ceCMR与PET评价冠状动脉慢性完全闭塞病变患者心肌活性的对比研究

摘要

Objective To compare positron emission tomography (PET) and contrast-enhanced cardiac magnetic resonance (ceCMR) in evaluating myocardial viability in patients with chronic total occlusion (CTO) of coronary artery. Methods CTO patients (n=77) were given simultaneously ceCMR and PET examinations within 1 week. The imagines of ceCMR were analyzed by using 17-segmental method, and transmural extent of late gadolinium enhancement (LGE) of ceCMR was scored and the results were showed as follows: 1 (0%), 2 (1%-25%), 3 (26%-50%), 4 (51%-75%) and 5 (76%-100%). The wall motion was scored and the results were showed as follows: 1 (normal), 2 (hypokinetic), 3 (akinetic) and 4 (dyskinetic). The myocardial viability was classified through blood perfusion and FDG uptake of PET. The myocardium having normal blood perfusion or increased FDG uptake (normal) and myocardium having decreased blood perfusion or normal or increased FDG uptake (mismatch) could be regarded as viable myocardium, and myocardium having decreased blood perfusion and decreased FDG uptake (match) could be regarded as nonviable myocardium.Results There was a significantly negative correlation between myocardial activity decided by PET and LGE of ceCMR (r=-0.657,P<0.001). With PET as gold standard, the sensitivity of ceCMR in detecting myocardial viability was 95.8%, specificity was 89.7%, positive predictive value was 98.1%, negative predictive value was 79.5%, and accuracy was 94.8%. The performance of ceCMR in detecting myocardial viability was analyzed by using receiver operator characteristic curve (ROC), and the results showed that area under curve (AUC) of ROC was 0.957. With LGE=50% as cut-off value, the sensitivity and specificity of ceCMR in differentiating viable myocardium and nonviable myocardium decided by PET were the highest. The consistency and correlation of ceCMR and PET were analyzed and the results showed that Kappa value was 0.795 (r=0.837,P<0.001)Conclusion With PET as gold standard, ceCMR has high consistency, sensitivity and specificity in detecting myocardial viability compared with PET in CTO patients. Thus, ceCMR can be used as an important method for detecting myocardial viability in CTO patients.%目的 比较正电子发射断层显像(PET)与延迟强化心脏磁共振成像(ceCMR)评价冠状动脉慢性完全闭塞病变(CTO)患者的心肌活性.方法 77例CTO患者在1周内同时行CMR与PET检查.通过17节段法对CMR图像进行分析,对延迟强化透壁程度进行评分:1分(0%),2分(1%~25%),3分(26%~50%),4分(51%~75%),5分(76%~100%),对室壁运动进行评分1分(运动正常),2分(运动减弱),3分(无运动),4分(反向运动).PET检查通过血流灌注与FDG摄取对心肌活性进行分类,心肌具有正常的血流灌注和正常或增加的FDG摄取(正常),以及心肌具有降低的血流灌注和正常或增加的FDG摄取(不匹配)可认为具有存活心肌;心肌具有降低的血流灌注和降低的FDG摄取(匹配)可认为无存活心肌.结果 PET所决定的心肌活性与CMR延迟强化透壁程度(LGE)呈显著地负相关性(r=-0.657,P<0.001).以PET为金标准,ceCMR检测心肌活性的敏感性为95.8%,特异性为89.7%,阳性预测值为98.1%,阴性预测值为79.5%,准确性为94.8%.运用ROC曲线分析ceCMR检测心肌活性的性能,ROC曲线下面积为0.957,LGE为50%临界值时,ceCMR区分以PET界定的存活心肌与非存活心肌的敏感性与特异性最高.对ceCMR和PET运动一致性及相关性进行分析,Kappa值为0.795,r=0.837(P<0.001).结论 以PET检查为金标准,ceCMR检测CTO患者的心肌活性与PET检查相比具有较高的一致性,敏感性和特异性.因此,ceCMR可以在CTO患者中作为一种重要的检测心肌活性的方法.