改良注射核素骨显像剂的拔针方法可提高图像质量

目的 探讨改良注射核素骨显像剂的拔针方法对全身骨显像图像质量的影响。方法 静脉注射核素骨显像剂后用两种方法拔针。常规组117例,拔针方法以一根棉签按压穿刺点迅速拔出针头,按压片刻。改良组117例,拔针方法以两根棉签置于针头进皮肤及血管两点,拔出针头同时按压两个进针点5min以上。2h后行SPECT全身骨骼平面显像。结果 常规组注射部位显像剂浓聚的发生率为16.24%,改良组为2.56%。结论 改良注射核素骨显像剂的拔针方法使注射部位显像剂浓聚的发生率明显下降,可以提高全身骨显像图像质量。     

静脉留置针在CT及MRI对比剂注射中的应用

目的研究静脉留置针在CT,MRI对比剂注射中的应用并和常规头皮静脉针穿刺比较,以及观察拔针后两种按压方式对提高注射成功率和减少局部出血的效果。方法将502例运用高压注射器注射对比剂的增强患者分成留置针和头皮静脉针两组,观察比较对比剂外渗情况。然后,再在头皮针组内随机选120例分两组在拔针后将棉签分别垂直和平行于血管走行按压在血管上（A法和B法）,比较局部出血情况。结果留置针注射对比剂外渗的发生率（0．57％）低于头皮静脉针组对比剂外渗的发生率（3．6％）;A,B两种按压方式局部出血的发生率相差13．3％。结论在CT,MRI增强造影运用留置针进行注射和拔针后棉签平行于血管走行按压可有效减少局部出血及其他不良反应,值得推广。     

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。     

核素骨显像诊断脊柱疾病的价值

目的：探讨核素骨显像在脊柱转移瘤及其他脊柱疾病诊断中的价值。材料和方法：104例经手术病理诊断的脊柱疾病患者行^99mTc-MDP全身骨平面显像，将显像图分为局部异常浓聚、局部异常稀疏、局部加其他部位异常浓聚或稀疏、其他部位异常浓聚或稀疏几种。结果：骨显像诊断脊柱疾病的灵敏度为：转移瘤90.6%，原发恶性肿瘤76.0%，良性肿瘤52.9%，瘤样病损85.7%，炎性病变100%，压缩性骨折100%，62.5%的转移瘤患者伴有其他部伞骨骼的异常浓聚或稀疏灶。非转移瘤的其他脊柱疾病，23.6%伴有异位异常浓聚或稀疏灶。结论：核素骨显像是诊断骨转移瘤的最佳方法。对其他脊柱疾病，骨显像可判断病灶是单发抑或多发。     

骨纤维异常增殖症的全身骨显像及局部SPECT/CT图像特点

目的 :探讨骨纤维异常增殖症(FDB)的~(99)Tc~m-MDP全身骨显像及局部SPECT/CT图像的特点,以提高对其影像学特征的认识。方法:回顾性分析65例经病理或临床随访证实为FDB的患者,均行全身骨显像,共发现126个病灶,并对其中76个行SPECT/CT图像融合,分析全身骨显像及局部SPECT/CT图像特点。结果:65例中,单骨型占78.46%(51/65),以附肢骨受累多见,且下肢骨受累最多见;多骨型占21.54%(14/65),单侧肢体受累11例,双侧肢体受累3例。65例~(99)Tc~m-MDP全身骨显像示病灶处显像剂异常浓聚,在附肢骨及肋骨表现为沿骨干走行的条形浓聚,在颅骨及中轴骨为团块状异常浓聚。SPECT/CT示:囊状型病灶11个,其中无浓聚3个,轻度浓聚5个,高度浓聚3个,所有病灶周缘均异常浓聚;硬化型病灶32个,其中20个均匀异常浓聚,12个不均匀异常浓聚;混合型病灶33个,其中硬化病灶异常浓聚,囊状病灶无明显浓聚。结论:全身骨显像联合局部SPECT/CT显像对FDB的显示有一定特点,不同解剖影像学分型可表现为不同的显像剂浓聚。     

快速骨扫描在SPECT骨显像中的临床应用

目的探讨Infinia快速骨扫描技术（Evolution for Bone,EFB）在骨显像中的应用价值。方法 25例在常规全身骨显像中表现为异常核素浓聚灶的患者,行局部骨断层,同时获得局部骨断层图像、同机定位CT以及两者的融合图像。最后进行快速骨扫描技术扫描及处理。结果 25例骨显像阳性患者骨断层显像与同机定位CT显像发现62处异常放射性浓聚,其中病灶58处;全身平面骨显像发现病灶53处;EFB发现病灶57处,EFB技术更易发现病灶、分辨病灶部位、提高诊断率。结论 Infinia快速骨扫描技术具有较高的临床应用价值,应作为全身骨显像的重要补充检查方法。     

介绍一种输液拔针时按压针眼的小技巧

在临床输液完毕拔针时,护士用一根无菌棉签按压针眼止血,止血时间一般2～3分钟。护士工作忙时总是让病人或病人家属按压,有时病人掌握不好按压时间,造成针眼出血或菅周瘀血。因此,我们利用压针眼胶布的拉力,使皮肤形成皱折来压迫止血,效果良好。方法:输液完毕,取下固定胶管和压针柄的胶布,留下压针眼的胶布。然后左手固定针柄,右手将压针眼胶布由右自左撕开至穿刺部位时,用力拉紧胶布,使皮肤形成皱折后,将胶布贴在皮肤上,立即将针头拔出。压针眼胶布一般用创可贴或输液贴,既无菌、粘性和弹性较好。此法的优点是:操作简单,易掌握,穿刺部位不…     

全身弥散加权成像对恶性肿瘤骨转移的临床应用

目的 研究全身弥散加权成像(WBDWI)对恶性肿瘤远处骨转移的临床应用.方法 62例经病理证实的恶性肿瘤患者,均在2周内分别行WBDWI及核素骨显像.将骨骼分为10个部位分析,分别为颅骨、胸骨、颈椎、胸椎、腰椎、骶椎、肋骨、肩胛骨、骨盆、股骨.以核素骨显像见异常浓聚灶或稀疏灶,WBDWI见高信号为阳性,分析比较两者所显示的病灶数.结果 62例患者中,WBDWI显示362处病灶,核素骨显像显示281处病灶.WBDWI可以发现更多的骨外器官及淋巴结的病变.结论 WBDWI对骨转移具有很好的诊断价值,可以与核素骨显像互相补充,为临床提供更加全面的信息.     

病理证实的130例脊柱疾病核素骨显像研究

目的:比较核素全身骨平面显像和MRI、CT及X线诊断脊柱转移瘤及其他脊柱疾病的价值.材料和方法:130例经病理证实的脊柱疾病患者行99mTc-MDP全身骨显像,其中104例同期行MRI、61例行CT、107例行X线片检查.结果:骨显像的诊断灵敏度为:转移瘤91.7%,原发骨恶性肿瘤73.3%,良性肿瘤54.2%,瘤样病损81.8%,炎性病变100%,压缩性骨折100%.61.1%的转移瘤患者伴有其他部位骨骼的异常浓聚或稀疏灶.结论:核素骨显像诊断骨转移瘤最有效;其他脊柱疾病,几种影像技术各有其优势,骨显像对判断病灶范围及伴发其他骨病变有较大价值.     

核素骨显像在骶骨肿瘤术前诊断中的应用

目的 评价术前骨显像在骶骨肿瘤诊断中的临床价值。方法103例骶骨肿瘤患者术前进行了99Tcm-亚甲基二膦酸盐（MOP）全身骨显像,其中39例加做了局部断层显像。全身显像用于观察有无多骨病变及骶骨肿瘤对显像剂的摄取;断层显像用于进一步观察骶骨肿瘤的核素摄取特征。结果该组恶性肿瘤为65例,良性病变38例。骨显像在17．5％（18／103）的患者中检出了多发病灶,51．7％（12／21）的转移性骶骨瘤患者在骨显像上仅表现骶骨单发病变。骶骨肿瘤表现为放射性减低型者在平面显像中占46．6％（48／103）,在断层显像中占84．6％（33／39）。放射性浓聚型或伴局部浓聚的放射性减低型骶骨肿瘤多为恶性病变;而单纯的放射性减低型骶骨肿瘤在无多骨病变发生的情况下多为良性病变;呈现“炸面圈”征的骶骨肿瘤则多为骨巨细胞瘤。结论骶骨肿瘤术前骨显像有助于全身多发病变的筛查,但对于单发的转移性肿瘤其诊断价值有限;观察肿瘤对显像剂的摄取特征,可为其鉴别诊断提供帮助。     

骨显像的技术操作及应用与质量控制

目的 探讨通过注意骨显像的技术操作要点及正确使用骨显像的各种方式提高骨显像影像质量的方法.方法 对本科2011年～2012年2543例接受骨显像检查的患者进行分析.显像仪器为GE公司生产的Infinia VC Hawkeye双探头带符合线路SPECT,配低能通用型准直器.全身骨显像、局部骨显像、SPECT/CT骨显像静脉注入显像剂,注射后嘱患者饮水500～1000ml,于3～4h后开始检查;三时相骨显像采用“弹丸”式静脉注射显像剂,于即刻、10min、3～4h分别采集血流相、血池相和延迟相.结果 2543例接受骨显像检查的患者,行全身骨显像2543例(100％),行三时相骨显像366(14.4％),行局部骨显像168例(6.6％),行SPECT/CT骨显像81例(3.2％).结论 技师可通过熟练掌握不同方式骨显像的操作技术及其适应症,并充分利用核医学全身显像、局部显像等各种显像方式的优势来提高骨显像影像质量.     

The development and in-vivo behavior of tin containing radiopharmaceuticals--II. Autoradiographic and scintigraphic studies in normal animals and in animal models of bone disease

Various 117mSn (2+ and 4+) compounds in well defined oxidation states were studied in normal mice using whole body autoradiography (WBARG), tissue distribution and scintigraphy in animal models of vitamin A induced bone disease, fracture, infected fracture and ischemic muscle lesions. The 117mSn4+-DTPA showed high affinity to normal bone with low soft tissue concentration. Increased deposition of this compound in fractures and ischemic lesions in muscle was also demonstrated. In hypervitaminosis A, reduced bone uptake of 117mSn4+-DTPA was shown to occur. Nude mice bearing osteogenic sarcoma of human origin showed uptake in spiculated pattern. The similar distribution of 117mSn4+-DTPA which does not contain phosphate or phosphonate groups, and the 99mTc(Sn) skeletal imaging compounds may indicate that tin is important in binding to bone. 117mSn4+-DTPA may not be ideal for routine imaging except when long term follow up is required. It should however be considered for therapy of bone tumors because of the long physical half-life of 117mSn (t1/2 = 14.03 days), abundance of short-range conversion and Auger electrons and its preferential deposition in cortical bone as indicated by our results.     

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。     

Tumour imaging radiopharmaceuticals.

32P, 131I-labeleed human serum albumin, 75Se-seleno-methionine, 107Hg-chlormerodrin, 67Ga-citrate and labelled bleomycin compounds, among others are discussed with particular respect to their observed clinical characteristics and suggested mechanisms of uptake. It is shown that there are striking similarities in the kinds of tumours demonstrable by these agents and that all of them may be taken up into inflammatory exudates. It is suggested that, while differences in the metabolism of each agent clearly exist, their mechanism of tumour uptake may be predominantly non-specific. It is concluded that radionuclide tumour imaging is of potential value mainly from the point of view of ease of whole body scanning for follow-up purposes and whereas other diagnostic methods may be more accurate in specific areas, ease of whole body screening is rarely a feature of these techniques. Methods for studying human cancer are necessarily restricted and the tumour imaging technique provides a unique, dynamic means of tumour observation. From the clinical point of view, the questions of why some tumours image well and others do not, what is the effect of treatment on uptake and how specific is the technique, are of most importance. In order to improve tumour imanging, more emphasis must be given to improving the lesion: background radioactivity ratio of the agents rather than attempting to improve detection equipment.     

Quantitation in PET using isotopes emitting prompt single gammas: application to yttrium-86

Several yttrium-90 labelled somatostatin analogues are now available for cancer radiotherapy. After injection, a large amount of the compound is excreted via the urinary tract, while a variable part is trapped in the tumour(s), allowing the curative effect. Unfortunately, the compound may also be trapped in critical tissues such as kidney or bone marrow. As a consequence, a method for assessment of individual biodistribution and pharmacokinetics is required to predict the maximum dose that can be safely injected into patients. However, (90)Y, a pure beta(-)particle emitter, cannot be used for quantitative imaging. Yttrium-86 is a positron emitter that allows imaging of tissue uptake using a PET camera. In addition to the positron, (86)Y also emits a multitude of prompt single gamma-rays, leading to significant overestimation of uptake when using classical reconstruction methods. We propose a patient-dependent correction method based on sinogram tail fitting using an (86)Y point spread function library. When applied to abdominal phantom acquisition data, the proposed correction method significantly improved the accuracy of the quantification: the initial overestimation of background activity by 117% was reduced to 9%, while the initial error in respect of kidney uptake by 84% was reduced to 5%. In patient studies, the mean discrepancy between PET total body activity and the activity expected from urinary collections was reduced from 92% to 7%, showing the benefit of the proposed correction method.     

Time-dependent image quality using 99mTc-pyrophosphate.

Technetium-99m-labeled pyrophosphate has proved to be a useful skeletal-imaging agent. In this study, specific areas of the skeleton were imaged at times ranging from 1/2 to 6 1/2 hr after injection of 99mTc-pyrophosphate. Count ratios between abnormal and normal bone with respect to adjacent soft tissue were obtained for selected regions of interest on computer-stored scintillation camera images. The results show that image quality improves most rapidly from 1/2 to 2 hr, but further modest gain in quality does occur on views recorded between 2 and 6 hr. All lesions detected on the later images were also observed on the early ones and the ratios of uptake between abnormal and normal bone from computer-processed scintillation camera images did not change appreciably with time after the 1/2-hr images. Our results confirm the clinical impression that overall image quality is better on views obtained at least 3 hr after injection. Further delays in imaging beyond 3-4 hr after injection probably will not result in any appreciable gain in diagnostic accuracy.     

噬血细胞综合征的18F-FDG PET/CT影像学特点

目的探讨噬血细胞综合征的18F-FDG PET/CT显像的影像学特点。方法回顾性分析我院7例HLH临床资料和18F-FDG PET/CT影像资料。结果 7例患者均因不明原因发热入院,7例患者均符合HLH诊断指南2004修订版的标准。肝脏增大4例,3例合并FDG摄取增高,脾脏增大6例,5例合并FDG摄取增高,2例出现全身多发淋巴结增大并FDG摄取增高,2例表现为脑皮质FDG摄取弥漫性减低,6例出现肺部改变(肺炎、肺不张、胸腔积液等)。结论认识该疾病的18F-FDG PET/CT影像表现,有助于提高该疾病的诊断率。     

Comparison as a lymphoscintigraphic agent between 99Tcm dextran and 99Tcm antimony sulphide colloid

To determine its suitability as a lymph node imaging agent, 99Tcm dextran (99TcmDx) was compared with 99Tcm antimony sulphide colloid (99TcmSb2S3) in rabbits and dogs. In two groups of five rabbits each, absorption from the interstitial injection site, popliteal lymph node sequestration and total body uptake and distribution of both agents were determined. In three dogs, both agents were studied simultaneously, 99TcmDx and 99TcmSb2S3 being injected into the left and right hind feet respectively; therefore, only popliteal lymph node sequestration and image qualities were evaluated. Uptake curves in the rabbits indicated that total body uptake of 99TcmDx is faster and greater than that of 99TcmSb2S3. In spite of rapid lymph node uptake rates, total popliteal lymph node sequestration of 99TcmDx is significantly lower than that observed for 99TcmSb2S3. While lymph node uptake of 99TcmDx in dogs is higher than in rabbits, disparity between the two agents persists and is demonstrable in the image in both species. Reduced lymph node sequestration of 99TcmDx may result from its non-colloidal nature as well as its instability, both of which render this agent unsuitable for imaging pathological features of lymph nodes although its rapid absorption and distribution may be ideal characteristics for the study of lymphatic kinetics.     

肾性骨病核素骨显像结果分析

目的 探讨99Tcm-亚甲基二磷酸盐(99Tcm-MDP)骨显像在肾性骨病中的应用价值.方法 选择我院2008～2011年经过确认的肾性骨病36例,行核素SPECT显像,分析其影像学表现.结果 10例双侧胫腓骨摄取增加;8例双下肢骨、6例全身长骨骨摄取不均匀;5例全身关节膨大,双侧肱骨、股骨弯曲畸形;6例全身关节膨大伴周围软组织钙化;1例全身关节膨大伴全身多处软组织包块.结论 结合临床资料,99Tcm-MDP骨显像能准确判断病变性质,可为肾性骨病的诊治提供有力依据.