Diagnostic value of blood flow reserve measurement with 13N-NH3·H2O PET/CT imaging in patients with coronary microvascular disease

中华核医学与分子影像杂志 Pub Date : 2019-12-25 DOI:10.3760/CMA.J.ISSN.2095-2848.2019.12.002

Kun Peng, Weiqiang Chen, Yongde Wang, Jian Zhang, Jianming Li

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Abstract

Objective To evaluate the diagnostic value of coronary flow reserve (CFR) on 13N-NH3·H2O PET/CT imaging for patients with suspected coronary microvascular disease (CMVD). Methods From September 2017 to September 2018, 54 clinical suspected CMVD patients (22 males, 32 females; age: 25-77 years) in TEDA International Cardiovascular Hospital were retrospectively analyzed. All patients underwent 13N-NH3·H2O PET/CT imaging to measure left ventricle CFR (LV-CFR), and were divided into CMVD group (LV-CFR<2.5) and non-CMVD group (LV-CFR≥2.5). Semi-quantitative parameters of PET/CT myocardial perfusion imaging (MPI), including summed stress score (SSS), summed rest score (SRS), summed difference score (SDS) and transient ischemic dilation (TID), as well as left ventricular function parameters, such as rest and stress imaging left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) were compared between two groups. Besides, rest and stress LV-myocardial blood flow (MBF) and CFR distribution of the CMVD group in the region of three coronary arteries was also analyzed and compared. Independent-sample t test, Mann-Whitney U test and Pearson correlation analysis were used to analyze the data. Results Rest LV-MBF of CMVD group was higher than that of non-CMVD group ((0.74±0.16) vs (0.63±0.09) ml·g-1·min-1) and stress LV-MBF was lower ((1.52±0.36) vs (1.89±0.22) ml·g-1·min-1; t values: 2.925, -4.503, both P 0.05). Positive correlations were found in CFR among left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) (r values: 0.798-0.836, all P<0.01). Conclusion CFR measured with PET/CT imaging is better than semi-quantitative parameters in MPI, which provides noninvasive and objective diagnosis and evaluation information for patients without obvious epicardial coronary artery stenosis and suspected with CMVD. Key words: Coronary artery disease; Microvascular angina; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Positron-emission tomography; Tomography, X-ray computed; Ammonia

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13N-NH3·H2O PET/CT血流储备测量对冠状动脉微血管疾病的诊断价值

目的评价13N-NH3·H2O PET/CT显像冠状动脉血流储备（CFR）对疑似冠状动脉微血管病（CMVD）患者的诊断价值。方法对2017年9月至2018年9月天津开发区国际心血管病医院54例临床疑似CMVD患者（男22例，女32例，年龄25-77岁）进行回顾性分析。所有患者均接受13N-NH3·H2O PET/CT显像测量左心室CFR（LV-CFR），并分为CMVD组（LV-CFR<2.5）和非CMVD组。PET/CT心肌灌注显像（MPI）的半定量参数包括总应力评分（SSS）、总静息评分（SRS）、总差异评分（SDS）和短暂性脑缺血扩张（TID），以及左心室功能参数，如休息和压力成像左心室射血分数（LVEF）、舒张末期容积（EDV）和收缩末期容积（ESV），在两组之间进行比较。此外，还对CMVD组静息和应激状态下左心室心肌血流量（MBF）和CFR在三条冠状动脉区域的分布进行了分析和比较。采用独立样本t检验、Mann-Whitney U检验和Pearson相关分析对数据进行分析。结果CMVD组静息LV-MBF高于非CMVD组（（0.74±0.16）vs（0.63±0.09）ml·g-1·min-1），应激LV-MBF低于对照组（1.52±0.36）vs；左前降支（LAD）、左旋支（LCX）和右冠状动脉（RCA）的CFR呈正相关（r值：0.798-0.836，均P<0.01），为无明显心外膜冠状动脉狭窄和疑似CMVD的患者提供了无创、客观的诊断和评价信息。关键词：冠状动脉疾病；微血管性心绞痛；血流储备分数，心肌；心肌灌注成像；正电子发射断层扫描；层析成像，X射线计算机；氨

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

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期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.