临床医学临床心血管分子显像

临床医学临床心血管分子显像第1页/共43页心血管病国家重点实验室：研究方向心血管疾病的早期预警、诊断和治疗研究分子影像危重心血管疾病创新技术——细胞治疗与生物医学工程研究心血管疾病预测、评估和人群防控第2页/共43页GatedSPECT第3页/共43页PET

Myocardial

Perfusion

Imaging第4页/共43页CardiacPerfusionandViabilityStudybyPET/CT75yearoldmaleScanprotocol:lowdoseCTforattenuationcorrection PET740MBqNH3,10minutescan,370MBqFDG,10minutescanDataCourtesyofUniversityofMichigan第5页/共43页第6页/共43页PET/CTallowsaccuratenoninvasiveclinicaldecisionmakingaboutCAD.Becauseofitshighnegativepredictivevalue,PET/CTmayplayanimportantroleinnoninvasiveselectionofCADpatientsforrevascularization.IntegrationofhigherperformancemultislicespiralCTscannersintoPET/CThybridswillacceleratetheclinicalimplementationofthePETtechnique.PET/CTforthediagnosisofCAD第7页/共43页PET/CTinCADNamdarM,etal.JNM2005第8页/共43页DirectImagingofExercise-InducedMyocardialIschemia

WithFluorine-18–LabeledDeoxyglucoseand

Tc-99m-SestamibiinCoronaryArteryDiseaseHeZX,etal.Circulation2003第9页/共43页IschemiaIschemiaandScarScarNoabnormality16(31%)6(12%)*3(6%)26(51%)34(67%)0*017(33%)p<0.001ComparisonofabnormalitiesinPtswith≥50%narrowingof≥1coronaryvessels(n=51)99mTc-Sestamibi18FDGHeZX,Circulation.2003;108:1208-1213第10页/共43页AbbottBG,etal.NuclMedCommun2007;28:89–94FDGasamemorymarkeroftransientmyocardialischaemia第11页/共43页71-y-oldman(patient7)withexertionalangina,90%stenosisofLADand80%stenosisofLCxandRCADouKF,YangMF,etal.JNuclMed2008;49:1986–1991第12页/共43页Tl-201SPECT

andFDGPET

inHCMIsobeS,etal.JNuclMed2003;44:1717–1724第13页/共43页YamanoM,Heart2009;95:1051第14页/共43页StressRestPersistentchestpain;elevatedtroponinlevels;heartrate112bpm,bloodpressure100/50mmHg;LVEF30%,biopsynegativeforhumoralrejectionQuantitativeMBF:Rest0.58ml/min/g;Stress0.86ml/min/g;MBFReserve=1.4616yearoldfemale,2yearsafterhearttransplantMicrovascularDiseaseCourtesyofHenrichSchelbert第15页/共43页HeartFailureandCADCADisnowconsideredthepredominantetiologyofheartfailure70%ofpatientsinrecentCHFtrialshadanischemiccardiomyopathyGeorghiade,Circ.1998YusufSetal,Lancet1994第16页/共43页MyocardialViabilityClinical–anginaPETMRIThalliumDobutamineEchoLe

GuludecD,EurJNuclMedMolImaging(2008)35:1709–1724第17页/共43页VerticalLongAxisSlicesMBFFDGMatchMBFFDGMBFMismatchMBFFDGShortAxisSlicesMismatchHorizontalLongAxisSlicesMBFFDGCourtesyofHenrichSchelbert第18页/共43页0.00.81.001224364860Time(months)MedicalCABGp=0.007SurvivalProbabilityWithPETMismatchWithoutPETMismatch0.00.81.001224364860MedicalCABGNSTime(months)SurvivalbyViabilityandTreatmentDiCarlietal,JThorCardiovascSurg1998;116:99793PatientswithIschemicCardiomyopathyandseverelydepressedleftventricularfunction第19页/共43页7778810131417232116141313101020SurvivalinPatientswithPET“Mismatch”FromDiCarlietal.AmJCardiol1994;73:527.048121620242830.81.0RevascularizationMedicalTherapyLowRank2=4.60p=0.03MonthsofFollow-UpCumulativeSurvival第20页/共43页PETImagingPatternsandMortality

inPatientswithCADandLVDysfunctionViableNonviable#MedicalRevasc.MedicalRevasc.Eitzman836/181/262/240/14DiCarli937/173/263/331/17Lee13710/214/492/402/19Total31323/568/1017/973/50Mortality41%8%7%6%第21页/共43页FDGIMAGINGINLVANEURYSMSZhangXetalJNuclMed2008;49:1288–129870ptswithLVaneurysm6.8yrsFUSurgeryforviabilityimprovedEFandsurvival(p.0001)Medicaltherapywithviabilityhadworstoutcome(p.0001)第22页/共43页MyocardialViabilityandImpactofRevascularisationinPatientswithCADDiseaseandLVDysfunction:AMeta-AnalysisAllmanKC,ShawLJ,HachamovitchR,UdelsonJ,JACC,2002-58.4%ViableNon-viableViableNon-viableREVASCULARISEDMEDICALTHERAPYp<0.0001p<0.001158%Numberofstudies=24N=3,088EF=32%±8%FU25±10MthsDeathRate(%/Yr)第23页/共43页SPECTvs.PET

forEvaluationofMyocardialViabilitySensitivity,%Specificity,%SegmentanalysisPET75-9567-84SPECT75-9331-56PatientanalysisPET8288SPECT65-10055-73第24页/共43页Tarakji,K.G.etal.Circulation2006;113:230-237Associationbetweenpredicted3-yearmortalityandtheamountofcompromisedviablemyocardiumdeterminedbyPET/FDGstudyaccordingtoperformanceofearlyinterventionamongpropensity-matchedpatients第25页/共43页Tarakji,K.G.etal.Circulation2006;113:230-237Propensity-matchedpatientsundergoingPETviabilitytesting(306/765)attheClevelandClinic第26页/共43页AdjustedsurvivalcurvesforPETandstandardarmsinOttawa-FIVEandrestofPARR2Abraham1A,JNuclMed2010;51:567–574第27页/共43页ACC/AHAGuidelinesfor

PercutaneousCoronaryIntervention

(Revisionofthe1993PTCAGuidelines)RecommendationsforPCIinAsymptomaticorClassIAnginaPatients:ClassIPatientswhodonothavetreateddiabeteswithasymptomaticischemiaormildanginawith1ormoresignificantlesionsin1or2coronaryarteriessuitableforPCIwithahighlikelihoodofsuccessandalowriskofmorbidityandmortality.Thevesselstobedilatedmustsubtendalargeareaofviablemyocardium.Smithetal.JACCVol.37,No.8,2001第28页/共43页ClassIindicationFollowinganinconclusiveSPECTscanFordeterminationofmyocardialviabilityasaprimaryorinitialdiagnosticstudypriortorevascularization.*FromAHA/ACCTaskForce,Circulation2002ACC/AHARecommendationforMyocardialViabilityUsingFDGPET第29页/共43页RecommendationsfordetectionofmyocardialviabilityinheartfailureIssueBodyClassEvidencelevelMyocardialperfusionimagingACC/AHAESCstudygroupIIaBHuntSA,etal.Circulation2005;112:e154–e235.UnderwoodSR,etal.EurHeartJ2004;25:815–836.第30页/共43页ContrastMRIvs.FDGSPECTLiuQ,etal.NuclMedComm2009第31页/共43页Thygesen,K.etal.Circulation2007;116:2634-2653第32页/共43页CriteriaforAcuteMI第33页/共43页CriteriaforPriorMI第34页/共43页AssessmentofMyocardialViabilityafterStemCellTherapyPETusingFDGforevaluatingglucoseutilizationSPECTwithFDGorTc-99m–labeledagentsLow-dosedobutamineechoforassessingcontractilereserve第35页/共43页InfluenceofintracoronarystemcelltherapyonLVEF,infarctarea,andFDGmetabolisminPETstudyBeforeTxAfterTxDifferencePValueLVEF,%529607+15%0.0001Infarctarea,%278199-30%0.0001FDG-PET,%43.88.050.511.6+15%0.012ModifiedfromStraueretal.JACCVol.46,No.9,2005第36页/共43页F-18-FDGandN-13-ammoniaPETJesu′sHerrerosa,etal.EuropeanHeartJournal(2003)24,2012–2020第37页/共43页RegenerationofHumanInfarctedHeart

MusclebyIntracoronaryAutologousBoneMarrow

CellTransplantationinChronicCAD:TheIACTStudyStraueretal.JACCVol.46,No.9,2005第38页/共43页TechniquesforinvivoimagingoflabelledtransplantedcellsMethodAgentAdvantagesDisadvantagesMRISPIOHighres