyperaemia with (82)Rb and (15)O-water PET in 33 participants (22 control subjects, aged 30 ± 13 years; 11 CAD patients without transmural infarction, aged 60 ± 13 years). A one-tissue compartment (82)Rb model with ventricular spillover correction was used. The (82)Rb flow-dependent extraction rate was derived from (15)O-water measurements in a subset of 11 control subjects. Myocardial flow reserve (MFR) was defined as the hyperaemic/rest MBF. Pearson's correlation r, Bland-Altman 95% limits of agreement (LoA), and Lin's concordance correlation ρ (c) (measuring both precision and accuracy) were used.
RESULTS
Over the entire MBF range (0.66-4.7 ml/min/g), concordance was excellent for MBF (r = 0.90, [(82)Rb-(15)O-water] mean difference ± SD = 0.04 ± 0.66 ml/min/g, LoA = -1.26 to 1.33 ml/min/g, ρ(c) = 0.88) and MFR (range 1.79-5.81, r = 0.83, mean difference = 0.14 ± 0.58, LoA = -0.99 to 1.28, ρ(c) = 0.82). Hyperaemic MBF was reduced in CAD patients compared with the subset of 11 control subjects (2.53 ± 0.74 vs. 3.62 ± 0.68 ml/min/g, p = 0.002, for (15)O-water; 2.53 ± 1.01 vs. 3.82 ± 1.21 ml/min/g, p = 0.013, for (82)Rb) and this was paralleled by a lower MFR (2.65 ± 0.62 vs. 3.79 ± 0.98, p = 0.004, for (15)O-water; 2.85 ± 0.91 vs. 3.88 ± 0.91, p = 0.012, for (82)Rb). Myocardial perfusion was homogeneous in 1,114 of 1,122 segments (99.3%) and there were no differences in MBF among the coronary artery territories (p > 0.31).
CONCLUSION
Quantification of MBF with (82)Rb with a newly derived correction for the nonlinear extraction function was validated against MBF measured using (15)O-water in control subjects and patients with mild CAD, where it was found to be accurate at high flow rates. (82)Rb-derived MBF estimates seem robust for clinical research, advancing a step further towards its implementation in clinical routine.
目的
使用发生器产生的（82）Rb 对心肌血流（MBF）进行定量是一种有吸引力的替代方法，适用于没有现场回旋加速器的中心。我们的目的是验证（82）Rb 测量的 MBF 与使用（15）O-水作为示踪剂测量的 MBF之间的相关性，（15）O-水示踪剂 100%可从循环中提取，即使在高流速下也是如此，在健康对照者和轻度冠状动脉疾病（CAD）患者中。
方法
在 33 名参与者（22 名对照者，年龄 30±13 岁；11 名无穿透性梗死的 CAD 患者，年龄 60±13 岁）中，使用（82）Rb 和（15）O-水 PET 在休息和腺苷诱导的充血期间测量 MBF。使用一室（82）Rb 模型，带有心室溢出校正。（15）O-水测量中得出了（82）Rb 流量依赖性提取率。心肌血流储备（MFR）定义为充血/休息 MBF。Pearson 相关系数 r、Bland-Altman 95%一致性界限（LoA）和 Lin 的一致性相关系数ρ（c）（同时测量精度和准确性）用于评估。
结果
在整个 MBF 范围内（0.66-4.7 ml/min/g），MBF 的一致性非常好（r = 0.90，[（82）Rb-（15）O-水]平均值差异±SD = 0.04±0.66 ml/min/g，LoA = -1.26 至 1.33 ml/min/g，ρ（c）= 0.88）和 MFR（范围 1.79-5.81，r = 0.83，平均差异 = 0.14±0.58，LoA = -0.99 至 1.28，ρ（c）= 0.82）。与 11 名对照者的亚组相比，CAD 患者的充血性 MBF 降低（（15）O-水：2.53±0.74 vs. 3.62±0.68 ml/min/g，p = 0.002；（82）Rb：2.53±1.01 vs. 3.82±1.21 ml/min/g，p = 0.013），这与较低的 MFR 相对应（（15）O-水：2.65±0.62 vs. 3.79±0.98，p = 0.004；（82）Rb：2.85±0.91 vs. 3.88±0.91，p = 0.012）。在 1122 个节段中的 1114 个节段中（99.3%）心肌灌注均匀，各冠状动脉区域之间的 MBF 无差异（p > 0.31）。
结论
使用（82）Rb 进行 MBF 定量，结合新的非线性提取函数校正，与使用（15）O-水在对照者和轻度 CAD 患者中测量的 MBF 进行了验证，发现其在高流速下具有准确性。（82）Rb 衍生的 MBF 估计似乎对临床研究具有稳健性，朝着在临床常规中实施的方向又迈进了一步。
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