CAJ | 학술논문

目的通过99Tcm-MIBI心肌灌注SPECT/18F-FDG心肌代谢PET显像和心脏MRI延迟增强成像(cMRI-LGE),探讨特发性扩张型心肌病(IDC)合并甲状腺功能减退(简称甲减)与心肌损伤的关系.方法 2010年10月至2012年12月诊断为IDC的连续病例63例[男42例,女21例,平均年龄(52±11)岁]入选,患者均进行血浆TT3、TT4、FT3、FT4和TSH全自动化学发光免疫法测定、99Tcm-MIBI心肌灌注SPECT/18F-FDG心肌代谢PET显像和cMRI-LGE.利用标准17节段模型进行心肌节段分析,灌注/代谢图像分成4种类型:正常灌注/代谢、灌注/代谢不匹配、灌注/代谢轻中度匹配、灌注/代谢完全匹配;cMRI-LGE图像分为无延迟强化、壁间强化和透壁强化.通过x2检验进行分组数据的比较.结果根据所测血浆激素水平,患者被分成甲状腺功能(简称甲功)正常组(53例)和甲减组(10例).甲功正常组正常灌注/代谢的心肌节段数所占的比例明显高于甲减组:71.8％(647/901)和57.6％ (98/170),x2=13.50,P＜0.001;而灌注/代谢不匹配的心肌节段比例则低于甲减组:17.8％(160/901)和31.2％ (53/170),x2=16.20,P＜0.001.甲功正常组cMRI-LGE无延迟强化的心肌节段比例明显高于甲减组,分别为88.0％ (793/901)和69.4％ (118/170),x2=35.70,P＜0.001;但壁间强化的心肌节段比例则低于甲减组,分别为4.8％(43/901)和24.1％(41/170),x2=74.70,P＜0.001.结论 99Tcm-MIBI心肌灌注SPECT/18F-FDG心肌代谢PET显像和cMRI-LGE证实甲减能够加重IDC患者的心肌损伤.SPECT/PET可以检测出更多的慢性缺血/存活心肌,而cMRI-LGE可以检测出更多的心肌纤维化病变,两者结合能提供更全面的心肌损伤信息.
목적 통과99Tcm-MIBI심기관주SPECT/18F-FDG심기대사PET현상화심장MRI연지증강성상(cMRI-LGE),탐토특발성확장형심기병(IDC)합병갑상선공능감퇴(간칭갑감)여심기손상적관계.방법 2010년10월지2012년12월진단위IDC적련속병례63례[남42례,녀21례,평균년령(52±11)세]입선,환자균진행혈장TT3、TT4、FT3、FT4화TSH전자동화학발광면역법측정、99Tcm-MIBI심기관주SPECT/18F-FDG심기대사PET현상화cMRI-LGE.이용표준17절단모형진행심기절단분석,관주/대사도상분성4충류형:정상관주/대사、관주/대사불필배、관주/대사경중도필배、관주/대사완전필배;cMRI-LGE도상분위무연지강화、벽간강화화투벽강화.통과x2검험진행분조수거적비교.결과 근거소측혈장격소수평,환자피분성갑상선공능(간칭갑공)정상조(53례)화갑감조(10례).갑공정상조정상관주/대사적심기절단수소점적비례명현고우갑감조:71.8％(647/901)화57.6％ (98/170),x2=13.50,P＜0.001;이관주/대사불필배적심기절단비례칙저우갑감조:17.8％(160/901)화31.2％ (53/170),x2=16.20,P＜0.001.갑공정상조cMRI-LGE무연지강화적심기절단비례명현고우갑감조,분별위88.0％ (793/901)화69.4％ (118/170),x2=35.70,P＜0.001;단벽간강화적심기절단비례칙저우갑감조,분별위4.8％(43/901)화24.1％(41/170),x2=74.70,P＜0.001.결론 99Tcm-MIBI심기관주SPECT/18F-FDG심기대사PET현상화cMRI-LGE증실갑감능구가중IDC환자적심기손상.SPECT/PET가이검측출경다적만성결혈/존활심기,이cMRI-LGE가이검측출경다적심기섬유화병변,량자결합능제공경전면적심기손상신식.
Objective To explore the relationship between hypothyroidism and myocardial injury in patients with idiopathic dilated cardiomyopathy (IDC) by 99Tcm-MIBI SPECT/18 F-FDG PET and late-gadolinium enhancement cardiac magnetic resonance imaging (cMRI-LGE).Methods Sixty-three consecutive patients (42 males and 21 females,(52±11) years) with IDC were enrolled from October 2010 to December 2012.Serum TT3,TT4,FT3,FT4 and TSH were determined using a fully automated chemiluminescence immunoassay.All patients underwent 99Tcm-MIBI myocardial perfusion SPECT/18F-FDG myocardial metabolism PET imaging and cMRI-LGE.Seventeen segments model was used for segmental analysis.Patterns of perfusion/metabolism were classified as normal,mismatch,mild-to-moderate match and complete match.cMRI-LGE was classified into 3 categories (non-LGE,mid-wall LGE and transmural LGE).x2 test was used for data analysis.Results All patients were divided into euthyroid group (n =53) and hypothyroidism group (n =10) according to the levels of serum thyroid hormones.The percentage of normal perfusion/metabolism segments in the euthyroid group was apparently higher than that in the hypothyroidism group:71.8％ (647/901) vs 57.6％ (98/170),x2 =13.50,P＜0.001 ; whereas the percentage of perfusion/metabolism mismatch segments in the euthyroid group was significantly lower than that in the hypothyroidism group:17.8％ (160/901) vs 31.2％ (53/170),x2=16.20,P＜0.001.The euthyroid group had a higher percentage of non-LGE segments (88.0％ (793/901) vs 69.4％ (118/170),x2 =35.70,P＜0.001) and a lower percentage of mid-wall LGE segments (4.8 ％ (43/901) vs 24.1％ (41 / 170),x2 =74.70,P＜ 0.001) compared to hypothyroidism group.Conclusions Hypothyroidism has a detrimental effect on myocardium.99Tcm-MIBI SPECT/18F-FDG PET imaging is sensitive in detecting viable/ischemia myocardium,and cMRI-LGE is good at detecting moderate fibrosis.Combining SPECT/PET imaging and cMRI-LGE for assessing myocardial injury would provide more comprehensive information.