中国医学影像学杂志2012年第20卷主题词索引

(按汉语拼音字母顺序排列)IDEAL序列IDEAL序列在脊柱脂肪抑制中的应用(黄敏华,郭勇,郑奎宏,等)(1):299m锝高锝酸钠核素显像诊断持续性不卧床腹膜透析所致腹腔渗漏(张卫方,韩庆峰,张燕燕,等)(1):5099m锝甲氧基异丁基异腈分化型甲状腺癌99Tcm-MIBI显像与术后刺激状态甲状腺球蛋白水平的关系(龙再颖,汤春静,马端兰,等)(5):38699Tcm-MIBISPECT/CT双时相显像对原发性甲状旁腺功能亢进症的诊断价值(汪太松,赵晋华,邢岩)(11):85599m锝美罗酸盐18F-FDG符合线路显像与99Tcm-MDP骨显像在     

SPECT显像诊断小儿Meckel''s憩室并出血

目的 :评价SPECT显像在美克耳憩室并出血诊断中的价值。材料和方法 :对 17例疑为美克耳憩室并出血的患儿进行了高锝酸盐 (99mTcO4- )腹部平面显像 ,2例作了断层显像。结果 :阴性显像 6例 ,5例经临床表现及相关检查排除美克耳憩室 ,1例经手术证实为美克耳憩室。阳性显像 11例 ,9例经手术及病理证实为美克耳憩室 ,1例为空肠及其系膜巨大海绵状血管瘤 ,1例为回肠管状重复畸形。SPECT显像对美克耳憩室诊断的敏感性、特异性和准确性分别为 90 .0 %、71.4%和 82 .4%。结论 :SPECT显像简单易行 ,是诊断美克耳憩室并出血的首选影像学方法 ,加采断层显像可以提高敏感性。     

胸腔积液的18F-FDGPET/CT病因诊断

目的:不明原因胸腔积液病因的诊断是临床治疗的前提,本研究探讨18F-脱氧葡萄糖(FDG)PET/CT显像在病因诊断中的价值.方法:对43例原冈未明的胸腔积液患者行18F-FDG PET/CT全身显像.结合PET和CT图像进行综合判断,PET结果的判断采用目测法和标准摄取值(SUV)测定.结果:恶性胸腔积液26例,良性17例(结核性7例,炎性6例,心源性4例).26例恶性者中,21例PET/CT检出原发病灶,5例未找到原发病灶;6例炎性者PET/CT诊断明确;7例结核性中5例经PET/CT检查诊断明确,另2例误诊为恶性;心源性4例PET/CT检查阴性.18F-FDG PET/CT对不明原因胸腔积液病因诊断的灵敏度80.8%(21/26),特异性为88.2%(15/17),阳性预测值为91.3%(21/23),阴性预测值为75.0%(15/20).结论:18F-FDG PET/CT可用于不明原因胸腔积液的病因诊断,并有较高的诊断准确率.     

18F-FDG PET/CT显像鉴别腹腔积液性质的价值

目的 探讨18F-FDG PET/CT显像在不明原因腹腔积液患者积液性质鉴别诊断中的作用.方法 回顾性分析因不明原因腹腔积液入院的初诊患者70例,所有患者均行18F-FDG PET/CT 显像、同机CT平扫和腹腔积液细胞学检查,PET/CT显像计算病灶SUV.结果经组织病理学、腹腔镜、胃镜、肠镜等检查及临床随访确定,随访时间均大于6个月.对疑有胃肠道病变患者行PET/CT 延迟显像以明确诊断.有无腹膜转移组间SUVmax差异行两样本t检验;PET/CT、同机CT平扫及腹腔积液细胞学检查对腹膜转移诊断效能比较用McNemar检验;三者与最终结果吻合度检验用Kappa检验.结果 腹腔积液患者70例,经手术、腹膜活组织检查或腹腔积液细胞学检查证实48例为腹膜转移癌引起的恶性积液,22例为良性积液.2组腹膜的SUVmax分别为6.08±3.92和2.66±1.74,差异有统计学意义(t=-5.063,P＜0.001).PET/CT诊断45例为恶性积液,其中2例为假阳性,另有5例恶性积液被误诊为良性积液,PET/CT诊断腹膜转移的灵敏度、特异性和准确性分别为89.6％ (43/48)、90.9％ (20/22)和90.0％ (63/70).定位CT诊断27例为腹膜转移,其中4例为假阳性,CT 准确诊断良性腹腔积液18例,另有25例假阴性;定位CT诊断腹膜转移的灵敏度、特异性和准确性分别为47.9％ (23/48)、81.8％ (18/22)和58.6％ (41/70).PET/CT与定位CT诊断腹膜转移的灵敏度差异有统计学意义(x2=14.286,P＜0.001).70例腹腔积液患者中仅21例腹腔积液中见癌细胞,其余患者细胞学检查均为阴性,腹腔积液细胞学对腹膜转移诊断的灵敏度、特异性和准确性分别为43.8％ (21/48)、100％ (22/22)和61.4％ (43/70);PET/CT与细胞学检查对腹膜转移诊断的灵敏度差异有统计学意义(x2=13.885,P＜0.001).PET/CT检查结果与最后诊断结果吻合度较强(Kappa=0.776,P＜0.001),定位CT、腹腔积液细胞学检查结果与最后诊断结果吻合度均较弱(Kappa值分别为0.236和0.328,P均＜0.05).结论 18F-FDG PET/CT显像对不明原因腹腔积液患者腹膜转移诊断有重要临床价值,可用于不明原因腹腔积液的良恶性鉴别诊断.     

小肠出血性病变的扫描法定位术

胃肠道出血目前仍是一个较大的诊断上的难题,通常采用的对比剂X光造影术、内窥镜和动脉造影术不一定都能成功地找到出血部位或(和)明确其出血病因。~(99m)锝-高锝酸盐扫描却能成功地做到这一点。本文介绍一例回肠平滑肌肉瘤引起反复出血患者,经~(99m)锝静脉注射后即刻显像和连续动     

淋巴管扩张的淋巴显像和淋巴管造影

1例23岁男性患者,患上睑下垂为特征的散发型Noonan综合征,轻度胸陷凹,手术矫正右隐睾病和中度肺狭窄/反流,生殖器水肿和慢性无痛性泡疹伴阴囊皮肤渗漏液7年。3年前磁共振显像显示其骨盆两侧至阴囊和腹膜后腔上至主动脉旁部位弥漫性淋巴管扩张。99m　Tc-硫化微胶体淋巴显像示包括入胸淋巴管广泛异常,示踪剂反流至阴囊证实骨盆淋巴管机能不全;示踪剂流至循环系统,表明有肝的延迟摄取,且与淋巴流动率降低一致。二足对比淋巴管造影亦证实淋巴管扩张,腹股沟韧带以上淋巴管解剖学异常,且整个淋巴侧管大多扩张。由此,临床作出乳糜反流至会阴、阴囊…     

八例Askin瘤的影像诊断

目的研究Askin瘤的影像表现，提高对该病的认识及鉴别诊断能力。方法回顾性分析经病理证实的8例Askin瘤的影像表现。8例均行X线检查，7例行CT检查，1例行MR检查，4例行核素骨扫描。结果8例Askin瘤均表现为位于胸壁或胸腔的软组织肿物，其中左侧4例，右侧4例。6例大病灶密度不均匀，2例较小病灶内密度或信号均匀；CT扫描4例可见囊变、坏死区。CT、MRI、核素骨扫描共显示肋骨破坏6例，其中CT显示4例，MRI显示1例，核素骨扫描显示放射性核素浓集3例。胸腔积液6例。瘤肺交界面清楚1例，不清楚7例。8例病灶中均未见钙化。结论Askin瘤影像学表现为胸腔或胸壁的软组织肿物，但不具有特异性，对发生于儿童及青少年的胸壁肿物，应注意鉴别诊断。     

99Tcm标记化合物显像检测冠心病的优化方案探讨

目的 探讨99Tcm标记化合物显像检测冠心病的优化方案.方法 选择临床可疑或确诊的冠心病患者4236例,进行99Tcm标记化合物显像8873例次,分析显像结果,提出99Tcm标记化合物显像检测冠心病的优化方案,并与临床资料对照验证.结果 在可疑冠心病诊断、心肌缺血检测、心肌梗死诊断中,该方案准确率高达94.1%.对临床特需的诊断要求如存活心肌检测、 "罪犯"血管检测、缺血性心肌病诊断、疗效监测等也有较高的准确率.结论 99Tcm标记化合物显像优化方案可以完成临床对冠心病的大部分诊断要求,克服了核素显像自身的部分缺陷,具有高效、简便、节约的优势,临床指导价值显著.     

全身骨显像诊断前列腺癌骨转移与PSA水平及病理分级的相关性研究

目的 探讨核素全身骨显像诊断前列腺癌骨转移与血清前列腺特异性抗原(PSA)水平及前列腺癌病理分级的关系,并研究前列腺癌发生骨转移的规律和特点.方法　对107例前列腺癌患者术前用放免法测定其血清PSA水平,并进行 99Tcm-亚甲基二瞵酸盐全身骨显像,术后对其进行病理分级,分析前列腺癌骨转移与3种方法检查结果的相关性.结...     

99Tcm-MIBI动态血流灌注显像和双时相核素显像对甲状腺冷结节良恶性的诊断价值研究

目的 探讨99Tcm-MIBI动态血流灌注显像和双时相显像对甲状腺冷结节良恶性的诊断价值.方法 回顾性分析甲状腺冷结节行手术治疗的患者28例,所有患者使用配备低能高分辨准直器的SPECT仪行99Tcm-MIBI动态血流灌注、30 min早期相及120 min延迟相静态平面显像,并用T/NT值等综合分析显像结果.结果 9例甲状腺癌患者在动态血流灌注、30 min早期相和120 min延迟相显像中阳性数分别为5例、6例、7例;19例良性病变患者在动态血流灌注、30 min早期相和120 min延迟相显像中阴性数分别为14例、11例、16例.99Tcm-MIBI动态血流灌注显像诊断甲状腺癌的灵敏度为55.56%,特异度为73.68%,准确率为67.85%;30 min早期相显像诊断甲状腺癌的灵敏度为66.67%,特异度为57.89%,准确率为67.85%;120 min延迟相显像诊断甲状腺癌的灵敏度为77.78%,特异度为84.21%,准确率为82.14%.结论 99Tcm-MIBI的双时相显像对甲状腺冷结节的诊断和鉴别诊断具有一定价值,通过对动态血流灌注和99Tcm-MIBI的双时相显像中T/NT值等综合分析,可以降低假阳性和假阴性的发生.     

The clinical utility of the Tc-99m SC intraperitoneal scan in CAPD patients

The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes to subcutaneous infiltration, leaks, and herniations through defects in the abdominal wall. In this setting, the incidence of abdominal hernias ranges between 9% and 24%. Life-threatening complications (incarceration/strangulation) occur in up to 13.2% of hernias. Therefore, the authors evaluated the efficacy of the Tc-99m sulfur colloid (SC) intraperitoneal scan in the detection of abdominal leaks and hernias in 11 continuous ambulatory peritoneal dialysis (CAPD) patients over a 2-year period at the Hospital of the University of Pennsylvania. Eleven patients (7M, 4F) ranging in age from 24 to 72 (mean = 50.8), on CAPD, were evaluated for clinically suspected abdominal hernias or dialysate leaks with intraperitoneally administered Tc-99m SC. After the injection of 3-5 mCi of Tc-99m into a standard 2 liter dialysate bag, multiple sequential anterior images of the abdomen were obtained in the supine position over the course of one hour. Delayed images were obtained after ambulation and post-drainage two or more hours postinjection in multiple projections and positions in order to demonstrate any abnormal focal accumulations of fluid to the best advantage. Any detected abnormalities were marked and correlated with the physical examination and the patient's symptoms. Two patients had normal scans. Of the nine abnormal scans, five hernias were identified in four patients and six leaks were detected in the other five patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Continuous ambulatory peritoneal dialysis

Purpose: To assess complications of continuous ambulatory peritoneal dialysis (CAPD) in uremic patients with and without clinical symptoms by CT peritoneography.Material and Methods: A total of 64 patients with end-stage renal disease and on continuous CAPD were investigated. Twenty-eight had some clinical symptoms, which might be related to the complications of CAPD. Thirty-six patients had no complaints or symptoms due to the dialysis treatment.Results: CT peritoneography revealed various complications including hernias (50%), dialysate leakage (46%), localized fluid collection (4%) and peritoneal adhesions (4%) in the patients who had clinical symptoms that might be related to the dialysis treatment. Moreover, similar complications were found in the asymptomatic patients at a lower rate: hernia (3%), dialysate leakage (17%), peritoneal adhesions (3%) and abdominal wall laxity (3%). Complication detection rate by CT peritoneography was 68% (n=19) in the symptomatic patients and 22% (n=8) in the asymptomatic patients. The number of complications found in each group was significant.Conclusion: CT peritoneography was an effective modality in detecting complications from CAPD in patients with and without clinical symptoms.     

The use of technetium-99m sulfur colloid in the detection of patent processus vaginalis in patients on continuous ambulatory peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD) is commonly used in patients with renal failure as an alternative to hemodialysis. A not infrequent complication is scrotal swelling due to bowel or fluid passing through a patent processus vaginalis secondary to increased abdominal pressure. A radionuclide study using Tc-99m sulfur colloid is a safe and simple method to determine if this complication is present or may be used as a pre-CAPD screening procedure.     

Scintigraphic detection of abdominal wall and diaphragmatic peritoneal leaks in patients on continuous ambulatory peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD) is utilized with increasing frequency for patients with end stage renal disease (ESRD). Several complications have been observed including catheter malfunction due to pericatheter leaks, abdominal wall and inguinal hernias and diaphragmatic leaks. Occasionally special diagnostic procedures are necessary to determine the nature of the abnormality and guide the surgical approach to correction. The four cases herein illustrate the usefulness of radionuclide imaging in diagnosing leakage of dialysate fluid in patients on CAPD.     

Comparison of peritoneal equilibration test with <Superscript>99m</Superscript>Tc-DTPA excretion in the assessment of peritoneal permeability

Assessment of peritoneal permeability is necessary for successful management of end-stage renal disease (ESRD) patients by continuous ambulatory peritoneal dialysis (CAPD). The objective of this study was to develop an alternative method of assessing the peritoneal permeability and to compare this method with the conventional method, the peritoneal equilibrium test, first described by Twardowski in 1987. Twenty patients undergoing regular CAPD were included in this study. Before starting the peritoneal dialysis, 370 MBq (10 mCi) technetium-99m diethylene triamine penta-acetic acid (^99mTc-DTPA) was injected intravenously. A standard dose of the same quantity was kept and used later for calculations. At the end of 4 h, a dialysate fluid sample (1 ml) was collected and the total dialysis effluent fluid volume was measured. Excretion of ^99mTc-DTPA into the dialysate fluid as a percentage of the injected dose was calculated. Simultaneously, standard peritoneal equilibrium test values were recorded for comparison. Peritoneal excretion of ^99mTc-DTPA ranged from 8% to 25% of the injected dose, depending on the peritoneal membrane permeability. When the results were compared with the conventional method, a good correlation (r=0.79) was found. This innovative radionuclide technique is a simple and convenient method to assess the peritoneal membrane permeability and can be used as an alternative to the peritoneal equilibrium test, which is very cumbersome and associated with many limitations.     

Pleuroperitoneal communication associated with malignant ascites. A potential cause for new pleural effusion suggestive of pulmonary embolism

A patient with metastatic gastric carcinoma and malignant ascites developed sudden-onset dyspnea secondary to a new large left pleural effusion. A radionuclide lung scan performed for suspected pulmonary embolism was indeterminate. Scintigraphy performed following intraperitoneal administration of Tc-99m sulfur colloid subsequently demonstrated rapid accumulation of activity in the left pleural space, indicating the presence of a pleuroperitoneal communication. In a patient with known or suspected ascites, a new pleural effusion, and an indeterminate lung scan, peritoneal scintigraphy may identify the origin of the effusion and obviate the need for further invasive evaluation for possible pulmonary embolism.     

Simultaneous demonstration of pleural effusion and ascites by technetium-99m sulfur colloid liver-spleen scintigraphy

Scintigraphic evidence of ascites has been observed in Tc-99m sulfur colloid studies of the liver and spleen, in Tc-99m HIDA hepatobiliary scans, in Ga-67 citrate scans, and in Tc-99m phosphonate bone images. Pleural effusion has been demonstrated in Tc-99m phosphonate bone scintigraphy. The case of a 48-year-old man whose Tc-99m sulfur colloid liver-spleen scintigram simultaneously demonstrated a right pleural effusion and ascites is presented.     

Modified computed tomography peritoneography: clinical utility in continuous ambulatory peritoneal dialysis patients

The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non-ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD-related complication was diagnosed in 33 of 40 (82%) CTP. Twenty-nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non-communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD-related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.     

Diffuse thoracoabdominal radioactivity seen in bone imaging

Diffusely increased radioactivity in the thoracoabdominal region (lower thorax and/or upper abdomen) occasionally has been observed when performing Tc-99m phosphonate bone studies. To assess the significance of activity in this finding, 1100 bone scintigrams were reviewed and the clinical data and other diagnostic imaging procedures were evaluated in these cases. With the exclusion of Tc-99m sulfur colloid liver-spleen scans 18 patients were found to have mild but diffuse increased radioactivity in the thoracoabdominal region either on the right or left. Clinical findings in these cases with abnormal uptakes were pleural effusions (six cases), hepatic colonic metastases (six cases), splenic metastases from bronchogenic carcinoma (one case), abdominal and peritoneal colonic metastases (one case), a massive metastatic squamous cell carcinoma (from lung) in the right lower chest (one case), and defective radiopharmaceuticals (three cases). Since the defective radiopharmaceuticals contained 5% of hydrolyzed reduced Tc-99m colloid by thin-layer chromatography, each of three patients received approximately 740 mu Ci of Tc-99m sulfur colloid. Factors to be considered in the interpretation of diffuse thoraco-abdominal activity from a bone agent should include splenic or hepatic metastases, a Tc-99m sulfur colloid splenic or hepatic metastases, a Tc-99m sulfur colloid study within the previous 24 hours, pleural effusion, faulty radiopharmaceuticals, and abdominal and peritoneal colonic metastases.     

Photopenia of a hemithorax on technetium-99m HMDP bone scintigraphy resulting from massive pleural effusion

Accumulation of Tc-99m labeled phosphonate bone scanning agent in a pleural effusion usually shows a mild and diffuse increase in radioactivity of the involved thorax. A malignant neoplasm was thought to account for this accumulation. The photon deficiency of the hemithorax on Tc-99m HMDP bone scintigraphy was shown in a case of massive pleural effusion, which was proved by autopsy to be due to metastatic breast carcinoma in the pleura. Two factors caused these scintigraphic findings: 1) a large amount of fluid in the pleural cavity caused photon attenuation; 2) the higher body background in the noninvolved hemithorax and other areas of the body was due to renal dysfunction resulting from chronic pyelonephritis. Whether the accumulation of the radiopharmaceutical agent in the pleural effusion was malignant or benign could not readily be distinguished.