Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, P.R. China.
Department of Intelligence and Computing, Tianjin University, Tianjin, P.R. China.
Medicine (Baltimore). 2024 Oct 25;103(43):e40175. doi: 10.1097/MD.0000000000040175.
The influence of computed tomography attenuation correction (CTAC) on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with F-18-FDG Positron Emission Tomography/Computed Tomography (PET/CT) metabolic imaging, compared with conventional SPECT MPI, remains to be fully elucidated. To evaluate the impact of CTAC on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT, compared to conventional SPECT MPI. 193 patients underwent CZT SPECT and F-18-FDG PET/CT imaging, while 39 patients underwent conventional SPECT and F-18-FDG PET/CT imaging, with both groups utilizing CT for attenuation correction. The injured myocardium (hibernating and scarring) was quantified using the Q.PET software. After CTAC, both groups showed significant improvements in perfusion of the injured myocardial areas, particularly in the inferior wall (INF). The reduction in perfusion was more notable in the CZT SPECT group than that in the conventional group, particularly in the inferior and lateral walls. Among patients with large cardiac chambers, those undergoing MPI with CZT, with normal weights, or males, hibernating myocardium (HM) and scar post-CTAC reductions were particularly significant in the INF. If HM ≥ 10% is considered an indicator for recommended revascularization, among the 87 patients without prior cardiac bypass, 25 (28.7%) might not require revascularization treatment. Dedicated cardiac CZT SPECT and conventional SPECT MPI combined with F-18-FDG PET/CT significantly influenced the assessment of viable myocardium. The impact of CTAC was more profound in dedicated cardiac CZT SPECT, particularly in the INF region. CTAC significantly enhances the accuracy of viable myocardial assessment and may influence clinical decisions regarding revascularization therapy. Therefore, CTAC should be routinely used in dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT for myocardial viability diagnosis.
使用 Tc-99m-MIBI 专用心脏 CZT 单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）结合 F-18-FDG 正电子发射断层扫描/计算机断层扫描（PET/CT）代谢成像，与传统 SPECT MPI 相比，计算断层扫描衰减校正（CTAC）对诊断存活心肌的准确性的影响尚不完全清楚。评估与传统 SPECT MPI 相比，使用 Tc-99m-MIBI 专用心脏 CZT SPECT MPI 结合 F-18-FDG PET/CT，CTAC 对诊断存活心肌的准确性的影响。193 例患者行 CZT SPECT 和 F-18-FDG PET/CT 成像，39 例患者行常规 SPECT 和 F-18-FDG PET/CT 成像，两组均使用 CT 进行衰减校正。使用 Q.PET 软件量化损伤心肌（冬眠和瘢痕）。在 CTAC 后，两组损伤心肌区域的灌注均有显著改善，特别是在下壁（INF）。与常规组相比，CZT SPECT 组的灌注减少更为显著，尤其是在下壁和侧壁。在心脏腔较大的患者中，在 MPI 中使用 CZT、体重正常或男性的患者中，冬眠心肌（HM）和瘢痕在 CTAC 后减少特别显著在 INF 中。如果 HM≥10%被认为是推荐血运重建的指标，在 87 例没有心脏旁路手术的患者中，有 25 例（28.7%）可能不需要血运重建治疗。专用心脏 CZT SPECT 和传统 SPECT MPI 结合 F-18-FDG PET/CT 显著影响存活心肌的评估。CTAC 对专用心脏 CZT SPECT 的影响更为显著，特别是在 INF 区域。CTAC 显著提高了存活心肌评估的准确性，并可能影响血管重建治疗的临床决策。因此，在专用心脏 CZT SPECT MPI 结合 F-18-FDG PET/CT 进行心肌存活诊断时，应常规使用 CTAC。
