摘要
目的分析^(11)C标记的匹兹堡化合物B(^(11)C-PiB)PET/MRI在原发性系统性轻链型淀粉样变(pAL)中评估器官受累的价值。方法回顾性分析2019年1月至2021年10月在华中科技大学同济医学院附属协和医院就诊的20例pAL患者及3名健康志愿者的临床资料,比较临床标准评估器官受累和PET/MRI评估的相关性,分析心脏相关生物学指标、疾病分期与心脏最大标准摄取值(SUVmax)之间的关系及24 h尿蛋白定量与肾脏SUVmax之间的关系。结果①纳入20例患者,初诊患者18例,非初诊患者2例。观察到^(11)C-PiB摄取阳性的脏器分别为:心脏15例(75%),肺部8例(40%),骨髓10例(50%),肌肉10例(50%),舌肌7例(35%),甲状腺6例(30%),唾液腺4例(20%),脾脏2例(10%),胃壁1例(5%)。②^(11)C-PiB在心脏及骨髓摄取的阳性率与临床评估标准具有很好的相关性。在肺组织、脾脏、腺体、肌肉和舌肌中,^(11)C-PiB PET/MRI评估的阳性率明显高于临床标准。但对于神经系统受累和脂肪组织的评估^(11)C-PiB PET/MRI具有局限性。③分析18例初诊患者心脏相关生物学指标与心脏SUVmax之间的关系。左心室射血分数(LVEF)<50%且室间隔厚度(ISV)≥1.2 cm的患者相较LVEF≥50%且ISV<1.2 cm的患者其心脏SUVmax更高(P<0.05)。心脏SUVmax值在Mayo2004分期、Mayo2012分期各期之间差异有统计学意义,分期越晚,SUVmax值越高(P<0.05)。心脏SUVmax与心肌肌钙蛋白酶Ⅰ、N末端前体脑钠肽水平呈明显正相关(P<0.01),肾脏SUVmax与24 h尿蛋白定量无明显相关性(P>0.05)。结论全身^(11)C-PiB PET/MRI作为一种淀粉样蛋白的可视化系统,若用于器官水平的定性评估,具有提高早期无创性诊断pAL水平的潜力;用于器官水平(尤其是心脏)的定量评估,有望更精准评估器官功能和预测疾病预后。
Objective To analyze the value of^(11)C-PiB PET/MRI for evaluating organ involvement in patients with primary light chain amyloidosis(pAL).Methods The clinical data of 20 patients with pAL and 3 healthy volunteers from January 2019 to October 2021 were retrospectively analyzed.The correlation between the organ involvement evaluated by clinical standards and PET/MRI was compared.The relationship between cardiac-related biological indicators,disease stage,and the maximum standardized uptake value(SUVmax)were analyzed.The relationship between 24-hour urinary protein quantification and kidney SUVmax was analyzed.Results①In 20 patients(18 newly diagnosed patients and 2 non-newly diagnosed patients),^(11)C-PiB positive uptake was observed in the heart(15 patients,75%),lung(8 patients,40%),bone marrow(10 patients,50%),muscle(10 patients,50%),tongue muscle(7 patients,35%),thyroid(6 patients,30%),salivary gland(4 patients,20%),spleen(2 patients,10%),and stomach wall(1 patient,5%).②Organ involvement on^(11)C-PiB PET/MRI showed good correlations with the clinical evaluation criteria for the heart and bone marrow.The positive rate of PET/MRI evaluation in the lung,spleen,gland,muscle,and tongue muscle was significantly higher than the clinical criteria.However,^(11)C-PiB PET/MRI has limitations in the evaluation of the nervous system and fat tissue.③To analyze the relationship between cardiac-related biological indexes and the SUVmax of the heart in 13 newly diagnosed patients.Patients with left ventricular ejection fraction(LVEF)<50%and interventricular septal thickness(ISV)≥1.2 cm showed a higher SUVmax than patients with LVEF≥50%and ISV<1.2 cm(P<0.05).There are significant differences in the SUVmax of the heart between the Mayo2004 stage and the Mayo2012 stage.The later the disease stage,the higher the SUVmax(P<0.05).The SUVmax of the heart was positively correlated with cardiac troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-proBNP)(P<0.01).There was no significant correlation between renal SUVmax and 24-hour urine protein(P>0.05).Conclusion Whole body^(11)C-PiB PET/MRI,as a visualization system of amyloid protein,is used to qualitatively evaluate organ involvement,which can improve the level of early noninvasive diagnosis.Whole body^(11)C-PiB PET/MRI can be used to perform quantitative evaluation of organ levels,especially the heart,which is expected to evaluate organ function and predict disease prognosis more accurately.
作者
王雅丹
杨雅景
武盈盈
孙春艳
Wang Yadan;Yang Yajing;Wu Yingying;Sun Chunyan(Institute of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2022年第4期316-322,共7页
Chinese Journal of Hematology