炎症显像剂~（99m）Tc－HIG一步法药盒的制备和实验研究

研制一种特异性亲炎症或感染部位的示踪定位显像剂９９ｍＴｃ标记的人多克隆免疫球蛋白Ｇ（ＨＩＧ）．方法：用２-亚氨基硫烷修饰ＨＩＧ，制备冷冻干燥９９ｍＴｃ标记一步法药盒，测定该药盒及其标记产物９９ｍＴｃ-ＨＩＧ的理化性质、生物性能，初步试用于临床．结果：室温下该药盒经与９９ｍＴｃＯ混合后，立即得到标记年大于９９％的９９ｍＴｃ-ＨＩＧ，标记方法简单便利；标记后室温保存２４小时，放化纯度仍大于９０％，产物稳定性好；在炎症／感染动物模型上，示踪剂定位明确．Ｔ／Ｂ值高；药盒的各项技术指标符合药典体内诊断试剂的规定．结论：经初步临床试用，诊断价值肯定，特别适合于我国国情．     

~（99m）Tc－HMPAOSPECT对偏头痛患者丘脑血流变化的研究

目的：了解偏头痛患者丘脑血流的变化。方法：用９９ｍＴｃ－六甲基两二胺肟和Ｎｏｖｏ－８１０高分辨率ＳＰＥＣＴ仪，以感兴趣区（ＲＯＩ）相对放射性计数百分率（ＲＯＩ％）为指标，对６０例次偏头痛患者的丘脑血流变化作了定量分析。结果：与无预兆偏头痛组的平均ＲＯＩ％值（２４９．Ｉｆ１４．９）相比，预兆偏头痛组ＲＯＩ％升高（２５９．１±１７．１），差异有显著意义（Ｐ＜０．０５）；偏瘫、偏身感觉异常预兆偏头痛组升高更明显（２６３．８±１７．２），差异有极显著性（Ｐ＜０．０１）；而单纯视觉预兆组稍升高（２５５．１±１６．４），差异无显著意义（Ｐ＞０．０５）。结论：偏瘫、偏身感觉异常预兆组丘脑血流升高，原因可能为：①缺血后高灌注。②除丘脑外，其它脑区血流减少。③各种神经、化学性刺激的结果。     

心功能参数图像对陈旧性冠心病梗死灶定位诊断价值的研究

目的　观察心功能参数图像对陈旧性冠心病 (CAD OMI)梗死灶的定位检出率及定位价值。方法　采用心功能参数图像观察陈旧性心肌梗死组并与放谢性核素心肌灌注断层显像及心电图 (ECG)对比分析。结果　应用心功能参数图像定位CAD OMI患者梗死部位 ,发生在左心室和心尖部位的病灶检出率高 ,室间隔部位心肌梗死灶检出率低 ;总体心肌梗死灶的定位检出率明显高于ECG(P <0 .0 5 )。结论　心功能参数图像对心肌梗死灶具有较高的定位诊断价值。     

Importance of intra-therapy single-photon emission tomographic imaging in calculating tumour dosimetry for a lymphoma patient

The dosimetry for two, similarly sized tumours in a lymphoma patient being treated with non-bone marrow ablative, monoclonal antibody therapy is reported. The 45-year-old man was infused with 2.48 GBq (67 mCi) of¹³¹I-labelled MB-1. Prior to therapy, a time series of diagnostic conjugate-view images and a radionuclide transmission scan were obtained and processed to obtain time-activity curves. Starting 2 days after the therapeutic infusion of radioactivity, a second conjugate-view time series was obtained. At that time, a quantitative single-photon emission tomography (SPET) acquisition was also carried out. Pre- and post-therapy X-ray computed tomography scans demonstrated a percentage reduction in volume for the right tumour which was 3.8 times that for the left tumour. In contrast, diagnostic conjugate views by themselves estimated the absorbed dose to be the same for the two tumours. Addition of therapy conjugate-view data increased the right-over-left ratio but only to 1.22. Normalizing either time-activity series by the intra-therapy SPET results increased the ratio to greater than 1.5. We assume here that a differential dose is correct according to the differential tumour shirnkage. One can further assume that the largest ratio corresponds most certainly to the most accurate dosimetric method. Other assumptions are possible. While additional study is essential, data from this patient suggest that the preferred dosimetric method is intra-therapy SPET normalization of either time series.     

99 TcmO-4甲状腺显像定量分析的临床应用

目的：探讨^99Tc^mO4^-甲状腺显像定量分析在甲状腺疾病诊疗中的价值。方法：采用Siemens Orbit SPECT仪对正常对照者和Graves病、桥本甲状腺炎（HD）及亚急性甲状腺炎（SAT）患者行^99Tc^mO4^-甲状腺动、静态双时相显像，测定颈动脉与甲状腺显像的时间差（Td)，甲状腺5min与1min时像素的平均放射性比值（AR），20min时甲状腺与股中段像素的平均放射性比值（UI）。结果（1）Graves病定量分析参数与体外甲状腺功能（简称甲功）指标基本一致，治疗后UI值的恢复速度慢于Td和AR，亦滞后于体外甲功指标的恢复。停药后复发者的UI值高于未复发者和对照组。（2）HD甲功增高组的表现与Graves病相似，甲功正常和亚临床甲低组的Td、AR和UI值与对照组相比差异均无显著性，甲低组的摄^99Tc^m能力降低。（3）SAT甲功升高者摄^99Tc^m能力降低，多呈弥漫性放射性分布稀疏，甲功正常组主要表现为局限性放射性分布稀疏。结论：^99Tc^mO4^-甲状腺显像定量分析能反映甲状腺形态改变与功能变化的内在关系，在常见甲状腺疾患诊疗中有重要价值。     

肺肿瘤99mTc-MDP显像研究

目的探讨99mTc-羟基亚甲基二磷酸(MDP)显像鉴别诊断肺肿瘤的机制和临床价值.方法对63例经病理证实的肺肿瘤患者和10例正常对照进行早期10min99mTc-MDP显像,用感兴趣区分析法计算肿瘤和正常肺组织的放射性比(T/NT),探讨肺肿瘤病灶早期摄取99mTc-MDP的机制.结果肺癌的T/NT值(2.36±0.56)明显高于良性病灶(1.44±0.47)和正常对照(0.98±0.12)(t=5.26,7.70,P＜0.01);以摄取比值＞1.8为判断标准,99mTc-MDP显像诊断肺癌的灵敏度、特异性和准确率分别为88.2%、86.3%和86.7%;肺癌组织内残留的宿主血管、大量的新生血管和病变周围的血管集束为高水平99mTc-MDP血流灌注的特征性病理结构,肺癌的局部浸润转移促进了99mTc-MDP的摄取.结论99mTc-MDP的早期摄取与肺肿瘤的血供和局部浸润转移密切相关,对肺肿瘤的鉴别诊断有一定的临床价值.     

平板运动试验、心肌显像潘生丁试验与冠状动脉造影的对照研究──附53例临床资料分析

ＴＥＴ及ＲＭＰＴ为冠心病的二项重要无创检查法。我院在１９９５年给５３名确诊或拟诊冠心病者作了此三项检查。ＴＥＴ检查的敏感性８８％，特异性９３％，而ＲＭＰＴ的准确率偏低，敏感性７０％，特异性仅５４％。本文推测ＲＭＰＴ特异性较低的原因与判别软组织衰减所致放射稀疏标准欠严，以及ＣＡＧ不能反映心肌病变及小冠状血管病变有关，而其敏感性偏低与本文大多患者服用各类抗心绞痛药物有关。两者比较，ＴＥＴ操作简便价格便宜，准确率也较高，应被列为冠心病的首选检查。     

Sentinel lymph node metastasis in experimental melanoma: Relationships among primary tumor size, lymphatic vessel diameter and99mTc-labeled human serum albumin clearance

Background: This study was designed to investigate the relationships among primary tumor size, lymphatic vessel diameters, the incidence of sentinel lymph node (SLN) metastasis and lymphatic clearance from murine footpad melanomas. Methods: Lymphatic clearance (LC) of [^99mTc]HSA from the middle of the footpad of syngeneic C57BL/6 mice, with or without primary melanomas (sizes varying from 1 to 5 mm in anteroposterior diameter), was quantitated using a gamma scintillation detection system. Lymphatic vessel diameters (LD) were measured after injection of aniline blue dye into footpad tumors. The incidence of SLN, femoral lymph node (FLN), and lung metastases was recorded. Results: Metastasis to SLNs increased as tumor growth progressed (r=0.976, p=0.001), and there was a correlation between tumor size and both FLN (p=0.041) and lung (p=0.055) metastases. There was also a correlation between lymph node metastasis and LC (r=0.83, p=0.04) and LD (r=0.84, p=0.04). Conclusions: These studies support the hypothesis that lymph flow and LD is increased in experimental murine melanomas and this relates to both primary tumor size and to lymphatic and hematogenous metastasis.Supported in part by CA 43709, NIH/NCI and the Stephen A. Bryant Fund.Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Presurgical identification of hibernating myocardium by combined use of technetium-99m hexakis 2-methoxyisobutylisonitrile single photon emission tomography and fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography in patients with coronary artery disease

We tested the possibility of identifying areas of hibernating myocardium by the combined assessment of perfusion and metabolism using single photon emission tomography (SPET) with technetium-99m hexakis 2-methoxyisobutylisonitrile (^99mTc-MIBI) and positron emission tomography (PET) with fluorine-18 fluoro-2-deoxy-d-glucose (¹⁸F-FDG). Segmental wall motion, perfusion and ¹⁸F-FDG uptake were scored in 5 segments in 14 patients with coronary artery disease (CAD), for a total number of 70 segments. Each subject underwent the following studies prior to and following coronary arterybypass grafting (CABG): first-pass radionuclide angiography, electrocardiography gated planar perfusion scintigraphy and SPET perfusion scintigraphy with ^99mTc-MIBI and, after 16 h fasting, ¹⁸F-FDG/PET metabolic scintigraphy. Wall motion impairment was either decreased or completely reversed by CABG in 95% of the asynergic segments which exhibited ¹⁸F-FDG uptake, whereas it was unmodified in 80% of the asynergic segments with no ¹⁸-FDG uptake. A stepwise multiple logistic analysis was carried out on the asynergic segments to estimate the postoperative probability of wall motion improvement on the basis of the preoperative regional perfusion and metabolic scores. The segments with the highest probability (96%) of functional recovery from preoperative asynergy after revascularization were those with a marked ¹⁸F-FDG uptake prior to CABG. High probabilities of functional recovery were also estimated for the segments presenting with moderate and low ¹⁸F-FDG uptake (92% and 79%, respectively). A low probability of functional recovery (13 %) was estimated in the segments with no ¹⁸F-FDG uptake. Despite the potential limitations due to the semiquantitative analysis of the images, the method appears to provide reliable information for the diagnostic and prognostic evaluation of patients with CAD undergoing CABG and confirms that the identification of hibernating myocardium with ¹⁸F-FDG is of paramount importance in the diagnosis of patients undergoing CABG.Correspondence to: G. Lucignani     

The placebo effect

The placebo effect will have a growing importance in the field of nuclear medicine as the potentials for palliative therapy with internal sources are realized. It is important for nuclear medicine physicians and their colleagues to be familiar with the role of placebo responses in clinical trials, especially when such trials involve the subjective assessment of pain. A summary of the literature on the placebo effect in pain studies is presented in which traditional values for placebo responses are contrasted with more current thinking in the field. The few published double-blind studies of pain relief after treatment with radiotherapeutic agents are summarized specifically with respect to their cited placebo response.