O-HO PET/CT 作为一种工具，用于定量评估乳腺癌患者放疗后早期心脏灌注变化。
O-HO PET/CT as a tool for the quantitative assessment of early post-radiotherapy changes of heart perfusion in breast carcinoma patients.
机构信息
1 Department of Oncology and Brachytherapy, Nicolaus Copernicus University in Toruń Ludwik Rydygier, Collegium Medicum in Bydgoszcz , Bydgoszcz , Poland.
2 Radiology Therapeutic Center in Krakow , Amethyst Radiotherapy Center in Zgorzelec , Poland.
出版信息
Br J Radiol. 2018 Jul;91(1088):20170653. doi: 10.1259/bjr.20170653. Epub 2018 Jul 20.
OBJECTIVE
Studies examining radiation-induced heart toxicity in breast cancer patients are inconclusive. The aim of this study was to prospectively and quantitatively asses myocardial blood flow (MBF) with, for the first time, O-HO PET/CT as a marker of heart damage in irradiated breast cancer patients.
METHODS
15 breast cancer patients receiving intact breast or chest wall irradiation were included in the analysis (six with right-sided and nine with left-sided breast cancer). They underwent O-HO PET/CT before radiotherapy (RT) and 2 and 8 months after RT. MBF was quantitatively assessed at rest and under stress conditions in 17 heart segments distinguished according to the American Ultrasound Association classification. Regional MBF values were derived in each of the coronary artery territories.
RESULTS
MBF decreased in 53% and increased in 33% of cases 2 months after RT in both left-sided and right-sided breast cancer patients. Stress testing was more sensitive than at-rest testing, demonstrating decreased perfusion in the segments supplied by the left anterior descending coronary artery (LAD) [5.41 ± 1.74 vs 4.52 ± 1.82 ml (gmin); p = 0.018], which persisted at 6 months [5.41 ± 1.74 vs 4.40 ± 1.38 ml (gmin); p = 0.032] and a decrease in global heart perfusion [5.14 ± 1.49 vs 4.46 ± 1.73 ml (g*min); p = 0.036]. A minimal radiation dose applied to the LAD correlated with MBF changes observed 2 months after RT (r = -0.57; p = 0.032). Radiological findings were not correlated with clinical symptoms of heart toxicity.
CONCLUSION
O-HO PET/CT is safe and effective for the early detection and quantitative analysis of subclinical post-RT changes in heart perfusion in breast cancer patients. The LV segments supplied by the LAD are the main site of MBF changes. A minimum radiation dose deposited in the LAD may be a predictor of radiation-induced heart toxicity. Advances in knowledge: This is the first time that O-HO PET/CT has been used to assess MBF after RT and the first granular description of the distribution of blood flow changes after breast cancer RT.
目的
研究乳腺癌患者放疗诱导性心脏毒性的结果尚无定论。本研究旨在前瞻性和定量评估心肌血流（MBF），这是首次使用 O-HO PET/CT 作为放射性乳腺癌患者心脏损伤的标志物。
方法
分析了 15 例接受完整乳房或胸壁放疗的乳腺癌患者（右侧 6 例，左侧 9 例）。他们在放疗（RT）前、RT 后 2 个月和 8 个月进行了 O-HO PET/CT 检查。根据美国超声心动图协会分类，在 17 个心脏节段定量评估静息和应激状态下的 MBF。在每个冠状动脉供血区得出节段性 MBF 值。
结果
左侧和右侧乳腺癌患者 RT 后 2 个月，MBF 分别有 53%和 33%下降。与静息测试相比，应激测试更敏感，显示左前降支（LAD）供应节段的灌注减少[5.41±1.74 比 4.52±1.82ml（gmin）；p=0.018]，6 个月时仍持续[5.41±1.74 比 4.40±1.38ml（gmin）；p=0.032]，并且整体心脏灌注减少[5.14±1.49 比 4.46±1.73ml（g*min）；p=0.036]。LAD 接受的最小辐射剂量与 RT 后 2 个月观察到的 MBF 变化相关（r=-0.57；p=0.032）。放射学发现与心脏毒性的临床症状无关。
结论
O-HO PET/CT 安全有效，可早期发现和定量分析乳腺癌患者 RT 后心脏灌注的亚临床变化。LAD 供应的 LV 节段是 MBF 变化的主要部位。LAD 中沉积的最小辐射剂量可能是放射性心脏毒性的预测因子。知识的进步：这是首次使用 O-HO PET/CT 评估 RT 后 MBF，也是首次对乳腺癌 RT 后血流变化分布进行详细描述。
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