肥厚型心肌病18F-FAPI PET/CT显像的初步探索:与心脏磁共振比较

doi:10.3969/j.issn.1006-7795.2022.06.005

首都医科大学学报 ›› 2022, Vol. 43 ›› Issue (6): 845-853.doi: 10.3969/j.issn.1006-7795.2022.06.005

• 核医学与分子影像辅助临床诊疗 • 上一篇下一篇

肥厚型心肌病¹⁸F-FAPI PET/CT显像的初步探索:与心脏磁共振比较

张雨¹, 董志翔², 李常城³, 王丽¹, 杨敏福^1*

1.首都医科大学附属北京朝阳医院核医学科,北京 100020;
2.中国医学科学院阜外医院磁共振影像科国家心血管病中心北京协和医学院, 北京 100037;
3.泰安市中心医院医学影像科,山东泰安 271099

收稿日期:2022-09-30 出版日期:2022-12-21 发布日期:2022-11-30
基金资助:
国家重点研发计划(2021YFF0501400)。

Preliminary study of ¹⁸F-FAPI PET/CT in hypertrophic cardiomyopathy: comparison with cardiac magnetic resonance imaging

Zhang Yu¹, Dong Zhixiang², Li Changcheng³, Wang Li¹, Yang Minfu^1*

1. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. 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;
3. Department of Radiology,Taian City Central Hospital, Taian 271099, Shandong Province, China

Received:2022-09-30 Online:2022-12-21 Published:2022-11-30
Contact: ^*E-mail:minfuyang@126.com

摘要/Abstract

摘要： 目的探讨肥厚型心肌病(hypertrophic cardiomyopathy, HCM)患者¹⁸F标记的成纤维细胞活化蛋白抑制剂(fibroblast activation protein inhibitor, FAPI)正电子发射型计算机断层扫描显像/电子计算机断层显像(positron emission tomography/computed tomography, PET/CT)显像特点,并与心脏磁共振(cardiac magnetic resonance, CMR)延迟强化(late gadolinium enhancement, LGE)技术比较,探讨两种检查方法的关系。方法前瞻性纳入经超声或CMR证实为HCM的患者22例,所有患者均行¹⁸F-FAPI PET/CT和CMR,并于CMR检查时抽取静脉血行实验室检查。正常对照组纳入22名与HCM组年龄、性别相符的健康志愿者,仅行¹⁸F-FAPI PET/CT。通过后处理软件获得HCM患者左心室心肌的最大标准摄取值(maximum standardized uptake value, SUV_max)和最大靶本底比值(maximum target-to-background ratio, TBR_max)。将¹⁸F-FAPI摄于大于SUV_max值40%的心肌定义为摄取心肌,并通过CMR获得的左心室心肌体积计算摄取百分比,即FAPI%。CMR检查使用3.0 T磁共振扫描仪,通过后处理软件获得HCM患者的左心室室壁最大厚度和左心室心肌LGE百分比(LGE%)。使用独立样本t检验或Mann–Whitney U检验比较HCM患者和健康志愿者心肌¹⁸F-FAPI摄取的差异,使用Pearson或Spearman相关性检验来比较¹⁸F-FAPI PET/CT参数和CMR参数的相关性及与实验室检查的相关性。结果 HCM患者的左心室心肌¹⁸F-FAPI摄取明显高于健康志愿者(TBR_max中位数:8.96 vs 1.19, P<0.001)。HCM患者左心室心肌¹⁸F-FAPI摄取的范围大于LGE的范围(FAPI% vs LGE%,中位数:73.77 vs 6.69, P<0.001)。¹⁸F-FAPI摄取的范围和CMR测量的LGE范围、左室射血分数(left ventricular ejection fraction, LVEF)呈中等相关(FAPI%, LGE% and LVEF, r = 0.67,-0.49, P<0.05)。同时,¹⁸F-FAPI摄取的范围和血清N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide, NT-proBNP)和肌酸激酶同工酶(creatine kinase-MB, CK-MB)的水平呈中等相关(FAPI%, NT-proBNP and CK-MB, r = 0.58,0.54, P<0.05)。CMR的参数和实验室检查无相关性。结论 ¹⁸F-FAPI与CMR参数中等相关,¹⁸F-FAPI PET/CT可以识别出更多的受累心肌。

关键词: 成纤维细胞活化蛋白抑制剂, 心脏磁共振, 肥厚型心肌病

Abstract: Objective To explore the characteristics of ¹⁸F-labeled fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) in the patients with hypertrophic cardiomyopathy (HCM), as well as the correlation between ¹⁸F-FAPI activity and cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) technique. Methods Twenty-two HCM patients were prospectively recruited in this study with ¹⁸F-FAPI PET/CT examination, CMR examination and blood tests. A control group of twenty-two healthy participants with the same age and sex as the HCM group was also recruited and only underwent ¹⁸F-FAPI PET/CT examination. The maximum standardized uptake value (SUV_max) and maximum target-to-background ratio (TBR_max) of left ventricular (LV) myocardium were then obtained by post-processing software. The region grow algorithm with a threshold of 40% of the SUV_max was set to determine the ¹⁸F-FAPI volume. The ¹⁸F-FAPI volume was further expressed as a percentage of LV volume derived from CMR, which was defined as the ¹⁸F-FAPI extent (FAPI%). CMR examination was performed on a 3.0 Tesla scanner. The maximum thickness and LGE extent (LGE%) of LV myocardium were then obtained by post-processing software. The independent-sample t test or Mann Whitney U test was used to evaluate the differences of ¹⁸F-FAPI uptake between the patients with HCM and healthy participants. The correlation of ¹⁸F-FAPI activity and CMR parameters were assessed by Pearson/Spearman's correlation test. Results The myocardial ¹⁸F-FAPI uptake of LV in patients with HCM was significantly higher than that in the healthy participants (TBR_max, median: 8.96 vs 1.19, P<0.001). In patients with HCM, the ¹⁸F-FAPI extent was larger than LGE extent (FAPI% vs LGE%, median: 73.77 vs 6.69, P<0.001), and moderate correlation was observed between ¹⁸F-FAPI extent, LGE extent and LVEF (FAPI, LGE% and LVEF, r = 0.67,-0.49, P<0.05).Moreover, moderate correlation was observed between ¹⁸F-FAPI extent with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatine kinase-MB (CK-MB) (FAPI% , NT-proBNP and CK-MB, r = 0.58,0.54, P<0.05). No correlation was observed between CMR parameters and blood tests. Conclusion The measurement of ¹⁸F-FAPI was moderately correlated with the CMR, and ¹⁸F-FAPI PET/CT could detect a wider range of myocardium than CMR.

Key words: fibroblast activation protein inhibitor, cardiac magnetic resonance, hypertrophic cardiomyopathy

中图分类号:

张雨, 董志翔, 李常城, 王丽, 杨敏福. 肥厚型心肌病¹⁸F-FAPI PET/CT显像的初步探索:与心脏磁共振比较[J]. 首都医科大学学报, 2022, 43(6): 845-853.

Zhang Yu, Dong Zhixiang, Li Changcheng, Wang Li, Yang Minfu. Preliminary study of ¹⁸F-FAPI PET/CT in hypertrophic cardiomyopathy: comparison with cardiac magnetic resonance imaging[J]. Journal of Capital Medical University, 2022, 43(6): 845-853.

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肥厚型心肌病¹⁸F-FAPI PET/CT显像的初步探索:与心脏磁共振比较

Preliminary study of ¹⁸F-FAPI PET/CT in hypertrophic cardiomyopathy: comparison with cardiac magnetic resonance imaging

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