^99Tc^m奥曲肽核素显像诊断结直肠癌的研究

目的：探讨^99Tc^m奥曲肽显像对结直肠癌的诊断价值。方法：30例经内窥镜检查活检病理确诊的结直肠癌及6例非结直肠癌患者,术前进行腹部的^99Tc^m奥曲肽显像,以^99Tc^m直接标记的奥曲肽进行分析。结果：^99Tc^m奥曲肽显像检测30例结直肠癌4例阳性,26例阴性;6例非结直肠癌2例阳性,4例阴性。^99Tc^m奥曲肽显像对结直肠癌诊断的敏感度、特异度和准确度分别为13.33%、33.33%和22.22%。结论：^99Tc^m奥曲肽显像是一种无创、安全、经济的检查方法,但对结直肠癌诊断价值有限;需要用各种亚型的生长抑素受体和扩大样本量做进一步研究,以提高诊断的准确度。     

99Tcm-奥曲肽显像在肺癌诊断中的应用

目的 探讨99Tcm-奥曲肽显像对肺癌的临床诊断意义.方法 30例CT检查被怀疑为肺部肿瘤的患者行99Tcm-奥曲肽显像,计算肿瘤病灶和对侧正常肺组织的摄取比值(T/N)并做半定量分析.结果 99Tcm-奥曲肽显像诊断肺癌的灵敏度、特异度和准确度分别为95.7%、71.4%和90.0%.30例患者中,有24例99Tcm-奥曲肽显像为阳性,其中2例为假阳性;6例患者诊断为阴性,其中1例为假阴性.99Tcm-奥曲肽显像共检出阳性病灶46个,其中3个为超声和CT检查未发现的病灶.小细胞肺癌(SCLC)组的T/N(2.78±1.07)明显高于非小细胞肺癌(NSCLC)组(1.75±0.31,t=3.82,P<0.05).结论 99Tcm-奥曲肽显像能够显示肺癌细胞表面的生长抑素受体(SSTR),对肺癌原发灶和转移灶具有一定的诊断价值;99Tcm-奥曲肽显像更有利于SCLC的检测,可作为常规显像方法的一种有效补充.     

~(99)Tc~m-RBC显像对软组织血管瘤的诊断

目的:评价99Tcm-RBC显像在诊断软组织血管瘤中的价值.方法:回顾性分析47例行99Tcm-RBC血管瘤显像患者的影像资料,47例患者共53个病灶均行彩色多普勒超声检查并经术后病理确诊. 结果: 99Tcm-RBC 血管瘤显像诊断软组织血管瘤灵敏度87.5% ,特异度100%,阳性预测值100%,阴性预测值72.2%.彩色多普勒超声检查诊断软组织血管瘤灵敏度 95.0%,特异度69.2%,阳性预测值90.5%,阴性预测值81.8%.两种方法检测灵敏度无显著性差异;99Tcm-RBC 血管瘤显像特异性显著高于彩色多普勒超声检查.结论:99Tcm-RBC显像对诊断软组织血管瘤有重要价值,而且无创、简便,阳性结果意义更大.     

99mTc-MIBI亲肿瘤阳性显像的临床应用

目的 探讨99mTc-MIBI肿瘤阳性显像在多种恶性肿瘤临床诊断中的应用价值.方法 静脉注射99mTc-MIBI 15～30 min后,行病变局部平面和断层显像,计算肿瘤与本底比值(T/N),当T/N≥1.4时判定显像结果阳性.结果 23例受检者中诊断为恶性肿瘤21例,良性肿瘤2例.21例恶性肿瘤99mTc-MIBI阳性显像17例阳性,4例阴性;2例良性肿瘤患者显像结果均为阴性.99mTc-MIBI阳性显像的敏感性为89.5%,特异性为100.0%,阳性预测值为100.0%,阴性预测值为66.7%,准确率为91.3%.结论 99mTc-MIBI阳性显像在良恶性肿瘤临床诊断中有良好的应用前景.     

~(99m)TcMIBI乳腺显像对乳腺肿物良恶性及淋巴结转移的诊断价值

目的 :探讨99mTc MIBI乳腺显像对乳腺癌及淋巴结转移的诊断价值。方法 :6 8例单侧乳腺肿物的女性患者 ,从病变乳腺对侧的肘静脉注入99mTc MIBI 740MBq ,10min后分别行前位、侧位乳腺显像。结果 :6 8例乳腺肿物患者 ,经病理证实恶性 38例 ,良性 30例。99mTc MIBI乳腺显像阳性共 37例 ,其中乳腺癌 34例 ,乳腺良性肿瘤 3例。99mTc MIBI乳腺显像诊断乳腺癌的灵敏性为 89 5 % ,特异性为 90 % ,阳性预测值为 91 9% ,阴性预测值为87 1% ;38例乳腺癌患者 8例淋巴结转移 ,6例99mTc MIBI显像阳性。结论 :99mTc MIBI乳腺显像可成为诊断乳腺癌及鉴别乳腺肿物良恶性较可靠的无创性方法 ,其对淋巴结转移的检测也有一定价值     

99^Tc^m-RBC显像对软组织血管瘤的诊断

目的：评价99^Tc^m-RBC显像在诊断软组织血管瘤中的价值。方法：回顾性分析47例行99^Tc^m-RBC血管瘤显像患者的影像资料,47例患者共53个病灶均行彩色多普勒超声检查并经术后病理确诊。结果：99^Tc^m-RBC血管瘤显像诊断软组织血管瘤灵敏度87.5%,特异度100%,阳性预测值100%,阴性预测值72.2%。彩色多普勒超声检查诊断软组织血管瘤灵敏度95.0%,特异度69.2%,阳性预测值90.5%,阴性预测值81.8%。两种方法检测灵敏度无显著性差异;99^Tc^m-RBC血管瘤显像特异性显著高于彩色多普勒超声检查。结论：99^Tc^m—RBC显像对诊断软组织血管瘤有重要价值，而且无创、简便，阳性结果意义更大。     

18F-FDG PET对老年人大肠癌分期、术后再分期临床诊断的价值

目的:评价18F-FDG PET对老年人大肠癌分期、术后再分期的临床价值。方法:36例经肠镜检查初步诊断为结、直肠癌的老年患者行全身18F-FDG PET检查,并在2周内完成手术及病理诊断。结果:36例病理证实为结、直肠癌,34例局部18F-FDG摄取增高,SUVmax6.931,(最大Standard Uptake Value);18F-FDGPET对肿瘤原发灶诊断准确率94.4%(34/36);局部淋巴结转移的检出率为66.7%(16/24);治疗方案改变36.1%(13/36)。随访50例老年结、直肠癌患者,26例PET阳性并证实发现局部和/或多发转移;24例PET显示阴性,其中6例随访2年后复发,阴性预测率75%。结论:18F-FDG PET显像对老年人大肠癌的分期、术后再分期诊断有较高的临床价值。     

核素靶向治疗在转移性甲状腺髓样癌治疗中的价值

目的 评价放射性同位素^90Y标记的奥曲肽（^90Y-DOTATOC）及^131I标记的间碘苄胍（^131I-MIBG）在治疗转移性甲状腺髓样癌中的价值。方法 12例经病理学检查证实的转移性甲状腺髓样癌患者均进行了^131In-奥曲肽和^131I-MIBG或^123I-MIBG联合显像。根据显像结果,分别选择奥曲肽显像阳性或MIBG显像阳性的患者行^90Y-DOTATOC或^131I-MIBG内照射靶向治疗。内照射靶向治疗方案为：静脉滴注3．33GBq ^90Y．DOTATOC,治疗间期为6周;或11．1GBq ^131I-MIBG,治疗间期3个月以上。结果 12例患者联合显像均为阳性,其中奥曲肽显像阳性8例,MIBG显像阳性6例。根据联合显像结果,筛选出4例采用^90Y-DOTATOC治疗,5例采用^131I-MIBG治疗。经过3-5个疗程的治疗,随访15～36个月,9例核素治疗的患者中,3例部分缓解,6例病情稳定,有效率为33．3％（3／9）,反应率为100％（9／9）,未见明显副作用。结论 核素标记的奥曲肽及MIBG靶向治疗转移性甲状腺髓样癌安全有效,可作为改善患者预后的一种方法。     

18F-FDG PET与99Tcm-MDP显像对肿瘤骨转移的诊断价值

  目的 探讨18F-FDG PET与99Tcm-MDP显像对肿瘤骨转移的诊断价值。方法 93例肿瘤患者2周内行18F-FDG PET和99Tcm-MDP显像，比较分析两种显像结果。结果 93例肿瘤患者PET和MDP诊断骨转移64例。64例骨转移患者中PET和MDP阳性43例，PET阳性而MDP阴性16例，PET阴性而MDP阳性5例。18F-FDG PET和99Tcm-MDP显像诊断骨转移的灵敏度分别为92.2 %，75.0 %（P＜0.05）；特异度分别为93.1 %，79.3 %（P＞0.05）；准确度分别为92.5 %，76.3 %（P＜0.01）。结论 18F-FDG PET诊断肿瘤骨转移的灵敏度和准确性显著高于99Tcm-MDP显像。18F-FDG PET对骨转移有一定的诊断价值。     

18F-FDGPET/CT在结直肠癌术后复发与转移诊断中的应用价值与CEA水平关系的研究

  目的   评价18F-FDG PET/CT显像对结直肠癌患者术后复发与转移的诊断价值与PET/CT检查期间CEA水平之间的关系。   方法  收集临床症状、血清CEA水平升高或CT等影像学检查怀疑复发, 并因此行PET/CT检查的结直肠癌术后患者75例, 其中男性46例, 女性29例。回顾性分析比较PET/CT显像的诊断价值在结直肠癌术后患者CEA阳性组与阴性组中的差异。   结果  PET/CT对复发与转移的检出率中CEA阳性组为89.3% (42/47), 阴性组为82.1% (23/28), 两组之间检出率差异无统计学意义(P > 0.05)。   结论  CEA水平无助于提高PET/CT对结直肠癌患者术后复发与转移的检出率, PET/CT对结直肠癌患者术后复发与转移具有较高的检出率, 是目前监测结直肠癌患者术后复发与转移较为理想的方法。      

端粒酶活性的原位检测在大肠癌早期诊断中的意义

目的:研究端粒酶活性的原位检测在大肠癌早期诊断中的意义。方法:运用原位杂交技术检测30例大肠癌组织、癌旁组织及其正常黏膜中端粒酶mRNA的表达情况。结果:在30例大肠癌中,端粒酶mRNA的阳性表达率为90.0%,明显高于癌旁组织、正常黏膜组织(P<0.005)。端粒酶活性的表达强度与肿瘤的浸润深度、临床分期以及淋巴结转移显著相关(P<0.05),与性别、年龄以及肿瘤的分化程度无相关性。结论:端粒酶的激活在大肠癌的发生、发展中起到一定的作用,可以将端粒酶作为一种新的肿瘤标记,通过对细胞端粒酶活性的原位检测来协助大肠癌的早期诊断。     

大肠癌患者血清基质金属蛋白酶-7含量的临床意义

目的:评估大肠癌患者血清MMP-7含量及其临床意义.方法:术前应用免疫酶联反应技术对50例大肠癌患者以及36例健康对照者的血清MMP-7含量进行检测,同时也检测这些患者血清CEA、CA19-9以及CA24-2含量.将大肠癌患者的血清MMP-7及其它肿瘤标志物的含量与健康对照者进行了比较.对不同临床病理分期的大肠癌患者血清MMP-7含量进行评估.结果:研究发现多数大肠癌患者的血清MMP-7含量升高.大肠癌患者的血清MMP-7含量,分布范围0.72-28.69ng/ml(平均4.41ng/ml;中位4.19ng/ml),显著高于健康对照者,分布范围0.69-3.97ng/ml(平均1.62ng/ml;中位1.36ng/ml)(P<0.01).大肠癌患者的血清MMP-7平均阳性率(46%)与CEA(30%),CA19-9(26%)及CA24-2(24%)相比均升高(P<0.05).进展期肿瘤患者血清MMP-7含量显著高于早期肿瘤患者(P<0.05).结论:血清MMP-7有可能成为大肠癌患者临床监测标志物.     

99mTc-EC显像用于原发输尿管癌手术定位及肾功能初步评价

目的：探讨核素^99mTc—EC显像在原发输尿管癌手术定位及肾功能评价方面的应用，为手术决策提供依据。方法：就诊病例10例，静脉注射^99mTc—EC后采集图像，根据影像资料判断梗阻位置，利用计算机处理所得肾图曲线获得两肾功能。结果：10例患者中，患侧输尿管显影6例，其中伴对侧输尿管显影1例，肾图曲线示双肾功能受损3例，总肾功受损5例，患肾排泄不良2例，患侧肾功能受损2例，患侧肾及输尿管未显影5例：与MRI及IVP比较，MRI阳性9例患者中，ECT阳性6例，IVP阳性2例(另l例过敏)，IVP阴性7例患者中有4例ECT阳性。结论：核素^99mTc—EC显像可从形态与功能两方面提供受试者泌尿系的动态情况，与其它诊断手段互相补充，为受检者术前提供必要的决策依据。     

The role of 99mTc-tetrofosmin scintigraphy for staging patients with laryngeal cancer

Diagnosis and staging of laryngeal cancer is currently based on physical examination, endoscopy, and imaging techniques such as computed tomography (CT) and/or magnetic resonance (MR) and histology. While imaging techniques have a pivotal role for defining the size of the primary tumor, they are less accurate for defining metastatic involvement of regional lymph nodes, especially if lymph nodes are smaller than 10-15 mm. The aim of this study was to comparatively assess the relevance of (99m)Tc-tetrofosmin scintigraphy for the staging of laryngeal tumors versus the CT scan. We evaluated the sensitivity of imaging with (99m)Tc-tetrofosmin in 28 consecutively enrolled patients with squamous cell laryngeal carcinoma. Total-body scintigraphy with 99mTc-tetrofosmin was performed preoperatively, and the results were compared to CT images of the neck and mediastinum. CT and (99m)Tc-tetrofosmin scintigraphy were equally sensitive (96%) in identifying the primary tumor. While CT was more sensitive for detecting metastatic lymph nodes (100% versus 50%), (99m)Tc-tetrofosmin scintigraphy was more specific (100% versus 56%; p < 0.04). The overall diagnostic capabilities of the two techniques for detecting lymph node metastases were comparable (Youden Index: J = 0.56 for CT and J = 0.50 for (99m)Tc-tetrofosmin scintigraphy). (99m)Tc-tetrofosmin scintigraphy is a useful complement to CT for staging laryngeal tumors, especially for detecting metastatic lymph nodes and distant metastases.     

The specific diagnosis of hepatocellular carcinoma by scintigraphy. Multiple radiotracer approach

The accuracy of scintigraphy in diagnosing hepatocellular carcinoma (HCC) at Boston City Hospital between January 1, 1978 and September 30, 1983 is retrospectively reviewed. A combined protocol using technetium-99m sulfur colloid (TsSC), gallium (Ga), and scintiangiography (STA) was employed in order to enhance diagnostic specificity. There were 14 cases of HCC, of which 10 were proven histologically. The others were diagnosed clinically and angiographically. With one exception, all patients who had triple tracer scintigraphy showed a specific pattern of findings: (1) cold defects with TcSC; (2) Ga-avid foci, and (3) increased vascular supply from hepatic arteries. One false-positive study and one false-negative study were originally reported, although in both cases, strict adherence to the three criteria above would have avoided diagnostic error. These results indicate that triple tracer scintigraphy may be an effective diagnostic test for HCC. The relative efficacy of scintigraphy, ultrasonography, and computerized tomography in diagnosing HCC is also discussed.     

Two peptide receptor ligands (99m)Tc-EDDA/HYNIC-Tyr(3)-octreotide and (99m)Tc-EDDA/HYNIC-(D)Glu-octagastrin for scintigraphy of medullary thyroid carcinoma

Somatostatin and gastrin receptors are overexpressed in medullary thyroid carcinoma (MTC) cells; hence, both of them are potential targets for peptide receptor scintigraphy and radiotherapy. Therefore, the aim of our study was to assess the clinical value of two technetium-99m-labeled peptides, a new gastrin analog, the EDDA/HYNIC-(D)Glu-octagastrin and a somatostatin analog, EDDA/HYNIC-Tyr(3)-octreotide (EDDA/HYNIC-TOC) for scintigraphy in patients with MTC to detect recurrences and metastases and select patients for peptide receptor radiotherapy. MATERIAL AND METHODS: Thirty (30) patients, 20 females and 10 males, 22-83 years of age (mean, 52.7) with the diagnosis of MTC in different stages of the disease (preoperative, postsurgery, remission, recurrence, or metastatic disease) were included in this study. Before surgery, in all patients serum calcitonin concentrations were elevated. The diagnosis of MTC was confirmed in all cases by histopathology of the removed tumor and immunohistochemical staining giving positive reactions for calcitonin and chromogranin A. Imaging studies using (99m)Tc-EDDA/HYNIC-TOC and a new minigastrin analog, (99m)Tc-EDDA/HYNIC-(D)Glu-octagastrin, were performed in each patient and the results compared with each other and with other imaging methods. Scans of the whole body, head, neck, and chest were performed 2 and 4 hours after injections of the tracer, 500-600 MBq in each case, using a double-head Varicam (Elscint, Israel) gamma camera. RESULTS: (99m)Tc-EDDA/HYNIC-TOC detected somatostatin receptor-positive lesions in 20 patients with MTC, whereas (99m)Tc-EDDA/HYNIC-(D)Glu-octagastrin displayed gastrin receptors in 11 patients. In 9 cases, the scans were positive in both methods, although in 2 cases different pathologic foci were visualized. In 12 cases, only (99m)Tc-EDDA/HYNIC-TOC scintigraphy was positive, whereas in 3 other cases only (99m)Tc-EDDA/HYNIC-(D)Glu-octagastrin revealed pathologic lesions. CONCLUSIONS: Scintigraphy using (99m)Tc-HYNIC-TOC permits the visualization of somatostatin receptor-positive MTC in the majority of cases. The new gastrin analog, (99m)Tc-HYNIC-(D)Glu-octagastrin, is well tolerated, shows no renal retention, and in some cases of MTC, provides additional information on the expression of gastrin receptors. However, inferior quality of octagastrin scans indicates the need for further improvement of this radiopeptide.     

端粒酶活性的原位检测在大肠癌早期诊断中的意义

目的：研究端粒酶活性的原位检测在大肠癌早期诊断中的意义。方法：运用原位杂交技术检测30例大肠癌组织、癌旁组织及其正常黏膜中端粒酶mRNA的表达情况。结果：在30例大肠癌中,端粒酶mRNA的阳性表达率为90.0%,明显高于癌旁组织、正常黏膜组织（P〈0.005）。端粒酶活性的表达强度与肿瘤的浸润深度、临床分期以及淋巴结转移显著相关（P〈0.05）,与性别、年龄以及肿瘤的分化程度无相关性。结论：端粒酶的激活在大肠癌的发生、发展中起到一定的作用,可以将端粒酶作为一种新的肿瘤标记,通过对细胞端粒酶活性的原位检测来协助大肠癌的早期诊断。