18^(F)-NaF PET/CT显像评估维持性血液透析患者血管钙化的作用

^(18)F-NaF PET/CT on Assessing Vascular Calcification of Maintenance Hemodialysis Patients

目的应用18^(F)-NaF PET/CT显像评估维持性血液透析(MHD)患者血管钙化与18^(F)-NaF摄取值之间的相关性,探讨18^(F)-NaF PET/CT成像对于MHD患者血管钙化的诊断评估价值。方法选择因骨科疾病行18^(F)-NaF PET/CT检查的MHD患者,通过视觉评估各段血管壁是否出现异常显像剂摄取,利用目标/背景比进行测量,计算PET评分,同时对CT图像进行视觉分析,评估血管壁是否发生钙化,计算相应的钙化积分,同时采集患者年龄、性别、血钙、血磷等临床信息及实验室检查结果,分析PET评分、临床、生化指标之间的关系,了解血管18^(F)-NaF摄取与血管钙化之间的相关性,评估18^(F)-NaF PET/CT显像对MHD患者血管钙化的应用价值。结果对20例患者的71个血管节段(颈动脉、冠状动脉、胸主动脉、腹主动脉、髂动脉)进行了分析,共检测到203处病灶,其中有153处PET、CT均为阳性,41处PET为阳性,而CT为阴性;9处PET为阴性,而CT为阳性。Spearman相关性分析显示血管钙化灶的18^(F)-NaF摄取值与钙化体积分数以及Agatston评分成正相关(P<0.0001)。冠状动脉钙化评分以及腹主动脉钙化评分与腹主动脉的PET评分成正相关(P<0.0001)。代表患者全身血管钙化水平的全身PET评分与透析时间、总胆固醇、甘油三酯、碱性磷酸酶呈正相关,与白蛋白呈负相关(P<0.05)。结论在维持性透析患者中,血管钙化灶的18^(F)-NaF摄取值与钙化积分有很强的相关性,并且能够发现CT显像上不可见的微钙化斑块以及评估较大钙化斑块的活动度以及稳定性。同时,基于18^(F)-NaF PET/CT显像的全身PET评分与评估血管钙化的临床、生化指标之间也有很好的相关性。18^(F)-NaF PET/CT显像有望成为早期、全面评估MHD患者血管钙化的影像学方法。

Objective^(18)F-NaF PET/CT imaging was used to evaluate the correlation between vascular calcification and 1SF-NaF uptake in maintenance hemodialysis(MHD)patients,and to explore the diagnostic value of ISF-NaF PET/CT imaging for vascular calcification in MHD patients.Methods Twenty MHD patients who underwent F-NaF-PET/CT examination due to orthopedic diseases in the Department of Nuclear Medicine of our hospital were selected.Visual evaluation was performed for abnormal tracer uptake in each segment of vascular wall.The target-to-background Ratio(TBR)was used for measurement,and PET score was calculated.Then the visual analysis of CT images was performed to evaluate the vascular calcification,and the calcification score of each vascular segment was calculated too.At the same time,clinical information such as age,gender,and laboratory examination results of patients were collected for analyzing the correlation between PET score and serological indicators.To investigate the correlation between vascular SF-NaF uptake and vascular calcification,and to evaluate the application value of SF-NAF-PET/CT imaging on vascular calcification in MHD patients.Results We studied 71 vascular segments(carotid artery,coronary artery,thoracic aorta,abdominal aorta,and iliac artery)in 20 patients.A total of 203 lesions were detected,of which 153 were positive for PET and CT,41 were positive for PET and negative for CT.Nine PET tests were negative,while CT tests were positive.Spearman analysis showed that the^(18)F-NaF uptake of vascular calcification was correlated well with calcification volumetric score(CVS)and Agatston score(AS)(P<0.0001).Coronary artery calcification score(CACS)and abdominal aortic calcification score(AACS)were positively correlated with PET score(P<O.0001).The whole-body PET score was positively correlated with dialysis time,total cholesterol,triglyceride,and alkaline phosphatase,but negatively correlated with albumin(P<0.05).Conclusion Here is a strong correlation between^(18)F-NAF uptake and calcification score in maintenance dialysis patients.^(18)F-NAF PET/CT can detect microcalcification plaques that are invisible on CT imaging and assess the activity and stability of larger calcified plaques.Meanwhile,there was a good corelation between the whole-body PET score based on^(18)F-NAF PET/CT imaging and the clinical and biochemical indicators.^(18)F-NAF PET/CT imaging is expected to be an early and comprehensive imaging method for evaluation of vascular calcification in MHD patients.