Image analysis and interpretation of positron-emission tomography myocardial viability assessment and its progress
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摘要: 心血管疾病是造成全球死亡和疾病负担的主要原因之一。准确评价心肌活性不仅有助于心血管疾病患者的临床决策，对其预后也具有重要的价值。正电子发射断层扫描（PET）图像质量好，在诊断和评估已知或疑似冠状动脉疾病患者中准确性较高。经典的PET心肌血流灌注-葡萄糖代谢显像评估存活心肌的价值已得到公认。目前PET存活心肌评估的图像分析主要依靠视觉评估或半定量评价。近年来，随着各种图像软件自动分析的推广应用，更多定量指标的纳入为临床提供了更有价值的参考信息。软件和技术设备的持续进步也推动着PET在评估存活心肌中更好地发挥其优势，人工智能技术的兴起及一体化PET/MR的探索应用更为PET心肌活性成像与图像解读提供了新的手段，但新技术同样伴随着机遇与挑战。本文就PET存活心肌评估中常用的软件、图像显示、不同图像分析方法及相关进展进行综述。Abstract: Cardiovascular disease is one of the leading causes of death and disease burden worldwide. Accurate evaluation of myocardial viability is helpful for clinical decision- making and has important prognostic value for patients with cardiovascular disease. Positron- emission tomography (PET) has good image quality and high diagnostic accuracy with known or suspected coronary artery disease. The value of classical PET myocardial perfusion and metabolic imaging in evaluating myocardial viability has been recognized. At present, the image analysis of PET myocardial viability assessment mainly relies on visual assessment or semi-quantitative scoring. With the promotion and application of automatic analysis by various software, the inclusion of quantitative indicators provides more valuable reference information for clinical practice. Continuous advances in software and technical equipment have also facilitated better use of PET in assessing myocardial viability. The rise of artificial intelligence technology and the exploration and application of integrated PET/MR provide new means for PET myocardial viability imaging and image interpretation, but the opportunities of new technology are accompanied by challenges as well. This review briefly describes the common software, image display, different image analysis methods and progress in PET myocardial viability assessment.
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表 1 目前常见心脏PET图像分析软件及基本信息
Table 1. Cardiac PET image analysis software and basic information
No. Name Team Image processing and analysis Quantitative perfusion Quantitative viability Quantitative gated Websites 1 Corridor4DM INVIA Medical Imaging Solutions, America Fully automated, allowing users to adjust √ √ √ https://www.inviasolutions.com 2 ECToolbox Emory University, America Fully automated, allowing users to adjust √ √ √ https://syntermed.com 3 PMOD PMOD Technologies, Switzerland Fully automated, allowing users to adjust √ √ √ https://www.pmod.com 4 QPET Cedars-Sinai Medical Center, America Fully automated, allowing users to adjust √ √ √ https://csaim.com 
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表 2 半定量5分法评分标准
Table 2. The standard of semi-quantitative 5-point scoring
Score The degree of tracer uptake Percentage of tracer uptake 0 Normal ≥70% 1 Mildly reduced ≥50% and < 70% 2 Moderately reduced ≥30% and < 50% 3 Severely reduced ≥10% and < 30% 4 Completely reduced < 10% or no uptake
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表 3 不同图像分析与解读方法优点与不足
Table 3. The advantages and disadvantages of different methods for image analysis and interpretation
Methods Advantages Disadvantages Visual assessment Convenient; Intuitive Subject to the subjective factors and experience of the observer; Low sensitivity and repeatability; Long calculation time Semi-quantitative Scoring Relatively simple and high repeatability; Parameters can be provided for clinical evaluation; Reduce the interference of subjective factors; Easy to misclassify scoring results; Lack of specificity due to relative quantification Software analysis High sensitivity and good repeatability; Quantitative indicators with objectivity; Shorten diagnostic time and improve efficiency; Rich functionality with new features in development Increased equipment cost; Lack of consistent protocols and specifications among software; Analysis results depend on software processing capabilities
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