Owais Dar, Mansimran Singh Dulay, Fernando Riesgo-Gil, Andrew Morley-Smith, Paul Brookes, Haifa Lyster, Alexandra Rice, Stephen R. Underwood, John Dunning, Kshama Wechalekar
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引用次数: 0
摘要
排斥反应是心脏移植(HTx)受者死亡和发病的主要原因。目前诊断排斥反应的方法存在局限性。目前还缺乏映射整个左心室并可靠识别潜在排斥部位的成像方法。动物实验表明,FDG PET-CT (FDG PET)有可能应用于人类移植受者。2020 年 12 月至 2022 年 2 月期间,伦敦 Harefield 医院所有确诊或疑似排斥反应的 HTx 受体在常规检查之外都接受了 FDG PET 检查。30 名热处理受体(12 名明确存在排斥反应,18 名疑似排斥反应)接受了 FDG PET 扫描。总体而言,30 名患者中有 12 名患者的 FDG PET 显示心肌酶活性升高,其中 2 人死亡(17%)。在 30 名患者中,有 18 名患者的 FDG PET 没有出现心肌嗜性,他们全部存活(100%,P = 0.15)。所有明确存在排斥反应的患者都在开始接受抗排斥治疗后两周内接受了扫描,结果显示心肌avidity增加。有5例患者尽管接受了脉冲类固醇治疗,但6周后FDG PET仍显示出心肌avidity,这表明心肌排斥反应尚未缓解。初步研究结果表明,FDG PET 可用于诊断心脏移植排斥反应。未来还需要盲法研究来进一步验证这一点。
Cardiac transplant rejection assessment with 18F-FDG PET-CT: initial single-centre experience for diagnosis and management
Rejection is a major cause of mortality and morbidity in heart transplant (HTx) recipients. Current methods for diagnosing rejection have limitations. Imaging methods to map the entire left ventricle and reliably identify potential sites of rejection is lacking. Animal studies suggest FDG PET-CT (FDG PET) could have potential application in human HTx recipients. Between December 2020 and February 2022, all HTx recipients at Harefield Hospital, London, with definite or suspected rejection underwent FDG PET in addition to routine work-up. Thirty HTx recipients (12 with definite and 18 with suspected rejection) underwent FDG PET scans. Overall, 12 of the 30 patients had FDG PET with increased myocardial avidity, of whom 2 died (17%). Eighteen patients of the 30 patients had FDG PET with no myocardial avidity and all are alive (100%, p = 0.15). All patients with definite rejection, scanned within 2 weeks of starting anti-rejection treatment, showed increased myocardial avidity. In 5 cases, FDG PET showed myocardial avidity beyond 6 weeks despite pulsed steroid treatment, suggesting unresolved myocardial rejection. Preliminary findings suggest FDG PET may have a role in diagnosing cardiac transplant rejection. Future blinded studies are needed to help further validate this.