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近年来,基于SPECT的心脏动态显像定量分析技术已逐步成熟并开始应用于临床。与传统的静态显像定性分析技术相比,定量分析技术更能满足临床精准诊断的迫切需求,在诊断准确率方面具有明显的优势。与传统的定性诊断技术相比,SPECT心肌灌注显像心肌血流定量分析技术诊断心肌缺血的灵敏度有了显著的提高[1-3];SPECT心脏神经显像也逐步建立了能够用于心脏疾病诊断和预后评估的定量指标[4-7]。传统的定性诊断技术与SPECT心肌灌注显像心肌血流定量分析技术联合应用能够进一步提高对心肌损伤的诊断效能,对因冠状动脉痉挛引起的一过性心肌缺血、急性心肌梗死后恶性心律失常等不良预后事件的预测等都有较好的诊断价值[8-9]。
另一方面,SPECT显像的性能也在不断提高。与传统SPECT相比,碲锌镉(cadmium zinc telluride,CZT)心脏专用SPECT(简称CZT SPECT)具有更优越的物理性能,其探测灵敏度、空间分辨率和能量分辨率均明显提高,能够对能峰较为接近的99Tcm和123I信号进行有效地鉴别,从而实现双核素显像,明显提高了诊断效率[10]。已有研究人员对99Tcm-MIBI/123I-间碘苄胍(metaiodobenzylguanidine, MIBG)双核素心肌灌注/交感神经显像的可行性进行了探索,结果表明CZT SPECT能够较好地辨别99Tcm-MIBI和123I-MIBG信号,有效避免双核素间的干扰,一次检查可以同时得到较为清晰的99Tcm-MIBI心肌灌注显像和123I-MIBG心脏交感神经图像[11-13]。本研究在上述研究的基础上,进一步利用CZT SPECT进行99Tcm-MIBI/123I-MIBG双核素双动态心脏显像定量分析,探讨双核素采集对心脏定量分析指标是否会产生显著的影响,从而确定这一技术在临床中应用的可行性。
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由表1可知,99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域的MBF的差异均无统计学意义(均P>0.05)。99Tcm-MIBI单核素动态SPECT心脏显像与进行非完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域的MBF的差异均有统计学意义(均P<0.05)。
显像方法 整体左心室 左前降支支配区域 左回旋支支配区域 右冠状动脉支配区域 99Tcm-MIBI单核素动态SPECT心脏显像(n=24) 0.74 (0.64,0.79) 0.72 (0.68,0.82) 0.73 (0.66,0.80) 0.77 (0.64,0.82) 完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像(n=24) 0.74 (0.64,0.80)a 0.74 (0.64,0.84)a 0.74 (0.61,0.79)a 0.77 (0.66,0.82)a 非完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像(n=24) 0.88 (0.76,0.94)b 0.91 (0.82,1.10)b 0.92 (0.87,1.10)b 0.86 (0.65,0.98)b 注:a表示与99Tcm-MIBI单核素动态SPECT心脏显像比较,差异均无统计学意义(Z=−1.349、−0.396、−0.350、−1.126,均P>0.05);b表示与99Tcm-MIBI单核素动态SPECT心脏显像比较,差异均有统计学意义(Z=−3.455、−3.849、−3.661、−2.273,均P<0.05)。MIBI为甲氧基异丁基异腈;SPECT为单光子发射计算机体层摄影术;MIBG为间碘苄胍 表 1 心功能不全患者99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正、非完整物理校正的99Tcm-MIBI/123I-MIBG双核素 双动态SPECT心脏显像获得的心肌血流量的比较[ml·min−1·g−1,M(Q1, Q3)]
Table 1. Comparison of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with or without complete physical correction (ml·min−1·g−1, M(Q1, Q3))
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如图1所示,99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域的MBF均有较好的相关性(均P<0.001)。如图2所示,2种方法获得的LV和LAD、LCX、RCA支配区域的MBF的平均差值为0.023、0.016、0.008、0.040 ml·min−1·g−1,95%CI分别为−0.125~0.170、−0.196~0.228、−0.181~0.196、−0.193~0.271。99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域的MBF均有较好的相关性和一致性。
图 1 99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的心肌血流量的相关性分析
Figure 1. Correlation analysis of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with complete physical correction
图 2 99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的心肌血流量的Bland-Altman一致性分析
Figure 2. Bland-Altman agreement analysis of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with complete physical correction
利用CZT SPECT进行双核素双动态心脏显像定量分析的可行性研究
Feasibility study of quantitative analysis in dual-isotope and dual-dynamic cardiac imaging using CZT SPECT
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摘要:
目的 探讨利用碲锌镉(CZT)SPECT进行99Tcm-甲氧基异丁基异腈(MIBI)/123I-间碘苄胍(MIBG)双核素双动态心脏显像,完成定量分析的可行性。 方法 对2021年10月至2023年6月于中国医学科学院阜外医院治疗的24例心功能不全患者进行前瞻性研究,其中男性14例、女性10例,年龄(49.2±16.8)岁。所有患者均于第1日先行99Tcm-MIBI单核素动态SPECT心脏显像;第2日行99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像,并进行完整物理校正和非完整物理校正。比较99Tcm-MIBI单核素动态SPECT心脏显像与99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像计算获得的整体左心室(LV)和冠状动脉左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)支配区域心肌血流量(MBF)的差异,以及两种显像方法的相关性和一致性。采用Wilcoxon秩和检验比较99Tcm-MIBI单核素动态SPECT心脏显像与99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域MBF的差异。采用Pearson 相关性分析及 Bland-Altman 法分析两种显像方法得到的MBF的相关性和一致性。 结果 99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像计算获得的LV的MBF分别为0.74(0.64,0.79) ml·min−1·g−1和0.74(0.64,0.80) ml·min−1·g−1,LAD支配区域的MBF分别为0.72(0.68,0.82) ml·min−1·g−1和0.74(0.64,0.84) ml·min−1·g−1,LCX支配区域的MBF分别为0.73(0.66,0.80) ml·min−1·g−1和0.74(0.61,0.79) ml·min−1·g−1,RCA支配区域的MBF分别为0.77(0.64,0.82) ml·min−1·g−1和0.77(0.66,0.82) ml·min−1·g−1。两者LV和LAD、LCX、RCA支配区域MBF的差异均无统计学意义(Z=−1.349、−0.396、−0.350、−1.126,均P>0.05)。99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的LV和LAD、LCX、RCA支配区域的MBF均有较好的相关性(r=0.857、0.832、0.708、0.815,均P<0.001)。99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像计算获得的LV和LAD、LCX、RCA支配区域的MBF的平均差值为0.023、0.016、0.008、0.040 ml·min−1·g−1,95%CI分别为−0.125~0.170、−0.196~0.228、−0.181~0.196、−0.193~0.271,两者的一致性较好。 结论 利用CZT SPECT 行99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像,在经过完整物理校正后,能够得到与99Tcm-MIBI单核素动态SPECT显像较为一致的MBF,通过一次检查完成MBF和心脏交感神经的定量分析是可行的。 -
关键词:
- 冠状动脉疾病 /
- 心肌灌注显像 /
- 心肌血流量 /
- 体层摄影术,发射型计算机,单光子 /
- 99m锝甲氧基异丁基异腈 /
- 3-碘苄胍 /
- 散射校正
Abstract:Objective To explore the feasibility of quantitative analysis in 99Tcm-methoxyisobutylisonitrile (MIBI)/123I-metaiodobenzylguanidine (MIBG) dual-isotope and dual-dynamic cardiac imaging using cadmium zinc telluride (CZT) SPECT. Methods Twenty-four patients (14 males and 10 females) aged (49.2±16.8) years with cardiac dysfunction were prospectively enrolled from October 2021 to June 2023 at Fuwai Hospital, Chinese Academy of Medical Sciences. All the patients underwent 99Tcm-MIBI single-isotope dynamic cardiac imaging (referred to as single-isotope imaging) on the first day and 99Tcm-MIBI/123I-MIBG dual-isotope dual-dynamic cardiac imaging (referred to as dual-isotope imaging) on the second day. And complete physical correction and incomplete-physical correction were performed. Myocardial blood flow (MBF) for left ventricle (LV), left anterior descending branch (LAD), left circumflex branch (LCX), and right coronary artery (RCA) dominant area was quantified. Differences, correlation, and agreement of these parameters from two imaging methods were analyzed using Wilcoxon rank sum test, Pearson correlation test, and Bland-Altman analysis. Results The MBF of LV and LAD, LCX, RCA dominant area of single-isotope imaging and dual-isotope imaging with complete physical correction were 0.74 (0.64, 0.79) ml·min−1·g−1 vs. 0.74 (0.64, 0.80) ml·min−1·g−1, 0.72 (0.68, 0.82) ml·min−1·g−1 vs. 0.74 (0.64, 0.84) ml·min−1·g−1, 0.73 (0.66, 0.80) ml·min−1·g−1 vs. 0.74 (0.61, 0.79) ml·min−1·g−1, and 0.77 (0.64, 0.82) ml·min−1·g−1 vs. 0.77 (0.66, 0.82) ml·min−1·g−1, respectively. The differences were not statistically significant (Z=−1.349, −0.396, −0.350, −1.126; all P>0.05). The MBF of LV and LAD, LCX, RCA dominant area between single-isotope imaging and dual-isotope imaging with complete physical correction showed good correlations (r=0.857, 0.832, 0.708, 0.815; all P<0.001). The MBF mean differences of LV and LAD, LCX, RCA dominant area between single-isotope imaging and dual-isotope imaging with complete physical correction were 0.023, 0.016, 0.008, 0.040 ml·min−1·g−1, and the 95% confidence intervals were −0.125 to 0.170, −0.196 to 0.228, −0.181 to 0.196, and −0.193 to 0.271, respectively. The agreement between the two acquisition methods was good. Conclusions CZT-SPECT can be used to obtain comparable MBF between single-isotope imaging and dual-isotope cardiac imaging on the basis of complete physical correction. It is feasible to conduct a quantitative analysis of MBF and cardiac sympathetic nervous system through a single examination. -
图 1 99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的心肌血流量的相关性分析
Figure 1. Correlation analysis of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with complete physical correction
图 2 99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像获得的心肌血流量的Bland-Altman一致性分析
Figure 2. Bland-Altman agreement analysis of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with complete physical correction
表 1 心功能不全患者99Tcm-MIBI单核素动态SPECT心脏显像与进行完整物理校正、非完整物理校正的99Tcm-MIBI/123I-MIBG双核素 双动态SPECT心脏显像获得的心肌血流量的比较[ml·min−1·g−1,M(Q1, Q3)]
Table 1. Comparison of myocardial blood flow between 99Tcm-methoxyisobutylisonitrile (MIBI) single-isotope dynamic cardiac imaging and 99Tcm-MIBI/123I-metaiodobenzylguanidine (MIBG) dual-isotope dual-dynamic cardiac imaging with or without complete physical correction (ml·min−1·g−1, M(Q1, Q3))
显像方法 整体左心室 左前降支支配区域 左回旋支支配区域 右冠状动脉支配区域 99Tcm-MIBI单核素动态SPECT心脏显像(n=24) 0.74 (0.64,0.79) 0.72 (0.68,0.82) 0.73 (0.66,0.80) 0.77 (0.64,0.82) 完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像(n=24) 0.74 (0.64,0.80)a 0.74 (0.64,0.84)a 0.74 (0.61,0.79)a 0.77 (0.66,0.82)a 非完整物理校正的99Tcm-MIBI/123I-MIBG双核素双动态SPECT心脏显像(n=24) 0.88 (0.76,0.94)b 0.91 (0.82,1.10)b 0.92 (0.87,1.10)b 0.86 (0.65,0.98)b 注:a表示与99Tcm-MIBI单核素动态SPECT心脏显像比较,差异均无统计学意义(Z=−1.349、−0.396、−0.350、−1.126,均P>0.05);b表示与99Tcm-MIBI单核素动态SPECT心脏显像比较,差异均有统计学意义(Z=−3.455、−3.849、−3.661、−2.273,均P<0.05)。MIBI为甲氧基异丁基异腈;SPECT为单光子发射计算机体层摄影术;MIBG为间碘苄胍 -
[1] Fang YHD, Liu YC, Ho KC, et al. Single-scan rest/stress imaging with 99mTc-sestamibi and cadmium zinc telluride-based SPECT for hyperemic flow quantification: a feasibility study evaluated with cardiac magnetic resonance imaging[J/OL]. PLoS One, 2017, 12(8): e0183402[2023-08-31]. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0183402. DOI: 10.1371/journal.pone.0183402. [2] Agostini D, Roule V, Nganoa C, et al. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study[J]. Eur J Nucl Med Mol Imaging, 2018, 45(7): 1079−1090. DOI: 10.1007/s00259-018-3958-7. [3] Dewey M, Siebes M, Kachelrieß M, et al. Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia[J]. Nat Rev Cardiol, 2020, 17(7): 427−450. DOI: 10.1038/s41569-020-0341-8. [4] Lotze U, Kaepplinger S, Kober A, et al. Recovery of the cardiac adrenergic nervous system after long-term beta-blocker therapy in idiopathic dilated cardiomyopathy: assessment by increase in myocardial 123I-metaiodobenzylguanidine uptake[J]. J Nucl Med, 2001, 42(1): 49−54. [5] Jacobson AF, Senior R, Cerqueira MD, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure: results of the prospective ADMIRE-HF (AdreView myocardial imaging for risk evaluation in heart failure) study[J]. J Am Coll Cardiol, 2010, 55(20): 2212−2221. DOI: 10.1016/j.jacc.2010.01.014. [6] Agostini D, Verberne HJ, Burchert W, et al. I-123- mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study[J]. Eur J Nucl Med Mol Imaging, 2008, 35(3): 535−546. DOI: 10.1007/s00259-007-0639-3. [7] Arora R, Ferrick KJ, Nakata T, et al. I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator[J]. J Nucl Cardiol, 2003, 10(2): 121−131. DOI: 10.1067/mnc.2003.2. [8] Jayachandran JV, Sih HJ, Winkle W, et al. Atrial fibrillation produced by prolonged rapid atrial pacing is associated with heterogeneous changes in atrial sympathetic innervation[J]. Circulation, 2000, 101(10): 1185−1191. DOI: 10.1161/01.cir.101.10.1185. [9] Zhou YL, Zhou WH, Folks RD, et al. I-123 mIBG and Tc-99m myocardial SPECT imaging to predict inducibility of ventricular arrhythmia on electrophysiology testing: a retrospective analysis[J]. J Nucl Cardiol, 2014, 21(5): 913−920. DOI: 10.1007/s12350-014-9911-7. [10] Bocher M, Blevis IM, Tsukerman L, et al. A fast cardiac gamma camera with dynamic SPECT capabilities: design, system validation and future potential[J]. Eur J Nucl Med Mol Imaging, 2010, 37(10): 1887−1902. DOI: 10.1007/s00259-010-1488-z. [11] 张宗耀, 汪蕾, 张海龙, 等. 利用CZT SPECT进行心脏99Tcm-MIBI/123I-MIBG双核素显像的可行性研究[J]. 中华核医学与分子影像杂志, 2021, 41(9): 536−539. DOI: 10.3760/cma.j.cn321828-20200915-00347.
Zhang ZY, Wang L, Zhang HL, et al. A feasibility study of 99Tcm-MIBI/123I-MIBG dual-isotope cardiac imaging using CZT SPECT[J]. Chin J Nucl Med Mol Imaging, 2021, 41(9): 536−539. DOI: 10.3760/cma.j.cn321828-20200915-00347.[12] Blaire T, Bailliez A, Bouallegue FB, et al. Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium-zinc-telluride (CZT) cameras: a gated cardiac phantom study[J/OL]. EJNMMI Phys, 2016, 3(1): 27[2023-08-31]. https://ejnmmiphys.springeropen.com/articles/10.1186/s40658-016-0163-2. DOI: 10.1186/s40658-016-0163-2. [13] Blaire T, Bailliez A, Ben Bouallegue F, et al. First assessment of simultaneous dual isotope (123I/99mTc) cardiac SPECT on two different CZT cameras: a phantom study[J]. J Nucl Cardiol, 2018, 25(5): 1692−1704. DOI: 10.1007/s12350-017-0841-z. [14] Sharir T, Slomka PJ, Berman DS. Solid-state SPECT technology: fast and furious[J]. J Nucl Cardiol, 2010, 17(5): 890−896. DOI: 10.1007/s12350-010-9284-5. [15] Fan P, Hutton BF, Holstensson M, et al. Scatter and crosstalk corrections for 99mTc/123I dual-radionuclide imaging using a CZT SPECT system with pinhole collimators[J]. Med Phys, 2015, 42(12): 6895−6911. DOI: 10.1118/1.4934830. [16] Du Y, Tsui BMW, Frey EC. Model-based crosstalk compensation for simultaneous 99mTc/123I dual-isotope brain SPECT imaging[J]. Med Phys, 2007, 34(9): 3530−3543. DOI: 10.1118/1.2768863. [17] Niimi T, Nanasato M, Sugimoto M, et al. Comparative cardiac phantom study using Tc-99m/I-123 and Tl-201/I-123 tracers with cadmium-zinc-telluride detector-based single-photon emission computed tomography[J]. Nucl Med Mol Imaging, 2019, 53(1): 57−63. DOI: 10.1007/s13139-018-0559-0. [18] Yang JT, Yamamoto K, Sadato N, et al. Clinical value of triple-energy window scatter correction in simultaneous dual-isotope single-photon emission tomography with 123I-BMIPP and 201Tl[J]. Eur J Nucl Med, 1997, 24(9): 1099−1106. DOI: 10.1007/BF01254240. [19] Gimelli A, Liga R, Avogliero F, et al. Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch[J]. J Nucl Cardiol, 2018, 25(4): 1101−1109. DOI: 10.1007/s12350-016-0753-3. [20] Gimelli A, Liga R, Genovesi D, et al. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study[J]. Eur J Nucl Med Mol Imaging, 2014, 41(5): 946−955. DOI: 10.1007/s00259-013-2640-3. [21] Gimelli A, Masci PG, Liga R, et al. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance[J]. Eur J Nucl Med Mol Imaging, 2014, 41(9): 1692−1694. DOI: 10.1007/s00259-014-2792-9. [22] Klein T, Abdulghani M, Smith M, et al. Three-dimensional 123I- meta-iodobenzylguanidine cardiac innervation maps to assess substrate and successful ablation sites for ventricular tachycardia: feasibility study for a novel paradigm of innervation imaging[J]. Circ Arrhythm Electrophysiol, 2015, 8(3): 583−591. DOI: 10.1161/CIRCEP.114.002105. [23] Giorgetti A, Burchielli S, Positano V, et al. Dynamic 3D analysis of myocardial sympathetic innervation: an experimental study using 123I-MIBG and a CZT camera[J]. J Nucl Med, 2015, 56(3): 464−469. DOI: 10.2967/jnumed.114.143669. [24] Tinti E, Positano V, Giorgetti A, et al. Feasibility of [123I]-meta-iodobenzylguanidine dynamic 3-D kinetic analysis in vivo using a CZT ultrafast camera: preliminary results[J]. Eur J Nucl Med Mol Imaging, 2014, 41(1): 167−173. DOI: 10.1007/s00259-013-2549-x. [25] Wu J, Lin SF, Gallezot JD, et al. Quantitative analysis of dynamic 123I-mIBG SPECT imaging data in healthy humans with a population-based metabolite correction method[J]. J Nucl Med, 2016, 57(8): 1226−1232. DOI: 10.2967/jnumed.115.171710.