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目的 以MRI为“金标准”,比较门控99Tcm-MIBI SPECT心肌灌注显像(G-SPECT)和门控18F-FDG PET心肌代谢显像(G-PET)测定左心室室壁瘤(LVA)患者左心室功能及筛选左心室功能衰竭患者的准确性.方法 选择2009年9月至2012年2月间行G-SPECT和G-PET、并经MRI确诊的LVA患者[96例,其中男88例,女8例,平均年龄(57±10)岁]进行回顾性分析.G-SPECT和G-PET均采用定量门控心肌断层显像(QGS)软件获得LVEF.非门控图像的心肌血流灌注评分采用17节段5分法进行半定量分析,4分代表无放射性分布,0分代表放射性分布正常.MRI图像采用Simpson法计算LVEF.采用SPSS 17.0软件对数据行配对t检验、Pearson相关分析和Bland-Altman一致性检验.结果 (1)根据心肌灌注缺损的节段数将患者分组发现,对于小范围心肌灌注缺损的患者(缺损0～2个节段,18例),G-PET、G-SPECT测定的LVEF与MRI测定值均相关(r=0.91和0.87,均P＜0.01),G-PET明显高估LVEF[(37± 13)％与(34±10)％;t=2.850,P＜0.05];对于大范围心肌灌注缺损的患者(缺损≥5个节段,48例),2种方法测定的LVEF与MRI测定值均相关(r=0.75和0.68,均P＜0.01),G-SPECT明显低估LVEF[(26±8)％与(30±10)％;=-3.992,P＜0.01].(2)以MRI测定的LVEF≤35％作为诊断严重左心室功能衰竭的“金标准”,G-SPECT诊断准确性明显高于G-PET[(95％ (59/62)与71％(44/62);x2=12.899,P＜0.01].结论 对于临床常规行心肌灌注显像和心肌代谢显像检测心肌存活性的LVA患者,建议2种方法均采用门控采集.对于小范围心肌灌注缺损的LVA患者,建议参考G-SPECT测定的LVEF,大范围者建议参考G-PET.以MRI测定值为标准,G-SPECT较G-PET能更准确地筛选出严重左心室功能衰竭(LVEF≤35％)的LVA患者.“,”Objective To compare the accuracy of gated 99Tcm-MIBI SPECT (G-SPECT) and gated 18F-FDG PET (G-PET) for assessing LVEF in patients with left ventricular aneurysm (LVA) by using MRI as a reference.Methods Ninety-six patients (88 males,8 females;mean age (57±10) years) with LVA diagnosed by MRI from September 2009 to February 2012,who also underwent G-SPECT and G-PET were retrospectively studied.LVEF was calculated using quantitative gated SPECT (QGS) software.Non-gated SPECT and PET images were analyzed with a 17-segment model and 5-score system.A severe myocardial perfusion defect (MPD) was defined as absence of activity (MIBI score=4),and a normal segment was defined as normal radiotracer activity (MIBI score =0).LVEF in MRJ was calculated by Simpson method.Paired-t test,Pearson correlation analysis and Bland-Altman test were used.Results (1) Patients were grouped according to the number of segments with MPD.In patients with small extent of MPD (0-2 segments,n=18),LVEF detected by G-SPECT was correlated with that detected by MRI (r =0.87,P＜0.01),and so was LVEF detected by G-PET(r=0.91,P＜0.01).The LVEF was overestimated by G-PET ((37 ± 13) ％ vs (34 ± 10) ％;t =2.850,P＜ 0.05).In patients with large extent of MPD (≥ 5 segments,n =48),correlations of LVEF were moderate between G-SPECT and MRI (r=0.68 P＜0.01),and between G-PET and MRI(r=0.75,P＜0.01).LVEF detected by G-SPECT was significantly lower than that by MRI ((26±8) ％ vs (30± 10) ％,t =-3.992,P＜0.01).(2) The diagnostic accuracy of G-SPECT to identify patients with severe heart failure (LVEF ≤ 35％ by MRI,n =62) was significantly higher than that of G-PET (95％ (59/62) vs 71％ (44/62);x2=12.899,P＜0.01).Conclusions For routinely scheduled SPECT perfusion imaging and PET metabolic imaging to detect myocardial viability in LVA patients,gated acquisition should be performed in both modalities.To LVA patients with small extent of MPD,LVEF from G-SPECT was more accurate,while LVEF measured by G-PET might be referred in patients with large extent of MPD.G-SPECT might be better to identify LVA patients with severe heart failure (LVEF≤35％).