Usefulness of PET and semiconductor SPECT as a biomarker of atral fibrillation

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K10443
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Radiation science
• Research Institution: Ehime University
• Principal Investigator: Miyagawa Masao 愛媛大学, 医学部附属病院, 教授 (90346685)
• Co-Investigator(Kenkyū-buntansha): 望月 輝一 愛媛大学, 医学系研究科, 教授 (80145094)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: PET/CT / 心房細動 / 炎症細胞 / 剖検心

Outline of Final Research Achievements

Among 8233 patients who underwent FDG-PET/CT as work-up for malignancies, we identified 180 patients with atrial fibrillation (Af; 2.2%). Of those, we selected 137 patients who had fasted >12 hr before FDG injection. For quantitative analysis, we used the maximum standard uptake value(SUVmax) in the left(LA) and right atria(RA) and target-to-background ratio(TBR). The sensitivity, specificity, and positive-predictive value for detecting Af visually were 54%, 95%, and 96%, respectively; for quantitative analysis,the respective values were 66%, 76%, and 86%. Multivariate analysis showed significant associations with RA SUVmax and LA volume. The RA TBR was greater in cases with persistent Af than in those with paroxysmal Af. Pathological investigation of 4 autopsy hearts confirmed infiltration of macrophages and lymphocytes in the regions with FDG uptake. Higher atrial FDG uptake was associated with Af. PET/CT could be a useful tool for detecting local inflammation in the atria with Af

Free Research Field

放射線診断学、核医学

Academic Significance and Societal Importance of the Research Achievements

FDG PET検査は、国内で年間約70万件が施行されているが、97%以上が悪性腫瘍診断を目的としている。心臓大血管系の診断については、心筋への生理的FDG集積が存在するため、心サルコイドーシスや高安動脈炎など小数患者への保険適用にとどまる。心房細動(Af)を有する患者は2030年には100万人を突破し、合併症の心原性脳塞栓症も大幅増が予想される。本研究により、Afに対する腫瘍FDG PETの陽性的中率は97%と拾い上げ診断が可能で、発作性、慢性の診断、アブレーション治療効果判定にも有用であることが示された。心房への炎症細胞浸潤という病理学的検所見は今後の治療法に結び付く可能性がある。