99Tcm-MDP SPECT/CT显像诊断乳腺癌骨转移

目的 评价⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以确诊的乳腺癌骨转移的诊断价值。方法 回顾分析⁹⁹Tc^m-MDP全身骨显像难以确诊的132例乳腺癌患者共210个骨转移灶的影像资料。以临床随访及病理检查获得最终诊断结果,计算⁹⁹Tc^m-MDP SPECT/CT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 210个病灶中, ⁹⁹Tc^m-MDP SPECT/CT正确诊断骨转移灶82个,良性病灶112个,诊断准确率为92.38%(194/210),灵敏度为94.25%(82/87),特异度为91.05%(112/123),阳性预测值为88.17%(82/93),阴性预测值为95.72%(112/117)。⁹⁹Tc^m-MDP SPECT/CT对脊椎病灶的诊断准确率明显高于肋骨病灶(χ²=7.81,P<0.05)。结论 利用⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以诊断的乳腺癌骨转移灶进行诊断,具有较高的诊断效能。     

足踝慢性疼痛SPECT/CT断层骨显像融合图像特征

目的 探讨足踝部慢性疼痛患者的SPECT/CT融合图像特征。方法 回顾性分析161例足踝部慢性疼痛患者足踝⁹⁹Tc^m-MDP SPECT/CT断层骨显像融合图像特征,包括骨显像剂⁹⁹Tc^m-MDP摄取类型、病灶部位以及CT表现。结果 161例中,⁹⁹Tc^m-MDP摄取增高者158例（158/161,98.14%）,3例（3/161,1.86%）无⁹⁹Tc^m-MDP摄取增高;155例（155/161,96.27%）CT出现阳性改变,6例（6/161,3.73%）CT表现阴性,其中4例存在⁹⁹Tc^m-MDP摄取增高病灶。3例⁹⁹Tc^m-MDP摄取阴性患者中,1例CT表现阳性。⁹⁹Tc^m-MDP摄取增高病灶多位于距上关节（81/161,50.31%）和距下关节（56/161,34.78%）;CT阳性病灶表现多为关节面骨质硬化（107/161,66.46%）和骨质密度增高（76/161,47.20%）。结论 SPECT/CT同机融合图像可有效评估足踝部慢性疼痛患者病变特点,对指导临床精准治疗具有一定价值。     

99Tcm-MDP全身骨显像联合SPECT/CT诊断骨外肿瘤

目的 观察⁹⁹Tc^m-亚甲基二磷酸盐（MDP）全身骨显像联合SPECT/CT诊断骨外肿瘤的价值。方法 回顾性分析68例骨外肿瘤患者94处病灶,观察其全身骨显像及SPECT/CT表现,并分析二者联合诊断效能。结果 单纯全身骨显像准确诊断52处骨外肿瘤,准确率55.32%（52/94）;其余42处病灶中,35处（35/94,37.23%）因影像学表现与骨骼存在重叠而误诊为转移性骨肿瘤,7处（7/94,7.45%）因病灶⁹⁹Tc^m-MDP摄取低于邻近骨骼而致漏诊。全身骨显像联合SPECT/CT诊断全部94处骨外肿瘤,准确率100%（94/94）。94处病灶中,49处接受病理学检查,其中33处（33/49,67.35%）病灶内见粗大钙化、9处（9/49,18.37%）见细微钙化;CT检出61处（61/94,64.89%）钙化,未显示9处细微钙化。结论 ⁹⁹Tc^m-MDP全身骨显像联合SPECT/CT可提高诊断骨外肿瘤的准确性。     

骨样骨瘤99Tcm-MDP SPECT/CT特征

目的 观察骨样骨瘤的⁹⁹Tc^m-MDP SPECT/CT特征。方法 对36例临床疑诊骨样骨瘤患者行⁹⁹Tc^m-MDP SPECT/CT显像,分析其特征;以手术病理或影像学随访结果为诊断标准,评价SPECT/CT显像对骨样骨瘤的诊断价值。结果 36例中,最终确诊28例骨样骨瘤。⁹⁹Tc^m-MDP SPECT/CT诊断骨样骨瘤28例、其他疾病8例,诊断敏感度、特异度和准确率均为100%。28例骨样骨瘤中,骨皮质型8例（8/28,28.57%）,骨膜下型4例（4/28,14.29%）,松质骨型16例（16/28,57.14%）;17例（17/28,60.71%）病变位于关节囊内,11例（11/28,39.29%）位于关节囊外;⁹⁹Tc^m-MDP SPECT/CT显像均可见双密度征,瘤巢显像剂摄取明显高于周围骨质硬化,并逐渐递减。结论 骨样骨瘤的⁹⁹Tc^m-MDP SPECT/CT表现具有一定特征性,可为诊断及鉴别诊断提供信息。     

99Tcm-ZPPAb在荷H22肝癌小鼠体内的生物学分布特性及显像特征

目的 探讨⁹⁹Tc^m-ZPPAb在荷瘤鼠体内生物学分布特征及显像特征。方法 ①建立荷H₂₂肝癌小鼠模型48只,分为实验组及对照组,各24只。制备⁹⁹Tc^m-ZPPAb及⁹⁹Tc^m-IgG。②体内分布实验:取实验组与对照组各21只小鼠,分别经尾静脉注射⁹⁹Tc^m-ZPPAb和⁹⁹Tc^m-IgG 7.4 MBq,于30 min、1、2、3、4、5、6 h,每时相取3只,计算各脏器每克组织的放射性摄取比率(%ID/g值)及肿瘤与对侧肌肉组织的放射性计数比值(T/NT值)。③显像实验:取实验组与对照组各3只小鼠,分别经尾静脉注射⁹⁹Tc^m-ZPPAb和⁹⁹Tc^m-IgG 7.4MBq,于30 min、1、2、3、4、5、6 h计算T/NT值。结果 ⁹⁹Tc^m-ZPPAb标记率为70%,⁹⁹Tc^m-IgG标记率为85%。体内分布实验结果显示,实验组荷瘤小鼠体内肿瘤组织不同时相间%ID/g值差异无统计学意义(F=0.89,P=0.5231),各时相肿瘤组织%ID/g值均高于除肝脏、肾脏和血液以外的其他组织器官(F=9.36,P=0.0007)。两组间同时相肿瘤组织%ID/g值差异有统计学意义(F=13.49,P=0.0001)。实验组不同时相T/NT值差异无统计学意义(F=1.53,P=0.2237);两组间同时相T/NT值差异有统计学意义(F=23.69,P=0.0001)。显像实验结果显示,实验组不同时相T/NT值差异无统计学意义(F=1.00,P=0.4526),两组间同时相T/NT值差异有统计学意义(F=6.09,P=0.0048)。结论 ⁹⁹Tc^m-ZPPAb标记简单,标记率较高,在肿瘤组织中有较高的摄取与滞留,有望成为肿瘤阳性显像剂。     

99Tcm-MDP骨显像腰椎标准摄取值与骨密度的相关性

目的 观察不同骨密度（BMD）患者⁹⁹Tc^m-亚甲基二磷酸盐（⁹⁹Tc^m-MDP）骨显像腰椎标准摄取值（SUV）的差异，并分析其与BMD的相关性。方法 回顾性分析62例接受⁹⁹Tc^m-MDP全身骨显像、腰椎SPECT/CT断层显像及双能X线腰椎BMD检测患者，根据BMD结果将其分为骨量正常组（n=18）、骨量减低组（n=24）和骨质疏松组（n=20），比较3组腰椎平均SUV（SUV_mean）、最大SUV（SUV_max）及BMD等的差异，分析其与腰椎平均CT值、患者年龄、体质量及身高的相关性。结果 腰椎SUV_max和SUV_mean分别为7.39±1.84和4.90±1.27，均与BMD呈正相关（r=0.64、0.63，P均<0.01）。腰椎SUV_max、SUV_mean和BMD均与年龄呈负相关（r=-0.33、-0.44、-0.43，P均<0.05），与体质量（r=0.42、0.30、0.35）及平均CT值（r=0.56、0.59、0.73）呈正相关（P均<0.05），与身高无明显相关（P均>0.05）。3组间腰椎SUV_max、SUV_mean、BMD和平均CT值差异均有统计学意义（F=24.09、30.50、94.85、30.24，P均<0.01）。骨量减低组腰椎SUV_max、SUV_mean、BMD和平均CT值明显低于正常组（P均<0.01）；骨质疏松组明显低于骨量正常组和骨量减低组（P均<0.01）。结论 ⁹⁹Tc^m-MDP骨显像腰椎SUV可用于评价骨质疏松及评估疗效。腰椎SUV_max及SUV_mean均与BMD呈正相关。骨质疏松患者腰椎SUV_max和SUV_mean明显降低。     

99Tcm-MDP SPECT/CT融合显像诊断骨纤维异常增殖症

目的 探讨⁹⁹Tc^m-MDP SPECT/CT融合显像诊断骨纤维异常增殖症（FD）的临床应用价值。方法 回顾性分析13例FD患者的临床和⁹⁹Tc^m-MDP SPECT/CT融合显像资料,其中11例经病理证实为FD,2例经随访确诊。所有患者均有原发肿瘤病史。结果 13例FD均为单发,位于颅面骨10例,位于肋骨、坐骨及胫骨骨干各1例。全身骨显像定性诊断准确率为38.46%（5/13）,SPECT/CT断层融合显像定性诊断准确率为69.23%（9/13）;92.31%（12/13）的患者全身骨显像表现为中-高代谢;CT征象中,磨玻璃密度影（GGO）和骨质膨胀分别占84.62%（11/13）和76.92%（10/13）,溶骨性破坏、硬化边分别占53.85%（7/13）、30.77%（4/13）,13例均未见骨皮质破坏。结论 ⁹⁹Tc^m-MDP SPECT/CT断层融合显像可综合提供功能和解剖学信息,有助于FD的诊断。骨显像中-高代谢及GGO和骨质膨胀的CT征象常提示FD。     

99Tcm-MDP SPECT/CT诊断钳夹型髋关节撞击综合征

目的 探讨⁹⁹Tc^m-MDP SPECT/CT诊断钳夹型髋关节撞击综合征（FAI）的价值。方法 对临床疑似钳夹型FAI的85例患者（共96个发病髋关节）行⁹⁹Tc^m-MDP SPECT/CT检查,并进行图像分析。最终由手术或6个月以上的随访资料确诊。分别计算CT、SPECT和SPECT/CT评价钳夹型FAI的诊断效能,并进行统计学分析。结果 96个髋关节中,临床最终确诊有钳夹型FAI 87个。CT、SPECT和SPECT/CT显像对钳夹型FAI的诊断灵敏度分别为77.01%（67/87）、95.56%（84/87）、95.56%（84/87）,特异度分别为44.44%（4/9）、100%（9/9）、100%（9/9）,准确率分别为73.95%（71/96）、96.88%（93/96）、96.88%（93/96）。三种方法诊断钳夹型FAI的灵敏度、特异度和准确率差异均有统计学意义（P均<0.01）,SPECT/CT融合显像和SPECT显像之间差异均无统计学意义（P均>0.05）,SPECT/CT或SPECT显像与CT检查间差异均有统计学意义（P均<0.01）。结论 ⁹⁹Tc^m-MDP SPECT/CT可灵敏、准确地诊断钳夹型FAI,值得临床推广。     

99Tcm-MDP骨显像在类风湿关节炎骨痛中的应用

目的 探讨⁹⁹Tc^m-羟基亚甲基二磷酸盐（⁹⁹Tc^m-MDP）骨显像诊断类风湿关节炎（RA）骨痛的价值。方法 回顾性分析40例确诊RA患者,均接受⁹⁹Tc^m-MDP骨显像,同期测定血清类风湿因子（RF）、抗环瓜氨酸肽抗体（anti-CCP）、抗突变型瓜氨酸波形蛋白抗体（anti-MCV）、葡萄糖-6-磷酸异构酶（GPI）、血沉（ESR）、C-反应蛋白（CRP）及免疫球蛋白G（LgG）。通过勾画ROI技术测出代谢最活跃关节的最高计数（Maxcount）,以其作为因变量,采用线性逐步回归分析Maxcoun与RF、anti-CCP、anti-MCV、GPI、ESR、CRP、LgG的相关性。结果 anti-MCV对Maxcount具有显著性影响（Beta=0.414,P=0.008）,且呈正相关（B=0.031,P=0.008）,回归方程有统计学意义（F=7.862,P=0.008）;其余6项血清测定值与Maxcount无明显相关（P均>0.05）。Pearson积距相关系数单侧检验显示anti-MCV与anti-CCP、ESR与CRP均显著正相关,且关系较密切 （r均>0.50,P均<0.001）。结论 ⁹⁹Tc^m-MDP骨显像不仅可早期诊断RA患者软骨和（或）骨破坏,还可间接提示RA是否处于活动期。     

99Tcm-3PRGD2 SPECT诊断大鼠骨移植瘤

目的 观察大鼠骨移植瘤模型⁹⁹锝^m-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸二聚体（⁹⁹Tc^m-3PRGD₂）的摄取，探究⁹⁹Tc^m-3PRGD₂ SPECT诊断骨转移瘤的可行性。方法 对30只Walker-256大鼠以乳腺癌细胞建立大鼠胫骨转移瘤模型，分为实验组（n=20）和对照组（n=10）。测定⁹⁹Tc^m-3PRGD₂的放射化学纯度后，行大鼠胫骨转移瘤⁹⁹Tc^m-3PRGD₂ SPECT显像，计算骨移植瘤部位放射性计数与对侧相应部位同等大小区域的放射性计数（T/NT）比值。显像结束取胫骨组织，行HE染色及免疫组织化学染色。结果 实验组10只大鼠成功建模。⁹⁹Tc^m-3PRGD₂于37℃温育1 h、2 h、4 h和6 h放射化学纯度分别为97.60%、97.20%、96.10%和95.40%。实验组T/NT（3.48±0.44）较对照组（1.10±0.84）明显增高（t=16.66，P<0.001）。HE染色示实验组大鼠胫骨内大量肿瘤细胞浸润；免疫组织化学染色实验组显示肿瘤细胞及新生血管内皮细胞包膜及包浆上整合素α_Ⅴβ₃受体染为棕黄色。结果 ⁹⁹Tc^m-3PRGD₂易标记，放射化学纯度高，稳定性好；⁹⁹Tc^m-3PRGD₂ SPECT显像可无创诊断大鼠胫骨转移瘤，有望为诊断骨转移瘤提供新的影像学方法。     

Contribution of tissue harmonic imaging and frequency compound imaging in interventional breast sonography.

OBJECTIVE: The purpose of this study was to retrospectively compare conventional imaging, frequency compound imaging (CI), and tissue harmonic imaging (THI) in interventional breast sonography. METHODS: Institutional Review Board approval and patient informed consent were not required. The authors reviewed 104 sonographically guided breast procedures in 83 patients. For each biopsy, 4 images obtained with conventional imaging, frequency CI at 10 and 14 MHz (CI10 and CI14), and THI were graded independently by 2 radiologists for lesion conspicuity, needle conspicuity, lesion and needle conspicuity, and overall image quality. Frequency CI at 10 MHz, CI14, and THI were compared with conventional imaging. Different clinical scenarios (fatty versus glandular background, fine needle versus core needle, and oblique versus horizontal needle direction) were evaluated. RESULTS: Statistical analysis showed that for overall image quality, CI10 was the best setting (odds ratios [OR], 3.67 and 7.48). For lesion conspicuity, CI14 (OR, 3.55) and THI (OR, 1.77) improved lesion visibility in a fatty background, whereas THI (OR, 0.26) was very limited in a glandular background. For needle conspicuity, no setting was better than conventional, whereas THI was the least valuable setting (OR, 0.011 and 0.049). For lesion and needle conspicuity, CI10 showed significantly better results than conventional for a dense background (P = .0268 and .4028; OR, 2.435 and 1.383) with 1 reviewer, whereas THI was the least valuable setting (OR, 0.014 and 0.042). CONCLUSIONS: Conventional imaging provided the best assessment of lesion and needle conspicuity. Frequency compounding is a useful setting for dense breast and for fine-needle aspiration. Tissue harmonic imaging has a role in the visualization of a lesion against a fatty background but is of limited value in needle visualization.     

MR imaging of intrahepatic cholangiocarcinoma

Background: The purpose of this study was to determine the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma. Methods: MR imaging studies of seven cases of pathologically proven intrahepatic cholangiocarcinoma were retrospectively reviewed. Results: On MR images the tumors presented as a single mass (N = 5) or multiple nodules (N = 2), as welldelineated (N = 5) or ill-defined (N = 2), and as non-encapsulated (N = 7). Mean tumor diameter ranged from 6–14 cm (mean, 10 cm). On T1-weighted (TR/TE = 400–600/10–17 msec) images, the tumors were hypointense compared to the liver. The five tumors studied with dynamic MR imaging showed progressive centripetal filling-in after intravenous administration of a gadolinium chelate. On T2-weighted (TR/TE = 2000–2500/80–100 msec) images, all tumors were hyperintense compared to the liver; five were markedly hyperintense and two moderately hyperintense. Vascular encasement, bile duct dilatation within the tumor, and central scar were depicted on MR images in four, three, and two tumors respectively. Conclusion: The typical MR appearance of intrahepatic cholangiocarcinoma is a large well-delineated nonencapsulated tumor associated with intrahepatic venous encasement.     

Tissue harmonic imaging, frequency compound imaging, and conventional imaging: use and benefit in breast sonography.

OBJECTIVE: The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization. METHODS: Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features. RESULTS: For lesion conspicuity, THI and CI14 were better than conventional imaging (P < .01) and CI10 (P < .01) particularly against a fatty background (P < .01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P < .01), as well as overall image quality (P < .01). For margin assessment, CI10 performed better for deep and large (> or =1.5-cm) lesions, whereas CI14 performed better for small (<1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P < .01) and posterior enhancement (P < .01). CONCLUSIONS: The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.     

MR imaging of adrenal lymphoma

A case of lymphoma of the adrenal glands is presented. Both computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated large bilateral adrenal masses with no other associated abdominal abnormalities. MR was better able to demonstrate inferior vena caval patency than CT, and effectively exclude pheochromocytoma as a differential diagnostic consideration due to signal characteristics of the masses.     

Gallbladder adenomyomatosis: imaging findings

In this pictorial essay, we describe the imaging findings of adenomyomatosis of the gallbladder and emphasize high-resolution ultrasound and magnetic resonance cholangiopancreatography in its diagnosis.     

Magnetic resonance imaging of bladder hemangioma

An 18-year-old woman with a bladder hemangioma is described. The tumor had a low signal intensity with multilocular pattern on T1-weighted magnetic resonance (MR) images and high signal intensity on T2-weighted MR images. MR images were useful in evaluating tumor character and its extent.     

MR imaging of ulcerative colitis

High-resolution magnetic resonance imaging (MRI) was used to study 16 resected rectosigmoid specimens of patients treated with total colectomy for severe ulcerative colitis (UC). Six normal colon specimens were also studied as a control group. Moreover, a parallel study of the pelvis of 24 patients with a proven diagnosis of UC was performed with the same MR system. Both in vitro and in vivo MRI findings [thickening and signal intensity (SI)] of the mural layers were qualitatively evaluated by two radiologists and compared with gross and microscopic aspects. In vitro results showed that MRI was able to identify all layers of the colonic wall. In particular in UC specimens, MRI identified thickening and the peculiar abnormal hyperintensity of the mucosal and submucosal layers on spin-echo (SE) T1-weighted images. In vivo results confirmed the high-signal intensity of the mucosal and submucosal layers. These findings were not observed in the control group in which the superficial layers appeared low in intensity on SE T1 images. Our preliminary experience suggests that MRI should be considered a new imaging modality for detecting UC colonic wall changes.     

二维斑点追踪成像与组织多普勒评价早期系统性硬皮病患者右心室功能

目的 采用超声二维斑点追踪成像(STI)及组织多普勒(TDI)评价早期硬皮病(SSc)患者右心室功能.方法 采用STI及TDI评价35例SSc患者(SSc组)及40名正常人(NOR组)的右心室游离壁基底段、中间段及心尖段应变.结果 STI与TDI均显示SSc组右心室游离壁基底段、中间段及心尖段应变均低于NOR组,差异具有统计学意义(P＜0.05);STI与TDI所测应变显著相关(P＜0.01).结论 SSc患者右心室功能减低.STI及TDI均可评价SSc患者右心室功能.     

New imaging of the anterior male urethra

Retrograde urethrography is the method commonly employed in the detection of anterior male urethra pathology. Ultrasonography and magnetic resonance imaging have been proposed recently as new methods that can replace conventional radiography. Normal urethral anatomy can be easily studied after saline distention of the urethra, which creates high contrast relative to adjacent structures such as mucosa and corpus spongiosum. Sonourethrography with high-frequency probes has a high spatial resolution and has proved to be sensitive, specific, and accurate in the diagnosis of anterior urethral pathologies such as strictures, syringocele, tumors, and trauma. It has a major role in the selection of therapy in patients with bulbar strictures. Magnetic resonance imaging with a surface coil with a small field of view can detect penile and bulbar stenoses and tumor extension. After contrast administration, the activity of the inflammatory process in the spongiosum can be assessed and used to modify the urethroplasty technique. The clinical use of the new imaging modalities in the male anterior urethra is limited despite their demonstrated accuracy in diagnosis and presurgical staging of different diseases.     

家庭聚集性新冠状病毒肺炎的临床与影像特征

【摘要】目的：探讨家庭聚集性新冠状病毒肺炎的临床及影像学特征，为临床诊疗提供依据。材料和方法：搜集七组临床确诊为新冠状病毒家庭，共16例，回顾性分析其家庭流行病学病史、发病时间、临床症状及影像学资料。结果：初次X线检查为阳性9例，阴性5例，可疑肺炎2例；CT阳性15例，阴性1例。CT显示双肺病变12例，单肺病变3例，未见异常1例；表现为单纯磨玻璃影4例，单纯结节影1例，磨玻璃影、实变影及结节影混合存在11例，伴有心包积液1例，胸膜及叶间胸膜增厚4例，少量胸腔积液1例。经治疗好转后，80%患者病变吸收大于50%，多数患者仍见残留灶。结论：X线易出现假阴性，高分辨CT灵敏度及分辨率高 ，结合患者流行病学及临床症状，能尽早诊断新冠状病毒肺炎，减少人员聚集的传播；并能评估家庭聚集性肺炎的程度及病情动态变化，从而指导临床治疗及随访。