肥胖患者碲锌镉心脏专用不同采集体位心肌衰减伪影与性别关系的比较研究

Comparative study of myocardial attenuation artifacts and gender relationship in different acquisition positions of SPECT in obese patients

目的:对比肥胖患者碲锌镉(cadmium-zinc-telluride,CZT)心脏专用单光子发射计算机断层显像不同采集体位心肌衰减伪影与性别的相互关系。方法:前瞻性收集了2024年1月至2024年3月肥胖患者(BMI≥28 kg/m^(2)),所有患者均于首都医科大学附属北京安贞医院核医学科进行了仰卧位、半直立位和直立位三个体位的门控负荷心肌灌注显像采集。使用美国心脏协会AHA 17节段5分法模型分析。衰减伪影定义为心肌灌注受损节段仅存在于一个或两个采集体位或在任意采集体位心肌节段灌注受损程度有所变化。采用Pearson卡方检验比较三个体位心肌衰减伪影的节段数量和总严重程度评分的差异。结果:共纳入73例肥胖患者,男性44例,女性29例。男性肥胖患者中,受累的左心室心肌衰减伪影节段总数量为10个,其中以下壁基底段数量和总严重程度评分最多,且在三个体位间比较差异有统计学意义。仰卧位、半直立和直立位采集时分别共有19、27和32例患者下壁基底段心肌无衰减伪影,准确率分别为43%(19/44)、61%(27/44)和73%(32/44)。女性肥胖患者中,受累的左心室心肌衰减伪影节段总数量为7个,其中下壁心尖段数量最多,且在三个体位间比较差异有统计学意义。仰卧位、半直立和直立位采集时分别共有21、16和11例患者下壁心尖段心肌无衰减伪影,准确率分别为72%(21/29)、55%(16/29)和38%(11/29)。结论:行CZT心脏专用单光子发射计算机心肌灌注断层显像时,男性肥胖患者优选直立位采集,以减少左心室下壁基底段心肌衰减伪影,女性肥胖患者优选仰卧位采集,以减少左心室下壁心尖段心肌衰减伪影。

Objective:To compare the relationship between soft tissue attenuation artifacts and gender in different acquisition positions of CZT SPECT in obese patients.Methods:Obese patients(BMI≥28 kg/m^(2))from January 2024 to March in 2024 were prospectively enrolled,and all patients underwent SPECT gated stress myocardial perfusion imaging in the Department of Nuclear Medicine of Anzhen Hospital in supine,semi-upright and upright positions.American Heart Association(AHA)17-segment 5-point model was used for analysis.The defects present in one or two position or showing change in severity within two or three positions were considered as positional artifacts.The Pearson chi-square test was used to compare the differences in the number of segments and the total severity scores of positional artifacts in the three positions,and P<0.05 was statistically significant.Results:A total of 73 obese patients were included,including 44 males and 29 females.The total number of segments involved in male obese patients was 10,among which the number of myocardial attenuation artifacts and the total severity score of the basal inferior segment were the largest,and there were statistically significant differences among the three positions.A total of 19,27,and 32 obese male patients were acquired in supine,semi-upright,and upright positions without attenuation artifacts in the basal inferior segment,with accuracy rates of 43%(19/44),61%(27/44),and 73%(32/44),respectively.A total of 21,16 and 11 female obese patients had no attenuation artifacts in the apical inferior segment,with an accuracy of 72%(21/29),55%(16/29)and 38%(11/29),respectively.Conclusion:The upright position was preferred in male obese patients to reduce the attenuation artifacts in the basal inferior segment of left ventricular wall,and the supine position was preferred in female obese patients to reduce the attenuation artifacts in the inferior apical segment of left ventricular wall when CZT SPECT myocardial perfusion imaging was performed.