CT衰减校正在IQ-单光子发射型电子计算机断层扫描心肌灌注显像中的应用价值
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摘要
目的:以无冠心病者为研究对象,IQ-SPECT模式采集图像,采用4DM软件对心肌节段的放射性摄取值(%)和17节段自动评分系统对结果进行评价,比较CT衰减校正(AC)对心肌灌注显像(MPI)结果判断的影响。方法:对59例行静息+负荷SPECT MPI结果为阴性,且冠状动脉造影或冠状动脉CT造影检查结果提示冠状动脉未见狭窄或狭窄<50%,对其静息心肌灌注图像进行回顾性分析。其中男性28例,女性31例,年龄(58.3±9.8)岁,体质指数(24.9±3.4)/(kg/m~2)。采用4DM软件比较衰减校正前后左心室5个大的心肌节段(心尖、前壁、间隔、下壁和侧壁)的放射性摄取值(%),以及17个心肌节段评分的变化情况。结果:AC后受检者下壁和间隔的放射性摄取值(%)显著性升高,心尖部的放射性摄取值(%)则明显降低(P<0.05)。AC后86%(51/59)的下壁和85%(50/59)间隔的放射性摄取值(%)升高,100%(59/59)心尖部放射性摄取值(%)均降低。采用17节段5分法的评分系统,AC后多数下壁(78%,46/59)、间隔(59%,35/59)和心尖部(69%,41/59)的评分保持不变。但对女性患者,AC后42%(13/31)的前壁和心尖部评分值均增加,可能会导致假阳性结果。结论:IQ-SPECT模式下,AC会导致受检者下壁和间隔的放射性摄取值(%)明显升高,心尖部则显著降低。临床医师在图像判读时需引起注意。
Objective: Using percent of radioactive counts( PRC) and auto-scores of 17 segments to evaluate the impact of CT attenuation correction( AC) on IQ-SPECT myocardial perfusion imaging( MPI) in patients without coronary artery disease. Methods: Fifty-nine patients [male 28,female 31,age( 8. 3 ± 9. 8)years,body mass index( 24. 9 ± 3. 4) kg/m~2],who had negative rest + stress MPI result,and coronary angiography or coronary CT angiography showed that the coronary artery was normal or with the stenosis < 50%,were respectively enrolled,and rest image of MPI was analyzed. Before and after AC,myocardial uptake( %)and scores were analyzed by using 4 DM software,17 segments and 5-score system. Two-sample t test was used for the comparison between patients with AC and NOAC. Independent-samples T test was used for the comparison between male and female. Results: After AC,myocardial uptake( %) in inferior wall and septal wall was remarkably increased,while myocardial uptake( %) in apex was decreased significantly( P < 0. 05). After AC,myocardial uptake( %) was increased in 86%( 51/59) inferior wall and 85%( 50/59) septal wall while it was decreased in 100%( 59/59) apex. However,scores in most inferior wall( 78%,46/59),septal wall( 59%,35/59) and apex( 69%,41/59) were not significantly changed. It indicated score was reliable.Meanwhile,after AC,in female patients,myocardial uptake was decreased in apex and anterior wall,which might lead to false positive MPI result. Conclusion: After AC,myocardial uptake was significant increased in inferior wall and septal wall,while it was significantly decreased in apex.
Objective: Using percent of radioactive counts( PRC) and auto-scores of 17 segments to evaluate the impact of CT attenuation correction( AC) on IQ-SPECT myocardial perfusion imaging( MPI) in patients without coronary artery disease. Methods: Fifty-nine patients [male 28,female 31,age( 8. 3 ± 9. 8)years,body mass index( 24. 9 ± 3. 4) kg/m~2],who had negative rest + stress MPI result,and coronary angiography or coronary CT angiography showed that the coronary artery was normal or with the stenosis < 50%,were respectively enrolled,and rest image of MPI was analyzed. Before and after AC,myocardial uptake( %)and scores were analyzed by using 4 DM software,17 segments and 5-score system. Two-sample t test was used for the comparison between patients with AC and NOAC. Independent-samples T test was used for the comparison between male and female. Results: After AC,myocardial uptake( %) in inferior wall and septal wall was remarkably increased,while myocardial uptake( %) in apex was decreased significantly( P < 0. 05). After AC,myocardial uptake( %) was increased in 86%( 51/59) inferior wall and 85%( 50/59) septal wall while it was decreased in 100%( 59/59) apex. However,scores in most inferior wall( 78%,46/59),septal wall( 59%,35/59) and apex( 69%,41/59) were not significantly changed. It indicated score was reliable.Meanwhile,after AC,in female patients,myocardial uptake was decreased in apex and anterior wall,which might lead to false positive MPI result. Conclusion: After AC,myocardial uptake was significant increased in inferior wall and septal wall,while it was significantly decreased in apex.
引文
[1]焦建,牟甜甜,董薇,等.早发冠心病核素心肌灌注显像阳性患者临床特点分析[J].心肺血管病杂志,2017(3),222-225.
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[4]Caobelli F,Kaiser SR,Thackeray JT,et al.IQ SPECT Allows a Significant Reduction in Administered Dose and Acquisition Time for Myocardial Perfusion Imaging:Evidence from a Phantom Study[J].J Nucl Med,2014,55(12),2064-2070.
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[6]Okuda K,Nakajima K,Matsuo S,et al.Creation and characterization of normal myocardial perfusion imaging databases using the IQ·SPECT system[J].J Nucl Cardiol,2017,1-10.
[7]Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart.A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart Association[J].J Cardiovasc Magn Reson,2002,9(2),240-245.
[8]Havel M,Kolacek M,Kaminek M,et al.Myocardial perfusion imaging parameters:IQ-SPECT and conventional SPET system comparison[J].Hellenic J Nucl Med,2014,17(3),200-203.
[9]Rajaram R,Bhattacharya M,Ding X,et al.Tomographic performance characteristics of the IQ SPECT system[J].2011.
[10]Joergensen T,Hansson SH.Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging[J].J Nucl Med Technol,2015,43(3),4834-4835.
[11]Singh B,Bateman TM,Case JA,et al.Attenuation artifact,attenuation correction,and the future of myocardial perfusion SPECT[J].J Nucl Cardiol,2007,14(2),153-164.(2017-06-22)
[2]董薇,贺毅,李全,等.心脏磁共振与核医学负荷心肌灌注显像探测冠心病心肌缺血的对比研究[J].心肺血管病杂志,2016,35(5),373-377.
[3]黄克敏,冯彦林,温广华,等.CT衰减校正对SPECT心肌灌注显像图像质量的影响[J].中国医学影像学杂志,2014,22(12),919-923.
[4]Caobelli F,Kaiser SR,Thackeray JT,et al.IQ SPECT Allows a Significant Reduction in Administered Dose and Acquisition Time for Myocardial Perfusion Imaging:Evidence from a Phantom Study[J].J Nucl Med,2014,55(12),2064-2070.
[5]Ogino Y,Horiguchi Y,Ueda T,et al.A myocardial perfusion imaging system using a multifocal collimator for detecting coronary artery disease:validation with invasive coronary angiography[J].Ann Nucl Med,2015,29(4),366-370.
[6]Okuda K,Nakajima K,Matsuo S,et al.Creation and characterization of normal myocardial perfusion imaging databases using the IQ·SPECT system[J].J Nucl Cardiol,2017,1-10.
[7]Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart.A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart Association[J].J Cardiovasc Magn Reson,2002,9(2),240-245.
[8]Havel M,Kolacek M,Kaminek M,et al.Myocardial perfusion imaging parameters:IQ-SPECT and conventional SPET system comparison[J].Hellenic J Nucl Med,2014,17(3),200-203.
[9]Rajaram R,Bhattacharya M,Ding X,et al.Tomographic performance characteristics of the IQ SPECT system[J].2011.
[10]Joergensen T,Hansson SH.Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging[J].J Nucl Med Technol,2015,43(3),4834-4835.
[11]Singh B,Bateman TM,Case JA,et al.Attenuation artifact,attenuation correction,and the future of myocardial perfusion SPECT[J].J Nucl Cardiol,2007,14(2),153-164.(2017-06-22)