张志婷, 王萱, 孙丹阳, 李玮. SPECT/CT的简易Z评分影像系统在评估颈动脉内膜切除术对颈动脉狭窄的治疗效果中的价值[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304041-00425
引用本文: 张志婷, 王萱, 孙丹阳, 李玮. SPECT/CT的简易Z评分影像系统在评估颈动脉内膜切除术对颈动脉狭窄的治疗效果中的价值[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304041-00425
Zhang Zhiting, Wang Xuan, Sun Danyang, Li Wei. Value of the simplified Z-Score imaging system of SPECT/CT in evaluating the therapeutic effect of carotid endarterectomy on carotid stenosis[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304041-00425
Citation: Zhang Zhiting, Wang Xuan, Sun Danyang, Li Wei. Value of the simplified Z-Score imaging system of SPECT/CT in evaluating the therapeutic effect of carotid endarterectomy on carotid stenosis[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304041-00425

SPECT/CT的简易Z评分影像系统在评估颈动脉内膜切除术对颈动脉狭窄的治疗效果中的价值

Value of the simplified Z-Score imaging system of SPECT/CT in evaluating the therapeutic effect of carotid endarterectomy on carotid stenosis

  • 摘要:
    目的  探讨SPECT/CT的简易Z评分影像系统(eZIS)在评估颈动脉内膜切除术(CEA)对颈动脉狭窄的治疗效果中的价值,并分析其与磁共振血管成像(MRA)的一致性。
    方法  回顾性分析2018年6月至2021年1月在天津医科大学总医院神经外科常规行99Tcm-双半胱乙酯(99Tcm-ECD)脑血流灌注SPECT/CT显像及MRA检查的18例颈动脉狭窄(单侧或双侧)患者的临床资料,根据是否行CEA,将患者分为手术治疗组和非手术治疗组,其中,手术治疗组7例,包括男性5例、女性2例,年龄(58.43±7.63)岁,这7例患者均于术前及术后6个月内行SPECT/CT显像和MRA检查;非手术治疗组11例,包括男性8例、女性3例,年龄(62.55±11.10)岁,这11例患者均接受常规药物治疗,并于治疗前及治疗后行SPECT/CT显像和MRA检查,且所有检查均于6个月内完成。 测量患者病变部位局部脑血流量并通过eZIS计算出治疗前后Z-Score的变化。对手术治疗组与非手术治疗组中Z-Score及狭窄程度的变化趋势的比较采用配对样本t检验。对MRA与SPECT/CT显像结果的一致性行Kappa分析。
    结果  手术治疗组术后Z-Score(0.54±2.71)较术前(−1.34±2.68)明显增高,且差异有统计学意义(t=3.899,P=0.008,df=6),而非手术治疗组患者晚期的Z-Score(−0.33±2.58)较早期(1.84±2.62)明显下降,且差异有统计学意义(t=4.618,P=0.001,df=10)。手术治疗组患者术后MRA狭窄程度较术前明显减轻,且差异有统计学意义(t=3.063,P=0.022,df=6);非手术治疗组患者治疗后MRA狭窄程度较治疗前则明显加重,且差异有统计学意义(t=4.820,P=0.001,df=10)。MRA和SPECT/CT的eZIS对颈动脉狭窄治疗前后病情评估的一致性较好(Kappa值为0.766,P<0.001)。
    结论  SPECT的eZIS能够无创、可视化评估CEA对颈动脉狭窄的治疗效果,其方法简便且与MRA具有较好的一致性。

     

    Abstract:
    Objective  To explore the value of eZIS in the evaluation of CEA in the treatment of carotid artery stenosis, and to analyze the consistency with MRA.
    Methods  From June 1, 2018 to January 31, 2021, the clinical data of 18 patients with carotid artery stenosis (unilateral or bilateral) who underwent 99mTc-biscystethone (99mTc-ECD) cerebral blood flow perfusion SPECT/CT imaging and MRA examination were collected and retrospectively analyzed. Patients were divided into surgical treatment group and non-surgical treatment group according to whether CEA was performed. In the surgical treatment group, 7 patients, including 5 males and 2 females, were 58.43±7.63 years old. SPECT/CT and MRA were performed before and 6 months after surgery. In the non-surgical treatment group, 11 patients, including 8 males and 3 females, all received conventional drug therapy, were 62.55±11.10 years old. SPECT/CT and MRA examinations were performed before and after treatment, and all examinations were completed within 6 months. The local cerebral blood flow at the lesion site was measured and the Z-Score changes before and after treatment were calculated by eZIS technique. Paired sample t test was used to verify the change trend of Z-Score and stenosis degree in the two subgroups. The consistency of MRA and SPECT/CT results was analyzed by Kappa.
    Results  The Z-Score after operation (0.54±2.71) was significantly higher than that before operation (−1.34±2.68), and the difference was statistically significant (t=3.899, P= 0.0080, df=6). The Z-Score (−0.33±2.58) in the non-surgical group was significantly lower than that before treatment (1.84±2.62), and the difference was statistically significant (P=0.0010, t=4.618, df=10). The degree of postoperative MRA stenosis in the operation group was significantly reduced compared with that before operation, with statistical significance (t=3.063, P=0.0222, df=6). The degree of MRA stenosis in the non-surgical group was significantly worse after treatment than before treatment, and the difference was statistically significant (t=4.820, P=0.0007, df=10). The kappa value of MRA and eZIS of SPECT/CT on the assessment of disease before and after treatment was 0.766.
    Conclusion  eZIS in SPECT can evaluate the effect of CEA on carotid artery stenosis in a non-invasive visual way. The method is simple and consistent with MRA

     

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