肿瘤PET/CT显像患者的心脏异常摄取分析

Incidence and etiological analysis of abnormal cardiac uptake in patients underwent oncologic PET/CT imaging

目的探讨行肿瘤氟-18-脱氧葡萄糖(18F-FDG)正电子发射型计算机断层扫描(PET/CT)显像患者心脏异常摄取的发生率、部位和病因。方法该研究为回顾性研究。选取北京朝阳医院2014年1月至2016年9月2000例疑诊或确诊恶性肿瘤患者的18F-FDG PET/CT图像,显像前患者禁食12 h以上,18F-FDG注射前空腹血糖水平需<6.7 mmol/L。左心室非基底段、非乳头肌部位的局灶性高摄取,高于左心室摄取的右心室摄取以及高于心血池摄取的心房摄取(左心室无摄取或低摄取时)定义为异常摄取,所有异常摄取的判定均由核医学医师进行视觉分析。收集患者的一般临床资料及心脏相关影像学检查结果,分析心脏异常摄取的发生率、部位和病因。结果2000例患者年龄(60.5±13.2)岁,男性1117例(55.85%),糖尿病患者138例(6.90%),既往有心血管疾病史的患者228例(11.40%)。恶性肿瘤、良性病变、未明确诊断的患者分别为939例(46.95%)、484例(24.20%)、557例(28.85%)。心脏异常摄取145例(7.3%),其中左心室、右心室和心房异常摄取分别为76例(52.4%)、18例(12.4%)和51例(35.2%)。左心室异常摄取76例中,25例(32.9%)由冠状动脉疾病引起,其他少见原因还包括肥厚型心肌病、心脏转移瘤及化疗相关性心肌损害;右心室异常摄取18例中,14例(14/18)由肺动脉高压引起;心房异常摄取51例中,20例(39.3%)由心房颤动引起。心脏异常摄取的患者中,PET/CT显像前无明确心脏疾病表现和证据的患者有71例(49.0%)。结论肿瘤18F-FDG PET/CT显像患者中心脏异常摄取并不少见,异常摄取部位以左心室最为常见,冠状动脉疾病、肺动脉高压、心房颤动是常见病因。

Objective To investigate the incidence,location and etiology of abnormal cardiac uptake in patients underwent oncologic 18F-fluorodeoxyglucose positron emission tomography/computed tomography(PET/CT)imaging.Methods The 18F-FDG PET/CT images of 2000 consecutive patients with suspected or diagnosed malignancy in Beijing Chaoyang Hospital from January 2014 to September 2016 were retrospectively analyzed.Fasting time was more than 12 hours before imaging,and fasting blood glucose level before 18F-FDG injection was less than 6.7 mmol/L.Focal uptake in the non-basal and non-papillary regions of the left ventricle,uptake in the right ventricle exceeding uptake in the left ventricle,and uptake in the atrium higher than that of the blood pool(when uptake of left ventricle was zero or low)were defined as abnormal,and all abnormal uptake was visually determined by experienced nuclear medicine physicians.General clinical data and the results of cardiac examination were collected to explore the incidence,location and etiology of cardiac diseases.Results There were 138 patients with history of diabetes(6.90%),228 patients with history of cardiovascular disease(11.40%)out of the 2000 patients((60.5±13.2)years,1117 male(55.85%)).The number and proportion of patients with malignancy,benign lesions,diseases of unknown etiology were 939(46.95%),484(24.20%),557(28.85%),respectively.Abnormal cardiac uptake was detected in 145 patients(7.3%).The proportion of abnormal uptake in left ventricle,right ventricle and atrium was 52.4%(76 cases),12.4%(18 cases),35.2%(51 cases),respectively.Of the 76 individuals who had abnormal uptake in left ventricle,25 cases(32.9%)were caused by coronary artery disease,and other causes included hypertrophic cardiomyopathy and myocardial damage caused by chemotherapy drugs,etc.Of the 18 cases who had abnormal uptake in right ventricle,14 cases(14/18)were caused by pulmonary hypertension.In addition,20 out of the 51 cases(39.3%)with abnormal uptake in atrium suffered from atrial fibrillation.Seventy-one patients with abnormal cardiac uptake(49.0%)had no clear manifestation and evidence of heart disease before imaging.Conclusions The abnormal 18F-FDG uptake on oncologic PET/CT is not rare.The most common site of abnormal uptake is left ventricle,coronary artery disease,pulmonary hypertension and atrial fibrillation are common causes of abnormal 18F-FDG uptake.