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2024,
48(1):
1-4.
Abstract:
2024,
48(1):
1-4.
doi: 10.3760/cma.j.cn121381-202308011-00380
Abstract:
Cardiovascular radionuclide imaging is an irreplaceable technique for the diagnosis and management of cardiovascular diseases. With the increasing clinical needs, radionuclide imaging technique is facing higher requirements for precision diagnostics. To play a more important role, further updated technology and more reasonable clinical usage are needed for the commonly used radionuclide myocardial perfusion imaging and myocardial metabolic imaging. Meanwhile, more and more novel radionuclide imaging techniques are translating from clinical trials to daily practice to fulfill the needs of precision diagnostics and promote the development of nuclear cardiology.
Cardiovascular radionuclide imaging is an irreplaceable technique for the diagnosis and management of cardiovascular diseases. With the increasing clinical needs, radionuclide imaging technique is facing higher requirements for precision diagnostics. To play a more important role, further updated technology and more reasonable clinical usage are needed for the commonly used radionuclide myocardial perfusion imaging and myocardial metabolic imaging. Meanwhile, more and more novel radionuclide imaging techniques are translating from clinical trials to daily practice to fulfill the needs of precision diagnostics and promote the development of nuclear cardiology.
2024,
48(1):
5-14.
doi: 10.3760/cma.j.cn121381-202307008-00383
Abstract:
Objective To investigate the diagnostic value of cadmium zinc telluride (CZT) cardiac SPECT dynamic myocardial perfusion imaging (D-MPI) quantitative parameters in prognostic assessment of patients with ischaemia and non-obstructive coronary arteries (INOCA) and obstructive coronary artery disease (OCAD). These parameters were compared with myocardial perfusion imaging (MPI) semi-quantitative parameters. Methods Retrospective analysis was performed on patients who received CZT cardiac SPECT D-MPI in TEDA International Cardiovascular Hospital from March 2020 to July 2021, had coronary angiography data before and after D-MPI, and completed follow-up. A total of 100 patients with INOCA (37 males and 63 females, aged 62.0(55.3, 66.0) years) and 203 patients with OCAD (122 males and 81 females, aged 63.0(57.0, 69.0) years) were followed for major adverse cardiovascular events (MACE). According to MACE results, patients with INOCA were divided into the MACE and non-MACE groups, similar to patients with OCAD. The D-MPI quantitative parameters (including myocardial flow reserve (MFR), rest myocardial blood flow (r-MBF), and stress myocardial blood flow (s-MBF)) and MPI semi-quantitative parameters (including summed stress score (SSS), summed rest score (SRS), summed different score (SDS), stress total perfusion defect (s-TPD) and rest total perfusion defect (r-TPD)) were compared between the MACE group and the non-MACE group. Two independent sample t-test or the Mann-Whitney U test were used to compare measurement data between groups, and the Pearson′s chi-square test was used to compare counting data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of quantitative parameters of D-MPI and semi-quantitative parameters of MPI in predicting MACE in patients with INOCA and OCAD. The Delong test and net reclassification index (NRI) were used to verify the differences in diagnostic efficacy between D-MPI quantitative parameters and MPI semi-quantitative parameters. Results Among the 100 patients with INOCA, s-MBF and MFR in the MACE group were significantly lower than those in the non-MACE group (1.27(1.03, 1.88) ml/(min·g) vs. 2.25(1.59, 3.13) ml/(min·g); 1.65(1.35, 2.04) vs. 2.52(1.75, 3.39)), and the differences were statistically significant (Z=−2.986 and −2.859, both P<0.05). ROC curve analysis showed that s-MBF and MFR had high diagnostic efficiency in predicting MACE in patients with INOCA (area under curve (AUC)=0.777 and 0.765, both P<0.001). When the cut-off value of s-MBF was 1.57 mL/(min·g), the sensitivity and specificity of predicting MACE in patients with INOCA were 72.7% and 75.3%, respectively. When the cut-off value of MFR was 2.04, the sensitivity and specificity of predicting MACE in patients with INOCA were 81.8% and 66.3%, respectively. According to NRI results, the proportion of correct classification in prognosis of INOCA patients with s-MBF≤1.57 ml/(min·g) and MFR≤2.04 was 44.4% and 44.5% higher than that of abnormal MPI semi-quantitative parameters (SSS≥4 and SDS≥2). Among 203 patients with OCAD, s-MBF and MFR in the MACE group were significantly lower than those in the non-MACE group (1.21 (0.61, 1.51) ml/(min·g) vs. 1.76 (1.14, 2.56) ml/(min·g); 1.51 (0.81, 1.91) vs. 2.02(1.50, 2.86)), and the differences were statistically significant (Z=−2.891 and −2.984, both P<0.05). ROC curve analysis showed that MFR and s-MBF had high diagnostic efficacy in predicting MACE in patients with OCAD (AUC=0.725 and 0.718, both P<0.001). When the cut-off value of MFR was 1.71, the sensitivity and specificity of predicting MACE in patients with OCAD were 75.0% and 63.6%, respectively. When the cut-off value of s-MBF was 1.49 ml/(min·g), the sensitivity and specificity of predicting MACE in patients with OCAD were 81.3% and 61.5%, respectively. According to NRI results, the proportion of correct classification in prognosis of OCAD patients with s-MBF≤1.49 ml/(min·g) and MFR≤1.71 was 32.9% and 28.7% higher than that of abnormal MPI semi-quantitative parameters (SSS≥4 and SDS≥2). Conclusions MFR and s-MBF obtained by CZT cardiac SPECT D-MPI can be used to indicate the occurence of MACE in patients with INOCA and OCAD and have good predictive diagnostic efficacy. Compared with MPI semi-quantitative parameters, MFR and s-MBF provide more accurate prognostic evaluation for clinical practice.
2024,
48(1):
15-21.
doi: 10.3760/cma.j.cn121381-202309001-00382
Abstract:
Objective To explore the diagnostic value of Al18F-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-fibroblast activation protein inhibitor (FAPI) PET/CT imaging in light chain cardiac amyloidosis (AL-CA). Methods The clinical data of 8 patients (7 males and 1 female, aged (62.9±5.6) years) diagnosed with AL-CA in Beijing Chao-Yang Hospital, Capital Medical University from September to December 2021 were prospectively studied. Five healthy volunteers and 5 patients with multiple myeloma (MM), who matched the gender and age with AL-CA patients, were recruited as controls. All subjects were divided into 4 groups: 5 cases in the AL-CA+MM group (AL-CA with MM), 3 cases in the AL-only group (AL-CA without MM), 5 cases in the MM control group (MM without AL-CA), and 5 cases in the healthy control group. All subjects underwent Al18F-NOTA-FAPI PET/CT imaging. Laboratory index type B natriuretic peptide (BNP) level, echocardiography data, and Al18F-NOTA-FAPI PET/CT imaging results were analyzed. Measurement data were compared among the 4 groups by using LSD or Kruskal-Wallis test and between 2 groups by independent samples t-test (homogeneity of variance). Enumeration data were compared by χ2 test. Results BNP level in the AL-only group was higher than that in the MM control group, and the difference was statistically significant ((259.0±40.0) pg/ml vs. (19.2±15.7) pg/ml, t=9.928, P<0.05). The left ventricular interventricular septum thickness and the left ventricular posterior wall thickness increased in the AL-CA+MM group, and the differences were statistically significant ((13.9±1.1) mm vs. (10.8±0.3) mm, t=6.197, P<0.05; (13.7±0.9) mm vs. (10.3±0.6) mm, t=6.774, P<0.05). Al18F-NOTA-FAPI PET/CT imaging results showed that the Al18F-NOTA-FAPI uptake of the left ventricular myocardium was positive in 3 cases (3/5, 60.0%) of the AL-CA+MM group and 3 cases (3/3, 100.0%) of the AL-only group. The left ventricular myocardium Al18F-NOTA-FAPI uptake was negative in 4 patients (4/5, 80.0%) of the MM control group and 5 subjects (5/5, 100.0%) of the healthy control group. The left ventricular myocardium maximum standardized uptake value (SUVmax) and target to background ratio (T/B) in the AL-only group were higher than those in the healthy control group (SUVmax: (4.1±1.1) vs. (2.1±0.2), t=3.234, P=0.081; T/B: (4.7±0.6) vs. (2.2±0.4), t=6.748, P=0.001). The SUVmax and T/B of the left ventricular myocardium in the AL-CA+MM group were higher than those in the MM control group (SUVmax: (4.2±1.8) vs. (2.5±1.4), t=1.699, P=0.128; T/B: (4.2±2.1) vs. (3.0±1.2), t=1.120, P=0.295). The SUVmax and T/B of left ventricular myocardium in the AL-CA+MM group were higher than those in the healthy control group (SUVmax: (4.2±1.8) vs. (2.1±0.2), t=2.642, P=0.056; T/B: (4.2±2.1) vs. (2.2±0.4), t=2.047, P=0.104). Conclusion Al18F-NOTA-FAPI PET/CT imaging can detect cardiac fibroblast activation non-invasively and effectively and has a certain diagnostic value in patients with AL-CA.
2024,
48(1):
22-29.
doi: 10.3760/cma.j.cn121381-202308025-00387
Abstract:
Objective To explore the clinical application value of 99Tcm-pyrophosphate (PYP) dual-phase planar imaging and tomographic imaging in the diagnosis of transthyretin-related cardiac amyloidosis (ATTR-CA). Methods This retrospective study was conducted on 157 patients with suspected cardiac amyloidosis (CA) at Fuwai Hospital, Chinese Academy of Medical Sciences, from March 2020 to January 2023, including 108 males and 49 females, aged (58.9±14.8) years, ranging from 10 to 88 years old. The patients were intravenously injected with 740 MBq 99Tcm-PYP, and planar imaging and tomographic imaging were performed at 1 h (hereinafter referred to as early imaging) and 3 h (hereinafter referred to as delayed imaging) after injection. The Perugini method and semi-quantitative analysis method were used for the positive diagnosis of ATTR-CA in planar imaging, while the semi-quantitative scoring method was used for the positive diagnosis of ATTR-CA in tomographic imaging. Using clinical classification as the grouping criteria, all patients were divided into light chain cardiac amyloidosis (AL-CA) group, ATTR-CA group, and non-CA group. Diagnostic results of the Perugini method in planar imaging (positive for ≥2 points), semi-quantitative analysis method in planar imaging (positive for the uptake ratio of heart to contralateral lung ≥1.5), and semi-quantitative scoring method in tomographic imaging (positive for 2 points) were compared among the groups, and the 99Tcm-PYP imaging characteristics and diagnostic efficacy of different acquisition phases and different acquisition methods were analyzed. One-way analysis of variance and Bonferroni test were used to analyze the intergroup differences in measurement data. The χ2 test or Fisher′s exact probability method was used to analyze intergroup differences in counting data. In addition, the Kappa test was used to analyze the intergroup consistency of counting data, and the paired χ2 test (McNemar test) was used to compare the differences in diagnostic efficiencies among various diagnostic methods. Results According to clinical diagnosis, of the 157 suspected patients with CA, 83 were confirmed to have CA (including 23 cases of ATTR-CA and 60 cases of AL-CA), and 74 cases were identified as non-CA. The sensitivity, specificity, and accuracy of the semi-quantitative scoring method for delayed tomographic imaging in the diagnosis of ATTR-CA were 91.3%, 98.5%, and 97.5%, respectively, compared with other diagnostic methods with different acquisition phases and different acquisition methods, and the accuracy was the highest. On the contrary, the sensitivity, specificity, and accuracy of the Perugini method for early planar imaging were 100%, 40.3%, and 49.0%, respectively, compared with various diagnostic methods, and the accuracy was the lowest. After pairwise comparison of the diagnostic results for various different acquisition phases and methods, early tomographic imaging and delayed tomographic imaging showed good consistency in the semi-quantitative scoring method for the diagnosis of ATTR-CA (Kappa=0.835), but the difference in diagnostic efficacy was not statistically significant (χ2=110.883, P=0.219). The Perugini method of delayed planar imaging and the semi-quantitative scoring method of delayed tomographic imaging also had good consistency in the diagnosis of ATTR-CA (Kappa=0.784), and the difference in diagnostic efficacy was statistically significant (χ2=101.258, P=0.004), with the latter having a higher diagnostic accuracy. Moreover, the diagnostic consistency among other diagnostic methods with different acquisition phases and methods was average or poor (Kappa is 0.135–0.679). Conclusions Misdiagnosis was found in the diagnosis of ATTR-CA using early planar imaging. Early tomographic imaging and delayed tomographic imaging, as well as delayed planar imaging, had high diagnostic accuracy for ATTR-CA.
2024,
48(1):
30-37.
doi: 10.3760/cma.j.cn121381-202309002-00385
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.
2024,
48(1):
38-45.
doi: 10.3760/cma.j.cn121381-202308010-00386
Abstract:
Objective To compare the capability of radionuclide myocardial perfusion/metabolic imaging (hereinafter referred to as 18F-FDG PET) and cardiac magnetic resonance (CMR) in the assessment of myocardial viability among patients with ischemic heart failure. Methods A total of 285 consecutive patients with ischemic heart failure combined with cardiac dysfunction who underwent 18F-FDG PET and CMR imaging simultaneously (within a month) at Fuwai Hospital, Chinese Academy of Medical Sciences from March 2016 to December 2019 were included in the retrospective analysis. The patients comprised 260 males and 25 females, aged (57.8±10.0) years. The 17-segment method was used to compare the agreement and differences of 18F-FDG PET and CMR in the identification of viable myocardium and infarcted myocardium in each myocardial segment. Spearman correlation coefficient and Kendall′s tau-b correlation coefficient were used to analyze the correlation between the two methods in the identification of different myocardial viabilities. The Bland-Altman method was used to evaluate the diagnostic agreement between the two methods in assessing infarcted myocardium. Results Of the 285 patients with a total of 4845 myocardial segments, 3376 (69.7%) myocardial segments with wall motion abnormality on 18F-FDG PET were included in the analysis. The total content of infarcted myocardium measured through 18F-FDG PET and CMR was 17.6%±13.0% and 19.2%±13.4%, respectively, and a significant correlation existed between them (r=0.67, P<0.001). By contrast, 18F-FDG PET may underestimate the content of infarcted myocardium compared with CMR (The 95%CI of the total difference in infarcted myocardium content was −12.7%–27.8%, and the mean difference was 7.5%). Among the 697 segments with motion abnormality detected through CMR as transmural infarctions, most (90.4%, 630/697) showed transmural or non-transmural infarctions detected through 18F-FDG PET, showing a high agreement between the two methods. Among the 1371 segments detected as non-transmural infarctions through CMR, as many as 686 (50.0%) did not show infarct changes on 18F-FDG PET. At the individual level, no significant correlation (r=−0.09, P=0.12) exists between the total infarcted myocardium content detected through CMR and the total hibernating myocardium content detected through 18F-FDG PET in each patient. Among the 1371 segments detected as non-transmural infarctions through CMR, 838 (61.1%) had hibernating myocardium detected through 18F-FDG PET. Moreover, among the 697 segments detected as transmural infarctions through CMR, 286 (41.0%) had hibernating myocardium detected through 18F-FDG PET. Segments with non-transmural infarctions detected through CMR contained more hibernating myocardium than those with transmural infarctions (61.1% vs. 41.0%, χ2=66.207, P<0.001). Conclusions 18F-FDG PET and CMR have their strengths in assessing myocardial viability in patients with ischemic heart failure. CMR is superior to 18F-FDG PET in terms of identifying infarcted myocardium, whereas 18F-FDG PET is more sensitive in detecting viable myocardium with the ability to distinguish hibernating myocardium. Combining 18F-FDG PET and CMR will provide more comprehensive information on myocardial viability.
2024,
48(1):
46-51.
doi: 10.3760/cma.j.cn121381-202307038-00381
Abstract:
Objective To evaluate the value of cold press test (CPT) myocardial perfusion imaging (MPI) in the diagnosis of vasospastic angina pectoris in patients with ischaemia and non-obstructive coronary arteries (INOCA). Methods A retrospective analysis was conducted on 676 suspected INOCA patients with angina pectoris or chest tightness, wheezing, and other equivalent symptoms of angina pectoris in Xuzhou Central Hospital from January 2019 to June 2023. The sample included 439 males and 237 females, aged (49.3±20.4) years. All patients underwent CPT and resting MPI. In accordance with 2019 expert consensus for key points of technique and image process during SPECT myocardial perfusion imaging, the degree of myocardial ischemia in the patients was assessed. Semiquantitative parameters, such as summed stress score (SSS), summed resting score, and total perfusion defect (TPD), were calculated. One-way ANOVA was used to compare the measurement data with a normal distribution, and the χ2 test was employed to compare the counting data. Results The number of patients with negative CPT MPI results (CPT (−) group) and positive results (CPT (+) group) was 202 and 474, respectively. A significant difference in the proportion of patients with anxiety symptoms was observed between the two groups (14.9% vs. 89.9%; χ2=4.667, P<0.05). No significant differences in the other general data was found between the two groups (t=1.009, χ2=0.136–3.042; all P>0.05). According to the SSS results, 299 (44.2%) patients had mild myocardial ischemia, 156 (23.1%) patients had moderate myocardial ischemia, and 19 (2.8%) patients had severe myocardial ischemia. The TPD results revealed that 318 (47.0%) patients had mild myocardial ischemia, 136 (20.1%) patients had moderate myocardial ischemia, and 20 (3.0%) patients had severe myocardial ischemia. On the basis of the location of ischemia, 331 (49.0%), 349 (51.6%), and 277 (41.0%) patients were determined to have transmural myocardial ischemia, apical myocardial ischemia, and subendocardial myocardial ischemia, respectively. Conclusion CPT MPI can diagnostically evaluate myocardial ischemia caused by vasospastic angina pectoris in patients with INOCA and provide an important reference for noninvasive imaging diagnosis of this kind of patients.
2024,
48(1):
52-59.
doi: 10.3760/cma.j.cn121381-202307028-00384
Abstract:
Ultra-high dose rate (FLASH) radiotherapy is an innovation radiotherapy technique that has emerged as one of the revolutionary technologies in the field of radiotherapy over the past six years. It demonstrates excellent normal tissue protective effects without compromising the therapeutic efficacy on tumors. Moreover, the extremely short delivery time of FLASH radiotherapy helps eliminate the impact of organ or tumor motion on treatment accuracy, thereby enhancing treatment precision and patient comfort. This technology holds the potential to fundamentally transform the landscape of malignant tumor treatment. Currently, the underlying mechanism of the protective effects of FLASH radiotherapy on normal tissues are not fully understood. The authors present provide a comprehensive overview of the research progress in FLASH radiotherapy, encompassing both normal tissue protection and tumor treatment effects. Additionally, this paper provides insights into the potential biological mechanisms underlying the protection effects of FLASH radiotherapy. Consequently this paper serves as a valuable reference for further research in the field of FLASH radiotherapy.
Ultra-high dose rate (FLASH) radiotherapy is an innovation radiotherapy technique that has emerged as one of the revolutionary technologies in the field of radiotherapy over the past six years. It demonstrates excellent normal tissue protective effects without compromising the therapeutic efficacy on tumors. Moreover, the extremely short delivery time of FLASH radiotherapy helps eliminate the impact of organ or tumor motion on treatment accuracy, thereby enhancing treatment precision and patient comfort. This technology holds the potential to fundamentally transform the landscape of malignant tumor treatment. Currently, the underlying mechanism of the protective effects of FLASH radiotherapy on normal tissues are not fully understood. The authors present provide a comprehensive overview of the research progress in FLASH radiotherapy, encompassing both normal tissue protection and tumor treatment effects. Additionally, this paper provides insights into the potential biological mechanisms underlying the protection effects of FLASH radiotherapy. Consequently this paper serves as a valuable reference for further research in the field of FLASH radiotherapy.
2024,
48(1):
60-63.
doi: 10.3760/cma.j.cn121381-202306026-00379
Abstract:
The authors reported a case of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). The characteristics of RAIR-DTC were analyzed from the aspects of clinical history and 18F-prostate specific membrane antigen (PSMA) PET/CT imaging. RAIR-DTC has a poor prognosis, and the diagnostic and therapeutic methods are limited. At present, there are few studies on 18F-PSMA PET/CT imaging in the diagnosis of RAIR-DTC patients. The authors performed 18F-PSMA PET/CT imaging on a patient with RAIR-DTC, in order to provide new diagnostic and therapeutic methods for patients with RAIR-DTC.
The authors reported a case of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). The characteristics of RAIR-DTC were analyzed from the aspects of clinical history and 18F-prostate specific membrane antigen (PSMA) PET/CT imaging. RAIR-DTC has a poor prognosis, and the diagnostic and therapeutic methods are limited. At present, there are few studies on 18F-PSMA PET/CT imaging in the diagnosis of RAIR-DTC patients. The authors performed 18F-PSMA PET/CT imaging on a patient with RAIR-DTC, in order to provide new diagnostic and therapeutic methods for patients with RAIR-DTC.
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