99m^Tc-MIBI显像对甲状腺单发结节的诊断价值

目的：探讨99m^Tc-MIBI显像对甲状腺单发结节鉴别诊断的临床价值。方法：对甲状腺99m^TcO4-核素显像为单个＂冷结节＂的患者进行99m^Tc-MIBI显像,采集15min、30min及2h三时相的静态图像,将显像结果进行定量分析并与病理结果比较。结果：甲状腺癌组三时相的99m^Tc-MIBI摄取比值皆高于良性病变组（P〈0.001）;RI无显著性差异（P〉0.05）;T/N1组与T/N2组摄取比值无显著性差异（P〉0.05）。以甲状腺癌组摄取比值的（-x±s）为判断阈值,99m^Tc-MIBI显像对甲状腺癌诊断的灵敏度为75.00%-100.00%,特异性为81.25%-93.75%,准确性为84.09%-93.18%。T/N1组与T/N2组定量分析的灵敏度、特异性与准确性无显著性差异（P〉0.05）。结论：99m^Tc-MIBI显像对甲状腺单发结节良恶性鉴别诊断有较大的临床应用价值。     

99mTc-MIBI显像对甲状腺结节良恶性的鉴别诊断价值

目的评价99mTc-MIBI(甲氧异腈)显像对鉴别甲状腺结节良恶性的临床价值.方法对122例99mTcO-4显像为结节的患者行99mTc-MIBI动态血流灌注、早期20分钟及延迟2小时静态平面显像.结果99mTc-MIBI动态血流灌注显像诊断甲状腺癌的灵敏度为53.8%(21/39),特异性为75.9%(63/83);早期20分钟静态平面显像诊断甲状腺癌的灵敏度为92.3%(36/39),特异性为60.24%(50/83);延迟2小时静态平面显像诊断甲状腺癌的灵敏度为87.2%(34/39),特异性为85.54%(71/83).5例患者颈部肿大的淋巴结摄取99mTc-MIBI.结论99mTc-MIBI显像对甲状腺结节良恶性的鉴别诊断具有较高的灵敏度和特异性,同时对甲状腺癌转移灶的诊断也有重要价值.     

99mTc-甲氧异腈显像在分化型甲状腺癌转移灶诊断中的临床应用

目的:探讨99mTc-甲氧异腈(MIBI)显像在分化型甲状腺癌(DTC)转移灶诊断中的临床应用价值.方法:72例接受131I治疗的分化型甲状腺癌随访患者,以甲状腺球蛋白增高阈值＞10ng/ml为标准分为实验组(n=35)和对照组(n=37),常规行131I全身扫描(WBS),同时以99mTc-MIBI作为显像剂行核素肿瘤显像.以核素显像感兴趣区(ROI)技术,测定放射性(T/NT)比值,进行半定量分析;比较99mTc-MIBI显像及131I全身显像在诊断甲状腺癌转移灶灵敏性、特异性、准确性上的差异.结果:实验组,99mTc-MIBI显像和131 I全身显像T/NT比值分别为3.24 ±0.43和5.35 ±0.32,有明显差异;对照组T/NT比值分别为1.31 ±0.18和1.26±0.25,无明显差异;两种方法诊断分化型甲状腺癌转移灶的灵敏性、特异性、准确性分别为24.52％、64.28％、32.83％和92.45％、57.14％、85.07％.结论:99mTc-MIBI显像诊断分化型甲状腺癌转移灶灵敏性及准确性均低于131I全身显像,特异性无明显差异,但99mTc-MIBI显像可作为131I全身显像阴性分化型甲状腺癌随访方法的有益补充.     

^（99m）Tc-MIBI肿瘤显像在肺肿瘤中的应用价值

目的探讨^99mTc-甲氧基异丁基异腈（MIBI）肺阳性显像对肺肿瘤诊断的临床价值。方法对64例肺结节患者行^99mTc-MIBI肺阳性显像,结合影像学表现和半定量指标早期相摄取比值（EUR）、延迟相摄取比值（DUR）对结节性质进行判断。结果EUR诊断肺癌的灵敏度为81.8%,特异性为87.1%,准确性为84.4%;DUR诊断肺癌的灵敏度为75.8%,特异性为96.8%,准确性为85.9%。结论^99mTc-MIBI阳性显像对判断肺结节良、恶性有重要的价值。     

99mTc-MIBI显像评价乳腺癌新辅助化疗疗效及预后的价值

目的:探讨99mTc-MIBI显像评价乳腺癌新辅助化疗(NCT)疗效及预后的临床价值.方法:57例乳腺癌患者NCT前及Z个周期(30例)、3个周期(57例)NCT后分别行乳腺.99mTc-MIBI显像.肿瘤部位摄取采用靶和非靶比值(T/N)表示,术后行乳腺癌病理化疗反应分析.以NCT后T/N比值降低百分率>30%为判断化疗有效的闭值,将结果与病理检查结果对比,评价其诊断效能.根据该判断阈将患者分为显像有效组和无效组,进行临床随访,分析两组无进展生存时阃(PFS).结果:2个周期NCT后,99mTc-MIBI显像评价疗效的灵敏度、特异性和准确性分别为89%、83%和86%,阴性和阳性预测值分别为88%和83%,与对3个周期NCT疗效评价的效能差异无统计学意义,P>0.05.显像示有效组平均PFS为46.93个月,显像示无效组平均PFS为35.76个月,两组差异有统计学意义,P<0.05.结论:99mTc-MIBI显像对评价乳腺癌NCT反应、估计预后具有临床应用价值.     

甲状腺冷结节^99mTc-MIBI显像诊断甲状腺癌的Meta分析

[目的]通过Meta分析综合评价甲状腺冷结节^99mTc-MIBI显像诊断甲状腺癌的价值,并比较观察法与定量,半定量法的准确性。[方法]检索万方、维普、中国知网CNKI数据库中研究甲状腺冷结节^99mTc-MIBI显像诊断甲状腺癌的文献,按照循证医学诊断性试验的标准筛选文献。用MetaDisc1．4软件合并纳入的试验结果,并绘制SROC曲线。[结果]观察法组纳入病例数为803例,合并灵敏度、特异度及加权SROC曲线下面积（AUC）分别为83．2％、78．2％、0．8904,定量／半定量法组纳入病例数为471例,上述各值分别为81．6％、90．0％、0．9273。[结论]甲状腺冷结节^99mTc-MIBI显像对甲状腺癌的诊断具有较高价值。观察法和定量／半定量法灵敏度相接近,后者的特异度高,对甲状腺癌的诊断准确性更高。     

99mTc-depreotide受体显像在分化型甲状腺癌转移灶诊断中的临床应用

目的:探讨99mTc-depreotide受体显像在分化型甲状腺癌转移灶诊断中的临床应用价值。方法:67例接受131I治疗的分化型甲状腺癌(DTC)随访患者,以甲状腺球蛋白增高阈值>10ng/ml为标准分为实验组(n=32)和对照组(n=35),常规行131I全身扫描(WBS),同时以99mTc-depreotide作为显像剂行肿瘤生长抑素受体显像。以核素显像感兴趣区(ROI)技术,测定肿瘤/非肿瘤(T/NT)比值,进行定量分析。比较99mTc-depreotide受体显像及131I全身显像在诊断甲状腺癌转移灶灵敏性、特异性、准确性的差异。结果:实验组99mTc-depreotide肿瘤受体显像和131I全身显像T/NT比值分别为4.45±0.44和2.14±0.51;对照组T/NT比值分别为1.13±0.21和1.42±0.16。两种方法的灵敏性、特异性、准确性分别为95.45%、50.00%、87.04%和81.82%、80.00%、81.48%。结论:99mTc-depreotide肿瘤受体显像可提高诊断分化型甲癌转移灶灵敏性,但特异性低于131I全身显像,99mTc-depreotide肿瘤受体显像可作为Tg、131I全身显像等分化型甲癌随访常规方法的有效补充。     

促甲状腺激素受体mRNA联合99mTc-MIBI显像诊断甲状腺结节良恶性的价值

摘 要：［目的］ 探讨促甲状腺激素受体(thyroid-stimulating hormone receptor,TSHR)mRNA联合99mTc-MIBI显像诊断良恶性甲状腺结节的价值。［方法］ 对55例99mTcO4-显像示为“冷”或 “凉”结节的患者行99mTc-MIBI亲肿瘤显像,同时采集其肘静脉血,利用荧光实时定量逆转录聚合酶链式反应（RT-PCR）检测其外周循环血中TSHR mRNA表达水平。两种检查方法联合分析并与患者术后病理结果比较。分别计算以上2种方法联合应用对诊断甲状腺结节的敏感性、特异性、准确性、阳性预测值和阴性预测值。并采用卡方检验,将联合应用后的结果分别与单一方法进行比较。［结果］ 55例患者术后病理证实23例恶性,32例良性。99mTc-MIBI显像的敏感性60.87%,特异性81.25%,准确性72.72%,阳性预测值70.00%,阴性预测值74.29%。TSHR mRNA表达水平检测敏感性73.91%,特异性87.50%,准确性81.82%,阳性预测值80.95%,阴性预测值82.35%。两种方法联合诊断良恶性甲状腺结节的敏感性95.65%,特异性81.25%,准确性87.27%,阳性预测值78.57%,阴性预测值96.30%。与99mTc-MIBI亲肿瘤显像比较,两种方法合用敏感性显著高于99mTc-MIBI亲肿瘤显像（P=0.047）,差异具有统计学意义,准确性高于99mTc-MIBI亲肿瘤显像单一应用,但差异无统计学意义（P>0.05）。［结论］ TSHR mRNA检测与99mTc-MIBI亲肿瘤显像联合应用能够更准确判断甲状腺结节的性质,指导临床治疗方案确定。     

99Tcm-MIBI脑显像对脑胶质瘤恶性程度的诊断及对预后的预测

背景与目的:判断胶质细胞瘤恶性程度对制订治疗方案、评估预后具有重要意义.传统的影像学诊断方法如CT、MRI对胶质瘤的分级仅限于提供解剖信息,有时难以明确诊断.立体定向活检为有创性检查,仅能反映局部病理变化,而且标本采集误差会使肿瘤分级不准确.18F-FDG PET显像可直接反映肿瘤的葡萄糖代谢率,被认为是最有价值的方法,但因费用昂贵目前尚不能广泛应用.本研究通过99Tcm-MIBI脑肿瘤显像,测定不同病理类型胶质瘤对99Tcm-MIBI的摄取,以探讨其对胶质瘤恶性程度诊断及预测预后的价值.方法:回顾性分析进行99Tcm-MIBI脑显像的52例胶质瘤患者及15例对照者的临床资料.计算99Tcm-MIBI脑SPECT诊断脑胶质瘤的敏感性、特异性、准确率.采用t检验比较病灶T/N比值在不同病理类型组间的差异.随访患者生存率,将患者按T/N比值在不同区间分组,平均生存期(MST)在不同T/N比值组间的比较采用t检验.结果:99Tcm-MIBI显像发现44例阳性,2例假阳性.诊断敏感性为84.6%(44/52),特异性为86.7%(13/15),准确率为85.1%.早期显像及延迟显像中,Ⅰ级星形细胞瘤与Ⅱ级之间以及室管膜瘤与少突胶质细胞瘤之间,T/N比值未见显著性差异.其它任意两组进行比较,随胶质瘤恶性程度增高,T/N比值显著提高(P＜0.001).T/N比值越高,患者MST越短.T/N比值1.2～2.0组MST显著高于T/N比值大于或等于4.1组(t=5.412,P＜0.001)和T/N比值为3.1～4.0组(t=4.418,P＜0.001);T/N比值2.1～3.0组MST亦显著高于大于或等于4.1组(t=3.382,P＜0.005)和T/N比值为3.1～4.0组(t=2.389,P＜0.05).T/N比值1.2～2.0组与2.1～3.0组之间以及3.1～4.0与大于或等于4.1组之间MST无显著性差异(P＞0.05).结论:99Tcm-MIBI脑显像对胶质瘤的诊断和恶性程度的鉴别有一定价值.密切监测残留病灶摄取强度的变化,可判断肿瘤的生物学行为,为预测预后提供帮助.     

99mTc-MIBI SPECT/CT同机融合显像联合血清CEA对肺占位病变的诊断价值

目的:探讨99mTc-MIBI SPECT/CT同机融合显像联合血清CEA检测对肺占位病变诊断的临床价值。方法:对56例疑是肺占位病变的患者行99mTc-MIBI SPECT/CT同机融合显像与血清CEA检查,分别计算出以上两种方法以及联合应用在诊断肺占位病变的灵敏度、特异性、准确性。结果:两种方法联合使用与单用99mTc-MIBI SPECT/CT同机融合显像相比,灵敏度比较差异有统计学意义(P<0.05),而特异度比较差异无统计学意义。两种方法联合使用与血清CEA相比,灵敏度比较差异有统计学意义(P<0.05),而特异度比较差异无统计学意义。结论:99mTc-MIBI SPECT/CT同机融合显像联合血清CEA在肺占位病变诊断中具有重要诊断价值。     

99mTcO4-与99mTc-MIBI显像联合彩色多普勒超声评分法对甲状腺结节良恶性的诊断价值

背景与目的：目前,彩色多普勒超声评分和核素显像是诊断甲状腺结节的两种重要影像学手段,但是二者检查原理不同,对临床诊断价值孰优,抑或二者联合诊断效果会更好,目前尚无定论。该研究旨在评价99mTcO4-与99mTc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)显像联合彩色多普勒超声评分法对甲状腺结节良恶性的诊断价值。方法：对50例甲状腺结节患者共54个结节作回顾性研究,患者均已行常规彩色多普勒超声检查及99mTcO4-与99mTc-MIBI显像,以手术病理检查结果为“金标准”,比较99mTcO4-与99mTc-MIBI显像联合常规彩色多普勒超声评分法鉴别甲状腺结节良恶性的诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值。结果：99mTcO4-与99mTc-MIBI显像诊断甲状腺结节的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为80.00%(16/20个)、70.59%(24/34个)、74.07%(40/54个)、61.54%(16/26个)、85.71%(24/28个),常规彩色多普勒超声评分法为80.00%(16/20个)、88.24%(30/34个)、85.16%(46/54个)、80.00%(16/20个)、88.24%(30/34个),两种影像学方法结合诊断为100.00%(20/20个)、64.71%(22/34个)、77.78%(42/54个)、62.50%(20/32个)、100.00%(22/22个)。两种影像学方法结合诊断灵敏度高于单独超声评分法或单独核医学检查(100.00%与80.0%、100.00%与80.00%,χ2=4.4444、4.4444,P=0.0350、0.0350),单独超声评分法诊断特异度高于两种影像学方法结合(88.24%与64.71%,χ2=5.2308,P=0.0222),但两种影像学方法结合诊断无一例假阴性。结论：99mTcO4-与99mTc-MIBI显像联合彩色多普勒超声评分法可以从结构和功能两方面更灵敏、更全面地评价甲状腺结节良恶性,以免漏诊。     

~(99m)Tc—MIBI显像诊断甲状腺癌的临床价值

〔目的〕探讨99mTc-甲氧基异丁基异睛（MIBI）对鉴别甲状腺冷（凉）结节良恶性的临床价值。[方法］对61例99mTc-高锝酸钠（99mTcO4－）显像为冷（凉）结节的患者行99mTc-MIBI显像,〔结果〕61例全部经手术切除,获得病理结果。61例中17例为甲状腺癌,99mTc－MIBI显像15例阳性,其中6例有淋巴结转移者淋巴结均呈阳性;另外44例为甲状腺良性病变,8例假阳性。诊断的灵敏度、特异性和假阳性率分别为88.24％（15／17）、81.82％（36／44）和18.18％（8／44）。［结论］99mTc－MIBI显像对鉴别甲状腺冷（凉）给节的良恶性具有重要的临床应用价值。     

'Low dose' 99mTc-Sestamibi for radioguided surgery of primary hyperparathyroidism.

AIM: In this study, we evaluated the efficacy of low dose (99m)Tc-Sestamibi administration for radioguided parathyroid surgery in patients with primary hyperparathyroidism (PHPT). METHODS: Three hundred consecutive PHPT patients were studied between September, 1999 and July, 2003. Pre-operative work-up included (99m)Tc-pertechnetate/(99m)Tc-Sestamibi subtraction scintigraphy and high resolution ultrasonography (US). 37MBq of (99m)Tc-Sestamibi was injected i.v. in the operating suite approximately 10 min prior to the beginning of the surgical procedure for intraoperative radiolocalization; quick parathyroid hormone (QPTH) assays were performed. RESULTS: Two hundred and seven of the 211 patients selected for minimally-invasive radioguided parathyroidectomy (MIRP) were successfully treated for a solitary parathyroid adenoma (PA) through a 2-2.5 cm skin incision (mean operative time 35 min, mean hospital stay 1.2 days). In the 89 patients selected for traditional bilateral neck exploration (BNE), radioguided surgery was not as successful in the identification of the PA, especially in patients with (99m)Tc-Sestamibi-avid thyroid nodules. Nevertheless, the combination of probe and QPTH measurement was very helpful in patients with multigland disease. CONCLUSIONS: Low-dose (99m)Tc-Sestamibi administered few minutes before surgery is sufficient for MIRP in patients with high likelihood of a solitary PA and without concomitant (99m)Tc-Sestamibi-avid thyroid nodules. The combination of radioguided surgery and QPTH measurements is very useful in the early identification of unanticipated multigland disease.     

99mTc-MIBI radio-guided surgery in primary hyperparathyroidism: a prospective study of 128 patients

AIMS AND STUDY DESIGN: We investigated the role of an intraoperative gamma probe (IGP) technique in 128 patients with primary hyperparathyroidism (HPT). The patients were evaluated before surgery by 99mTc04/MIBI scintigraphy and neck ultrasound and then operated on by the same surgical team. The IGP technique consisted of the injection of a low dose (37 MBq) of 99mTc-MIBI in the operating room shortly before the start of surgery. Quick parathyroid hormone (QPTH) was routinely measured during the operation. RESULTS: In 94/97 patients (96.9%) with a preoperative diagnosis of solitary parathyroid adenoma (PA) minimally invasive radioguided surgery (MIRS) was successfully performed; in the other 3/97 patients (3.1%) conversion to bilateral neck exploration (BNE) was required because of the intraoperative diagnosis of parathyroid carcinoma in two cases and multiglandular disease (MGD) in one. MIRS was successfully performed also in 23 patients who had undergone previous thyroid or parathyroid surgery. In 31 patients with a preoperative diagnosis of MGD (n = 5) or concomitant nodular goiter (n = 26) the IGP technique was used during a bilateral neck exploration. Among these patients IGP was useful in localizing an ectopic parathyroid gland in the thymus in one case of MGD and a PA located deep in the neck (n = 2) or ectopic at the carotid bifurcation (n = 1) in three cases with nodular goiter. However, in several other patients with nodular goiter it was difficult for the probe to distinguish intraoperatively between thyroid nodules and PA located close to the thyroid gland. CONCLUSIONS: It can be concluded that a) in primary HPT patients with a high likelihood (according to scintigraphic and ultrasound findings) of being affected by a single PA and with a normal thyroid gland, the IGP technique appears useful in MIRS; b) a 99mTc-MIBI dose as low as 37 MBq appears to be adequate to perform MIRS; c) the measurement of QPTH is strongly recommended in HPT patients selected for MIRS to confirm the radicality of parathyroidectomy; d) MIRS can be useful also in HPT patients who underwent previous parathyroid or thyroid surgery to limit the surgical trauma of reoperation and minimize complications; e) with the exception of PAs located at ectopic sites or deep in the neck, the IGP technique does not seem to be recommendable in HPT patients with concomitant nodular goiter.     

The single palpable thyroid nodule: evaluation by 99mTc-pertechnetate imaging.

The role of 99mTc-pertechnetate thyroid imaging in the preoperative assessment of patients with single palpable thyroid nodules was evaluated. The frequency of cancer in hypofunctional nodules was similar to that found in previous studies with 131I. The 99mTc-pertechnetate image allowed a reliable separation of pathologically uninodular thyroids from those that were multinodular, and demonstrated multiple thyroid lesions that had not been detected by physical examination in over one-third of the cases. The frequency of cancer in thyroids containing a solitary or dominant hypofunctional nodule was higher (17%) than that in thyroids with a multinodular scan appearance (less than 5%).     

The role of technetium-99m methoxyisobutyl isonitrile scintigraphy in suspected recurrent breast cancer

The aim of this study was to determine the role of technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI) scintigraphy in the evaluation of recurrence and metastases in breast cancer patients with mastectomy and/or radiotherapy. A prospective study was designed to assess the accuracy of 99mTc-MIBI scintigraphy in 36 patients (mean age 49 years) with suspected recurrent breast cancer. The scintigraphic studies were correlated with radiological findings and/or with histopathology. At 10-15 min after 740MBq 99mTc-MIBI injection, standard planar images were obtained in prone lateral and anterior supine views and then single-photon emission computed tomography (SPECT) imaging was performed. A whole body imaging was also performed to demonstrate distant metastatic lesions. Totally 52 lesions were evaluated which 19 of them in 9 patients were malignant, while 33 lesions in 27 patients were benign. The sensitivity was 33%, 88% and the specificity was 96%, 93% for planar and SPECT imaging, respectively in loco-regional lesions. Overall, the sensitivity and the specificity of MIBI imaging including whole body were 89%, 81%, in other conventional radiological imaging methods were 95%, 65%, respectively. 99mTc-MIBI scintigraphy using SPECT imaging may provide useful complementary information in patients with suspected recurrence breast cancer.