前期调糖对冠心病患者18F-FDG PET心肌代谢显像图像质量的影响

 目的 探讨前期调糖对冠心病(coronary heart disease,CHD)患者¹⁸F-FDG PET心肌代谢显像图像质量的影响。方法 选择131例年龄33～79岁,CHD患者,男121例,女10例,其中68例合并糖尿病(DM),采用空腹口服葡萄糖＋静脉注射胰岛素法调节血糖,测量其FBG、PBG、BG_注射、记录其高糖及胰岛素用量,之后行¹⁸F-FDG PET心肌代谢显像。图像质量评定采用盲法评定评分法。结果 131例中仅1例显像失败,显像成功率99.2%;将130例显像成功者按是否合并DM分析显示,不合并DM者易获得更佳的图像质量(P=0.002)。患者FBG及BG_注射对图像质量有影响,FBG和BG_注射较低者更易获得高质量的图像,差异有统计学意义(P均=0.000),而PBG和BG_差对最终图像质量无明显影响(P分别=0.191及0.283)。不合并DM组的患者胰岛素/高糖比值与图像质量无明显相关性(P=0.484),而合并DM组患者的胰岛素/高糖在不同图像质量组间有差异,图像质量更好组(评分3分)的胰岛素/高糖更高,差异有统计学意义(P=0.021)。结论 口服葡萄糖+静脉注射胰岛素法¹⁸F-FDG PET心肌代谢显像成功率高,影响图像质量的主要因素是患者FBG和BG_注射。

Effect of early blood glucose regulation on myocardial metabolism imaging quality of 18F-FDG PET in patients with coronary heart disease

Objective To investigate the effect of early blood glucose regulation on myocardial metabolism imaging quality of ¹⁸F-FDG PET/CT patients with CHD.Methods One hundred and thirty-one patients with CHD and aged 61.1±9.3 (33~79) years (121 males and 10 females, including 68 patients with DM and 63 patients without DM) were enrolled. Fasting oral glucose + intravenous insulin was administered to regulate blood glucose. Fasting blood glucose (FBG), peak blood glucose (PBG), blood glucose during injection(BGinjection), high glucose and insulin dosage were measured before ¹⁸F-FDG PET myocardial metabolism imaging was performed. The image quality was assessedusing the blind scoring method.Results Imaging failed in only one case among the 131 patients, so the success rate of imaging was 99.2%.Analysis of the 130 successful imaging patients with or without diabetes showed that non-diabetic patients were more likely to obtain better-quality images(P=0.002). FBG and BGinjection had an impact on image quality. Patients with low FBG and BGinjection were more likely to obtain high-quality images, and the difference was statistically significant (Both P=0.000), while PBG and the deviation value of blood glucose (BGdeviation)had no significant impact on final image quality (P=0.191 and 0.283, respectively). There was no significant correlation between the insulin/glucose ratio and image quality in the non-diabetic group (P=0.484), but the insulin/glucose ratio in the non-diabetic group was different between groups ofdifferent image quality.The insulin/glucose ratio in the better image quality group (score 3) was higher, with statistically significant difference (P=0.021). Conclusions The success rate of ¹⁸F-FDG PET myocardial metabolism imaging is high with oral glucose + intravenous insulin. The main factors that affectimage quality are FBG and BGinjection. Patients with diabetes need to use higher doses of insulin and lower doses of glucose.