18F-FDG、18F-NaF PET/CT及心脏CT血管成像联合显像对2型糖尿病冠状动脉疾病的诊断及评估

18F-FDG and 18F-NaF PET/CT with cardiac computed tomography angiography in type 2 diabetes mellitus with coronary atherosclerotic heart disease

目的探讨18F-FDG、18F-NaF PET/CT及心脏CT血管成像(CTA)联合影像对2型糖尿病(T2DM)伴冠状动脉粥样硬化性心脏病(CAD)患者动脉斑块的诊断效能,及其相关因素分析。方法收集2016年1月至2019年6月北部战区总医院心血管内科住院患者108例,包括CAD患者34例,CAD+T2DM患者74例,依次接受CTA、18F-FDG、18F-NaF PET/CT检查,分析其临床诊断价值,以及冠状动脉钙化积分(CCS)、斑块总体积(TPV),非钙化斑块体积(NPV)、低CT衰减斑块体积(LAP)、SUVmax与靶本比(TBR)的相关性。结果18F-NaF对冠状动脉斑块的检出率高于18F-FDG;T2DM伴CAD患者冠状动脉受累血管节段数、狭窄程度、CCS、TPV、NPV、LAP、TBR、最大标准化摄取值(SUVmax)均较CAD组高。SUVmax与血管狭窄程度、LAP及TBR均呈正相关,而TBR还与TPV、NCP及LAP呈正相关。结论18F-NaF、18F-FDG PET/CT分子探针联合CTA可视化动脉斑块显像,对冠状动脉斑块具有较高的定性及定量诊断价值;18F-NaF较18F-FDG更敏感地反映细胞代谢情况;冠状动脉斑块的能量代谢与斑块性质及血管狭窄程度相关,可反映斑块活性。

Objective To investigate the diagnostic and evaluation value of arterial plaques in patients with type 2 diabetes mellitus(T2 DM)and coronary atherosclerotic heart disease(CAD)observed in the combined images of 18F-flurodeoxyglucose(FDG)and 18F-NaF PET/CT and CTA.Methods The study included 108 patients from January 2016 to June 2019,including 34 cases of coronary heart disease and 74 cases of coronary heart disease with type 2 diabetes mellitus,followed by CTA,18F-FDG,and 18F-NaF PET/CT examination to analyze its clinical diagnostic value,as well as the association between coronary calcification integral(CCS),plaque total volume(TPV),non-calcification plaque volume(NPV),low CT attenuation plaque volume(LAP),SUVmax,and target to background ratios(TBR).Results The detection rate of coronary plaques was higher with 18F-NaF PET/CT than with 18F-FDG PET/CT.The number of coronaryinvolved vascular segments,stenosis,CCS,TPV,NPV,LAP,TBR,SUVmax were higher in patients with CAD with T2 DM than in those without T2 DM.SUVmax was positively associated with vascular stenosis,LAP,and TBR,while TBR was also positively associated with TPV,NCP,and LAP.Conclusion 18F-NaF and 18F-FDG PET/CT molecular probe combined with CTA visual makes arterial plaques easily visible;it had high qualitative and quantitative diagnostic value for coronary artery plaque.18F-NaF PET/CT is more sensitive to cell metabolism than 18F-FDG PET/CT,and the energy metabolism of coronary artery plaques is related to the plaque properties and vascular stenosis,reflecting plaque activity.