放射性核素肺断层显像预测残留肺功能的应用研究

应用放射性核素肺断层显像预测肺切除术后的残留肺的肺功能状态。１４０例均经手术或病理证实，其中原发性肺癌１２７例，良性病变１１例和转移性肺癌２例。对８７例肺部手术病人的呼气容积预测值和手术后的实测值、４０例肺叶切除病人的手术前后Ｑ值进行了对比分析，均示显著相关，前者Ｐ＞０．０５，γ＝０．９９２５，后者Ｐ＞０．０５，γ＝０．８６５。文中描述了残留肺功能预测的公式推导和计算方法，并就断层显像方法学的优点     

肺通气/灌注显像预测肺癌术后肺功能

目的 利用肺通气/灌注显像预测肺癌切除术后残余肺功能及评价手术适应证.方法 26例原发性肺癌患者：21例行肺灌注/通气显像,其中13例行手术治疗;5例行肺灌注显像行手术治疗;所有患者于术前1周左右行肺功能检查,其中18例手术治疗患者于术后2个月再次行肺功能检查.采用Neuhaus公式计算术后肺功能：第1秒用力呼气量预测值（ppoFEV1）.对通气、灌注显像2种方法计算所得的ppoFEV1值进行t检验,并分别与术后2个月肺功能实测值进行t检验和相关性分析.结果 21例患者通气法ppoFEV1为（1.347±0.539）L,灌注法ppoFEV1为（1.410±0.543）L,差异无统计学意义（t=0.062,P＞0.05）;13例手术者其中术前通气ppoFEV1为（1.545±0.588）L,术后2个月实测值为（1.450±0.521）L,差异无统计学意义（t=0.092,P＞0.05）.所有18例手术者术前灌注ppoFEV1为（1.697±0.546）L,术后2个月实测值为（1.457±0.488）L,差异无统计学意义（t=0.017,P＞0.05）.13例肺通气法ppoFEV1与术后2个月实测值显著相关,r=0.950,P＜0.01;肺灌注法ppoFEV1值与术后2个月实测值也显著相关,r=0.937,P＜0.01.18例肺灌注法ppoFEV1与术后2个月实测值也显著相关（r=0.922,P＜0.01）.结论 肺通气/灌注显像结合肺功能测定有利于判断肺癌患者尤其合并低肺功能患者能否进行手术及确定手术部位和范围,能用于预测肺癌切除术后残余肺功能.     

结,直肠癌术后孤立性肺转移

目的：探讨结、直肠癌术后肺孤立性转移瘤的影像表现，与原发肺癌的鉴别。材料与方法：３１年间１３例结、直肠癌术后肺孤立肿物，均经手术切除及病理证实。转移性腺癌１１例１３次，原发肺癌２例。结、直肠癌切除与肺转移瘤切除间隔时间为３￣９６个月，中位３３个月。均有正侧位胸片，病灶体层和ＣＴ各６例。结果：肿物直肠１．５￣８．５ｃｍ（中位３．４ｃｍ），类圆形３例，椭圆形８例１０个，浅分叶１０例；边缘光整８例１０个     

肺灌注显像评价一例肺动脉血栓内膜剥脱术疗效

肺灌注显像评价一例肺动脉血栓内膜剥脱术疗效方纬史蓉芳周宝贵患者，男，３４岁。劳力性呼吸困难３年，伴咳嗽、咯血１个月，间断性下肢浮肿１年。患下肢静脉炎１３年。患者于１９９７年１月２７日行９９ｍＴｃ聚合白蛋白肺灌注显像及双下肢深静脉显像。见双肺形态均不...     

肺灌注/通气显像与肺动脉造影诊断肺栓塞的对比分析

目的：评价肺灌注／通气显像诊断肿栓塞的价值。方法：回顾性分析45例疑肺栓塞患者的肺核素显像结果，并与肺动脉造影检查对照。结果：肺动脉造影诊断为肺栓塞的患者26例，有180个肺动脉支为充盈缺损，其肺灌注显像示167个节段呈完全肺段性或亚肺段缺损，符合率为92．7％。肺动脉造影显示为86个肺动脉支为部分充盈缺损，肺灌注显像有63个肺段或亚肺段缺损，符合率为73．2％（P＜0．01）。肺核素显像对肺栓塞诊断的灵敏度为92．3％，特异性为84．2％，阳性预测值和阴性预测值均为88．9％。26例肺动脉造影诊断为肺栓塞的患者，有23例行肺通气显像，通气／灌注均不匹配。结论：肺灌注／通气显像对肺栓塞诊断具有重要的临床价值。     

放射性核素肺断层显像的初步应用

放射性核素肺断层显像的初步应用刘蕴忠，刘秀杰，张卫和，吴清文，周宝贵肺脏几乎占据了人体整个胸腔，前后径及左右径均较其他器官为大，平面图像难以显示肺深部病变．肺断层显像可以得到肺三维灌注及通气图像．本文报告１７例放射性核素肺断层显像及与平面显像进行对比...     

99mTc－培普利欧霉素诊断肺肿瘤的价值与99mTc－MIBI比较

目的：评价＾９９ｍＴｃ－ＰＰＭ平面显像诊断肺癌的临床价值。材料与方法：２８例经Ｘ线、ＣＴ证实肺肿瘤患者，其中２０例恶性，８例良性。注射＾９９ｍＴｃ－ＰＰＭ后５ｍｉｎ、１５ｍｉｎ、３０ｍｉｎ、１ｈ行平面显像，选延迟相图像以ＲＯＩ法处理，计算Ｔ／ＮＴ；并与＾９９ｍＴｃ－ＭＩＢＩ比较。结果：８例良性肿瘤的＾９９ｍＴｃ－ＰＰＭ Ｔ／ＮＴ值为１．０４±０．０８；２０例恶性肿瘤的Ｔ／ＮＴ值为１．４１±０．１６     

定量CT、核素肺灌注及解剖分段法预测肺癌切除术后肺功能对比的初步研究

目的 对定量CT(QCT)、核素肺灌注扫描和解剖分段法预测肺癌切除术后肺功能的准确性进行初步的对比研究.方法 分析12例手术治疗的肺癌患者资料.术前均行肺功能检查、呼吸门控QCT扫描及核素肺灌注扫描.术前肺功能测毋第1秒用力呼气容积(FEV1.0)、努力肺活量(FVC)和一氧化碳弥散最(DLco).对CT资料和核素肺灌注扫描资料分别进行定量分析,根据QCT、核素肺灌注扫描及解剖分段法相应计算术后肺功能的公式,得出FEV1.0、FVC和DLco预测值,并与术后2个月时患者肺功能复查测量的实际值进行配对t检验及Pearson相关性检验.应用Bland-Altman分析对QCT、核素肺灌注扫描及解剖分段法所得到的肺功能预测值进行一致性检验.结果 QCT、核素肺灌注扫描及解剖分段法对患者术后肺功能各指标的预测值:FVC分别为(3.05±0.82)、(2.98±0.75)、(2.98±0.86)L;FEV1.0分别为(2.20±0.81)、(2.17±0.78)、(2.16±0.84)L;DLco分别为(5.95±2.10)、(5.85±1.98)、(5.87±2.23)mmol·min-1·kPa-1;FVC、FEV1.0及DLco术后实测值分别为:(3.09±0.72)L、(2.23±0.81)L、(5.59±2.01)mmol·min-1·kPa-1;3种方法 预测值与术后临床肺功能实测值的相关系数:FVC分别为0.87、0.80、0.86;FEV1.0分别为0.93、0.91、0.93;DLco分别为0.93、0.95、0.93(P值均<0.01).结论 QCT、核素肺灌注扫描及解剖分段法均可以作为预测肺癌切除术后肺功能的有效手段,预测值均具有良好的准确性.     

肺通气/灌注显像用于肺容积 减少术的病例选择

目的 评价肺通气／灌注（Ｖ／Ｐ）显像对慢性阻塞性肺病（ＣＯＰＤ）肺容积减少术（ＬＶＲＳ）病例的选择及手术部位和范围确定的价值。方法 １２８例ＣＯＰＤ患者（均为男性，年龄４５～７６岁）进行Ｖ／Ｐ显像，其中２９例（年龄４５～７４岁）进行ＬＶＲＳ治疗，术后３～６个月复查，通气显像采用＾９９Ｔｃ＾ｍ－ＤＴＰＡ气溶胶吸入法，灌注显像用＾９９Ｔｃ＾ｍ－人血清聚合白蛋白（ＭＡＡ）静注法，根据显像类型分成①局灶型     

激光诱发自体荧光光谱区分肺癌组织和正常肺组织

目的：确立激光诱发自体荧光（ＬＩＡＦ）光谱区分肺癌组织和正常肺组织的判断依据。探讨应用激光诱发荧光（ＬＩＦ）光谱方法诊断肺癌的可行性。方法：收集肺癌手术标本４２例,使用三倍频ＹＡＧ激光（波长３５５ｕｍ）和多光道分析仪（ＯＭＡ）测定肺癌标本的激光诱发荧光光谱,根据正常肺组织和肺癌组织的激光诱发自体荧光光谱特征规律,寻找能够区分两者的光诸差异,得出判断依据,并与病理结果比较。结果：（１）正常肺组织在５８０ｎｍ与６００ｎｍ的荧光强度比为０．８４２±０．１５８;肺癌为ｌ．２６９±０．１４７（Ｐ＜０．００１）。（２）肺癌阳性判断标准域值：荧光强度比值判据为Ｉ５８０ｎｍ／Ｉ６００ｎｍ≥１．０７３;与病理结果比较,符合荧光强度比值判据的判断敏感性为９３．２％．特异性为８８．１％．阳性预测值为８９．６％,阴性预测值为９８．３％．结论：激光诱发自体荧光光谱区分肺癌组织和正常肺组织是可行的。     

Prediction of postoperative pulmonary function using perfusion magnetic resonance imaging of the lung

PURPOSE: To assess semiquantitatively the regional distribution of lung perfusion using magnetic resonance (MR) perfusion imaging.MATERIALS AND METHODS: Subjects were 20 consecutive patients with bronchogenic carcinoma, who underwent MR imaging (MRI) and radionuclide (RN) perfusion scans for preoperative evaluation. Three-dimensional (3D) images of whole lungs were obtained before and 7 seconds after bolus injection of contrast material (5 ml of Gd-DTPA). Subtraction images were constructed from these dynamic images. Lung areas enhanced with the contrast material were measured and multiplied by changes in signal intensity, summed for the whole lung, and the right-to-left lung ratios were calculated. The predicted postoperative forced expiratory volume in 1 second (FEV1) was estimated using MR and RN perfusion ratios.RESULTS: The correlation between perfusion ratios derived from the MR and RN studies was excellent (r = 0.92). Sixteen of 20 patients underwent surgery, and 12 patients had postoperative pulmonary function tests. The predicted FEV1 derived from the MR perfusion ratio correlated well with the postoperative FEV1 in the 12 patients (r = 0.68).CONCLUSION: Perfusion MRI is suitable for semiquantitative evaluation of regional pulmonary perfusion.     

99Tcm-PPM及99Tcm-MIBI肺显像诊断原发性肺癌

目的 探讨99Tcm－培普利欧霉素（PPM）及99Tcm-甲氧基异丁基异腈（MIBI）肺显像诊断原发性肺癌的临床价值。方法 对28例临床诊断肺肿瘤患者进行99Tcm-PPM ey 99T0-MIBI肺肿瘤显像并进行比较。结果 肺癌与良性病变对99T -PPMey 99T-MIBI观的摄取差异有显著性（P＜0．01）,以肺癌晚期显像摄取比值（T／NT,X－S）作为判断良恶性阈值,99Tcm-PPM及99Tcm-MIBI对肺癌诊断的灵敏度,准确性分别为90％,89．3％,和80％,82．1％,两者结合显像阳性率为95％,病灶对放射性药物的摄取与肿瘤大小无明显相关（P＞0．05）,结论 99Tcm-PPM ey 99T-MIBI肺显像对肺癌的诊断,鉴别诊断有一定的临床价值。两者联合应用可提高肺癌的阳性检出率,单独使用99Tcm-PPM优于99Tcm-MIBI。     

Lung perfusion SPECT in predicting postoperative pulmonary function in lung cancer

The aim of this prospective study is to evaluate the availability of preoperative perfusion SPECT in predicting postoperative pulmonary function following resection. Twenty-three patients with lung cancer who were candidates for lobectomy were investigated preoperatively with spirometry, x-ray computed tomography and^99mTc macroaggregated albumin SPECT. Their postoperative pulmonary functions were predicted with these examinations. The forced vital capacity and the forced expiratory volume in one second were selected as parameters for overall pulmonary function. The postoperative pulmonary function was predicted by the following formula: Predicted postoperative value=observed preoperative value × precent perfusion of the lung not to be resected. The patients were reinvestigated with spirometry at 3 months and 6 months after lobectomy, and the values obtained were statistically compared with the predicted values. Close relationships were found between predicted and observed forced vital capacity (r=0.87, p < 0.001), and predicted and observed forced expiratory volume in one second (r=0.90, p < 0.001). The accurate prediction of pulmonary function after lobectomy could be achieved by means of lung perfusion SPECT.     

Compression of the Right Pulmonary Artery by a Massive Descending Aortic Aneurysm Causing Bilateral Perfusion Defects on Pulmonary Scintigraphy

A 67-year-old woman, who presented with a 2 month history of dyspnea, had a ventilation and perfusion lung scan that showed absent perfusion of the entire right lung with normal ventilation, as well as a rounded matched defect in the left lower lung adjacent to midline, suspicious for an aortic aneurysm or dissection. CT pulmonary angiography revealed a massive descending aortic aneurysm compressing the right pulmonary artery as well as the left lung parenchyma, accounting for the bilateral perfusion scan defects. We present the Xe-133 ventilation, Tc-99m MAA perfusion and CT pulmonary angiography imaging findings of this rare case.     

99Tcm-MIBI门控心肌灌注断层显像与超声心动测定左室射血分数的对比研究

目的探讨GE VG/Hawkeye单光子发射断层扫描仪(SPECT)随机携带3种左室射血分数算法对静息态99Tcm-MIBI门控心肌断层显像测定左室射血分数(LVEF)的临床应用价值。方法对103例、6组受检者进行门控心肌断层显像,使用3种算法分别测定3组左室射血分数(LVEF0、LVEF1、LVEF2),分别与M型超声心动获得的LVEF(UEF)进行对比分析。结果(1)103例受检者图像显影清晰;(2)根据不同算法获得门控心肌断层显像3组LVEF值(EF0、EF1、EF2)与超声心动图检查结果(UEF)均具有显著相关性(r0=0.948、r1=0.937、r2=0.940),其中EF0与UEF一致性较好;(3)静息态99Tcm-MIBI门控心肌断层显像测定左室射血分数可重复性好(P<0.05);(4)各组间t检验示:心肌缺血组、心梗组及扩张型心肌病组与正常组比较均存在显著性差异(P<0.05);高血压组、心肌炎组、扩张型心肌病和心肌缺血组比较均存在显著性差异(P<0.05);高血压组、心肌炎组、扩张型心肌病组与心梗组比较均存在显著性差异(P<0.05);扩张性心肌病组与心肌炎组比较亦存在显著性差异(P<0.05)。结论静息态99Tcm-MIBI静息态门控心肌断层显像测定左心室射血分数(LVEF)可靠,3种算法中以第一种最好,具有较好的临床应用价值。     

MR增强肺灌注成像对肺动脉栓塞治疗疗效评价的可行性及准确性

目的 评价MR肺灌注成像(MRPP)对肺动脉栓塞治疗疗效的可行性及在随访中的作用.方法 60例可疑肺栓塞患者,将MRPP作为常规检查,其中27例同时进行了放射性核素肺通气-灌注显像扫描.将放射性核素肺通气-灌注显像与MRPP进行一致性检验,验证MRPP诊断肺栓塞的可行性.所有患者中有22例抗凝或溶栓治疗后3 d至1个月内进行了MRPP复查,通过分析治疗前后MRPP中肺实质的信号强度变化率(TROS),时间-峰值曲线以及肺动脉主干的相关参数(血流峰值、平均流速、单位时间内流量等),对MR增强肺灌注成像在肺动脉栓塞治疗疗效评价方面的可行性及准确性进行评估.获得的数据采用t检验、秩和检验进行统计学分析.结果 MRPP与放射性核素肺通气-灌注显像具有很好的一致性(以患者为研究对象时Kappa值为0.705,而肺叶、段及亚段的一致性分别为0.7632、0.8280、0.7344).两种方法比较,治疗前后MRPP肺实质强化率分别为(2.86±2.48)和(6.72±2.54)倍(t=3.370,P＜0.01),峰值时间分别为(13.98±5.60)和(12.33±3.63)s(t=3.930,P＜0.01),肺动脉干血流峰值分别为(60.39±15.17)和(69.93±13.22)cm/s(t=2.930,P=0.01),平均流速分别为(11.68±5.46)和(13.54±4.18)cm/s(t=2.380,P＜0.05),差异均有统计学意义,而单位时间内的流量分别为(80.57±24.87)和(85.48±11.81)ml/s,差异无统计学意义(t=0.860,P＞0.05).结论 MRPP与放射性核素肺通气-灌注显像具有很好的一致性.MRPP具有更高的空间分辨率和时间分辨率,并能够对肺血流进行半定量分析.对肺栓塞的诊断和治疗后的评估具有重要的临床意义.     

Semi-quantitative ventilation/perfusion scintigraphy and single-photon emission tomography for evaluation of lung volume reduction surgery candidates: description and prediction of clinical outcome.

Ventilation/perfusion scans with single-photon emission tomography (SPET) were reviewed to determine their usefulness in the evaluation of lung volume reduction surgery (LVRS) candidates, and as a predictor of outcome after surgery. Fifty consecutive planar ventilation (99mTc-DTPA aerosol) and perfusion (99mTc-MAA) scans with perfusion SPET of patients evaluated for LVRS were retrospectively reviewed. Technical quality and the severity and extent of radiotracer defects in the upper and lower halves of the lungs were scored from visual inspection of planar scans and SPET data separately. An emphysema index (EI) (extent x severity) for the upper and lower halves of the lung, and an EI ratio for upper to lower lung were calculated for both planar and SPET scans. The ratios were compared with post-LVRS outcomes, 3, 6 and 12 months after surgery. All perfusion and SPET images were technically adequate. Forty-six percent of ventilation scans were not technically adequate due to central airway tracer deposition. Severity, extent, EI scores and EI ratios between perfusion and SPET were in good agreement (r = 0.52-0.68). The mean perfusion EI ratio was significantly different between the 30 patients undergoing biapical LVRS and the 17 patients excluded from LVRS (3.3+/-1.8 versus 1.2+/-0.7; P<0.0001), in keeping with the anatomic distribution of emphysema by which patients were selected for surgery by computed tomography (CT). The perfusion EI ratio correlated moderately with the change in FEV1 at 3 months (r = 0.37, P = 0.04), 6 months (r = 0.36, P = 0.05), and 12 months (r = 0.42, P = 0.03), and the transition dyspnea index at 6 months (r = 0.48, P = 0.014) after LVRS. It is concluded that patients selected to undergo LVRS have more severe and extensive apical perfusion deficits than patients not selected for LVRS, based on CT determination. SPET after aerosol V/Q imaging does not add significantly to planar perfusion scans. Aerosol DTPA ventilation scans are not consistently useful. Perfusion lung scanning may be useful in selecting patients with successful outcomes after LVRS.     

运动静息介入三步^99mTc—MIBI心肌显像预测PTCA疗效

目的：探讨组合方案的ＳＰＥＣＴ ９９ｍＴｃＭＩＢＩ 心肌显像术前预测ＰＴＣＡ 疗效的价值。材料与方法：采用运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像对１２２ 例拟行ＰＴＣＡ 治疗的患者进行监测,并以术后１ ～２ 周的运动、静息显像作为疗效指标进行比较。结果：术前心肌显像显示的缺损变化与ＰＴＣＡ 疗效有重要关系。以运动与ＮＴＧ 显像组合反映的缺损变化作为预测指标,则与疗效指标呈正相关（ｒ ＝ ０ ．９３６６） 。结论：运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像能够在术前全面准确地预测ＰＴＣＡ 的疗效。     

Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases

We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r = .729, r = .883, and r = .826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV1) (r = .806) and forced vital capacity (FVC) (r = .781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025 < p < or = 0.05). Radioaerosol lung imaging may reflect the pulmonary function impairment in parenchymal lung diseases. Retention of Tc 99m EL may be related to number of BAL cells or presence of a lymphocytic alveolitis. Long residency time of Tc 99m EL in the lungs implies that erythromycin can also be administered by inhalation for therapeutic purposes.