Utility of gallium-67 scintigraphy for evaluation of cardiac sarcoidosis with ventricular tachycardia

Background The outcome of cardiac sarcoidosis is sometimes very poor. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most common cause of sudden death among most patients. However, there is no established method for potential VT in patients with cardiac sarcoidosis. Thus, we investigated the utility of evaluation of gallium-67 scintigraphy for potential VT in patients with cardiac sarcoidosis.Methods and Results Cardiac sarcoidosis was diagnosed in 25 patients at ours or collaborating hospitals during the period 1982 through 2004. Twenty-one of these patients were treated with corticosteroid, and these patients were divided into two groups, depending on whether VT was present: a non-VT group (n=7) and a VT group (n=14). Laboratory and gallium-67 scintigraphy findings were examined in both groups. During the follow-up period, initial and maintenance dosages of corticosteroid did not differ significantly between the groups. Accumulation of gallium-67 in the heart at the time of diagnosis was detected more frequently in the VT group than in the non-VT group (14.3 vs. 71.4%, p<0.05). Six of the seven VT patients who underwent follow-up examination showed improvement on the scintigram obtained after treatment. Five of the six showed no VT recurrence in terms of Holter electrocardiogram, electrophysiologic study, or delivery of implantable cardioverter defibrillator shock. Serum angiotensin-converting enzyme and lysozyme concentrations were within normal limits in most patients in both groups.Conclusions Activity of sarcoid granulomas may be associated with the occurrence of VT. Gallium-67 scintigraphy reflects the activity of sarcoid granulomas and thus is useful for evaluation of cardiac sarcoidosis in patients with potential VT.     

Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy

Background

The presence and extent of late gadolinium enhancement (LGE) has been associated with adverse events in patients with hypertrophic cardiomyopathy (HCM). Signal intensity (SI) threshold techniques are routinely employed for quantification; Full-Width at Half-Maximum (FWHM) techniques are suggested to provide greater reproducibility than Signal Threshold versus Reference Mean (STRM) techniques, however the accuracy of these approaches versus the manual assignment of optimal SI thresholds has not been studied. In this study, we compared all known semi-automated LGE quantification techniques for accuracy and reproducibility among patients with HCM.

Methods

Seventy-six HCM patients (51 male, age 54 ± 13 years) were studied. Total LGE volume was quantified using 7 semi-automated techniques and compared to expert manual adjustment of the SI threshold to achieve optimal segmentation. Techniques tested included STRM based thresholds of >2, 3, 4, 5 and 6 SD above mean SI of reference myocardium, the FWHM technique, and the Otsu-auto-threshold (OAT) technique. The SI threshold chosen by each technique was recorded for all slices. Bland-Altman analysis and intra-class correlation coefficients (ICC) were reported for each semi-automated technique versus expert, manually adjusted LGE segmentation. Intra- and inter-observer reproducibility assessments were also performed.

Results

Fifty-two of 76 (68%) patients showed LGE on a total of 202 slices. For accuracy, the STRM >3SD technique showed the greatest agreement with manual segmentation (ICC = 0.97, mean difference and 95% limits of agreement = 1.6 ± 10.7 g) while STRM >6SD, >5SD, 4SD and FWHM techniques systematically underestimated total LGE volume. Slice based analysis of selected SI thresholds similarly showed the STRM >3SD threshold to most closely approximate manually adjusted SI thresholds (ICC = 0.88). For reproducibility, the intra- and inter-observer reproducibility of the >3SD threshold demonstrated an acceptable mean difference and 95% limits of agreement of −0.5 ± 6.8 g and −0.9 ± 5.6 g, respectively.

Conclusions

FWHM segmentation provides superior reproducibility, however systematically underestimates total LGE volume compared to manual segmentation in patients with HCM. The STRM >3SD technique provides the greatest accuracy while retaining acceptable reproducibility and may therefore be a preferred approach for LGE quantification in this population.     

Focal myocardial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance in children and adolescents with dilated cardiomyopathy

Background

Different patterns of late gadolinium enhancement (LGE) including mid-wall fibrosis using cardiovascular magnetic resonance (CMR) have been reported in adult patients presenting with non-ischemic dilated cardiomyopathy (DCM). In these studies, LGE was associated with pronounced LV remodelling and predicted adverse cardiac outcomes. Accordingly, the purpose of our study was to determine the presence and patterns of LGE in children and adolescents with DCM.

Methods

Patients <18 years of age presenting with severe congestive heart failure who were admitted for evaluation of heart transplantation at our centre underwent CMR examination which consisted of ventricular functional analysis and assessment of LGE for detection of myocardial fibrosis. Ischemic DCM was excluded by coronary angiography, and right ventricular endomyocardial biopsies ruled out acute myocarditis.

Results

Thirty-one patients (mean age 2.1 ± 4.2 years) with severe LV dilatation (mean indexed LVEDV 136 ± 48 ml/m²) and LV dysfunction (mean LV-EF 23 ± 8%) were examined. LGE was detected in 5 of the 31 patients (16%) appearing in various patterns characterized as mid-wall (n = 1), focal patchy (n = 1), RV insertion site (n = 1) and transmural (n = 2). Based on histopathological analysis, 4 of the 5 LGE positive patients had lymphocytic myocarditis, whereas one patient was diagnosed with idiopathic DCM.

Conclusions

In children and adolescents with DCM, focal histologically proven myocardial fibrosis is rarely detected by LGE CMR despite marked LV dilatation and severely depressed LV function. LGE occurred in various patterns and mostly in patients with inflammatory cardiomyopathy. It remains unclear whether myocardial fibrosis in childhood DCM reflects different endogenous repair mechanisms that enable favourable reverse remodelling. Larger trials are needed to assess the prognostic implications of LGE in childhood DCM.     

心脏磁共振钆对比剂延迟强化的临床意义及判断预后的价值

钆对比剂延迟强化磁共振成像(LGE-MRI)具有高度的组织特异性和良好的空间分辨力,能够准确识别梗死心肌或瘢痕组织。钆对比剂延迟强化(LGE)可见于缺血性心脏病,如急性或慢性心肌梗死,也可见于非缺血性心肌病、炎症性心脏病和浸润性心肌病。延迟强化的有无及其部位和程度在心血管疾病的诊断、治疗和预后判断方面起着重要作用。     

Comparison of cardiovascular magnetic resonance characteristics and clinical consequences in children and adolescents with isolated left ventricular non-compaction with and without late gadolinium enhancement

Background

Although cardiovascular magnetic resonance (CMR) is showing increasingly diagnostic potential in left ventricular non-compaction (LVNC), relatively little research relevant to CMR is conducted in children with LVNC. This study was performed to characterize and compare CMR features and clinical outcomes in children with LVNC with and without late gadolinium enhancement (LGE).

Methods

A cohort of 40 consecutive children (age, 13.7 ± 3.3 years; 29 boys and 11 girls) with isolated LVNC underwent a baseline CMR scan with subsequent clinical follow-up. Short-axis cine images were used to calculate left ventricular (LV) ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), myocardial mass, ratio of non-compacted-to-compacted myocardial thickness (NC/C ratio), and number of non-compacted segments. The LGE images were analyzed to assess visually presence and patterns of LGE. The primary end point was a composite of cardiac death and heart transplantation.

Results

The LGE was present in 10 (25 %) children, and 46 (27 %) segments were involved, including 23 non-compacted segments and 23 normal segments. Compared with LGE- cohort, LGE+ cohort had significantly lower LVEF (23.8 ± 10.7 % vs. 42.9 ± 16.7 %, p < 0.001) and greater LVEDV (169.2 ± 65.1 vs. 118.2 ± 48.9 mL/m², p = 0.010), LVESV (131.3 ± 55.5 vs. 73.3 ± 46.7 mL/m², p = 0.002), and sphericity indices (0.75 ± 0.19 vs. 0.60 ± 0.20, p = 0.045). There were no differences in terms of number and distribution of non-compacted segments, NC/C ratio, and myocardial mass index between LGE+ and LGE- cohort. In the LGE+ cohort, adverse events occurred in 6 patients compared to 2 events in the LGE- cohort. Kaplan-Meier analysis showed a significant difference in outcome between LGE+ and LGE- cohort for cardiac death and heart transplantation (p = 0.011).

Conclusions

The LGE was present in up to one-fourth of children with LVNC, and the LGE+ children exhibited a more maladaptive LV remodeling and a higher incidence of cardiovascular death and heart transplantation.     

Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography

Background

Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical practice in selected patients can add additional prognostic information after routine echo. We assessed whether CMR improves outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources.

Methods and results

We prospectively enrolled 1044 consecutive patients referred for CMR. There were 38 deaths and 3 cardiac transplants over a median follow-up of 1.0 years (IQR 0.4-1.5). We first reproduced previous survival curve strata (presence of LGE and ejection fraction (EF) < 50%) for transplant free survival, to support generalizability of any findings. Then, in a subset (n = 444) with contemporaneous echo (median 3 days apart, IQR 1–9), EF by echo (assessed visually) or CMR were modestly correlated (R² = 0.66, p < 0.001), and 30 deaths and 3 transplants occurred over a median follow-up of 0.83 years (IQR 0.29-1.40). CMR EF predicted mortality better than echo EF in univariable Cox models (Integrated Discrimination Improvement (IDI) 0.018, 95% CI 0.008-0.034; Net Reclassification Improvement (NRI) 0.51, 95% CI 0.11-0.85). Finally, LGE further improved prediction beyond EF as determined by hazard ratios, NRI, and IDI in all Cox models predicting mortality or transplant free survival, adjusting for age, gender, wall motion, and EF.

Conclusions

Among those referred for CMR after echocardiography, CMR with LGE further improves risk stratification of individuals at risk for death or death/cardiac transplant.     

Prevalence and distribution of late gadolinium enhancement in a large population of patients with Duchenne muscular dystrophy: effect of age and left ventricular systolic function

Background

Duchenne muscular dystrophy (DMD), an X-linked disorder affects approximately 1 in 5000 males, is universally associated with heart disease. We previously identified myocardial disease by late gadolinium enhancement (LGE) in DMD subjects at various stages of disease, but the true prevalence is unclear. Cardiovascular magnetic resonance (CMR) is well established for both assessment of ventricular function and myocardial fibrosis by LGE. We sought to establish i) prevalence and distribution of LGE in a large DMD population and ii) relationship among LGE, age, LVEF by CMR and current living status.

Methods

Current living status, demographic and CMR data including ventricular volumes, LVEF and LGE from 314 DMD patients undergoing evaluation at a single large tertiary referral center were analyzed.

Results

113 of 314 (36%) of DMD subjects showed LGE positivity with prevalence increasing from 17% of patients <10 years to 34% of those aged 10–15 years and 59% of those >15 years-old. Patients with LVEF ≥55% were LGE positive in 30% of cases; this increased to 84% for LVEF <55%. LGE was more prevalent in the free wall (531/1243, 42.7%) vs. septal segments (30/565, 5.3%). Patients with septal involvement were significantly older and had lower LVEF than those with isolated free wall LGE. Ten percent (11/113) patients who had LGE died 10.8 months after CMR. Only one patient from the LGE negative group died. Patients who died had higher heart rate, larger left ventricular volume and mass, greater number of positive LGE segment and increase incident of septal LGE compared to those who remained alive.

Conclusion

In DMD patients, LGE occurs early, is progressive and increases with both age and decreasing LVEF. Segmentally, the incidence of the number of positive LGE segments increase with age and lower LVEF. Older patients and those who died during the study period had more septal LGE involvement. The current studies suggest that the time course and distribution of LGE-positivity may be an important clinical biomarker to aid in the management of DMD-associated cardiac disease.     

Influence of phase correction of late gadolinium enhancement images on scar signal quantification in patients with ischemic and non-ischemic cardiomyopathy

Background

Myocardial fibrosis imaging using late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has been validated as a quantitative predictive marker for response to medical, surgical, and device therapy. To date, all such studies have examined conventional, non-phase corrected magnitude images.  However, contemporary practice has rapdily adopted phase-corrected image reconstruction. We sought to investigate the existence of any systematic bias between threshold-based scar quantification performed on conventional magnitude inversion recovery (MIR) and matched phase sensitive inversion recovery (PSIR) images.

Methods

In 80 patients with confirmed ischemic (N = 40), or non-ischemic (n = 40) myocardial fibrosis, and also in a healthy control cohort (N = 40) without fibrosis, myocardial late enhancement was quantified using a Signal Threshold Versus Reference Myocardium technique (STRM) at ≥2, ≥3, and ≥5 SD threshold, and also using the Full Width at Half Maximal (FWHM) technique. This was performed on both MIR and PSIR images and values compared using linear regression and Bland-Altman analyses.

Results

Linear regression analysis demonstrated excellent correlation for scar volumes between MIR and PSIR images at all three STRM signal thresholds for the ischemic (N = 40, r = 0.96, 0.95, 0.88 at 2, 3, and 5 SD, p < 0.0001 for all regressions), and non ischemic (N = 40, r = 0.86, 0.89, 0.90 at 2, 3, and 5 SD, p < 0.0001 for all regressions) cohorts. FWHM analysis demonstrated good correlation in the ischemic population (N = 40, r = 0.83, p < 0.0001). Bland-Altman analysis demonstrated a systematic bias with MIR images showing higher values than PSIR for ischemic (3.3 %, 3.9 % and 4.9 % at 2, 3, and 5 SD, respectively), and non-ischemic (9.7 %, 7.4 % and 4.1 % at ≥2, ≥3, and ≥5 SD thresholds, respectively) cohorts. Background myocardial signal measured in the control population demonstrated a similar bias of 4.4 %, 2.6 % and 0.7 % of the LV volume at 2, 3 and 5 SD thresholds, respectively. The bias observed using FWHM analysis was −6.9 %.

Conclusions

Scar quantification using phase corrected (PSIR) images achieves values highly correlated to those obtained on non-corrected (MIR) images. However, a systematic bias exists that appears exaggerated in non-ischemic cohorts. Such bias should be considered when comparing or translating knowledge between MIR- and PSIR-based imaging.     

High-resolution 3-dimensional late gadolinium enhancement scar imaging in surgically corrected Tetralogy of Fallot: clinical feasibility of volumetric quantification and visualization

Background

The extent of surgical scarring in Tetralogy of Fallot (TOF) may be a marker of adverse outcomes and provide substrate for ventricular arrhythmia. In this study we evaluate the feasibility of high resolution three dimensional (3D) late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) for volumetric scar quantification in patients with surgically corrected TOF.

Methods

Fifteen consecutive patients underwent 3D LGE imaging with 3 Tesla CMR using a whole-heart, respiratory-navigated technique. A novel, signal-histogram based segmentation technique was tested for the quantification and modeling of surgical scar. Total scar volume was compared to the gold standard manual expert segmentation. The feasibility of segmented scar fusion to matched coronary CMR data for volumetric display was explored.

Results

Image quality sufficient for 3D scar segmentation was acquired in fourteen patients. Mean patient age was 32.2 ± 11.9 years (range 21 to 57 years) with mean right ventricle (RV) ejection fraction (EF) of 53.9 ± 9.2% and mean RV end diastolic volume of 117.0 ± 41.5 mL/m². The mean total scar volume was 11.1 ± 8.2 mL using semi-automated 3D segmentation with excellent correlation to manual expert segmentation (r = 0.99, bias = 0.89 mL, 95% CI -1.66 to 3.44). The mean segmentation time was significantly reduced using the novel semi-automated segmentation technique (10.1 ± 2.6 versus 45.8 ± 12.6 minutes). Excellent intra-observer and good inter-observer reproducibility was observed.

Conclusion

3D high resolution LGE imaging with semi-automated scar segmentation is clinically feasible among patients with surgically corrected TOF and shows excellent accuracy and reproducibility. This approach may offer a valuable clinical tool for risk prediction and procedural planning among this growing population.     

Multi-contrast late enhancement CMR determined gray zone and papillary muscle involvement predict appropriate ICD therapy in patients with ischemic heart disease

Background

Myocardial infarct heterogeneity indices including peri-infarct gray zone are predictors for spontaneous ventricular arrhythmias events after ICD implantation in patients with ischemic heart disease. In this study we hypothesize that the extent of peri-infarct gray zone and papillary muscle infarct scores determined by a new multi-contrast late enhancement (MCLE) method may predict appropriate ICD therapy in patients with ischemic heart disease.

Methods

The cardiovascular magnetic resonance (CMR) protocol included LV functional parameter assessment and late gadolinium enhancement (LGE) CMR using the conventional method and MCLE post-contrast. The proportion of peri-infarct gray zone, core infarct, total infarct relative to LV myocardium mass, papillary muscle infarct scores, and LV functional parameters were statistically compared between groups with and without appropriate ICD therapy during follow-up.

Results

Twenty-five patients with prior myocardial infarct for planned ICD implantation (age 64±10 yrs, 88% men, average LVEF 26.2±10.4%) were enrolled. All patients completed the CMR protocol and 6–46 months follow-up at the ICD clinic. Twelve patients had at least one appropriate ICD therapy for ventricular arrhythmias at follow-up. Only the proportion of gray zone measured with MCLE and papillary muscle infarct scores demonstrated a statistically significant difference (P < 0.05) between patients with and without appropriate ICD therapy for ventricular arrhythmias; other CMR derived parameters such as LVEF, core infarct and total infarct did not show a statistically significant difference between these two groups.

Conclusions

Peri-infarct gray zone measurement using MCLE, compared to using conventional LGE-CMR, might be more sensitive in predicting appropriate ICD therapy for ventricular arrhythmia events. Papillary muscle infarct scores might have a specific role for predicting appropriate ICD therapy although the exact mechanism needs further investigation.     

Prediction of long-term segmental and global functional recovery of hibernating myocardium after revascularisation based on low dose dobutamine and late gadolinium enhancement cardiovascular magnetic resonance

Background

This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR).

Methods

Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. In total, 319 at baseline dysfunctional and successfully revascularised segments were available for statistical analysis.

Results

The likelihood of long-term functional improvement was directly related to the presence of CR and inversely related to both the LGE and the degree of contractile dysfunction at baseline. The time course of functional improvement was protracted, with significantly more delay in segments with more extensive LGE (p = 0.005) and more severe contractile dysfunction at baseline (p = 0.002). The presence of CR was the predictor of earlier functional improvement (p < 0.0001). Using a definition of viable segment as a segment without any LGE or with any LGE and producing CR during LDD stimulation, ≥55% of viable segments from all dysfunctional and revascularised segments in a patient was the only independent predictor of significant improvement (≥5%) in the left ventricular ejection fraction (LVEF) after revascularisation, with a 72% sensitivity and an 80% specificity (AUC 0.76, p = 0.014). Reverse LV remodelling was observed in patients who had a significant amount of viable myocardium successfully revascularised.

Conclusions

In patients with chronic ischaemic LVD, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of functional improvement are related to the LGE, CR and the degree of contractile dysfunction at baseline. At 35 ± 6 months after revascularisation, patients with ≥55% of viable segments from all dysfunctional and revascularised segments significantly improve LVEF and experience reverse LV remodelling. A combination of LDD–CMR and LGE–CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from revascularisation.     

心脏MR延迟钆强化评估心肌淀粉样变性患者预后:Meta分析北大核心CSCD

目的采用Meta分析方法评价心脏MR(CMR)延迟钆强化(LGE)评估心肌淀粉样变(CA)患者预后的价值。方法检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、中国知网及万方医学网自建库至2020年10月以CMR-LGE评价CA患者死亡风险的队列研究,依照纳入及排除标准筛选文献;合并纳入文献中的死亡风险比(HR),评价LGE阳性、LGE类型或位置、CA类型与CA患者死亡风险的关系,以STATA 15.0软件行Meta分析。结果共纳入14篇文献,均为英文文献,包括1490例患者,其中666例发生死亡事件。合并分析结果显示LGE阳性患者死亡风险增大,HR为1.46[95%CI(1.06,2.02),P<0.05];透壁性[HR=2.36,95%CI(1.79,3.12),P<0.05]及心内膜下LGE阳性[HR=3.83,95%CI(2.12,6.91),P<0.05]患者死亡风险增高;左心室[HR=2.82,95%CI(1.33,5.98),P<0.05]及右心室LGE阳性[HR=1.94,95%CI(1.12,3.35),P<0.05]患者死亡风险不同程度升高;轻链型淀粉样变性患者LGE阳性死亡风险增大,HR为1.94[95%CI(1.53,2.46),P<0.05]。结论CMR-LGE阳性与CA患者死亡风险增加密切相关,可作为预测CA患者预后的独立因素。     

Three-dimensional segmentation of the left ventricle in late gadolinium enhanced MR images of chronic infarction combining long- and short-axis information

Automatic segmentation of the left ventricle (LV) in late gadolinium enhanced (LGE) cardiac MR (CMR) images is difficult due to the intensity heterogeneity arising from accumulation of contrast agent in infarcted myocardium. In this paper, we present a comprehensive framework for automatic 3D segmentation of the LV in LGE CMR images. Given myocardial contours in cine images as a priori knowledge, the framework initially propagates the a priori segmentation from cine to LGE images via 2D translational registration. Two meshes representing respectively endocardial and epicardial surfaces are then constructed with the propagated contours. After construction, the two meshes are deformed towards the myocardial edge points detected in both short-axis and long-axis LGE images in a unified 3D coordinate system. Taking into account the intensity characteristics of the LV in LGE images, we propose a novel parametric model of the LV for consistent myocardial edge points detection regardless of pathological status of the myocardium (infarcted or healthy) and of the type of the LGE images (short-axis or long-axis). We have evaluated the proposed framework with 21 sets of real patient and four sets of simulated phantom data. Both distance- and region-based performance metrics confirm the observation that the framework can generate accurate and reliable results for myocardial segmentation of LGE images. We have also tested the robustness of the framework with respect to varied a priori segmentation in both practical and simulated settings. Experimental results show that the proposed framework can greatly compensate variations in the given a priori knowledge and consistently produce accurate segmentations.     

全身骨显像联合肿瘤标志物检测对乳腺癌骨转移诊断、病情评价及放疗疗效评估的临床意义

目的观察和分析单光子发射型计算机辅助断层(SPECT)全身骨显像联合肿瘤标志物检测对乳腺癌骨转移诊断、病情评价及放疗疗效评估的临床意义。方法选取200例乳腺癌患者作为研究对象,于术后给予患者SPECT全身骨显像检查和血清糖链抗原15-3(CA15-3)、癌胚抗原(CEA)及碱性磷酸酶(ALP)等肿瘤标志物检测。对发生骨转移的患者给予放疗治疗,并于治疗后复查SPECT全身骨显像和血清肿瘤标志物水平。结果 3种肿瘤标志物联合检测在诊断乳腺癌骨转移中的灵敏度显著高于单独检测(χ~2=8.067、12.079、10.376,P0.05),全身骨显像的灵敏度显著高于单独检测或联合检测3种肿瘤标志物(χ~2=28.058、34.842、32.041、6.512,P0.05),3种肿瘤标志物与全身骨显像联合检测的灵敏度显著高于单独检测或联合检测3种肿瘤标志物及单独检测全身骨显像(χ~2=74.169、83.557、79.732、38.922、16.316,P0.05)。随着乳腺癌骨转移分级的升高,其血清肿瘤标志物水平均呈显著上升的趋势(P0.05),并与患者的骨转移分级具有相关性(r_s=0.859、0.602、0.661,P0.05);治疗有效组患者治疗后的血清肿瘤标志物水平均较治疗前显著降低(t=25.615、15.633、42.816,P0.05),且均显著低于治疗无效组(t=9.972、12.454、8.297,P0.05)。结论联合应用全身骨显像检查和肿瘤标志物检测可提高对于乳腺癌骨转移的诊断灵敏度,肿瘤标志物水平可作为评价骨转移程度和放疗疗效的辅助指标。     

18F-FDG符合探测显像与99mTc-MDP骨显像评价肿瘤骨转移的对比研究

目的：比较18F-脱氧葡萄糖（18F-FDG）符合探测显像及99mTc-亚甲基二膦酸盐（99mTc-MDP）骨显像在肿瘤骨转移诊断及疗效评价中的价值。方法收集本院行18F-FDG符合探测显像及99mTc-MDP骨显像的骨转移患者42例,平均年龄（53.62±12.48）岁。其中未进行任何治疗患者18例,另11例治疗后多次（2-5次）行18F-FDG符合探测显像及99mTc-MDP全身骨显像。两种检查在1周内完成。比较两种方法在肿瘤骨转移诊断及疗效评价中的价值。结果18F-FDG符合探测显像有36例明确诊断,99mTc-MDP骨显像有32例明确诊断,两种方法的诊断准确率差异无统计学意义（χ2=1.25,P=0.320）。18例未行治疗患者中,18F-FDG符合探测显像均明确诊断,99mTc-MDP骨显像有12例明确诊断,两种方法的诊断准确率差异有统计学意义（χ2=4.17,P＜0.05）。治疗后疗效评价,符合探测显像复查结果与临床疗效评估结果有较强的正相关性（r=0.834,P＜0.02）。结论18F-FDG符合探测显像在初诊骨转移患者诊断及患者疗效评价中较99mTc-MDP骨显像有优势。     

双期CT增强联合三维重建技术在甲状腺肿瘤定性诊断中的应用

目的  观察双期CT增强联合三维重建技术在甲状腺肿瘤定性诊断中的应用价值。方法  回顾性分析2017年1月~2021年5月于我院收治的98例甲状腺肿瘤患者临床资料,患者均行双期CT增强联合三维重建技术检查,以手术病理检查作为金标准。探究双期CT增强、双期CT增强联合三维重建技术对甲状腺肿瘤的诊断价值,分析双期CT增强联合三维重建技术对甲状腺肿瘤病理特征的诊断价值。结果  双期CT增强对甲状腺肿瘤的诊断敏感度为84.91%,特异性为82.22%,准确率为83.67%;双期CT增强联合三维重建技术对甲状腺肿瘤的诊断敏感度为92.45%,特异性为80.00%,准确率为86.73%。双期CT增强联合三维重建技术对患者单侧或双侧淋巴结肿大、粗钙化、微钙化、病灶数目的诊断准确率为94.23%、72.73%、89.74%、87.12%。双期CT增强联合三维重建技术检查显示,甲状腺癌患者的单侧或双侧淋巴结肿大占检出总数的71.43%,甲状腺腺瘤的单侧或双侧淋巴结肿大占检出总数的28.57%;甲状腺癌患者的70个病灶中钙化占比为52.86%,甲状腺腺瘤患者的45个病灶中钙化占比为31.11%。结论  双期CT增强联合三维重建技术在甲状腺肿瘤定性诊断中的应用价值较高,颈部淋巴结肿大、钙化具备辅助诊断的价值。     

高场MRI扫描在手部类风湿性关节炎中的应用效果及对疾病活动度的评估价值

目的 探讨高场磁共振成像(MRI)扫描在手部类风湿性关节炎(RA)中的应用效果及对疾病活动度的评估价值.方法 选取2016年1月至2019年12月收治的93例手部RA患者作为研究对象,根据是否处于活动期将其分为活动期组(48例)与非活动期组(45例).两组患者均行高场MRI扫描,比较两组的MRI征象、滑膜强化率及滑膜厚...     

超声血管增强技术在布-加综合征诊断及介入治疗疗效评估中的应用

目的 探讨超声血管增强技术(VET)在布-加综合征(BCS)诊断及介入治疗疗效评估中的应用价值.方法 应用二维超声、彩色多普勒及VET对93例BCS患者介入术前肝内血管及下腔静脉进行系统检测,存储上述血管静态及动态图像,术后同法检测治疗血管.比较术前被检血管及术后治疗血管二维超声与VET图像的清晰度,并比较经DSA证实...     

Usefulness of color doppler sonography and 99m Tc-RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2-year-old child

Venous malformations of the small intestine are rare in children, and the preoperative diagnosis of a venous malformation in the small bowel can be very difficult. We report the case of a 2-year-old girl with a solitary cavernous venous malformation of the small intestine that caused gastrointestinal bleeding and anemia and review the usefulness of the combination of color Doppler sonography and 99m Tc-RBC scintigraphy for the diagnosis of venous malformation of the small intestine.