-
18F-FDG PET/CT心肌代谢显像是一种无创、定量或半定量评价局部心肌血流灌注、生理和病理状态下的心肌代谢及心脏受体分布的影像学检查方法[1]。其在心肌缺血的诊断、心肌缺血范围与程度的客观评价及预后判断、冠心病处理决策上的选择、疗效评价等方面具有突出优势[2],并且可以鉴别诊断心肌病、预测心功能状况、患者的生活质量和血运重建术后全心或区域收缩功能的改善情况[3]。利用显像剂随血流进入心肌细胞,标记某些化合物或能量底物,体外采用PET/CT扫描获得心肌细胞的存活情况。心肌可利用游离脂肪酸(free fatty acid,FFA)、葡萄糖、乳糖、丙酮酸、酮体和氨基酸等作为能量来源。FFA和葡萄糖是心肌能量代谢的主要底物,底物选择的过程是动态的,在很大程度上取决于底物的可用性、氧浓度和心肌负荷[4]。空腹时心肌主要利用FFA供给能量,而进餐后葡萄糖成为正常心肌的能量代谢底物。当心肌细胞发生坏死后,心肌所有代谢活动均停止,葡萄糖则成为缺血心肌的唯一能量来源[5]。因此,糖负荷和胰岛素水平决定了PET/CT的图像质量[6]。
18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究进展
Current status of studies on factors affecting myocardial metabolism imaging quality of 18F-FDG PET/CT
-
摘要: 18F-FDG PET/CT心肌代谢显像是目前被公认的监测患者存活心肌的“金标准”,在冠心病的临床诊疗、血管再通术的预后评价等方面起指导作用。保证合格的图像质量是发挥其作用的关键。然而,18F-FDG PET/CT心肌代谢显像图像质量受到许多因素影响,其中血糖水平、胰岛素功能是主要的影响因素。通过调整显像前饮食结构、禁食时间、长期服用药物、检查日的血糖水平、调节血糖的方法以及注射显像剂的时间等可提高图像质量,并提升显像的成功率。为此,笔者对18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究现状及最新进展进行综述。
-
关键词:
- 正电子发射断层显像计算机体层摄影术 /
- 氟脱氧葡萄糖F18 /
- 冠心病 /
- 心肌代谢显像 /
- 血糖
Abstract: The 18F-FDG PET/CT myocardial metabolism imaging is currently recognized as the "gold standard" for monitoring patient myocardial survival and plays a guiding role in the treatment of coronary heart disease and the prognosis evaluation of vascular recanalization. Ensuring qualified image quality is the key in achieving this role. However, the myocardial metabolism imaging quality of 18F-FDG PET/CT is affected by many factors, such as diet before examination, fasting time, long-term drug use, daily blood glucose level examination, blood glucose regulation methods and the timing of tracer injection. To this end, the author intends to review the research status and the latest progress of the factors affecting the quality of myocardial metabolism imaging with the 18F-FDG PET/CT. -
[1] Momose M, Kondo C. Assessment of myocardial viability by FDG-PET[J]. RinSho Byori, 2007, 55(7): 639−647. [2] 邸丽娟, 王荣福. 核素心血管显像在冠心病诊断中的应用及进展[J]. 中华临床医师杂志(电子版), 2010, 4(10): 1910−1913.
Di LJ, Wang RF. Application and progress of radionuclide cardiovascular imaging in the diagnosis of coronary heart disease[J]. Chin J Clin (Electron Ed), 2010, 4(10): 1910−1913.[3] 孙茉茉, 李剑明, 刘志刚. PET/CT检测冠状动脉旁路移植术患者存活心肌的研究进展[J]. 医学综述, 2017, 23(16): 3291−3295, 3301. DOI: 10.3969/j.issn.1006−2084.2017.16.036.
Sun MM, Li JM, Liu ZG. Research Progress of PET/ CT Imaging for Detection of Viable Myocardium in Patients with Coronary Artery Bypass Grafting[J]. Med Recapit, 2017, 23(16): 3291−3295, 3301. DOI: 10.3969/j.issn.1006−2084.2017.16.036.[4] Chong CR, Clarke K, Levelt E. Metabolic remodelling in diabetic cardiomyopathy[J]. Cardiovasc Res, 2017, 113(4): 422−430. DOI: 10.1093/cvr/cvx018. [5] 王雪梅. 核医学[M]. 北京: 中国医药科技出版社, 2016: 62−63.
Wang XM. Clinical Medicine[M]. Beijing: China Medical Science Press, 2016: 62−63.[6] 李婷, 李剑明, 卢如明. 静脉糖负荷联合胰岛素法调控血糖在猪18F-FDG PET/CT心肌显像中的应用[J]. 中国医学影像技术, 2018, 34(9): 1323−1327. DOI: 10.13929/j.1003−3289.201712089.
Li T, Li JM, Lu RM. Application of intravenous glucose loading combined with insulin regulating blood glucose in porcine 18F-FDG PET/CT myocardial imaging[J]. Chin J Med Imaging Technol, 2018, 34(9): 1323−1327. DOI: 10.13929/j.1003−3289.201712089.[7] de Groot M, Meeuwis APW, Kok PJM, et al. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut[J]. Eur J Nucl Med Mol Imaging, 2005, 32(1): 98−101. DOI: 10.1007/s00259−004−1670−2. [8] Balink H, Hut E, Pol T, et al. Suppression of 18F-FDG Myocardial Uptake Using a fAt-Allowed, Carbohydrate-Restricted Diet[J]. J Nucl Med Technol, 2011, 39(3): 185−189. DOI: 10.2967/jnmt.110.076489. [9] Demeure F, Hanin FX, Bol A, et al. A Randomized Trial on the Optimization of 18F-FDG Myocardial Uptake Suppression: Implications for Vulnerable Coronary Plaque Imaging[J]. J Nucl Med, 2014, 55(10): 1629−1635. DOI: 10.2967/jnumed.114.138594. [10] Lu Y, Grant C, Xie KR, et al. Suppression of Myocardial 18F-FDG Uptake Through Prolonged High-Fat, High-Protein, and Very-Low-Carbohydrate Diet Before FDG-PET/CT for Evaluation of Patients With Suspected Cardiac Sarcoidosis[J]. Clin Nucl Med, 2017, 42(2): 88−94. DOI: 10.1097/rlu.0000000000001465. [11] Israel O, Weiler-Sagie M, Rispler S, et al. PET/CT quantitation of the effect of patient-related factors on cardiac 18F-FDG uptake[J]. J Nucl Med, 2007, 48(2): 234−239. [12] 宋建波. 实验犬放射性心脏损伤心肌代谢-灌注显像及超微结构损伤研究[D]. 太原: 山西医科大学, 2017.
Song JB. The research of myocardial metabolism/perfusion imaging and ultrastructural damage in experimental dogs with radiation induced heart disease[D]. Taiyuan: Shanxi Medical University, 2017.[13] Knuuti MJ, Yki-Järvinen H, Voipio-Pulkki LM, et al. Enhancement of Myocardial[Fluorine-18] Fluorodeoxyglucose Uptake by a Nicotinic Acid Derivative[J]. J Nucl Med, 1994, 35(6): 989−998. [14] Bax JJ, Veening MA, Visser FC, et al. Optimal metabolic conditions during fluorine-18 fluorodeoxyglucose imaging; a comparative study using different protocols[J]. Eur J Nucl Med, 1997, 24(1): 35−41. DOI: 10.1007/BF01728306. [15] 郭佳, 张国旭, 王治国, 等. 葡萄糖/胰岛素负荷后正常及冬眠心肌18F-氟脱氧葡萄糖摄取状态研究[J]. 临床军医杂志, 2018, 46(11): 1273−1275.
Guo J, Zhang GX, Wang ZG, et al. Study on the uptake status of 18F-FDG in normal and hibernating myocardium after glucose/insulin load[J]. Clin J Med Offic, 2018, 46(11): 1273−1275.[16] Hu LJ, Qiu C, Wang XS, et al. The association between diabetes mellitus and reduction in myocardial glucose uptake: a population-based 18F-FDG PET/CT study[J/OL]. BMC Cardiovasc Disord, 2018, 18(1): 203[2019-06-24]. https://link.springer.com/article/10.1186/s12872-018-0943-9. DOI: 10.1186/s12872−018−0943−9. [17] 黄钢. 影像核医学[M]. 2版. 北京: 人民卫生出版社, 2010: 134−136.
Huang G. Imaging Nuclear Medicine[M]. 2nd Ed. Beijing: Peoples Medical Publishing House, 2010: 134−136.[18] 刘晓洁, 褚俊, 杨扬, 等. 18氟标记脱氧葡萄糖心肌正电子发射型计算机断层扫描显像仪心肌代谢显像检查的方法学研究[J]. 中国临床保健杂志, 2011, 14(2): 132−134. DOI: 10.3969/J.issn.1672−6790.2011.02.007.
Liu XJ, Chu J, Yang Y, et al. The methodology study on 18F-FDG PET/CT myocardial metabolism scintigraphy[J]. Chin J Clin Health, 2011, 14(2): 132−134. DOI: 10.3969/J.issn.1672−6790.2011.02.007.[19] 杨易剑, 侯翠红, 田丛娜, 等. 18F-氟代脱氧葡萄糖心肌代谢显像探测左心室室壁瘤的存活心肌及其合并室性心律失常对患者长期预后的影响[J]. 中国循环杂志, 2015, 30(12): 1152−1156. DOI: 10.3969/j.issn.1000−3614.2015.12.005.
Yang YJ, Hou CH, Tian CN, et al. Long-term Prognosis in Patients With Viable Myocardium in Left Ventricular Aneurysm and Arrhythmia Asseeed by 18F-FDG Imaging[J]. Chin Circulat J, 2015, 30(12): 1152−1156. DOI: 10.3969/j.issn.1000−3614.2015.12.005.[20] Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI Procedure standard for positron emission tomography (PET) nuclear cardiology procedures[J]. J Nucl Cardiol, 2016, 23(5): 1187−1226. DOI: 10.1007/s12350−016−0522−3. [21] 刘建文, 耿亚琴. 糖负荷联合皮下注射胰岛素法在双核素心肌代谢显像血糖调控中的应用[J]. 护理研究, 2015, 29(7A): 2414−2416. DOI: 10.3969/j.issn.1009−6493.2015.19.042.
Liu JW, Geng YQ. Application of glucose load combined with subcutaneous injection of insulin in dual-isotope myocardial metabolic imaging (DISA) blood sugar regulation[J]. Chin Nurs Res, 2015, 29(7A): 2414−2416. DOI: 10.3969/j.issn.1009−6493.2015.19.042.[22] 吴锐先, 王治国, 郭佳, 等. 不同血糖调节方法对18F-氟脱氧葡萄糖正电子发射计算机断层成像心肌代谢显像影响[J]. 临床军医杂志, 2018, 46(11): 1282−1284.
Wu RX, Wang ZG, Guo J, et al. Effect of different blood glucose regulation methods on myocardial metabolic imaging of 18F-FDG PET[J]. Clin J Med Offic, 2018, 46(11): 1282−1284.[23] Jeong J, Kong E, Chun K, et al. The Impact of Energy Substrates, Hormone Level and Subject-Related Factors on Physiologic Myocardial 18F-FDG Uptake in Normal Humans[J]. Nucl Med Mol Imaging, 2013, 47(4): 225−231. DOI: 10.1007/s13139−013−0230−8. [24] 科雨彤, 田丛娜, 魏红星, 等. 门控心肌灌注和心肌代谢显像动态评价小型猪室壁瘤形成后左心室功能和重构变化的实验研究[J]. 中国循环杂志, 2015, 30(6): 580−584. DOI: 10.3969/j.issn.1000−3614.2015.06.018.
Ke YT, Tian CN, Wei HX, et al. Dynamic Evaluation of Left Ventricular Function and Remodeling by Gated SPECT Perfusion and Gated FDG PET Metabolic Imaging During Ventricular Aneurysm Formation in Experimental Pigs[J]. Chin Circulat J, 2015, 30(6): 580−584. DOI: 10.3969/j.issn.1000−3614.2015.06.018.[25] Coort SLM, Bonen A, van der Vusse GJ, et al. Cardiac substrate uptake and metabolism in obesity and type-2 diabetes: Role of sarcolemmal substrate transporters[J]. Mol Cell Biochem, 2007, 299(1/2): 5−18. DOI: 10.1007/s11010−005−9030−5. [26] 王海宁, 方纬, 刘辰, 等. 2型糖尿病患者氟-18标记脱氧葡萄糖心肌代谢显像图像质量与相关代谢因素的分析[J]. 中华老年医学杂志, 2009, 28(1): 11−14. DOI: 10.3760/cma.j.issn.0254−9026.2009.01.003.
Wang HN, Fang W, Liu C, et al. Study on the relationship between the metabolic factors and the quality of 18F-fluorode oxyglucose myocardial metabolic imaging in patients with type 2 diabetes[J]. Chin J Geriat, 2009, 28(1): 11−14. DOI: 10.3760/cma.j.issn.0254−9026.2009.01.003.
计量
- 文章访问数: 12782
- HTML全文浏览量: 12565
- PDF下载量: 45