Ling Xueying, Chen Jianxin, Shang Jingjie, Tang Yongjin, Cheng Yong, Xu Hao
Department of Nuclear Medicine.
Department of Cardiology, the First Affiliated Hospital of Jinan University, Guangzhou, China.
Nucl Med Commun. 2020 Jan;41(1):40-47. doi: 10.1097/MNM.0000000000001109.
To evaluate the utility of sequential F-18 fluorodeoxyglucose PET/diffusion-weighted imaging in assessing myocardial perfusion and viability in coronary artery disease.
Fourteen coronary artery disease patients and five non-coronary artery disease subjects underwent sequential cardiac F-18 fluorodeoxyglucose PET/diffusion-weighted imaging using a trimodality PET/computed tomography-MRI system. The perfusion data were acquired by measuring low b-values apparent diffusion coefficient using diffusion-weighted imaging. Regional myocardial viability was determined by perfusion/metabolism patterns. The perfusion/metabolism patterns obtained by low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake were analyzed and compared with the results from the combination of rest methoxyisobutylisonitrile (Tc-MIBI) myocardial perfusion single-photon emission computed tomography with F-18 fluorodeoxyglucose PET/computed tomography.
Ten coronary artery disease patients and five non-coronary artery disease subjects were included in the final analysis. Low b-values apparent diffusion coefficient defects involved with 25 myocardial regions were demonstrated in nine coronary artery disease patients, while Tc-MIBI defects involved with 21 myocardial regions were shown in the same patients. The agreement between low b-values apparent diffusion coefficient and MIBI uptake was good in coronary artery disease patients (κ = 0.627, P < 0.001) and was better still in the whole subjects (κ = 0.733, P < 0.001). Low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake demonstrated mismatch patterns in six coronary artery disease patients and MIBI/fluorodeoxyglucose uptake revealed mismatch patterns in seven coronary artery disease patients. Agreement in the evaluation of regional myocardial viability between low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake and MIBI/fluorodeoxyglucose uptake was high in coronary artery disease patients (κ = 0.627, P < 0.001) and all subjects (κ = 0.728, P < 0.001).
Low b-values apparent diffusion coefficient/fluorodeoxyglucose uptake is comparable to MIBI/fluorodeoxyglucose uptake in assessing perfusion/metabolism patterns, indicating that microperfusion might dominate the diffusion signal at low b-values and sequential PET/diffusion-weighted imaging might be useful to evaluate myocardial viability in coronary artery disease patients.
评估序贯F-18氟脱氧葡萄糖正电子发射断层显像/扩散加权成像在评估冠状动脉疾病心肌灌注和存活心肌方面的效用。
14例冠状动脉疾病患者和5例非冠状动脉疾病受试者使用PET/计算机断层扫描-磁共振成像三联模式系统接受序贯心脏F-18氟脱氧葡萄糖正电子发射断层显像/扩散加权成像。通过使用扩散加权成像测量低b值表观扩散系数来获取灌注数据。通过灌注/代谢模式确定局部心肌存活情况。分析低b值表观扩散系数/氟脱氧葡萄糖摄取所获得的灌注/代谢模式，并与静息甲氧异丁基异腈（锝-甲氧基异丁基异腈，Tc-MIBI）心肌灌注单光子发射计算机断层显像与F-18氟脱氧葡萄糖正电子发射断层显像/计算机断层扫描联合检查的结果进行比较。
最终分析纳入10例冠状动脉疾病患者和5例非冠状动脉疾病受试者。9例冠状动脉疾病患者显示25个心肌区域存在低b值表观扩散系数缺损，而同一批患者显示21个心肌区域存在Tc-MIBI缺损。冠状动脉疾病患者中低b值表观扩散系数与MIBI摄取之间的一致性良好（κ = 0.627，P < 0.001），在所有受试者中一致性更好（κ = 0.733，P < 0.001）。6例冠状动脉疾病患者的低b值表观扩散系数/氟脱氧葡萄糖摄取显示不匹配模式，7例冠状动脉疾病患者的MIBI/氟脱氧葡萄糖摄取显示不匹配模式。冠状动脉疾病患者以及所有受试者中，低b值表观扩散系数/氟脱氧葡萄糖摄取与MIBI/氟脱氧葡萄糖摄取在评估局部心肌存活方面的一致性较高（冠状动脉疾病患者κ = 0.627，P < 0.001；所有受试者κ = 0.728，P < 0.001）。
在评估灌注/代谢模式方面，低b值表观扩散系数/氟脱氧葡萄糖摄取与MIBI/氟脱氧葡萄糖摄取相当，这表明在低b值时微灌注可能主导扩散信号，序贯正电子发射断层显像/扩散加权成像可能有助于评估冠状动脉疾病患者的心肌存活情况。
