SPECT／CT对脊柱病变鉴别诊断的价值

目的评价SPECT／CT显像在脊柱病变鉴别诊断中的应用价值。方法对53例^99Tc^m-MDP全身骨显像脊柱呈放射性浓聚患者进行SPECT／CT显像,获得SPECT、CT及两者的融合图像。所有病灶均以病理学诊断及6个月以上的影像学随访为最终诊断结果,计算SPECT／CT融合图像的诊断效能。结果SPECT／CT骨显像诊断骨转移肿瘤的灵敏度为96．00％（24／25）,特异性为96．43％（27／28）,准确性为96．23％（51／53）,假阳性率为3．57％（1／28）,假阴性率为4．00％（1／25）,阳性预测值为96．00％（24／25）,阴性预测值为96．43％（27／28）。对脊柱浓聚灶诊断非转移性骨病变的灵敏度为96．43％（27／28）,特异性为96．00％（24／25）,准确性为96．23％（51／53）,假阳性率为4．00％（1／25）,假阴性率为3．57％（1／28）,阳性预测值为96．43％（27／28）,阴性预测值为96．00％（24／25）。结论SPECT／CT同机融合显像结合了CT的解剖定位功能与^99Tc^m-MDP骨显像的高灵敏度,可提高诊断的特异性和准确性,有助于对脊柱病变的鉴别诊断。     

SPECT/CT融合显像对乳腺癌骨转移的诊断价值

目的 评价SPECT/CT融合显像对^99Tc^m-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值.方法 对^99Tc^m-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异.结果 ①210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个（39.0％）,良性病灶112个（53.3％）,诊断准确率为92.4％（194/210）,灵敏度为94.3％,特异度为91.1％,阳性预测值为88.2％,阴性预测值为95.7％.②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9％（94/97）,肋骨最低,为83.7％（36/43）,其差异有统计学意义（χ^2=7.81,P＜0.05）.结论 SPECT/CT同机融合显像能够对^99Tc^m-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低.     

^99Tc^m—MDP SPECT结合定位CT评价鼻咽癌颅底骨侵犯

目的用^99Tc^m-亚甲基二膦酸盐（MDP）SPECT结合定位CT评价鼻咽癌（NPC）颅底骨侵犯（SBBI）。方法NPC患者44例,1周内行头颅^99Tc^m-MDP SPECT、定位CT、全身骨显像（WBI）和MRI检查,对照组10例其他部位肿瘤患者行头颅^99Tc^m-MDP SPECT结合定位CT显像。于SPECT图像矢状面,颅底放射性浓聚程度最高（L）层面与高位颈椎体（C1～C3,S）处勾画相同大小的感兴趣区（ROI）,L／S〉1提示SBBI。对计数资料行χ^2检验或Fisher精确概率检验。结果（1）对照组10例I／S=0．66±0．13。（2）根据MRI结果,SPECT结合定位CT、WBI和单独SPECT诊断SBBI的灵敏度、特异性、准确性分别为83．3％（20／24）、80．0％（16／20）、81．8％（36／44）,70．8％（17／24）、70．0％（14／20）、70．4％（31／44）和77．3％（17／22）、72．7％（16／22）、75．0％（33／44）,差异无统计学意义（χ^2=2．00,P=0．37）;SPECT结合定位CT与MRI相关[χ^2=17．65,相依系数（CC）=0．535,P〈0．05]。（3）头痛组与无头痛组SBBI阳性率分别为92．9％（13／14）与36．7％（11／30）,差异有统计学意义（χ^2=12.16,P〈0．05）,低分化鳞癌组与未分化癌组SBBI阳性率分别为50．0％（19／38）与83．3％（5／6）,差异无统计学意义（χ^2=2．69,P=0．19）。（4）SPECT结合定位CT图像除能提供准确的定位外,还能柃测部分颅底骨破坏。结论SPECT结合定位CT能有效地榆测鼻咽痛SBBI。     

SPECT和CT融合骨显像在小儿神经母细胞瘤中的应用

目的探讨SPECT和CT融合骨显像在探测小儿神经母细胞瘤（NB）转移性骨肿瘤中的临床价值。方法回顾性分析24例NB患儿,均行全身平面骨显像及局部SPECT和CT融合骨显像。将骨病灶显示的清晰度分为5级（不可见、模糊、可见、清晰、非常清晰）,良恶性诊断的确定性分为3级（不确定、可以确定、十分确定）,诊断效能指标包括灵敏度、特异性及准确性。对显像图像在骨病灶的清晰度显示、良恶性确定性诊断及探测恶性骨病灶的诊断效能方面进行分析,采用秩和检验及χ^2检验进行比较。结果24例NB患儿,全身平面骨显像发现骨病灶72个,有5个骨病灶未能显示,SPECT和CT融合显像和单独SPECT显像均分别发现骨病灶77个。对骨病灶的清晰度显示SPECT和CT融合显像,单独SPECT显像均优于平面显像（日值均为69．000,P均〈0．05）。平面显像和SPECT显像诊断恶性骨病灶的准确性分别为45．45％（35／77）和62．34％（48／77;χ^2=4．416,P〈0．05）,SPECT和CT融合诊断恶性骨病灶的灵敏度、特异性和准确性均较平面显像有提高,分别为82．35％（42／51）和53．19％（25／47）、88．46％（23／26）和40．00％（10／25）、84．42％（65／77）和45．45％（35／77）,χ^2=12．571,14．016和25．667,P均〈0．01。与SPECT显像的特异性（14／26,53．85％）和准确性（48／77,62．34％）相比,SPECT和cT融合诊断恶性骨病灶的特异性和准确性提高（χ^2=7．589,9．606,P均〈0．01）,两者间灵敏度差异无统计学意义（χ^2=2．942,P〉0．05）。SPECT和CT融合显像骨病灶良恶性的确定性诊断优于SPECT（H=28．000,P〈0．05）和平面显像（H=21．000,P〈0．05）。结论SPECT和CT融合骨显像能探测到NB患儿更多的骨病灶,是一种较好的探测NB患儿转移性骨肿瘤的显像方法。     

^99Tc^m—MIBI双时相显像定位诊断继发性甲状旁腺功能亢进症的价值

目的探讨^99Tc^m-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症（SHPT）中的临床价值。方法回顾性分析2010年至2013年间20例（男8例,女12例,平均年龄49．6岁）行甲状旁腺切除术的肾性SHPT患者影像学资料,以术后病理结果为“金标准”,计算^99Tc^m-MIBI双时相SPECT／CT显像结果与彩色多普勒超声（CDUS）对SHPT的诊断效能,同时对延迟显像中甲状旁腺摄取的最高放射性比值（T／NT）与患者近期全段PTH（iPTH）水平及术中切除的相应甲状旁腺体积的关系作分析。采用x^2检验、Pearson相关或Spearson相关分析数据。结果^99Tc^m-MIBI双时相显像和CDUS诊断SHPT的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为66．67％（44／66）、100％（14／14）、100％（44／44）、38．89％（14／36）、72．50％（58／80）和78．19％（43／55）、52．38％（11／21）、81．13％（43／53）、47．83％（11／23）、71．05％（54／76）。二者诊断SHPT的特异性和阳性预测值差异有统计学意义（x^2=9．33和9．26,均P〈0．05）,其余3个指标差异均无统计学意义（x^2=1．97、0．04和0．46,均P〉0．05）。最高T／NT与患者iPTH水平及手术切除的相应甲状旁腺体积均呈正相关（r=0．638,rs=0．571,均P〈0．05）。结论^99Tc^m-MIBISPECT／CT显像诊断SHPT的特异性高于CDUS0^99Tc^m-MIBI双时相显像可准确定位功能亢进的甲状旁腺,为手术治疗提供依据。     

99Tcm-tetrofosmin SPECT诊断肺部肿瘤的临床价值

目的：探讨99Tcm-tetrofosmin（99Tcm-TF）SPECT亲肿瘤显像诊断肺部肿瘤的临床价值。方法收集在我科进行99Tcm-TF肺亲肿瘤显像的患者41例;所有患者均在治疗前一周行胸部CT检查及99Tcm-TF SPECT肺亲肿瘤显像。对照最终结果,评价两种方法鉴别肺肿瘤病变性质的诊断效能。以肿瘤3 cm大小为界,分≥3 cm组和<3 cm组,评价99Tcm-TF SPECT显像在两组中的诊断效能。结果99Tcm-TF SPECT肺亲肿瘤显像的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为66.7%、35.7%、56.1%、66.7%和35.7%;CT肺扫描的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为92.6%、50.0%、78.0%、78.1%和77.8%。CT较99Tcm-TF SPECT的灵敏度（χ2=5.594, P<0.05）和准确率（χ2=4.473,P<0.05）高,而特异度两者间的差异无统计学意义,（χ2=0.583,P>0.05）。同时,肿瘤≥3 cm和<3 cm组中,99Tcm-TF检查肺肿瘤的灵敏度、特异度、准确率分别为78.9%、25.0%、69.6%和37.5%、40.0%、38.9%,而两组的特异度差异无统计学意义（χ2=0.28,P>0.05）,灵敏度（χ2=4.352,P<0.05）和准确率（χ2=3.858,P<0.05）有差异。结论 CT对于肺癌诊断有一定的价值,相比而言,99Tcm-TF的诊断价值有限。临床医生在行该项检查之前需经过筛选才有可能提高其临床价值。     

^18F-FDG PET／CT显像诊断妇科肿瘤复发、转移的价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像诊断妇科肿瘤复发、转移的价值,并评价其对临床再分期及治疗决策的影响。方法对47例临床可疑复发、转移的妇科肿瘤患者行^18F—FDG PET／CT显像,对PET、CT及PET／CT图像进行对比分析。采用SPSS12．0软件,对数据行∥检验、校正的,检验及确切概率法分析。结果47例患者中共发现病灶158处,其中恶性病灶149处,良性病灶9处。^18F-FDG PET／CT诊断妇科肿瘤复发、转移的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为95．97％（143／149）,6／9,94．30％（149／158）,97．95％（143／146）及50．00％（6／12）。PET／CT在诊断妇科肿瘤复发、转移的灵敏度、准确性及阴性预测值方面明显优于单纯CT（χ^2=18．198,18．890,6．825,P均〈0．05）;^18F-FDG PET／CT和单纯PET在各项诊断效能指标间差异无统计学意义（χ^2=0．632,0．000,0．459,0．000,0．150,P均〉0．05）,但PET／CT使33．54％（53／158）的单纯PET无法准确定位的病灶得到了准确定位。同单纯CT及PET相比,PET／CT分别使44．68％（21／47）和31．91％（15／47）的患者TNM分期改变,对T分期的影响最明显;共有19．15％（9／47）的患者临床分期改变,并改变相应的治疗决策。结论^18F—FDG PET／CT显像诊断妇科肿瘤复发、转移准确而全面,对临床再分期及治疗决策有重要影响。     

ROC曲线评价18F—FDGPET／CT、99Tcm—MDP骨显像及二者联合对骨转移的检出效能

目的采用ROC曲线比较18F-FDGPET／CT、99TcmMDP骨显像及二者联合对骨转移患者的检出效能。方法296例恶性肿瘤患者在2个月内同时接受了18F-FDGPET／CT和99TcmMDP骨显像,对2种显像结果按5分法（0分：骨转移阴性,1分：可能阴性,2分：不能确定,3分：可能阳性,4分：肯定阳性）分别评分,两者之和为联合评分值。以病理诊断或临床随访为确诊“金标准”,采用。检验比较ROC曲线下面积,以评价骨显像、PET／CT及联合评分法对骨转移患者的检出效能,采用r检验比较不同方法在各自最佳诊断阈值下的灵敏度、特异性、准确性、阳性预测值、阴性预测值。结果296例患者中,确诊骨转移阳性61例（占20．6％）、阴性235例（占79．4％）。骨显像、PET／CT及联合评分诊断骨转移的ROC曲线下面积（95％可信区间）分别为0．919（0．867—0．971）、0．949（0．906～0．991）、0．994（0．988～0．999）,联合评分法的曲线下面积明显大于骨显像（z=2．866,P=0．004）和PET／CT（z=2．027,P=0．043）各自单独评分法,骨显像和PET／CT法曲线下面积差异没有统计学意义（z=0．881,P=0．378）。最佳阈值点下,骨显像和PET／CT单独检出骨转移患者的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为90．2％（55／61）、85．1％（200／235）、86．1％（255／296）、61．1％（55／90）、97．1％（200／206）和88．5％（54／61）、97．0％（228／235）、95．3％（282／296）、88．5％（54／61）、97．0％（228／235）,而联合评分检出的结果分别为98．4％（60／61）、95．7％（225／235）、96．3％（285／296）、85．7％（60／70）、99．6％（225／226）。PET／CT对骨转移患者检出的特异性（X2=19．600,P〈0．001）、准确性（X2=13．755,P〈0．001）、阳性预测值（x2=13．608,P〈0．001）均高于骨显像,灵敏度（r=0,P=1．000）差异无统计学意义;与骨显像、PET／CT单独评分比较,联合评分法检出的特异性（X2=19．862,P〈0．001）、准确性（x2=23．361,P〈0．001）和阳性预测值（x2=11．791,P=0．001）均明显高于骨显像,灵敏度明显高于PET／CT（x2=4．167,P=0．031）。结论18F—FDGPET／CT对骨转移患者的检出效能优于99Tcm—MDP骨显像,二者联合明显提高了对骨转移患者的检出率。     

^99Tc^m-depreotide生长抑素受体显像在肺癌诊断中的应用

目的探讨^99Tc^m-地普奥肽（depreotide）生长抑素受体显像对肺癌的诊断价值。方法52例肺部肿瘤患者[小细胞肺癌（SCLC）8例,非小细胞肺癌（NSCLC）38例,良性结节6例]静脉注射^99Tc^m-depreotide（740±60）MBq后行平面及胸部SPECT显像,并勾画感兴趣区（ROI）,计算肿瘤和对侧正常肺组织的放射性（T／N）比值,所有病灶均经病理检查证实。采用SPSS 11.5软件,行两样本t检验。结果^99Tc^m-depreotide显像诊断52例肺癌的灵敏度、特异性、准确性分别为93．5％（43／46）、5／6和92．3％（48／52）;假阴性3例,假阳性1例。3例假阴性分别为2例鳞癌、1例腺癌,1例假阳性为炎性假瘤。SCLC和NSCLC组T／N比值分别为1．948±0．282和1．280±0．160。SCLC对^99Tc^m-depreotide的摄取明显高于NSCLC（t=0．130,P〈0．05）。结论^99Tc^m-depreotide生长抑素受体显像是一种无创、安全、有效、简便的检查方法,对肺癌尤其是SCLC有良好的诊断价值。     

核素显像心肌灌注缺损与CTCA冠状动脉不同狭窄程度的关系分析

目的通过分析核素显像心肌灌注缺损与CTCA示冠状动脉（简称冠脉）不同狭窄程度间的关系,探讨和评价CTCA预测心肌灌注缺损的诊断效能。方法回顾性分析同期行CTCA和MPI患者478例。按目测法将CTCA所示冠脉管腔狭窄程度分成无狭窄、轻度狭窄、中度狭窄、重度狭窄和管腔闭塞,将MPI结果分成灌注正常和灌注缺损,分别在病例和血管水平统计各组灌注缺损的发生率。以MPI为参考标准,将CTCA预测心肌灌注缺损的冠脉狭窄程度判定界值设为≥50％或≥75％,在病例水平和血管水平上确定该方法的诊断效能。计数资料统计分析采用χ^2检验、χ^2分割法和Fisher确切概率法。结果478例患者中58例出现MPI灌注缺损。无论按病例水平还是血管水平分析,各组灌注缺损发生率有随冠脉狭窄程度增加而升高趋势（χ^2=116．62和483．83,P均〈0．05）。在病例水平上分析,当判定界值为≥50％或≥75％时,CTCA预测心肌灌注缺损的诊断灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为62．1％（36／58）或34．5％（20／58）（χ^2=8．84,P〈0．05）、84．5％（355／420）或97．1％（408／420）（χ^2=40．16,P〈0．05）、35．6％（36／101）或62．5％（20／32）（χ^2=7．19,P〈0．05）、94．2％（355／377）或91．5％（408／446）（χ^2=2．18,P〉0．05）、81．8％（391／478）或89．5％（428／478）（χ^2=11．66,P〈0．05）;在血管水平上分析,判定界值为≥50％或≥75％时,CTCA预测心肌灌注缺损的诊断灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为58．8％（40／68）或30．9％（21／68）（χ^2=10．73,P〈0．05）、95．9％（1768／1844）或99．0％（1826／1844）（χ^2=36．72,P〈0．05）、34．5％（40／116）或53．8％（21／39）（χ^2=4．59,P〈0．05）、98．4％（1768／1796）或97．5％（1826／1873）（χ^2=4．14,P〈0．05）、94．6％（1808／1912）或96．6％（1847／1912）（χ^2=10．31,P〈0．05）。结论心肌灌注缺损的发生率随冠脉狭窄程度增加有升高趋势。CTCA预测心肌灌注缺损的诊断特异性和阴性预测值较佳。当判定界值为≥75％时,其阳性预测值较判定界值为≥50％时有明显提高。     

Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients

PURPOSE: Our purpose was to assess the clinical value and additional benefit of fusion single-photon computed tomography (SPECT) and computed tomography (CT) images in locating the parathyroids in a selected group of patients affected by primary (PHP) and secondary hyperparathyroidism (SHP). MATERIALS AND METHODS: Sixteen patients (11 women and five men; age range 35-80 years) with severe hyperparathyroidism (HP) (ten PHP, six SHP) were studied by ultrasound (US), and, after i.v. injection of 370 MBq of 99mTc-sestamibi, by planar parathyroid scintigraphy, SPECT and SPECT/CT using a dual-detector scintillation camera GE Infinia Hawkeye. All patients underwent parathyroidectomy. RESULTS: US findings were inconclusive in 12/16 patients affected by multinodular goitre, and two probable eutopic parathyroid glands were identified. "Double phase" parathyroid scintigraphy identified 14 probable parathyroid glands, SPECT 23 (14 ectopic and nine eutopic) and SPECT/CT confirmed all 23 probable parathyroid lesions, offering more precise localisation and an evident improvement in diagnostic accuracy. Sixteen of these foci of increased uptake were hyperplastic parathyroid glands, six were adenomas, one was a parathyroid carcinoma and one was a thyroid follicular carcinoma. Surgical detection of the 23 sestamibi-positive lesions was correctly matched with 100% of SPECT/CT images and 61% of SPECT data alone. Hybrid imaging thus provided additional data in 39% of lesions, and in three patients with retrotracheal glands, it modified the surgical approach. CONCLUSIONS: We believe 99mTc-sestamibi SPECT/CT to be a more reliable presurgical method to study a patient subgroup affected by PHP or SHP in whom conventional US and other scintigraphic methods have failed for intrinsic reasons due to the concomitant presence of multinodular goitre or ectopic parathyroid gland. The additional practical benefit derived from this methodology was evident. In fact, anatomical information provided by CT enables precise localisation of the functional abnormalities highlighted by SPECT, and both are essential to a correct surgical approach.     

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism

A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.     

99Tcm-MIBI甲状腺显像鉴别甲状腺结节良恶性再认识

目的评价^99Tc^m-甲氧基异丁基异腈（MIBI）甲状腺亲肿瘤显像鉴别甲状腺结节良恶性的临床价值。方法106例甲状腺结节手术患者中101例先进行了甲状腺结节常^99Tc^mO4^-显像；106例患者均静脉注射^99Tc^m-MIBI 370 MBq后进行15min早期和2h延迟显像，结果与病理检查结果对比。结果13例甲状腺恶性肿瘤中的5例、93例良性结节中的23例^99Tc^m-MIBI显像阳性。^99Tc^m-MIBI显像诊断甲状腺恶性肿瘤的灵敏度为38．5％，特异性为75．3％，准确性为70．8％。甲状腺良恶性肿瘤显像的阳性率差异无显著性（x^2=0．49，P〉0．05）。结论^99Tc^m-MIBI显像不能鉴别甲状腺结节的良恶性，其临床意义有限。     

Potential false positive Tc-99m sestamibi parathyroid study due to uptake in brown adipose tissue

We report on a 55-year-old woman with suspected primary hyperparathyroidism who underwent dual phase Tc-99m sestamibi parathyroid imaging. Symmetric, patchy activity in the neck and shoulders was localized to low attenuation areas on integrated SPECT/CT and attributed to uptake in brown adipose tissue (BAT). Focal uptake in the anterior thorax on SPECT images, which potentially may have been misinterpreted as ectopic parathyroid tissue, was demonstrated on SPECT/CT as uptake in BAT. Recognition of this pattern on parathyroid SPECT/CT scintigraphy may avoid false positive reports. Our case provides further evidence that in addition to F-18 FDG, I-123 MIBG, and Tc-99m tetrofosmin, Tc-99m sestamibi may also accumulate in BAT.     

The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia.

As SPECT/CT technology evolves, its applications and indications need to be evaluated clinically for more efficient and cost-effective use. This retrospective study evaluated the clinical value of simultaneously acquired (99m)Tc-sestamibi SPECT/CT versus conventional SPECT in diagnosing and locating parathyroid adenomas or hyperplasia in patients with primary hyperparathyroidism. METHODS: Immediately and 60 minutes after intravenous administration of 740-925 MBq of (99m)Tc-sestamibi, static planar images of the neck and chest were obtained. SPECT/CT images were acquired 30 minutes after injection. Two experienced masked readers independently evaluated whether conventional SPECT images provided information beyond what was available from the planar images either by changing the diagnosis or by better locating the glands and whether the SPECT/CT images provided information beyond what was available from the planar plus conventional SPECT images. Forty-eight consecutive patients with a clinical diagnosis of primary hyperparathyroidism were included in the study. The 32 whose scans showed positive results underwent surgical resection and were examined histopathologically. RESULTS: Planar and SPECT imaging, with or without CT fusion, identified 89% of the surgically confirmed diseased parathyroid glands. Use of SPECT/CT changed the diagnosis in only 1 patient (2%) from positive to negative and better located the glands in only 4 patients (8%). SPECT/CT was particularly helpful in locating the 2 ectopic parathyroid adenomas diagnosed in this cohort. Tracer retention in diseased glands did not correlate with histologic characteristics. Also, biochemical markers did not correlate with the scan findings. CONCLUSION: SPECT/CT has no significant clinical value additional to that of conventional SPECT for parathyroid imaging except in locating ectopic parathyroid glands. Eliminating the CT acquisition will spare patients the additional time, radiation exposure, and expense.     

放射性核素显像与常规CT对肝局灶性结节增生的诊断价值

目的分析放射性核素显像和常规CT诊断肝局灶性结节增生（FNH）的各自优势,探讨二者结合对FNH的诊断价值。方法回顾性分析32例（男15例,女17例,年龄22～59岁）FNH患者的病理及影像资料。32例患者均行常规CT（平扫及增强）检查。其中24例行放射性核素显像,在肝胶体显像时加做融合图像采集,经计算机处理后得到SPECT及定位CT的融合图像。对显像发现病灶的患者行肝胆动态显像,包括血流灌注相、早期相及延迟相。检查结果的比较采用四格表∥检验或四格表Fisher确切概率法检验。结果32例患者共切除32个病灶,均为单发。病理均为FNH,其中25个为病理经典型,7个为病理非经典型;大病灶（最大径〉3cm）20个,小病灶（最大径≤3cm）12个。32例患者常规CT检出所有病灶,确诊病理经典型FNH15个,其中大病灶10个,小病灶5个;其余病灶均误诊或诊断不明确。24例患者进行放射性核素显像,结果示大病灶11个,其中病理经典型7个,病理非经典型4个;其余病灶诊断不明确或未检出。常规CT与放射性核素显像对病理经典型病灶确诊率分别为60．0％（15／25）和38．9％（7／18）,病理非经典型为0／7和4／6;大病灶为50．O％（10／20）和73．3％（11／15）,小病灶为41．7％（5／12）和0／9;对FNH的总确诊率为46．9％（15／32）和45．8％（11／24）。24例行放射性核素显像患者同时行常规CT检查,2种方法结合共确诊FNH18个,总确诊率75．0％（18／24）。在病理非经典型、小病灶FNH的诊断方面,常规CT与放射性核素显像比较,差异有统计学意义（P=0．02,0．04）;2种方法结合对FNH的总确诊率与单种方法的确诊率比较,差异均有统计学意义（χ2=4．48和4．27,P均〈0．05）。结论常规CT与放射性核素显像对FNH的诊断各有优势;二者结合可提高对FNH的总确诊率。     

~(99)Tc~m-甲氧基异丁基异腈SPECT评价非小细胞肺癌化疗疗效

目的 探讨~(99)Tc~m-氧基异丁基异腈(~(99)Tc~m-MIBI)SPECT评估非小细胞肺癌(NSCLC)化疗疗效的价值.方法 71例NSCLC患者根据胸部CT分为化疗有效组(完全缓解+部分缓解)和无效组(病情稳定+疾病进展),于化疗前行~(99)Tc~m-MIBI SPECT,静脉注射~(99)Tc~m-MIBI 740 MBq后10～30 min及2～3 h分别行早期及延迟显像,在~(99)Tc~m-MIBI显像图上用感兴趣区(ROI)的方法勾画出病灶,然后选取镜像ROI于健侧肺的相应部位,由此分别获得早期相肿瘤,正常肺组织摄取比值(ER)和延迟相肿瘤/正常肺摄取比值(DR),并计算滞留指数(RI).采用t检验及秩和检验分析化疗有效组与化疗无效组ER、DR和RI之间的差别.结果 ~(99)Tc~m-MIBI显像结果中,化疗有效组的ER、DR分别为2.39±0.21、2.50±0.19,均显著高于化疗无效组的1.89±0.19、2.05±0.21,统计学差异有意义(t=8.311、8.480,P＜0.05).化疗有效组的RI中位值为6.63%,高于化疗无效组的5.13%,统计学差异有意义(Z=2.416,P＜0.05).结论 ~(99)Tc~m-MIBI显像在评估NSCLC化疗疗效方面具有重要的临床价值.     

Tc-99m-MIBI scintigraphy for recurrent hyperparathyroidism after total parathyroidectomy with autograft

The aim of this study is to assess the sensitivity of Tc-99m-MIBI for the pre-operative localization of hyperfunctioning parathyroid glands in patients with persistent or recurrent hyperparathyroidism (HPT) after total parathyroidectomy (PTX) with autograft. PATIENTS AND METHODS: Tc-99m-MIBI scintigraphy was performed on 7 patients (3 men and 4 women; aged 32 to 62) on hemodialysis with persistent or recurrent HPT after PTX due to secondary hyperparathyroidism. Tc-99m-MIBI of 370 MBq was injected intravenously. Double-phase planar images were acquired at 15 min and 120 min-postinjection. SPECT images of the chest in an early phase were also obtained. RESULTS: All patients underwent surgery after scintigraphy. The enlarged parathyroid grafts were removed in 4 patients. An unusual location of parathyroid hyperplasia was found in 2 patients. In one patient, the abnormal graft coexisted with an ectopic parathyroid in the mediastinal region. Tc-99m-MIBI was able to identify all hyperfunctioning parathyroids correctly (100% sensitivity). In one case, a focus of the increased uptake in SPECT was considered as a false positive. The remnant of ectopic parathyroid in the mediastinum was only detected by SPECT images. CONCLUSION: Tc-99m-MIBI parathyroid scintigraphy is useful for the pre-operative localization of persistent or recurrent HPT following total PTX with autograft.     

吸氧99Tcm-MIBI SPECT与定位CT结合对肺部病灶的鉴别诊断价值

目的 探讨吸氧99Tcm-甲氧基异丁基异腈（MIBI）SPECT与定位CT结合对肺部病灶的鉴别诊断价值,为肺部病灶的良恶性鉴别建立一种高性价比方法。方法对2008年9月至2009年3月47例可疑恶性肺部病灶患者进行前瞻性研究,对疑似炎性反应病例短期应用抗生素。所有受检者于注射99TcmMIBI前开始经鼻腔导管吸氧,注射后10min进行SPECT与CT定位融合显像,2h后进行延迟显像。对良、恶性肺部病灶（T）与对侧相应肺组织（N）的摄取比值（早期：EUR,延迟：DUR）比较应用独立样本t检验,并对EUR和DUR的诊断效率进行受试者工作特征（ROC）曲线分析。结果47例患者（32例原发性肺癌,4例肺转移,11例良性病变）共51个肺部病灶,恶性病灶39个,良性病灶12个。99TcmMIBISPECT与定位CT融合显像诊断肺部良恶性病灶的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为94．9％（37／39）、83．3％（10／12）、92．2％（47／51）、94．9％（37／39）和83．3％（10／12）。恶性病灶EUR为2．95±1．16[95％可信区间（CI）：2．57～3．32）],良性病灶EUR为1．43±0．33（95％CI：1．22～1．64）,两者差异有统计学意义（t=-4．44,P〈0．01）;恶性病灶DUR为3．19±1．74（95％CI：2．62—3．75）,良性病灶DUR为1．60±0．32（95％CI：1．39—1．81）,两者差异有统计学意义（t=-3．12,P〈0．01）。半定量ROC分析显示：以EUR≥1．625为诊断肺部恶性病灶的界值,灵敏度97．4％（38／39）,特异性83．3％（10／12）;以DUR≥1．75为诊断肺部恶性病灶的界值,灵敏度94．9％（37／39）,特异性83．3％（10／12）。结论吸氧99TcmMIBISPECT与定位CT结合显像对肺部病灶的良恶性鉴别具有较高的临床价值。