^(18)F-FDG PET心肌代谢显像、GSPECT心肌灌注显像和超声心动图评价心肌梗死患者左心室功能的对比研究

Comparison Study of Left Ventricular Function Assessment by ^(18)F-FDG PET,Gated SPECT and 2D-Echocardiography in Patients with Myocardial Infarction

评价18F-FDG PET心肌代谢显像、门控单光子发射计算机断层(GSPECT)心肌灌注显像、超声心动图(Echo)检测心肌梗死患者左心功能的应用价值,并进行比较。64例临床诊断为冠心病心肌梗死的患者,分别于2周内行PET、GSPECT及Echo中至少两种检查,测定左室舒张末期容积(EDV)、收缩末期容积(ESV)和射血分数(EF)值。将三种检查方法获得的左心功能参数进行两两比较,并行相关性分析及一致性检验。配对t检验发现,测量EDV时,18F-FDG PET较GSPECT高估10.63mL[(137.98±61.71)mL vs.(125.35±59.34)mL];测量ESV时,18F-FDG PET较Echo高估11.25mL[(85.89±55.21)mL vs.(68.22±41.37)mL],GSPECT较Echo高估17.88mL[(82.39±55.56)mLvs.(68.22±41.37)mL];测量EF时(GSPECT<18F-FDG PET<Echo,39.75%±15.64%vs.41.96%±15.08%vs.52.18%±13.87%),18 F-FDG PET较GSPECT高估3.85%,较Echo低估9.53%,GSPECT较Echo低估13.45%。PET、GSPECT和Echo测量左心功能的结果两两之间均存在较好的正相关关系(r=0.643~0.873,P值均为0.000)。Bland-Altman一致性检验结果提示,18 F-FDG PET与Echo测量左心功能的结果一致性好,可以相互参照;GSPECT与18 F-FDG PET测量ESV的结果和GSPECT与Echo测量EDV、EF的结果可以相互参照,其他指标GSPECT不能与18 F-FDG PET或Echo相互替换。因此,临床医师应根据患者的实际情况和检查目的决定检查方法。

The aim of this study is to analyze the concordance between EDV, ESV and LVEF values derived from 18 F- FDG PET, GSPECT and ECHO in patients with myocardial infarction. Sixty four patients with coronary artery dis- ease （CAD） and myocardial infarction were enrolled in the study.. Each patient underwent at least two of the above mentioned studies within 2 weeks. LVEF. EDV and ESV values were analyzed with dedicated software. Statistical evaluation of correlation and agreement was carried out EDV was overestimated by 18F-FDG PET compared with GSPECT [-（137.98±61.71） mL and （125.35±59.34） mL~; ESV was overestimated by 18F FDG PET （85.89± 55.21） mL and GSPECT （82.39±55.56） mL compared with ECHO （68.22±41.37） mL; EF was overestimated by 18F-FDG PET （41.96%± 15.08%Q） and ECHO （52.18%± 13.87%） compared with GSPECT （39.75%±15.64%）, and EF was also overestimated by 18F-FDG PET compared with GSPECT. The results of linear regres sion analysis showed good correlation between EDV, ESV and LVEF values derived from 18 F-FDG PET, GSPECT and ECHO （r=0. 643-0. 873, P= 0. 000）. Bland-Ahman analysis indicated that 18 F-FDG PET correlated well withECHO in the Left ventricular function parameters. While GSPECT correlated well with 18F-FDG PET in ESV, GSPECT had good correlation with Echo in respect of EDV and EFV whereas GSPECT had poor correlation with PET/ECHO in the remaining left ventricular function parameters. Therefore, the clinical physicians should decide whether they would use the method according to the patients＇ situation and diagnostic requirements.