摘要
目的比较^99Tc^m-MIBI SPECT/^18F-FDGPET心肌灌注／代谢显像与心脏MRI延迟增强成像2种影像学方法评价特发性扩张型心肌病（IDCM）心肌损伤的特点。方法对42例明确诊断为IDCM的连续患者[其中男29例，女13例，年龄（53±12）岁]，行^99Tc^m-MIBI SPECT/^18F-FDGPET心肌灌注／代谢显像和心脏MRI延迟成像，间隔时间为3—7d。利用17节段模型分别为各节段心肌灌注和代谢图像的放射性摄取评分，共分为4个等级：0=摄取正常，1=摄取轻度降低，2=摄取中度降低，3=摄取严重降低。根据心肌灌注／代谢匹配情况分为正常、不匹配、轻中度匹配、完全匹配4组；根据心脏MRI延迟成像结果分为无延迟强化、壁间强化、透壁强化3组，采用，检验比较不同强化组间的灌注／代谢异常率差异和不同灌注／代谢匹配组间的延迟强化发生率。结果全部42例患者中，18例心脏MRI延迟成像出现延迟强化，其中94．4％（17／18）患者心肌灌注／代谢异常；而另外24例心脏MRI延迟成像无延迟强化患者中，仅有33．3％（8／24）患者心肌灌注／代谢异常（X^2=15．944，P〈0．001）。心肌节段分析中，无延迟强化、壁间强化、透壁强化3组相应的心肌灌注／代谢情况有差异，灌＇注／代谢正常率分别为86．2％（526／610）、71．0％（44／62）和28．6％（12／42）（X^2=14．276，P〈0．001）。灌注／代谢不匹配组中75．9％（63／83）的心肌节段无延迟强化，而灌注／代谢完全匹配组透壁强化的发生率（44．4％，12／27）明显高于其他3组[正常组2．1％（12／582）、不匹配组18．1％（15／83）、轻中度匹配组13：6％（3／22）,X^2=112．530，P〈0．001]。结论心脏MRI延迟成像检测轻度纤维化更敏感，而心肌灌注／代谢显像能够检测更多受损但存活的心肌。结合2种影像学方法评价IDCM患者心肌损伤可以提供更加全面的信息。
Objective To evaluate the relationship of myocardial MR contrast delay-enhancement and nuclear perfusion-metabolism pattern in patients with idiopathic dilated cardiomyopathy （IDCM）, Methods Forty-two consecutive patients （29 men and 13 women, age： （53 -＋ 12） years） diagnosed clini- cally with IDCM were enrolled. All patients underwent ^99Tc^m-MIBI SPECT/^18F-FDG PET imaging and MR contrast delay-enhancement imaging within 3 -7 d. The myocardial perfusion-metabolism segment analysis was performed using a 17-segment model. Segmental ^99Tc^m-MIBI and ^18F-FDG uptakes were scored visually using a 4-grade scoring system （0 = normal uptake, 1 = mildly reduced uptake, 2 = moderately reduced uptake, 3 = severely reduced uptake）. Patterns of perfusion/metabolism were classified as normal, mis- match, mild-to-moderate match and severe match. Myocardial MR contrast delay-enhancement was classi- fied into 3 categories （non, mid-wall and transmural delay-enhancement）. X2 test was used to analyze the differences of perfusion/metabolism patterns among non, mid-wall and transmural delay-enhancement groups and the myocardial MR contrast delay-enhancement incidence among four perfusion/metabolism groups. Results Among the 42 patients, myocardial delay-enhancement was present in 18 patients, of which 94.4% （17/18） showed abnormal myocardial perfusion/metabolism patterns and only 33.3% （8/24） patients without abnormal myocardial delay-enhancement had abnormal myocardial perfusion/metabolism patterns （X2 = 15. 944, P 〈 0. 001 ）. Perfusion/metabolism patterns varied in three different categories of non, mid-wall and transmural delay-enhancement （X2 = 14. 276, P 〈 0.001 ）. The normal perfusion/metabolism pattern proportions in the non, mid-wall and transmural delay-enhancement groups were 86. 2% （526/610）, 71.0% （ 44/62 ） and 28. 6% （ 12/42 ）, respectively. The incidence of transmural delay-enhancement （44. 4% （12/27）） was significantly higher in segments with severe match than that in the other 3 groups （ normal： 2.1% （12/582） ; mismatch ： 18.1% （ 15/83 ） ; mild-to-moderate match ： 13.6% （3/22） ; X2 = 112. 530, P 〈 0.001 ）. Conclusions MR contrast delay-enhancement is much more sensitive in detecting moderate fibrosis, while nuclear perfusion-metabolism imaging can detect more impaired but viable myocar- dium. Combining the two imaging modalities is useful for providing comprehensive evaluations of myocardial injury in patients with IDCM.
出处
《中华核医学与分子影像杂志》
CSCD
北大核心
2013年第2期141-145,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
