摘要
目的通过与心脏MRI比较, 探讨^(18)F-成纤维细胞激活蛋白抑制剂(FAPI)PET/CT显像识别肥厚型心肌病(HCM)患者受累心肌的能力。方法前瞻性纳入2021年7月至2022年1月期间在北京朝阳医院经超声或心脏MRI证实为HCM的患者50例[男32例、女18例, 年龄(43±13)岁], 所有患者行心脏^(18)F-FAPI PET/CT和MRI。通过后处理软件获得左心室心肌SUV_(max)和最大靶/本底比值(TBR_(max));将心肌摄取^(18)F-FAPI程度不低于阈值(SUV_(max)的40%、50%、60%)的区域定义为阳性摄取心肌, FAPI总量为TBR_(max)与FAPI阳性摄取范围(FAPI%)的乘积。通过心脏MRI后处理软件获得左心室心肌钆对比剂延迟强化(LGE)范围(LGE%)、初始T_(1)值、细胞外容积分数(ECV)及心肌形变特征。采用Spearman秩相关评估^(18)F-FAPI显像参数和心脏MRI参数之间的相关性及FAPI总量与5年心脏性猝死(SCD)风险评分的相关性;采用线性回归分析确定影响FAPI总量的因素。结果左心室心肌^(18)F-FAPI阳性摄取的阈值为60%时, FAPI总量及FAPI%与MRI组织学参数相关性最佳(r_(s)值:-0.465~0.460, 均P<0.05)。多因素线性回归分析示, HCM病程[β=0.128(95%CI:0.022~0.233), P=0.008]、血清N末端B型利钠肽原(NT-proBNP)水平[β=0.190(95%CI:0.099~0.280), P<0.001]、左心室射血分数[β=-0.005(95%CI:-0.011~0.000), P=0.041]是FAPI60总量的独立影响因素。阈值分别为40%、50%、60%时, 对应的FAPI总量与5年SCD风险评分均相关(r_(s)值:0.32、0.29、0.29, P值:0.026、0.039、0.040)。结论当^(18)F-FAPI阳性摄取的阈值为60%时, ^(18)F-FAPI PET/CT显像能够更有效地识别出HCM患者的受累心肌。FAPI总量与HCM患者5年SCD风险评分相关。
Objective:To investigate the ability of ^(18)F-fibroblast activation protein inhibitor(FAPI)PET/CT imaging to identify involved myocardium in patients with hypertrophic cardiomyopathy(HCM)compared with cardiac MRI.Methods:A prospective study was conducted on 50 patients(32 males,18 females,age(43±13)years)with HCM confirmed by ultrasound or cardiac MRI in Beijing Chaoyang Hospital from July 2021 to January 2022.All patients underwent both cardiac ^(18)F-FAPI PET/CT and MRI.The SUV_(max) and maximum target-to-background ratio(TBR_(max))of the left ventricular myocardium were obtained using post-processing software.Regions with ^(18)F-FAPI uptake not less than predefined thresholds(SUV_(max) 40%,50%,60%)were defined as myocardium with positive uptake.The FAPI amount was defined as the product of TBR_(max) and the extent of FAPI-positive uptake(FAPI%).Cardiac MRI post-processing software was used to measure the extent of left ventricular myocardial late gadolinium enhancement(LGE)(expressed as LGE%),native T 1 value,extracellular volume fraction(ECV),and myocardial deformation characteristics.Spearman rank correlation analysis was employed to assess the correlation between ^(18)F-FAPI imaging parameters and cardiac MRI parameters,as well as the correlation between FAPI amount and the 5-year risk score for sudden cardiac death(SCD).Linear regression analysis was utilized to identify factors associated with FAPI amount.Results:When the threshold for ^(18)F-FAPI-positive uptake in the left ventricular myocardium was set at 60%,the correlations between FAPI amount,FAPI%,and MRI parameters were optimal(r_(s) values:from-0.465 to 0.460,all P<0.05).Multivariate linear regression analysis revealed that HCM duration(β=0.128,95%CI:0.022-0.233,P=0.008),serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(β=0.190,95%CI:0.099-0.280,P<0.001),and left ventricular ejection fraction(β=-0.005,95%CI:-0.011 to 0.000,P=0.041)were independent predictors of FAPI amount.FAPI amount was positively correlated with the 5-year SCD risk score across different thresholds(40%:rs=0.32,P=0.026;50%:rs=0.29,P=0.039;60%:rs=0.29,P=0.040).Conclusions:When the threshold for ^(18)F-FAPI-positive uptake is set at 60%,^(18)F-FAPI PET/CT imaging can more effectively identify the involved myocardium in HCM.FAPI amount is correlated with the 5-year SCD risk score in patients with HCM.
作者
王丽
王怡璐
张雨
苏瑶
董志祥
杨敏福
Wang Li;Wang Yilu;Zhang Yu;Su Yao;Dong Zhixiang;Yang Minfu(Department of Nuclear Medicine,Bejing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Cardiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Magnetic Resonance Imaging,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中华核医学与分子影像杂志》
北大核心
2025年第9期519-524,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
国家重点研发计划(2021YFF0501400, 2021YFF0501402)。
