异常灌注评分法评价肺血栓栓塞症患者治疗效果的价值

目的 分析异常灌注评分法对肺血栓栓塞症（PTE）疗效的评估价值。方法 选择明确诊断为急性PTE的患者46例，在治疗前及治疗后14d行肺灌注显像，2位核医学科医师分别对肺灌注显像图进行定性分析，随后采用异常灌注评分法和Parker创建的肺段评分法进行肺灌注显像结果判读，比较两者在判读结果方面的一致性及其相关性，并比较2种方法所示的治疗后灌注改善率。结果 2位医师对左肺灌注结果判读的一致性为100％（Kappa值为1．0），对右肺灌注结果判读的一致性为91．3％（Kappa值为0．69）。治疗前后2种灌注评分结果均有较高度的一致性（Kappa值分别为0．657和0．665，P均〈0．001）。在治疗前和治疗后通过2种评分方法所计算的联合评分均呈显著正相关（r值分别为0．770和0．771，P均〈0．001）。肺灌注改善率在2种评分方法之间无显著差异（P=0．128）。结论 异常灌注评分法判读简单，是评价PTE治疗效果的较好方法。     

腮腺显像对鼻咽癌放疗后腮腺功能的评价

目的利用腮腺显像研究鼻咽癌放疗后腮腺的摄取与排泄功能.方法48例鼻咽癌患者中,对38例肿瘤和肿大淋巴结行加速调强放疗（SMART）,其亚临床灶和预防照射区接受常规照射;余10例行常规放疗.放疗前后均行腮腺显像,计算腮腺的放射性摄取指数（UI）及酸性刺激后排泌指数（EI）,对腮腺功能损伤情况进行分析;同时记录患者口干程度并分级.结果鼻咽癌SMART组放疗后腮腺UI和EI分别下降21.9%和37.3%,中重度口干者12例;而常规放疗组腮腺功能明显下降,UI和EI分别下降56.1%和96.1%,中重度口干者9例,两者比较差异均有显著性（P＜0.05）.结论腮腺显像可灵敏地监测鼻咽癌放疗后腮腺功能.     

99Tcm标记人源化抗人血小板膜糖蛋白Ⅲ a单克隆抗体SZ21F(ab)2血栓栓塞显像

目的用动物血栓栓塞模型显像评估99^Tc^m标记人源化抗人血小板膜糖蛋白（GP）Ⅲa单克隆抗体（简称单抗）F（ab）2片段SZ21F（ab）2的应用价值。方法通过体外抑制二磷酸腺苷（ADP）诱导的犬血小板聚集实验，评估SZ21F（ab）2与血小板结合的亲和性和特异性。以2-亚氨基噻吩盐酸盐（IT）法修饰SZ21F（ab）2分子的亚氨基，以99^Tc^m-葡庚糖酸钠（GH）转换络合法进行标记。分别用快速薄层层析（ITLC）法和ELISA测定标记物的放化纯及生物活性。对3条肺动脉血栓和8条（包括上述3条）后肢深静脉血栓栓塞比格犬模型进行显像研究。结果SZ21F（ab）2抑制ADP诱导的犬富含血小板血浆（PRP）聚集实验的半数有效剂量（IC50）为（2．49±1．88）μg／ml。ITLC法测得标记物的放化纯为90％～95％，ELISA测定结果表明标记后抗体保留了免疫活性。注射显像剂后1h，肺动脉血栓部位和后肢深静脉血栓部位均出现放射性浓聚。注射后3h，在体显像肺动脉血栓和后肢深静脉血栓栓塞模型的放射性靶／本底（T／B）比值分别为3．03±1．18和3．51±0.62。肺动脉血栓部位和后肢深静脉血栓部位的每克组织百分注射剂量率（％ID／g）分别为0．083％ID／g和0．076％ID／g。体外检测结果表明：肺动脉血栓与正常肺组织的单位质量放射性比值平均为12．8，后肢深静脉血栓与血液的单位质量放射性比值平均为5．2，与肌肉的比值平均为127.0。结论99^Tc^m-SZ21F（ab）2与人血小板具有较高的亲和力，有潜在的血栓显像应用前景。     

An Evaluation of Technetium-99m Tin Colloid--Its Value in the Diagnosis of Renal Transplant Rejection

The value of the Technetium-99m tin colloid (TTC) scan in thediagnosis of renal transplant rejection occurring more than1 month following transplantation was assessed. To our knowledge,use of this agent has not previously been reported. Gamma cameraimaging was performed on 15 occasions in 14 patients in whomplasma creatinine was rising and in three patients in whom renalfunction was stable. Both a qualitative and a quantitative assessmentof images was made. The radioactivity recorded over the graft at 12–16 mmpost injection was expressed as a percentage of that recordedat 0–4 min. In the nine patients in whom graft perfusionwas adequate to allow interpretation of the TTC scan and inwhom rejection was diagnosed by biopsy (six cases) or on clinicalgrounds (three cases), the index ranged from 45 to 153%. Intwo patients the graft was poorly perfused and the accumulationof TTC was predictably low despite the presence of rejection.In the seven patients with either a stable creatinine or withrising creatinine not due to rejection, the index ranged from5 to 43%. Previously reported studies have shown that sulphur colloidsmay be of value in diagnosing graft rejection. This study suggeststhat Tc99m tin colloid may be regarded as a suitable alternativescanning agent and that some simplification of data collectionand analysis can be achieved.     

Comparison of transfer and distribution of technetium and rhenium in radish plants from nutrient solution

Tracer experiments were carried out to compare the plant uptake behavior of Tc and Re from nutrient solutions. Radish plants, transplanted to nutrient solution including various tracers, showed the same uptake and distribution of ^95mTc and ¹⁸³Re. The trend was the same when the ⁹⁹Tc and stable-Re concentrations were increased in nutrient solution. The behavior of other elements was different from that of Tc and Re. These findings suggest the possible use of Re as the chemical analogue of Tc in soil solution to plant uptake experiments.     

99Tcm直接标记αvβ3受体拮抗剂环形RGD多肽

目的探讨^99Tc^m直接标记αvβ3受体配体——含2个二硫键的精氨酸-甘氨酸-天冬氨酸（RGD）-九肽（RGD-4CK）的可行性和不同标记条件对标记率的影响。方法采用预锡化法^99Tc^m直接标记RGD-4CK，3MM色谱纸层析测定^99Tc^m-RGD-4CK的雕值，计算标记率与比活度。研究各种标记条件对^99Tc^m-RGD-4CK标记率的影响。通过高效液相色谱仪（HPLC）分析，Sep-Pak C18柱层析，进行体外稳定性实验、半胱氨酸置换实验以及血清蛋白结合实验，评价^99Tc^m-RGD-4CK的放射化学性质。结果^99Tc^m-RGD-4CK在以丙酮和V（氨水）：V（乙醇）：V（水）=1：2：5为流动相中的雕值分别为0与0．8～0．9，标记率为（97．8±0．4）％，基础标记条件下的比活度为（11．90±0．05）TBq／mmol。在以下条件下放化纯均〉95％：（1）酒石酸亚锡为150～300μg；（2）预锡化反应pH值为2．0～3．5，温度60℃，保温时间6h以上；（3）^99Tc^mO4^-活度为37～185MBq，体积在200μl内；（4）标记温度为95℃，标记时间30min.^99Tc^m-RGD-4CKHPLC的保留时间与其洗脱液的放射峰基本一致；^99Tc^m-RGD-4CK室温放置6h，放化纯仍〉95％；Sep—Pak C18柱层析测定的^99Tc^m O4^-峰仅比3MM纸层析高0．5％；标记物与300mmol／L半胱氨酸37℃保温1h，^99Tc^m O4^-峰仅增加1．88％；^99Tc^m-RGD-4CK与血清蛋白无明显结合。结论预锡化法^99Tc^m直接标记RGD-4CK方法简便、标记率高，无需分离纯化即可直接应用，还可用于制备冻干品药盒。标记产物^99Tc^m-RGD-4CK具有良好的放射化学性质。     

99mTc—DTPA—甲硝唑正常动物体内分布研究

目的：探讨＾９９ｍＴｃ－ＤＴＰＡ－甲硝唑在正常动物的体内分布。方法：经小鼠和家兔耳缘静脉注射＾９９ｍＴｃ－ＤＰＴＡ－甲硝唑（３．７ＭＢｑ）后５ｍｉｎ２４ｈ,连续采集血液和其它脏器标本,测其放射性。结果：＾９９ｍＴｃ－ＤＴＰＡ－甲硝唑正常小鼠生物分布除肝脏、肾脏外,其余器官无明显分布。家兔血液清除研究在血中清除快,在血中呈双指数下降Ｔ１／２α为０．４５ｈ,Ｔ１／２β为３．１８ｈ。结论：＾９９ｍＴｃ－     

Measurement of the secretion of technetium-99m hexamethylpropylene amine oxime into breast milk

There are no published data for the activity of technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO) found 1in breast milk. The amount of radioactivity in breast milk following the administration of 500 MBq^99mTc-HMPAO for a brain perfusion study has been measured. The effective dose to the infant was calculated to be 0.26 mSv, so necessitating no interruption of breast feeding. Unbound^99mTc is readily secreted into breast milk and the effective dose will remain less than 1 mSv if the^99mTc-HMPAO labelling effici ency is 99% for the worse reported case, and could remain <1 mSv for the mean reported case for^99mTc-HMPAO labelling efficiencies down to 94%.     

Reproducibility of quantitative hexakis-2-methoxyisobutylisonitrile single photon emission tomography in stable coronary artery disease

The quantification of myocardial perfusion abnormalities is necessary to allow comparison of repeated studies, especially in the evaluation of the success of medical, interventional or combined treatment in stable coronary artery disease or in evolving myocardial infarction. The purpose of this study was to assess inter-observer reproducibility of tomographic study processing using a semi-automatic quantitative programme. Technetium 99m hexakis-2-methoxyisobutylisonitrile (^99mTc-Sestamibi) was chosen for tomographic imaging of repeated rest-stress studies in patients with stable coronary artery disease. The quantification was performed using a modification of the Cedars polar coding and comparison with the normal data base. The perfusion defects were quantified separately for each standard perfusion area [left anterior descending (LAD), right coronary (RCA) and left circumflex (LCX) arteries] and total area of hypoperfused myocardium. The inter-observer variability for 40 tomographic studies was accomplished. The defects were the largest in the LAD perfusion area (average 19.7% of the normalized LAD supply area) with an inter-observer correlation of 0.84 for this region. The greatest variability was found for the LCX region (r=0.55) and is attributed to a small average perfusion defect (7.1%), only 18 studies having abnormal perfusion in this area. In total, an average 14.3% of the left ventricular myocardium was significantly hypoperfused, and the inter-observer correlation was 0.87. These results show good inter-observer reproducibility using semi-automatic quantitation of perfusion defects. Careful interpretation of smaller defects in the evaluation of treatment results is advised when repeated ^99mTc-Sestamibi single photon emission tomography studies are processed by more than one observer.The work was performed at Nuclear Medicine Department in Ulm. Offprint requests to: M. Milinski