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在过去数十年中,PET和MRI技术在心血管疾病中的应用迅速发展,PET显像可在心肌灌注和冠状动脉血流储备的绝对定量以及分子水平上对特定过程(如新陈代谢、炎症或神经支配)进行可视化和定量分析,MRI在左右心室功能的量化、整体和局部心室壁运动异常的确定、组织特征(瘢痕、脂肪和水肿)及瓣膜功能诊断方面具有极大优势。近年来,PET/MR作为新型的多模态融合显像技术,整合了PET与MRI两种独立的显像技术,实现了两者同步扫描,且在不同类型的心血管疾病中的研究和应用越来越广泛[1]。笔者就PET/MR在心血管疾病中的应用现状进行回顾和展望,并探讨其优点和局限性。
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心脏PET显像是使用不同正电子核素标记与心脏生物学相关的分子形成显像剂,引入人体后经过心脏生物学变化摄取显像剂,通过PET设备接收显像剂的正电子湮灭辐射产生的γ光子对,经过数据处理,最终形成PET图像。而PET显像剂的研制及应用,是心血管疾病诊断、治疗和疗效评估的基础。依据不同心血管疾病表达的不同靶点或特点,研发出心脏的灌注、代谢及受体等PET显像剂。表1总结了不同PET显像剂在心血管疾病中的应用与研究[13]。目前,也出现了以纳米材料为基础的PET/MR多模态显像剂,如靶向巨噬细胞的MDIO-64Cu-DOTA[14]。虽然此类多模态显像剂仍未用于临床,但PET/MR已显示出了在心脏核医学中的巨大临床应用潜力。
显像剂名称 作用靶点或特点 应用 15O-H2O、13N-NH3、82Rb-RbCl 心肌血流 判断心肌血供和活性 18F-FDG 葡萄糖代谢 判断心肌活性、心肌炎症等 18F-fluciclatide avβ3和avβ5整合素 判断心肌梗死后血管或功能恢复 11C-hydroxyephedrine 心脏神经支配显像 心脏移植及充血性心衰预后评估等 11C-PIB、18F-florbetapir、18F-flutemetamol、18F-florbetaben 淀粉样蛋白 心脏淀粉样变性 18F-sodium fluoride 淀粉样蛋白、微钙化 心脏淀粉样变性、动脉粥样硬化斑块 64Cu-DOTATATE、68Ga-DOTATATE 生长抑素受体 动脉粥样硬化斑块 18F-MISO 组织缺氧 动脉粥样硬化斑块 68Ga-NOTA-RGD、18F-galacto-RGD 血管再生 动脉粥样硬化斑块 11C-PK11195 转运蛋白 动脉粥样硬化斑块 注,表中,FDG:氟脱氧葡萄糖;DOTATATE:奥曲肽;MISO:硝基咪唑;NOTA:三乙酸;RGD:精氨酸-甘氨酸-天冬氨酸;PK11195:异喹啉-3-氨甲酰 表 1 PET显像剂在心血管疾病中的应用
Table 1. PET tracers for cardiovascular applications
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与CT扫描相比,CMR成像技术除了可以降低受检者的辐射剂量外[13],还可以提供很好的软组织结构特征。另外,CMR电影成像也可以准确评估心室腔容积、心肌质量、心室壁运动和射血分数等变化;而CMR晚期钆增强(late gadolinium enhanced,LGE)图像可以评价心肌损伤范围和程度;同时,CMR还具有定量评估弥散性心肌纤维化、心肌水肿及心肌铁沉积的T1-mapping、T2-mapping和T2*-mapping成像序列[15]。近年来,还出现了对冠状动脉粥样硬化斑块性质评估的全心冠状动脉斑块定性技术(CATCH)序列成像[16]。
PET/MR在心血管疾病中的应用进展
Progress in the application of PET/MR in diagnosing cardiovascular diseases
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摘要: PET/MR作为新型的多模态成像技术,集合了MRI高软组织对比度、多序列、多参数、可定量和PET多分子探针显像的高灵敏度的优势,实现了PET分子功能影像与具有精细解剖结构和组织特征的MRI影像同步扫描,在多种心血管疾病中的应用和研究越来越广泛。笔者总结PET/MR心血管成像的优点和局限性,并探讨其在临床中的主要应用。
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关键词:
- 心血管疾病 /
- 正电子发射断层显像术 /
- 磁共振成像 /
- 分子显像
Abstract: As a new multimodal imaging technology, PET/MR combines the ability of MRI and its various functional imaging parameters to obtain excellent and highly sensitive soft tissue contrast and the capability of PET to quantify radiotracer metabolism. Via simultaneous scanning, this combined method achieves PET images and allows the examination of fine anatomical structures through MRI. The effectiveness of this combined method is increasingly explored in diagnosing cardiovascular diseases. This review summarizes the advantages and limitations of PET/MR in diagnosing cardiovascular diseases and discusses its potential clinical applications. -
表 1 PET显像剂在心血管疾病中的应用
Table 1. PET tracers for cardiovascular applications
显像剂名称 作用靶点或特点 应用 15O-H2O、13N-NH3、82Rb-RbCl 心肌血流 判断心肌血供和活性 18F-FDG 葡萄糖代谢 判断心肌活性、心肌炎症等 18F-fluciclatide avβ3和avβ5整合素 判断心肌梗死后血管或功能恢复 11C-hydroxyephedrine 心脏神经支配显像 心脏移植及充血性心衰预后评估等 11C-PIB、18F-florbetapir、18F-flutemetamol、18F-florbetaben 淀粉样蛋白 心脏淀粉样变性 18F-sodium fluoride 淀粉样蛋白、微钙化 心脏淀粉样变性、动脉粥样硬化斑块 64Cu-DOTATATE、68Ga-DOTATATE 生长抑素受体 动脉粥样硬化斑块 18F-MISO 组织缺氧 动脉粥样硬化斑块 68Ga-NOTA-RGD、18F-galacto-RGD 血管再生 动脉粥样硬化斑块 11C-PK11195 转运蛋白 动脉粥样硬化斑块 注,表中,FDG:氟脱氧葡萄糖;DOTATATE:奥曲肽;MISO:硝基咪唑;NOTA:三乙酸;RGD:精氨酸-甘氨酸-天冬氨酸;PK11195:异喹啉-3-氨甲酰 -
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