缺血性脑白质疏松症患者血浆同型半胱氨酸、血清叶酸及维生素B12水平的变化

目的 通过测定缺血性脑白质疏松症(LA)患者的血浆同型半胱氨酸(Hcy)、血清叶酸、维生素B12水平,探讨其与缺血性LA发生发展的相关性及临床意义.方法 选择CT或(和)MRI证实的缺血性LA患者100例,测定其空腹血浆总Hcy、血清叶酸及维生素B12水平,结果与对照组比较.结果 缺血性LA患者血浆Hcy水平明显升高,血清叶酸、维生素B12水平降低,与对照组相比差异显著(P＜0.001).Hcy与叶酸、维生素B12水平呈负相关(r=-0.52,r=-0.46,P＜0.001).结论 血浆Hcy的升高,血清叶酸、维生素B12的降低与缺血性LA的发生发展有关.     

老年脑白质疏松与血清同型半胱氨酸水平关系的临床研究

目的探讨血浆同型半胱氨酸(Hcy)与老年脑白质疏松症(LA)的相关性,了解脑白质疏松症的危险因素。方法 182例老年患者根据CT/MRI结果按有无脑白质疏松,分为LA组95例和非LA组87例,采用循环酶法对两组患者血浆Hcy的浓度进行测定。结果 LA组Hcy浓度(21.13±4.62)μmol/L明显高于非LA组(15.36±4.58)μmol/L,两组比较差异有统计学意义(P<0.01)。结论血清同型半胱氨酸水平与老年脑白质疏松关系密切,高同型半胱氨酸血症(Hhcy)是脑白质疏松症的一个独立危险因素。     

腹部淋巴管瘤的CT及MR表现

目的 探讨腹部淋巴管瘤(lymphangioma,LA)的CT及MRI诊断价值.资料与方法 回顾性分析5例经病理证实的腹部LA的CT及MRI表现.结果 5例中肠系膜3例.腹膜后2例,表现为跨区、沿组织间隙适形性生长的囊袋状病灶,壁薄、光滑,囊及囊壁无明显强化.1例见肠系膜血管征伴周缘多发滋养血管.结论 CT及MRI对腹部LA的诊断具有重要价值,联合应用有助于提高其诊断准确性.     

脑血管腔内碘对比剂浓度对脑血管CT血管成像图像质量的影响

目的探讨脑血管腔内不同碘对比剂浓度对脑血管 CT 血管成像(CTA)图像质量的影响,以确定使血管显示最佳的 CT 值阈值.资料与方法连续测量60例 CTA 病例左侧颈内动脉入颅前段(LEICA)、左侧大脑中动脉 M1段(LM1)、左侧大脑前动脉A2段(LA2)、左侧椎动脉颅内段(LIVA)、基底动脉(BA)血管腔内 CT 值,头颈部 CTA 加测左侧颈外动脉(LECA)CT 值,观察段血管发生病变时测量对侧,评价常规与减影 CTA 血管重建图像质量.结果常规与减影 CTA 图像中,优、良、差组患者年龄差异无统计学意义(P>0.05).LEICA、BA、LIVA 及 LECA 常规与减影 CTA 图像以及 LM1常规 CTA 图像优、良组与差组 CT 值差异有统计学意义(P<0.017),优组与良组差异无统计学意义(P>0.017).LM1减影 CTA 图像及 LA2常规与减影 CTA 图像优、良、差组两两比较,各组间 CT 值差异均有统计学意义(P<0.017).LM1减影 CTA 图像及 LA2常规与减影 CTA 图像中最佳图像显示的 CT 值阈值分别为(506±89)Hu、(460±67)Hu、(436±60)Hu.结论随着脑血管腔内碘对比剂浓度增高,血管强化程度增强,有利于提高脑血管 CTA 的图像质量.     

心房颤动与脑白质疏松症的关系

目的：探讨心房颤动与脑白质疏松症（LA）的关系。方法：选择186例老年LA患者,并按1：1配对的病例对照研究,对其相关因素如：有无心房颤动,高血压病,心肌梗塞,左室肥厚,既往缺血性脑血管病史等进行调查。结果：在单因素分析中,心房颤动在LA组的发病率显著高于无LA组（14．0％及7．0％,P＝0．028）,在多因素Logistic回归分析中,经高血压病,缺血性脑血管病及左室肥厚等因素调整后心房颤动仍与老年LA显著相关（OR＝2．29;95％可信区间1．06－4．57,P＝0．035）。结论：心房颤动可能为老年LA独立的危险因素。     

心脏CT评估导管消融前房颤病人的肺静脉和左心房解剖变异

正摘要目的通过心脏CT在射频消融术前获得房颤(AF)病人的肺静脉(PV)和左心房(LA)路径图。方法 1 420例受试者行心脏CT检查以获得准确的解剖学信息,包括710例     

红细胞分布宽度、血小板计数与乳酸水平对慢加急性肝衰竭患者经血浆置换治疗预后评估价值

目的探讨红细胞分布宽度(RDW)、血小板计数(PLT)与乳酸(LA)对慢加急性肝衰竭(ACLF)患者经血浆置换治疗的预后评估价值。方法回顾性分析自2015年1月至2018年6月收治的确诊为ACLF的90例患者的临床资料。根据治疗结果将患者分为病死组(n=35)与存活组(n=55),比较两组患者的RDW、PLT及LA水平。对存活组患者进行6个月随访,通过受试者工作特征曲线(ROC)评估RDW、PLT及LA对ACLF患者接受血浆置换治疗后短期死亡的预测价值,采用Kaplan-Meier法、对数秩和检验进行生存分析。结果病死组患者RDW、LA水平高于存活组,PLT低于存活组,差异有统计学意义(P<0.05)。RDW、PLT及LA水平预测ACLF接受血浆置换治疗后短期死亡的曲线下面积分别为0.859(95%可信区间:0.775～0.908,P<0.05)、0.833(95%可信区间:0.704～0.888,P<0.05)、0.642(95%可信区间:0.500～0.778,P<0.05),对应的敏感度分别为77.9%、78.3%、63.8%,特异性分别为84.6%、83.2%、74.7%。联合三项指标的曲线下面积为0.903(95%可信区间:0.800～0.944,P<0.05),敏感度为85.5%,特异性为70.3%。生存分析结果表明,与低RDW组、高PLT组及低LA水平组比较,高RDW组、低PLT组及高LA组患者的存活率显著降低,生存时间显著缩短。结论 RDW、PLT及LA对ACLF患者接受血浆置换治疗后的短期死亡及长期预后均有较高的预测价值,且三者联合应用的预测效果优于单一指标应用。     

64排螺旋CT仿真内窥镜对脑血管疾病的诊断

目的 探讨64 排螺旋CT仿真内窥镜(CTVE)在脑血管病中的诊断价值.方法 44 例脑血管病行64 排螺旋CT血管成像(CTA)扫描后,应用CTVE进行血管腔内、外重建,并与容积再现(VR)比较.结果 44 例脑血管病中,11例12 枚动脉瘤、3 例动静脉畸形、30 例动脉狭窄或闭塞(烟雾病6 例,动脉硬化24 例),血管内CTVE均显示病变血管腔大小、形态及内壁变化.44例血管外CTVE与VR诊断结果一致.结论 64 排螺旋CT仿真内窥镜可直观地显示脑血管病变的腔内、外情况,是脑CTA其他三维重建技术的补充.     

维持性透析患者脑白质变性的高危因素及3.0TMRI弥散功能成像的评估价值

目的探讨维持性透析患者脑白质变性(leukoaraiosis,LA)的高危因素以及3.0TMRI弥散功能成像的评估价值。方法 75例发生LA的透析患者作为LA组,43例未发生LA的患者作为非LA组,对两组患者的一般情况、生化指标进行统计学比较,有统计学差异的数据进行Logistic回归分析,找出发生LA的独立高危因素。对LA组患者进行MRI颅脑常规扫描、DWI、DTI扫描,借鉴ARWMC分级标准,分为Ⅰ~Ⅲ级,各级别LA患者独立高危因素间进行统计学分析,有统计学差异的高危因素与LA组患者主要脑叶的ADC值、FA值进行pearson相关性分析。结果维持性透析患者发生LA的独立因素为年龄、透析时长、胱抑素C水平。各级别LA患者的年龄、透析时长相互间存在统计学差异(P0.05),Ⅰ级LA患者胱抑素C水平与Ⅱ、Ⅲ级LA患者存在统计学差异(P0.05)。LA组患者双侧额顶枕叶脑白质ADC值、FA值分别与年龄、透析时长存在着正、负线性相关(P0.05)。结论维持性透析患者发生LA的独立因素为年龄、透析时长、胱抑素C水平,弥散功能成像可客观、敏感、数据化的反映LA的特点及程度,并与独立高危因素水平的表现存在协同性。     

可疑及局部晚期胰腺癌FOLFIRINOX新辅助化疗后的CT评估

正摘要目的探讨可疑可切除性(BR)及局部晚期(LA)胰腺癌二次手术后FOLFIRINOX(5-氟尿嘧啶/亚叶酸钙/伊立替康/奥沙利铂)新辅助化疗后CT解剖变化与预测可切除性     

Acetazolamide induced myocardial ischemia in patients with severe coronary artery disease

Acetazolamide (ACZ)-augmented brain SPECT is commonly used for evaluating cerebral vascular reserve in patients with cerebrovascular disease. ACZ may cause myocardial ischemia in patients with coronary artery disease. To evaluate the risk of induction of myocardial ischemia with ACZ-augmented myocardial SPECT, we performed combined ACZ-augmented Tl-201 myocardial SPECT (ACZ-myo SPECT) with Tc-99m HMPAO brain SPECT in patients with severe coronary artery disease.Methods: Nine patients underwent combined ACZ-myo SPECT with Tc-99m HMPAO brain SPECT. (1) For qualitative analysis, SPECT images were divided into 13 segments to calculate the total defect scores. (2) Six ROIs were placed on the slices in the myocardial SPECT short-axis images and the regional uptake ratio was obtained as the ratio of the mean counts in the myocardium to the maximal count in the slice. The total defect score and regional uptake ratio of ACZ-myo SPECT were compared with those of early and delayed dipyridamole T1-201 myocardial SPECT (DP-T1 SPECT) images.Results: (1) In the 21 coronary artery territories with coronary stenosis ≧ 75%, the total defect score in ACZ-myo SPECT, early and delayed DP-T1 SPECT images were 3.52 ± 4.14*, 4.19 ± 4.65* and 2.25 ± 3.34, respectively (*: p < 0.05 vs. delayed DP-Tl SPECT images). (2) In 44 of 54 ROIs with coronary stenosis ≧75%, the regional uptake ratio of ACZ-myo SPECT, early and delayed DP-Tl SPECT images were 0.670 ± 0.166**, 0.677 ± 0.194**, 0.721 ± 0.178, respectively (**: p < 0.01 vs. delayed DP-Tl SPECT images). Systolic blood pressure fell at 11 min after ACZ infusion without electrocardiographic ST-T changes or chest pain.Conclusion: As ACZ has the potential to cause myocardial ischemia, ACZ-augmented brain SPECT should be performed with caution in patients with severe coronary artery disease associated with cerebrovascular disease.     

Tumour-like thallium-201 accumulation in brain infarcts,an unexpected finding on single-photon emission tomography

Thallium-201 brain single-photon emission tomography (²⁰¹Tl-SPET) is widely used to detect viable tumour tissue with increased metabolic activity. When reperfusion takes place early in cerebrovascular lesions of embolic origin, the presence of tissue areas with increased regional blood flow and preserved metabolic activity can also be assumed. In the present study our purpose was to investigate whether or not foci of ²⁰¹Tl accumulation occur in reperfused areas with sustained morphological integrity indicated by computed tomography (CT) scans not showing hypodensity in the acute or subacute period.In 16 stroke patients with possible cortical embolic infarction, dual ²⁰¹Tl and technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO) SPET was performed in both the acute and the subacute period. ^99mTc-HMPAO SPET was performed to detect reperfusion. Follow-up CT scans from the same period were also available. In five cases ^99mTc-HMPAO SPET ruled out reperfusion and ²⁰¹Tl SPET was also negative. In four cases ^99mTc-HMPAO studies indicated reperfusion early in the acute phase (24–72 h), and comparative CT, without showing hypodensity in the acute or subacute period, also favoured the possibility of sustained metabolic activity. In these cases ²⁰¹Tl SPET was negative in both the acute and the subacute period. In seven cases CT already showed necrosis in ^99mTc-HMPAO hypoperfused areas in the acute period, with negative results on corresponding ²⁰¹Tl SPET. Later reperfusion occurred in the subacute period (8–14 days) as indicated by ^99mTc-HMPAO SPET, at which time an unexpected focal accumulation of ²⁰¹Tl was detected. We cannot give any explanation for the findings, but further studies might clarify the matter and improve our knowledge of the precise mechanism of ²⁰¹Tl uptake under different conditions. Until then the phenomenon should be borne in mind as a possible pitfall when assessing tissue viability.     

Follow-up study of postoperative patients with thyroid cancer by thallium-201 scintigraphy and serum thyroglobulin measurement

The utility of 201TI scintigraphy and thyroglobulin measurement in the follow-up observation of postoperative patients with thyroid cancer was evaluated. Thallium-201 scintigraphy was performed in 149 postoperative patients with thyroid cancer. Serum thyroglobulin concentration was concomitantly evaluated in 86 patients. Among 55 patients with positive 201TI scans, 51 patients (92.7%) had recurrent diseases, while 80 of 94 patients (85.1%) with negative scans were free of disease. Twenty-five of 28 patients (89.3%) with elevated thyroglobulin levels were recurrent and 43 of 58 patients (74.1%) with normal thyroglobulin level had no recurrence nor metastasis. All 19 patients with positive 201TI scans and elevated thyroglobulin level had recurrent lesions. Seven of 10 patients with negative 201TI scans and elevated thyroglobulin level showed the presence of metastasis. By concomitant measurement of serum thyroglobulin, more than half of the recurrent patients with negative 201TI scintigraphy were detected. Both 201TI scintigraphy and serum thyroglobulin measurement should be undertaken in the follow-up evaluation of postoperative patients with thyroid cancer.     

Clinical validation of simultaneous dual-isotope myocardial scintigraphy

Simultaneous dual-isotope (rest thallium-201/stress technetium-99m sestamibi) myocardial single-photon emission tomography (SPET) would be an ideal procedure; however, (99m)Tc cross-talk on the (201)Tl window hampers its routine use. Photon energy recovery (PER) is a spectral deconvolution technique validated for scatter and cross-talk removal in phantom studies and a limited series of patients. In this study we aimed to validate the technique in 295 patients within a context of clinical routine practice. Conventional separate rest (201)Tl myocardial SPET data sets were visually compared with simultaneous dual-isotope data sets corrected by PER. Conventional separate rest (201)Tl data sets were identical to dual PER-corrected (201)Tl data sets in 173 (58.6%) patients. As dual PER (201)Tl data sets are corrected for (99m)Tc cross-talk but also for (201)Tl scatter, they were compared with separate rest (201)Tl data sets corrected by PER in the 122 discordant patients. No difference was found in 77 (26.1%) patients. In 26 (8.8%) patients, the difference consisted in the presence of a defect on dual PER (201)Tl data sets only, mirroring an ischaemic defect on (99m)Tc-sestamibi data sets. This difference can be attributed to the influence of stress on the kinetics of (201)Tl injected at rest. In the remaining 19 (6.4%) patients, the difference between separate and simultaneous PER-corrected data sets was scored as mild in 11 and moderate in eight patients and seemed to be related to multiple methodological factors. It is concluded that PER correctly removes (99m)Tc cross-talk. With the addition of an appropriate attenuation correction, the PER technique may allow the routine use of simultaneous dual-isotope myocardial scintigraphy in the near future.     

Thallium-201 lung uptake in patients with chronic phase of myocardial infarction

To study pathophysiological significance of Tl-201 lung uptake in coronary artery disease Tl-201 lung uptake was studied in 159 patients with chronic phase of myocardial infarction. Tl-201 lung uptake images were collected after rest Tl-201 myocardial imaging. Tl-201 lung uptake was estimated by comparing maximal lung counts with maximal myocardial counts (thallium lung heart ratio: LHR). Good correlation between LHR and mean pulmonary artery wedge pressure (mPw) and between LHR and left ventricular ejection fraction (EF) were obtained, (mPw = 2.7 +/- 10.5 LHR r = 0.52 n = 102, p less than 0.001, EF = 84.9-52.2 LHR r = -0.61 n = 159, p less than 0.001). It was noted that Tl-201 did not accumulate uniformly through the lung field and usually maximal Tl-201 lung uptake was noted at the basal zone of the right lung. Tl-201 lung uptake in the upper zone of the right lung increased in proportion to the hemodynamic deterioration. Interesting differences were noted between Tl-201 lung uptake in patients with chronic phase of myocardial infarction and that in patients with acute phase of myocardial infarction. The prognosis and clinical status of patients with markedly increased Tl-201 lung uptake (LHR greater than 0.8) in chronic phase were more excellent than the patients with similar Tl-201 lung uptake in acute phase. Hemodynamic parameters in patients with markedly increased Tl-201 lung uptake (LHR greater than or equal to 0.8) in chronic phase were significantly better than in those in acute phase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thallium-201 single-photon emission tomography in the treatment follow-up of nasopharyngeal carcinoma

In order to assess the usefulness of thallium-201 single-photon emission tomography (SPET) in the treatment follow-up of nasopharyngeal carcinoma (NPC), a total of 75²⁰¹Tl SPET studies were performed in 18 patients with histologically proven NPC. The findings were compared with those of magnetic resonance imaging (MRI) before and after therapy. Four patients received radiotherapy alone while the other 14 received concurrent chemo-radiotherapy. Treatment response was classified as complete (CR) or partial (PR) based on the findings of MRI and²⁰¹Tl SPET. Intense²⁰¹Tl uptake by the tumour was seen in all 18 patients before treatment. After treatment, MRI showed seven CRs and 11 PRs, whereas²⁰¹Tl SPET showed 13 CRs and five PRs. In 12 patients, the results of²⁰¹Tl SPET were in agreement with those of MRI. In six patients MRI showed PR but²⁰¹Tl showed CR. Follow-up (mean 10.6 months) MRI and²⁰¹Tl SPET studies of these six patients revealed that tumour gradually decreased and finally vanished in three patients. This preliminary study indicates that²⁰¹Tl SPET has potential in the assessment of early response to treatment of patients with NPC when compared with MRI.     

Differentiation of prostate cancer and benign prostatic hyperplasia: the clinical value of<Superscript>201</Superscript>Tl SPECT—A pilot study

PURPOSE: Thallium-201 (201Tl) is a recognized tumor-imaging agent; however, the usefulness of 201Tl in prostate cancer has not been studied. The purpose of this preliminary study was to evaluate the efficacy of 201Tl single-photon emission computed tomography (SPECT) imaging for differentiating prostate cancer from benign prostatic hyperplasia (BPH). METHODS: 201Tl pelvic SPECT was performed in 10 patients (aged 64-78 years) with biopsy-proven BPH before transurethral resection of the prostate and 15 patients (aged 65-81 years) with biopsy-proven prostate cancer prior to any therapeutic modality or invasive surgical procedures for treatment of their prostate cancer. RESULTS: From the 15 patients with prostate cancer, 201Tl pelvic SPECT detected prostate cancer in 13 (86.7%) but not in 2 (13.3%) patients with Gleason scores of 5 (2 + 3). In contrast, all 10 patients with BPH (100.0%) had negative results of 201Tl pelvic SPECT. CONCLUSION: Our study showed that 201Tl pelvic SPECT scan is very helpful in distinguishing between prostate cancer and BPH.     

双核素心肌显像检测存活心肌的对比研究

目的 对比多巴酚丁胺负荷201Tl/静息99Tcm-甲氧基异丁基异腈(MIBI)双核素同步心肌断层显像及多巴酚丁胺负荷-再分布/再注射201Tl心肌断层显像法检测存活心肌的作用.方法 对160例临床怀疑有冠心病的患者予静息状态下静脉注射740 MBq99Tcm-MIBI,休息15 min后进行多巴酚丁胺负荷试验,在达到终止指标时静脉注射111 MSq201TICI.注射后观察5-lO min,分别行早期(10 min)、延迟(3 h)99Tcm-MIBI和201Tl双核素同步心肌断层显像.对早期负荷201Tl图像发现放射性缺损,延迟再分布201Tl和静息99Tcm-MIBI图像未见放射性填充的患者再注射37 MBq201TICI,30min后行再注射心肌灌注显像.负荷枷201Tl图像示放射性缺损,静息99Tcm-MIBI、再分布201Tl及再注射201Tl图像中发现任何一种放射性填充者均为存活心肌.断层显像后2周内全部患者进行了冠状动脉造影.采用SAS 6.12软件进行x2检验.结果 (1) 160例患者冠状动脉造影均发现冠状动脉狭窄.其中单支病变76例、双支病变5l例、三支病变33例.(2)152例多巴酚丁胺负荷201Tl图像发现放射性缺损的患者中,63例201Tl再分布和静息99Tcm-MIBI图像均发现放射性填充,5例201Tl再分布发现放射性填充而静息99Tcm-MIBI图像未见放射性填充,9例静息99Tcm-MIBI图像发现放射性填充而2001Tl再分布未见放射性填允,75例201Tl再分布和静息99Tcm-MIBI图像均未发现放射性填充,负荷201Tl-延迟再分布显像(66.0%,68/103)和负荷201Tl/静息99Tcm-MIBI显像(69.9%,72/103)鉴别存活心肌的灵敏度差异无统计学意义(x2=O.36,P>0.05).(3)75例201Tl再分布和静息99Tcm-MIBI图像均未发现放射性填充患者中,再注射201Tl显像后有26例放射性填充,再注射201Tl显像较单纯201Tl再分布或静息99Tcm-MIBI显像多检测出34.7%(26/75)患者有存活心肌.(4)8例多巴酚丁胺负荷201Tl、201Tl再分布图像和静息99Tcm-MIBI图像均未发现放射性稀疏,为假阴性,其中3例为三支冠状动脉病变,1例为双支冠状动脉病变(狭窄分别为90%及60%),3例为单支冠状动脉病变(狭窄<75%2例,85%1例),1例冠状动脉闭塞后有充分的侧枝循环.结论 多巴酚丁胺负荷-再分布/再注射201Tl心肌断层显像鉴别存活心肌优于多巴酚丁胺负荷201Tl/静息99Tcm-MIBI双核素同步心肌断层显像,是一种有效、无创的鉴别存活心肌的方法.     

Fixed defect on rest/stress Tc-99m sestamibi study underestimates myocardial ischemia: comparison with 24-hour thallium-201 study for short- and intermediate-term follow-up

PURPOSE: We assessed whether a same day rest/stress gated Tc-99m sestamibi (MIBI) SPECT myocardial study underestimates reversible ischemia in patients with fixed perfusion defects compared with a 24-hour thallium-201 (Tl-201) study. The short- and intermediate-term outcome with or without Tl-201 reversibility was assessed. METHODS: Forty-nine consecutive patients with fixed MIBI defects received an additional Tl-201 study and were evaluated. Tl-201 was given to patients with a high clinical suspicion of underestimation of reversibility. Images were interpreted semiquantitatively by 3 nuclear medicine physicians using a 17-segment, 5-point model. A summed stress score (SSS) from stress MIBI images, a summed rest score (SRS) from Tl images, and a summed difference (SDS = SSS - SRS) score were calculated. SDS >3 indicated significant Tl-201 redistribution. Composite end points included acute myocardial infarction, unstable angina needing admission, cardiac death, or revascularization within 3 and 6 months. RESULTS: Fifteen of 49 patients showed no Tl-201 redistribution. Thirty-four of 49 (69%) patients had significant Tl-201 redistribution, and these patients had significantly higher cardiac events (CE) at 3 months (29% vs. 7%; P = 0.039), and higher at 6 months (32% vs. 7%; P = 0.027). These patients with CE had a larger amount of Tl-201 redistribution, mean SDS 8.6 vs. 5.3 (P = 0.047). Patients with significant Tl-201 redistribution had a lower left ventricular ejection fraction (mean 37%; P = 0.001). CONCLUSION: With short- and intermediate-term follow-up, our study shows a significant association towards fixed defects on the rest/stress MIBI study underestimating CE risk when compared with a delayed Tl-201 study, especially in patients with a large amount of Tl-201 redistribution. Hence, the addition of a Tl-201 study may be useful in the management of patients with large fixed MIBI defects, especially with a depressed left ventricular ejection fraction.     

Comparative whole-body 201Tl and bone scintigraphies for the detection of bone marrow involvement in multiple myeloma

The objectives of this study were to investigate the role of whole-body 201Tl-chloride scintigraphy in comparison with bone scintigraphy in the detection of bone marrow involvement in patients with multiple myeloma and to assess the follow-up evaluation using 201Tl-chloride. Twenty-one patients with untreated multiple myeloma were evaluated. 201Tl-chloride images were acquired 10 min (early) and 2 h (delayed) after the injection of 111 MBq 201Tl-chloride. Bone images were acquired 3 h after the intravenous injection of 740 MBq 99mTc-hydroxymethylene diphosphonate (HMDP). The 201Tl-chloride scan patterns were classified as normal, diffuse (presence of bone marrow), focal (localized areas of uptake) and diffuse+focal. The bone scan patterns were classified as normal and abnormal. Eight of the 21 patients also underwent 201Tl-chloride scintigraphy after chemotherapy for the evaluation of the therapeutic response. On the early 201Tl-chloride image, two patients showed a normal, 13 a diffuse, two a focal and four a diffuse + focal pattern. On the delayed 201Tl-chloride image, nine patients showed a normal, six a diffuse, four a focal and two a diffuse + focal pattern. Bone scintigraphy showed an abnormal accumulation in only five of the 21 patients. Of the eight patients who underwent follow-up 201Tl-chloride studies, the abnormal diffuse pattern was changed to a normal pattern on post-treatment scintigraphy in three, and the degree of abnormal 201Tl-chloride accumulation decreased in comparison with the pre-treatment scan in three. These six patients were considered to be in clinical remission. In the two remaining patients, the degree of abnormal 201Tl-chloride accumulation increased in comparison with the pre-treatment scan, and they were considered to be in clinical progression. 201Tl-chloride scintigraphy is a non-invasive tool, which may be more useful than bone scintigraphy for the diagnosis of multiple myeloma, and may be helpful in the follow-up of multiple myeloma.