磁共振对比剂Gd—DTPA对肝脏^99Tc^m-MDP摄取的影响

全身骨显像（whole—body bonescan,WBS）是临床常用的一种影像学检查方法。WBS时骨外组织摄取^99Tc^m-MDP的现象多有报道,以肝脾异常摄取多见。在^99Tc^m-MDP注射前、后静脉给予MRI对比剂Gd—DTPA可导致正常肝脾组织异常放射性摄取。笔者回顾性分析了10例非肝脏疾病引起的肝脏异常摄取^99Tc^m-MDP的骨显像图及相关临床资料,探讨Gd—DTPA对肝脾摄取^99Tc^m-MDP的影响,现报道如下。     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

钆双胺对^99Tc^m—MDP骨显像影响的实验研究

目的探讨MRI对比剂钆双胺注射液（欧乃影;Gd—DTPA—BMA）应用后对家兔^99Tc^m-MDP骨显像的影响。方法采用自身前后对照方法,实验组（注射欧乃影＋^99Tc^m-MDP）与自身对照组（注射生理盐水＋^99Tc^m-MDP）处理相隔7d。（1）取家兔5只,注射欧乃影或生理盐水后30min注射^99Tc^m-MDP,并于注射^99Tc^m-MDP后5、10、30、60、120、180、240和360min、24h时行骨显像,勾画ROI,计算靶／本底（T／B）值,观察家兔显像剂分布及代谢情况。（2）取家兔30只,按欧乃影或生理盐水与^99Tc^m-MDP的注射间隔（30、60、120、240和360min、24h）分为6组,每组5只。均于注射^99Tc^m-MDP后120min行骨显像,勾画ROI,计算T／B值。（3）采用TLC测定2种药物相互作用后在体内的放化纯差异。以配对t检验进行统计分析。结果注射欧乃影后30min再注射^99Tc^m-MDP,5min时肝、脾开始显影,其T／B比值120min时达最高峰（肝、脾分别为4．56±0．32和3．56±0．41）;而2组椎体24h时T／B值均达最大值（实验组为4．32±0．07,自身对照组为6．31±0．09）,但各时间点实验组均较自身对照组低。两药物注射间隔为30、60、120和240min时,可出现肝、脾异常显影,对应的实验组T／B（肝：2．47～4．22;脾：1．85～3．23）明显高于自身对照组（肝：1．52—1．58;脾：1．25～1．29）,但实验组椎体的T／B（3．08～4．28）则较自身对照组低（4．82～4．85）,以上差异均有统计学意义（t=7．750—31．916,均P〈0．05）。余时间间隔组,肝、脾未见明显摄取^99Tc^m-MDP。TLC曲线示,实验组在Rf为0—0．2处形成小峰,^99Tc^m-MDP放化纯降为（63．51±2．24）％。结论注射欧乃影后短时间内行^99Tc^m-MDP骨显像,肝、脾会出现异常摄取;间隔360min再行^99Tc^m-MDP骨显像可避免此现象发生。     

肺性肥大性骨关节病的骨显像研究

目的 观察各种肺疾病肺性肥大性骨关节病（HPO）的发生率、治疗后HPO的消失率以及骨显像与X线诊断HPO的价值。方法 对703例各种肺疾患患者的骨显像作回顾性分析。显像剂为^99Tc^m-亚甲基二磷酸盐（MDP）。结果 （1）703例各种肺疾患患者HPO的发生率为7．4％,其中肺癌患者HPO发生率为7．6％。（2）41例肺癌经手术或化疗后HPO消失31例。（3）32例甲状腺癌和骨癌肺转移患者骨显像无1例发生HPO,但4例鼻咽癌肺转移患者3例为HPO。结论 （1）骨显像出现HPO图像可提示肺疾患的发生;（2）鼻咽癌肺转移HPO发生率较高,临床上鼻咽癌患者骨显像出现HPO表现可提示发生肺转移。     

18F-NaF的合成及其在肺癌骨转移中的临床应用

目的 合成并检测^18F-NaF；比较^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像与^18F-NaFPET／CT骨显像对诊断肺癌骨转移的价值。方法 用MINItrace回旋加速器通过核反应^18O（P，n）^18F-生产^18F-F^-1，用离子交换法合成^18F-NaF并进行质控检测。对10例已行^99Tc^m-MDP全身骨显像的肺癌患者行^18F-NaFPET／CT检查，对两者图像进行比较。结果 ^18F-NaF注射液符合要求^18F-NaFPET／CT骨显像探测到^99Tc^mMDP骨显像发现的所有病灶，并探测到后者未发现的8个病灶，使^99Tcm-MDP骨显像不确定诊断数减少。结论 ^18F-NaFPET／CT诊断肺癌骨转移准确性更高，可作为^99Tc^m-MDP骨显像的补充。     

MDP对小鼠骨摄取^99Tc^m—MDP的影响

目的 为临床应用^99Tc－亚甲基二膦酸盐（^99Tc-MDP,“云克”）治疗类风湿疾病提供实验和理论依据。方法 进行K^99TcO4与Na^99Tc^mO4竞争标记MDP实验、MDP量的增加对^99Tc标记MDP的影响实验、小鼠骨摄取^99Tc^m-MDP与MDP量的依赖关系实验以及重复注射MDP203次对骨摄取^99Tc^m-MDP的影响实验。结果 K^99TcO4可与Na^99Tc^mO4竞争标记MDP,且MDP量的增加对^99Tc^m标记MDP无影响。小鼠骨摄取^99Tc^m-MDP与MDP的量在实验范围（≤2mg MDP/只）内无依赖关系,且重复注射2μgMDP（相当于人5mg/次）20次对小鼠骨摄取^99Tc^m-MDP无影响。结论 “云克”的配方有科学性,其使用方法可行。     

外照射治疗部位软组织浓聚骨显像剂的影像表现探讨

目的：探讨恶性肿瘤患者放射治疗局部软组织浓聚骨显像剂的影像变化。材料与方法：53例乳腺癌、30例鼻咽癌、49例肺癌、22例食管癌患者行99Tc—MDP全身骨显像，观察放射治疗局部软组织浓聚骨显像剂的情况。结果：154例患者中47例（30．5％）局部软组织浓聚。照射剂量＜30Gy组，16．1％（10／62）出现软组织浓聚，照射剂量≥30Gy组，40．2％（37／92）出现软组织浓聚，两者差异有显著性。结论：放射治疗可引起软组织弥漫性浓聚骨显像剂，软组织浓聚骨显像剂与放射治疗受照剂量有关。     

99Tcm-MDP骨显像肝脏异常显影原因分析

目的 分析99Tcm-MDP全身骨显像肝脏异常显影的可能原因。方法 回顾性分析2013年1月至2015年7月于我院核医学科行99Tcm-MDP全身骨显像患者中肝脏异常显影20例,显像结果与其他影像学检查和（或）病理结果、实验室检查进行对比分析。结果 20例肝脏异常显影的患者中,原发性肝损伤3例、继发性肝损伤17例[其中包括多发性骨髓瘤引发肝功能异常1例,恶性肿瘤化疗后肝功能异常8例,肿瘤肝转移7例（结肠癌肝转移5例、肝癌肝内转移1例、肺癌肝转移1例）、慢性肾衰竭铁剂治疗后肝脏摄取1例]。结论 99Tcm-MDP全身骨显像肝脏异常显影的原因较多,除显像技术原因外,应警惕各种原因导致的肝脏损伤,为患者提前进行临床干预提供一定参考。     

强直性脊柱炎核素关节显像

目的 探讨^99Tc^m-人免疫球蛋白（HIgG)与99Tc^m-亚甲基二膦酸盐（MDP）关节显像在强直性脊柱炎（AS）中的应用价值。方法 对经确诊的21例AS和18例活动期类风湿关节炎（RA）患者行^99Tc^m-HIgG全身显像，其中12例AS患者行^99Tc^m-MDP显像。结果 ①21例AS患者中20例^99Tc^m-HIgG显像示骶髂关节异常放射性增高；44个有临床症状或体征的外周关节中，32个显像异常，临床符合率75％，无一例累及手部小关节。②18例活动期RA患者^99Tcm-HIgG显像均有手部关节的异常改变，无一例累及骶髂关节。③12例AS患者^99Tc^m-HIgG与^99Tc^m-MDP显像比较显示：前者有11例骶髂关节异常放射性分布增高，而后者显像异常仅7例。31个临床累及的外周关节中，^99Tc^m-HIgG显像阳性24个，^99Tc^m-MDP显像异常16个，与临床符合率分别为77．4％和51．6％，差异有显著性（P＜0．025）。结论 ^99Tc^m-HIgG显像能较^99Tc^m-MDP显像更为准确地探测AS患者病变关节的炎症改变，帮助临床早期明确诊断。     

18F-FDG SPECT/CT诊断肺癌骨转移的价值:与全身骨显像比较

目的：探讨^18F—FDG SPECT／CT肿瘤代谢显像在诊断肺癌骨转移方面的应用价值。材料和方法：对32例肺癌患者分别进行^18F—FDGSPECT／CT显像和^99Tc^m-MDP全身骨显像，间隔时间不超过2周。其他影像学和临床随访结果为确诊依据，比较两种方法诊断骨转移的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果：11个病人共48个病灶最终诊断为骨转移。^18F—FDG SPECT／CT诊断11个病人有骨转移^99T^m-MDP全身骨显像诊断10个病人。按病灶分析，FDG和MDP的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为94％、71％、89％、92％、77％和83％、64％、79％、89％、53％。”F—FDGSPECT／CT的敏感性和准确性优于^99Tc^m-MDP全身骨显像（P〈0.05）。结论：^18F—FDG SPECT／CT显像在诊断肺癌骨转移方面的敏感性和准确性高于^99Tc^m—MDP全身骨显像。     

Concentration of Tc-99m MDP in ovarian carcinoma and its soft tissue metastases

A patient with ovarian carcinoma was evaluated for skeletal metastasis with a routine whole body bone scan. Although no bone metastases were visualized, there was dramatic accumulation of tracer in the soft tissues of the abdomen. CT revealed calcifying soft tissue metastases on the liver surface, the bowel serosa, and in the pelvis corresponding to the abnormal areas of Tc-99m MDP uptake. Tumor necrosis and ongoing calcification within the metastatic sites are possible explanations for this unusual soft tissue concentration of the bone-seeking radiopharmaceutical. In patients with metastatic ovarian carcinoma, careful review of extraosseous regions on bone scan images may provide valuable diagnostic information.     

Role of 99mTc-octreotide acetate scintigraphy in suspected lung cancer compared with 18F-FDG dual-head coincidence imaging.

The aim of this study was to evaluate the clinical value of tomographic (99m)Tc-octreotide acetate (hereafter, (99m)Tc-octreotide) scintigraphy in the detection of patients with suspected lung cancer in comparison with that of (18)F-FDG dual-head coincidence imaging (DHC). METHODS: Forty-four consecutive patients with suspected pulmonary neoplasms underwent tomographic (99m)Tc-octreotide scintigraphy and (18)F-FDG coincidence imaging using the same gantry. The region of interest was drawn on the entire primary lesion. The tumor-to-normal tissue tracer values for both (99m)Tc-octreotide and (18)F-FDG were determined using region of interests and expressed as T/N(r) and T/N(m), respectively. Final diagnosis was confirmed by histopathologic analysis or clinical follow-up. RESULTS: Thirty-one of the 44 patients had lung cancer-6 with small cell lung cancer (SCLC) and 25 with non-small cell lung cancer (NSCLC). Thirteen of the 44 patients had benign lung lesions. The sensitivity, specificity, positive predictive value, and negative predictive value of (99m)Tc-octreotide were 100%, 75.7%, 90.1%, and 100%, respectively, and of (18)F-FDG DHC were 100%, 46.1%, 83.8%, and 100%, respectively. In the 31 patients with malignant tumors, all 38 abnormal lymph nodes in 20 patients showed abnormal high focal uptake of (18)F-FDG; only 7 patients with 10 regional lymph adenopathies showed moderate uptake of (99m)Tc-octreotide. Thirteen patients with 39 distant sites of abnormal uptake visualized (imaging stage IV) with (99m)Tc-octreotide included 2 patients with brain metastases, 6 patients with pleural invasion and multiple bone metastasis, 2 patients with contralateral internal lung metastasis and pleural invasion, and 3 patients with only multiple bone metastasis. The final diagnosis was confirmed by histopathology or clinical follow-up. CONCLUSION: The sensitivity of (99m)Tc-octreotide for the detection of lung cancer at the primary lesion was comparable with that of (18)F-FDG coincidence imaging. Tomographic (99m)Tc-octreotide scintigraphy had lower sensitivity for the detection of hilar and mediastinal lymph node metastasis compared with that of (18)F-FDG coincidence PET, but it had high sensitivity for the detection of remote metastatic lesions. However, because of the small population, further investigation is necessary.     

562例原发肺癌患者核素骨显像结果分析

目的 通过核素骨显像检查,探讨不同病理组织学类型肺癌的骨转移规律。方法 对562例已确诊的原发肺癌患者进行99Tcm-亚甲基二膦酸盐(99Tcm MDP)全身骨显像,对骨显像的结果和肺癌病理类型进行回顾性分析。结果 各类型肺癌骨转移平均发生率为43.06%,肺腺癌和小细胞癌骨转移率较高,分别为55.43%和45.16%,腺鳞癌、鳞癌骨转移发生率分别为37.93%和35.19%。结论 肺癌骨转移发生率较高,肺腺癌和小细胞癌较其他类型肺癌更易发生骨转移;核素全身骨显像是诊断肺癌早期骨转移的首选方法,对帮助判断疾病的进展程度,选择合适的治疗方案,改善患者的生存质量和延长生命有重要的临床意义。     

A comparison between the diagnostic efficacy of 99mTc-MDP, 99mTc-DPD and 99mTc-HDP for the detection of bone metastases

We have investigated the clinical efficacy for the detection of bone metastases of two recently marketed bone-seeking radiopharmaceuticals, HDP and DPD, compared with traditionally used MDP. Twenty patients received 15 mCi 99mTc-MDP; after assessment ten of these patients later received 15 mCi 99mTc-DPD and ten other patients of this group were injected with 15 mCi 99mTc-HDP. Scintigraphy took place 3 h after tracer injection. Quantitative analysis included the calculation of normal bone to soft tissue ratios, lesion to soft tissue ratios and lesion to normal bone ratios for all three radiopharmaceuticals. Visual inspection of the scintiphotos revealed the same number of bone lesions at the same localisations. Statistical evaluation of our quantitative data showed that the lesion to normal bone ratio was significantly higher for MDP than for DPD. No further significant differences in the uptake in normal bone or in the metastatic lesions were found between all three radiopharmaceuticals. It is concluded that the new bone-seeking agents DPD and HDP do not possess clinical advantages over MDP for the detection of skeletal metastases.     

Demonstrating alcoholic cirrhosis of the liver by Tc-99m BIDA scintigram

Six patients with decompensated cirrhosis of the liver underwent Tc-99m BIDA studies. All demonstrated 1) persistently high blood pool activity in the heart, lung, and soft tissue, 2) slow hepatic tracer uptake, 3) prolonged liver-to-bowel transit time, and 4) visualization of an enlarged spleen. Four of the six patients demonstrated evidence of ascites and in one patient there were visible collateral veins of the abdomen. These findings are due primarily to hepatic dysfunction and retaining Tc-99m BIDA in blood pool because of Tc-99m BIDA exclusively hepatic excretion and little or no alternative renal excretion. All six Tc-99m sulfur colloid studies were performed concomitantly. Except for bone marrow uptake and reversal of the normal liver-spleen ratio of radioactivity, the imaging abnormalities observed with Tc-99m BIDA were similar to those seen by Tc-99m SC. It is concluded that with Tc-99m BIDA studies, three of six abnormal findings, as described, suggest a decompensated stage of cirrhosis of the liver.     

562例原发肺癌患者核素骨显像结果分析

目的 通过核素骨显像检查,探讨不同病理组织学类型肺癌的骨转移规律.方法 对562例已确诊的原发肺癌患者进行~(99)Tc~m-亚甲基二膦酸盐(~(99)Tc~m MDP)全身骨显像,对骨显像的结果和肺癌病理类型进行回顾性分析.结果 各类型肺癌骨转移平均发生率为43.06%,肺腺癌和小细胞癌骨转移率较高,分别为55.43%和45.16%,腺鳞癌、鳞癌骨转移发生率分别为37.93%和35.19%.结论 肺癌骨转移发生率较高,肺腺癌和小细胞癌较其他类型肺癌更易发生骨转移;核素全身骨显像是诊断肺癌早期骨转移的首选方法,对帮助判断疾病的进展程度,选择合适的治疗方案,改善患者的生存质量和延长生命有重要的临床意义.     

The role of 99mTc(V)-DMSA scan as compared to 99mTc-MDP and CT scans in imaging the primary tumor and metastases of osteosarcoma

The oncophilic complex of technetium-99m labeled pentavalent dimercaptosuccinic acid (99mTc(V)-DMSA) has been successfully used for the detection of primary and metastatic medullary thyroid cancer and for imaging various soft tissue tumors like lung, brain and prostate cancer. In this article, the role of 99mTc(V)-DMSA in the diagnosis of the primary tumor and metastases of osteosarcoma patients as compared to the 99mTc-MDP scan and the CT scan was studied. Twenty-eight patients with bone disease were referred to the Nuclear Medicine Department of Saint Savas Oncology Hospital in Athens from the Orthopedics Department of the same Hospital. From them, 18 (Group A) had osteosarcoma, 7 (Group B) osteomyelitis and 3 (Group C) bone fractures. The final diagnosis was made after fine needle aspiration biopsy. All patients were subjected to the 99mTc(V)-DMSA scan, the standard bone scan (99mTc-MDP) and CT scan. Group A patients showed a selective uptake of 99mTc(V)-DMSA in the primary tumor region. No abnormal 99mTc(V)-DMSA uptake was observed in the patients of Groups B and C. The 99mTc(V)-DMSA scan was found to be superior to the 99mTc-MDP and the CT scans in identifying metastases of osteosarcoma. Sensitivity was 100%, 86% and 98% respectively.