INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA.
J Nucl Cardiol. 2019 Apr;26(2):374-386. doi: 10.1007/s12350-019-01615-0. Epub 2019 Feb 26.
Rb kinetics may distinguish scar from viable but dysfunctional (hibernating) myocardium. We sought to define the relationship between Rb kinetics and myocardial viability compared with conventional Rb and F-fluorodeoxyglucose (FDG) perfusion-metabolism PET imaging.
Consecutive patients (N = 120) referred for evaluation of myocardial viability prior to revascularization and normal volunteers (N = 37) were reviewed. Dynamic Rb 3D PET data were acquired at rest. F-FDG 3D PET data were acquired after metabolic preparation using a standardized hyperinsulinemic-euglycemic clamp. Rb kinetic parameters K, k, and partition coefficient (KP) were estimated by compartmental modeling RESULTS: Segmental Rb k and KP differed significantly between scarred and hibernating segments identified by Rb-FDG perfusion-metabolism (k, 0.42 ± 0.25 vs. 0.22 ± 0.09 min; P < .0001; KP, 1.33 ± 0.62 vs. 2.25 ± 0.98 ml/g; P < .0001). As compared to Rb-FDG analysis, segmental Rb KP had a c-index, sensitivity and specificity of 0.809, 76% and 84%, respectively, for distinguishing hibernating and scarred segments. Segmental k performed similarly, but with lower specificity (75%, P < .001) CONCLUSIONS: In this pilot study, Rb kinetic parameters k and KP, which are readily estimated using a compartmental model commonly used for myocardial blood flow, reliably differentiated hibernating myocardium and scar. Further study is necessary to evaluate their clinical utility for predicting benefit after revascularization.
Rb 动力学可区分瘢痕组织与存活但功能不良（冬眠）的心肌。我们旨在定义 Rb 动力学与心肌存活之间的关系，将其与常规 Rb 和 F-氟脱氧葡萄糖（FDG）灌注-代谢 PET 成像进行比较。
回顾性分析了 120 例拟行血运重建前评估存活心肌的连续患者（N=120）和 37 例正常志愿者（N=37）。在休息时采集 Rb 3D PET 动态数据。使用标准化的高胰岛素-正常血糖钳夹进行代谢准备后，采集 F-FDG 3D PET 数据。通过房室模型估算 Rb 动力学参数 K、k 和分配系数（KP）。
通过 Rb-FDG 灌注-代谢确定的瘢痕和冬眠节段之间，Rb 的 k 和 KP 存在显著差异（k，0.42±0.25 比 0.22±0.09 min；P<0.0001；KP，1.33±0.62 比 2.25±0.98 ml/g；P<0.0001）。与 Rb-FDG 分析相比，KP 区分冬眠和瘢痕节段的曲线下面积（AUC）、敏感度和特异度分别为 0.809、76%和 84%。k 的表现类似，但特异性较低（75%，P<0.001）。
在这项初步研究中，使用常用的心肌血流房室模型估算的 Rb 动力学参数 k 和 KP 可靠地区分了冬眠心肌和瘢痕组织。进一步的研究对于评估其在预测血运重建后获益方面的临床应用价值是必要的。
