臨床醫(yī)學(xué)臨床心血管分子顯像

1、臨床醫(yī)學(xué)臨床心血管分子顯像國(guó)家心血管病中心心血管病國(guó)家重點(diǎn)實(shí)驗(yàn)室：研究方向心血管疾病的早期預(yù)警、診斷和治療研究分子影像危重心血管疾病創(chuàng)新技術(shù)細(xì)胞治療與生物醫(yī)學(xué)工程研究心血管疾病預(yù)測(cè)、評(píng)估和人群防控Gated SPECTPET Myocardial Perfusion ImagingCardiac Perfusion and Viability Study by PET/CT75 year old maleScan protocol: low dose CT for attenuation correction PET 740 MBq NH3, 10 minute scan, 370 MBq F

2、DG, 10 minute scanData Courtesy of University of MichiganPET/CT allows accurate noninvasive clinical decision making about CAD. Because of its high negative predictive value, PET/CT may play an important role in noninvasive selection of CAD patients for revascularization. Integration of higher perfo

3、rmance multislice spiral CT scanners into PET/CT hybrids will accelerate the clinical implementation of the PET technique.PET/CT for the diagnosis of CADPET/CT in CADNamdar M, et al. JNM 2005Direct Imaging of Exercise-Induced Myocardial IschemiaWith Fluorine-18Labeled Deoxyglucose andTc-99m-Sestamib

4、i in Coronary Artery DiseaseHe ZX, et al. Circulation 2003IschemiaIschemiaand ScarScarNo abnormality16 (31%)6 (12%)*3 (6%)26 (51%)34 (67%)0*017 (33%)p0.001Comparison of abnormalities in Pts with 50% narrowing of 1 coronary vessels (n=51)99mTc-Sestamibi18FDGHe ZX, Circulation. 2003;108:1208-1213Abbot

5、t BG, et al. Nucl Med Commun 2007;28:8994FDG as a memory marker of transient myocardial ischaemia71-y-old man (patient 7) with exertional angina, 90% stenosis of LAD and 80% stenosis of LCx and RCADou KF, Yang MF, et al. J Nucl Med 2008 ; 49:19861991Tl-201 SPECT and FDG PET in HCMIsobe S, et al. J N

6、ucl Med 2003; 44:17171724Yamano M, Heart 2009;95:1051StressRestPersistent chest pain; elevated troponin levels; heart rate 112 bpm, blood pressure 100/50 mmHg; LVEF 30%, biopsy negative for humoral rejectionQuantitative MBF: Rest 0.58 ml/min/g; Stress 0.86 ml/min/g; MBF Reserve = 1.4616 year old fem

7、ale, 2 years after heart transplantMicrovascular DiseaseCourtesy of Henrich SchelbertHeart Failure and CADCAD is now considered the predominant etiology of heart failure70% of patients in recent CHF trials had an ischemic cardiomyopathyGeorghiade, Circ. 1998Yusuf S et al, Lancet 1994Myocardial Viabi

8、lityClinical anginaPETMRIThalliumDobutamine EchoLe Guludec D, Eur J Nucl Med Mol Imaging (2008) 35:17091724Vertical Long Axis SlicesMBFFDGMatchMBFFDGMBFMismatchMBFFDGShort Axis SlicesMismatchHorizontal Long Axis SlicesMBFFDGCourtesy of Henrich Schelbert0.00.20.40.60.81.001224364860Time (months)Medic

9、alCABGp = 0.007Survival ProbabilityWith PET MismatchWithout PET Mismatch0.00.20.40.60.81.001224364860MedicalCABGNSTime (months)Survival by Viability and TreatmentDi Carli et al, J Thor Cardiovasc Surg 1998; 116: 99793 Patients with Ischemic Cardiomyopathy and severely depressed left ventricular func

10、tion 7778810131417232116141313101020Survival in Patients with PET “Mismatch”From Di Carli et al. Am J Cardiol 1994;73:527.04812162024283200.20.40.60.81.0RevascularizationMedical TherapyLow Rank2=4.60p=0.03Months of Follow-UpCumulative SurvivalPET Imaging Patterns and Mortalityin Patients with CAD an

11、d LV DysfunctionViableNonviable#MedicalRevasc.MedicalRevasc.Eitzman836/181/262/240/14Di Carli937/173/263/331/17Lee13710/214/492/402/19Total31323/568/1017/973/50Mortality41%8%7%6%FDG IMAGING IN LV ANEURYSMSZhang X et al J Nucl Med 2008; 49:1288129870 pts with LV aneurysm6.8 yrs FUSurgery for viabilit

12、y improved EF and survival (p .0001)Medical therapy with viability had worst outcome (p .0001)Myocardial Viability and Impact of Revascularisation in Patients with CAD Disease and LV Dysfunction: A Meta-AnalysisAllman KC, Shaw LJ, Hachamovitch R, Udelson J, JACC, 2002-58.4%ViableNon-viableViableNon-

13、viableREVASCULARISEDMEDICAL THERAPYp0.0001p0.001158%Number of studies = 24N = 3,088EF = 32% 8%FU 25 10 MthsDeath Rate (%/Yr)SPECT vs. PET for Evaluation of Myocardial Viability Sensitivity, % Specificity, % Segment analysis PET75-9567-84SPECT75-9331-56Patient analysis PET8288SPECT65-10055-73Tarakji,

14、 K. G. et al. Circulation 2006;113:230-237Association between predicted 3-year mortality and the amount of compromised viable myocardium determined by PET/FDG study according to performance of early intervention among propensity-matched patientsTarakji, K. G. et al. Circulation 2006;113:230-237Prope

15、nsity-matched patients undergoing PET viability testing (306/765)at the Cleveland ClinicAdjusted survival curves for PET and standard arms in Ottawa-FIVE and rest of PARR 2Abraham1 A, J Nucl Med 2010; 51:567574ACC/AHA Guidelines forPercutaneous Coronary Intervention(Revision of the 1993 PTCA Guideli

16、nes)Recommendations for PCI in Asymptomatic or Class I Angina Patients: Class IPatients who do not have treated diabetes with asymptomatic ischemia or mild angina with 1 or more significant lesions in 1 or 2 coronary arteries suitable for PCI with a high likelihood of success and a low risk of morbi

17、dity and mortality. The vessels to be dilated must subtend a large area of viable myocardium.Smith et al. JACC Vol. 37, No. 8, 2001Class I indicationFollowing an inconclusive SPECT scanFor determination of myocardial viability as a primary or initial diagnostic study prior to revascularization.*From

18、 AHA/ACC Task Force, Circulation 2002ACC/AHA Recommendation for Myocardial Viability Using FDG PETRecommendations for detection of myocardial viability in heart failureIssue BodyClassEvidence levelMyocardial perfusion imagingACC/AHA ESC study groupIIaBHunt SA, et al. Circulation 2005;112:e154e235.Un

19、derwood SR, et al. Eur Heart J 2004;25:815836.Contrast MRI vs. FDG SPECTLiu Q, et al. Nucl Med Comm 2009Thygesen, K. et al. Circulation 2007;116:2634-2653Criteria for Acute MICriteria for Prior MIAssessment of Myocardial Viability after Stem Cell TherapyPET using FDG for evaluating glucose utilizati

20、onSPECT with FDG or Tc-99mlabeled agents Low-dose dobutamine echo for assessing contractile reserveInfluence of intracoronary stem cell therapy on LVEF, infarct area, and FDG metabolism in PET studyBefore TxAfter TxDifferenceP ValueLVEF, %529607+15%0.0001Infarct area, %278199-30%0.0001FDG-PET, %43.8

21、8.050.511.6+15%0.012Modified from Strauer et al. JACC Vol. 46, No. 9, 2005F-18-FDG and N-13-ammonia PET Jesus Herrerosa, et al. European Heart Journal (2003) 24, 20122020Regeneration of Human Infarcted HeartMuscle by Intracoronary Autologous Bone MarrowCell Transplantation in Chronic CAD: The IACT StudyStrauer et al. JACC Vol. 46, No. 9, 2005Techniques for in vivo imaging of labelled transpl