Technetium-99m-labelled HL91 and technetium-99m-labelled MIBI SPECT imaging for the detection of ischaemic viable myocardium: a preliminary study

Purpose: The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work‐up of patients with coronary artery disease. Technetium‐99m labelled sestamibi (^99mTc‐MIBI) myocardial perfusion imaging may underestimate the viability of ischaemic myocardium. Technetium‐99m labelled 4,9‐diaza‐3,3,10,10‐tetramethyldodecan‐2,11‐dione dioxime (^99mTc‐HL91) is a hypoxia‐avid agent which can identify acutely ischaemic viable myocardium in a canine model using a standard gamma camera. The aim of this study was to evaluate uptake character of ischaemic viable myocardium and diagnostic performance of single‐photon emission computed tomography (SPECT) imaging by ^99mTc‐HL91 and ^99mTc‐MIBI in detecting ischaemic viable myocardium in coronary heart disease. Methods: A total of 41 patients with coronary artery disease were recruited from March 2008 to May 2009. For detecting ischaemic viable myocardium, SPECT imaging by ^99mTc‐HL91 and ^99mTc‐MIBI were performed in all patients before coronary revascularization. Six patients with single ischaemic myocardial segment received a 2‐day SEPCT/CT imaging protocol and the uptake of ^99mTc‐HL91 in ischaemic myocardium was quantitatively analysed. The remaining 35 patients received a 1‐day ^99mTc‐HL91 and ^99mTc‐MIBI SPECT imaging protocol. Resting ^99mTc‐MIBI myocardial perfusion imaging in 3–18 months after revascularization was used as the standard methodology to evaluate the myocardial viability. Results: In 41 patients, 66 ischaemic myocardial segments were proven to be viable and 12 to be necrotic by resting ^99mTc‐MIBI myocardial perfusion imaging after coronary revascularization. Furthermore, 60 viable segments with negative uptake of ^99mTc‐MIBI showed positive uptake of ^99mTc‐HL91. The remaining six viable segments and 12 necrotic segments showed both negative uptake of ^99mTc‐HL91 and ^99mTc‐MIBI. The sensitivity, specificity, accuracy, Younden Index, positive predictive value and negative predictive value for evaluating ischaemic viable myocardium were 90·9%, 100%, 92·3%, 90·9%, 100% and 66·7%, respectively. Ischaemic viable myocardium had the negative ^99mTc‐MIBI uptake and positive ^99mTc‐HL91 uptake, which demonstrated a mismatched uptake character. Quantitative analysis indicated the uptake of ^99mTc‐HL91 in viable myocardium was increasing in the first 1–3 h and remained stable at the 3–4 h after injection. Conclusion: Functional SPECT imaging with ^99mTc‐HL91 and ^99mTc‐MIBI can be used to detect the seriously ischaemic but viable myocardium with a mismatched uptake character. The uptake of ^99mTc‐HL91 in the viable myocardium reached a stable level at 3–4 h after injection.     

Extra cardiac activity detected on myocardial perfusion scintigraphy after intra-arterial injection of 99mTc-MIBI

Purpose: We present an unusual case of extra cardiac activity of ^99mTc‐MIBI in the left part of thorax and left upper extremity in a patient admitted for myocardial perfusion scintigraphy. Methods: A standard 2‐day protocol of ^99mTc‐MIBI perfusion scintigraphies starting day 1 with stress (dipyridamol) imaging and followed by rest imaging day 2 was performed. Results: On day 2, when rest perfusion scintigraphy was carried out, extra cardiac activity was present in the left part of thorax and in the left upper extremity resulting in reduced accumulation of ^99mTc‐MIBI in cardiac tissue, prolongation of the study and interference of the extra cardiac activity with the cardiac image reconstructions. Whole‐body scintigraphy disclosed an arterial flow distribution of activity to skeletal muscles in left shoulder and upper limb. Conclusion: Accidentally injected radiotracer retrogradely into the arterial system resulted in an unusual extra cardiac activity interfering with later image processing.     

Intrathyroidal parathyroid carcinoma mimicking a thyroid nodule in a MEN type 1 patient

A 59‐year‐old woman with classic manifestations of hyperparathyroidism associated with multiple endocrine neoplasia type 1 presented with a right adrenal mass and two pituitary microadenomas on imaging studies. For evaluation of hypercalcemia, ^99mTc‐MIBI scintigraphy was done and showed focal uptake at the thyroid level of the right anterior neck. Subsequent neck sonography showed several thyroid nodules, but there was no parathyroid tumor. Percutaneous fine‐needle aspiration of the dominant thyroid nodule indicated a follicular nodule. After surgery, final histopathology revealed intrathyroidal parathyroid carcinoma. This case illustrates the difficulty in diagnosing parathyroid carcinoma via fine‐needle aspiration. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:212–214, 2014     

Efficient lung scintigraphy

Lung scintigraphy is a first‐choice method to diagnose lung embolism. The clinical routine in most centres is a perfusion study complemented with a ventilation study when judged necessary. We describe a routine with ventilation scintigraphy preceding perfusion scintigraphy, which is completed within one hour. Furthermore, the data acquired allow the determination of lung clearance of the tracer ^99mTc‐DTPA (diethylene triamine penta‐acetate) used for the ventilation scintigraphy. An aerosol generator charged once a day with ^99mTc‐DTPA solution is used for all inhalations during the day. Inhalation is monitored with a counter and interrupted when the count rate corresponds to about 20 MBq. The ventilation imaging starts and ends with posterior projections. This allows calculation of lung clearance of ^99mTc‐DTPA. Perfusion scintigraphy is performed in a standard fashion with 100 MBq of ^99mTc‐MAA (macro‐aggregated albumin). The ventilation study was considered to give some diagnostic information in the majority of the patients. The clearance determination allows detection of inflammatory lung disease. The background activity caused by the ventilation study comprised only 13% of the activity in the perfusion scintigraphy and did not significantly interfere with interpretation of the perfusion scan. The cost for the investigation is low because of the rational system for aerosol administration and the short time for a complete study.     

A comparison of single plasma sample methods to estimate renal clearance using 99mTc‐ethylenedicysteine and 99mTc‐mercaptoacetyltriglycine

Several single sample methods for determination of ^99mTc‐mercaptoacetyltriglycine (MAG3) clearance are being used clinically. Kabasakal et al. proposed a similar formula for ^99mTc‐ethylenedicysteine (EC). This study was performed to compare his method with Bubeck et al. formula for ^99mTc‐MAG3 already in use. Twenty‐eight subjects divided in two groups were registered which included 22 patients with various renal diseases (group‐I) and six normal volunteers (group II). All subjects were studied twice using both the radiopharmaceuticals. The images and renogram parameters, that is T_MAX and T_1/2 of both the agents, were similar in all the subjects. The clearance of the ^99mTc‐EC was however considerably higher than ^99mTc‐MAG3 in both the groups (mean ± SEM =279 ± 14 ml min^?1/1·73 m² versus 177 ± 15 ml min^?1/1·73 m² in group‐I and 377 ± 11·90 ml min^?1/1·73 m² versus 238 ± 8·23 ml min^?1/1·73 m² in group II). This difference was more pronounced in cases with reduced renal functions. Among the Effective Renal Plasma Flow (ERPF) values determined from EC and MAG3 clearances in six normal volunteers, four cases only in MAG3 had ERPF below the lower limit. This study has demonstrated superiority of single sample method for ^99 mTc‐EC clearance over its analogous method for ^99mTc‐MAG3.     

Inter-relations between the calcium set-points of Parfitt and Brown in primary hyperparathyroidism: a sequential citrate and calcium clamp study

Abstract. The objective of the present study was to compare the calcium set-points of E. M. Brown and A. M. Parfitt obtained by sequential citrate and calcium clamp in patients with primary hyperparathyroidism and healthy controls. Twenty-six patients with primary hyperparathyroidism were investigated and compared to 22 healthy volunteers. All participants were investigated by sequential calcium lowering and raising comprising the following four phases: Phase (1) blood ionized calcium lowering of about 0·20 mmol l^-1; phase (2) steady-state (relative) hypocalcaemia of blood ionized calcium 0·20 mmol l^-1 below baseline; phase (3) blood ionized calcium is raised to about 0·20 mmol l^-1 above baseline; and phase (4) (relative) hypercalcaemia of blood ionized calcium 0·20 mmol l^-1 above baseline. Serum parathyroid hormone (1–84) was measured by an immunoradiometric assay. Blood ionized calcium was measured by a calcium selective electrode. We found the calcium set-points of Parfitt to be 1·42 mmol l^-1 (SD 0·12, n= 52) vs. 1·25 mmol l^-1 (SD 0·04, n= 44) in patients and controls, respectively (P < 0·001). The calcium set-points of Brown were 1·32 mmol l^-1 (SD 0·10, n= 26) vs. 1·13 mmol l^-1 (SD 0·04, n= 22), respectively (P < 0·001). By comparing the calcium set-points of Parfitt and Brown, a strikingly good correlation was observed, in patients (r= 0·91, P < 0·001) and in controls (r= 0·85, P < 0·001). We demonstrate in this paper in vivo that Brown's and Parfitt's calcium set-points are raised in primary hyperparathyroidism and return to normal following parathyroidectomy. The values for Brown's and Parfitt's calcium set-points are significantly different, but strikingly well correlated, supporting the view that Brown and Parfitt describe two different points on the same sigmoidal curve, corresponding to 50% and about 85% inhibition of PTH maximum, respectively. The mathematical form of the sigmoidal curve between blood ionized calcium and parathyroid hormone is very similar in primary hyperparathyroidism and normal humans.     

Lung clearance of inhaled aerosol of Tc‐99m‐methoxyisobutyl isonitrile: relationships with cigarette smoking,age and gender

Tc‐99m‐methoxyisobutyl isonitrile (Tc‐99m‐MIBI) is a radiolabelled xenobiotic, the disappearance rate of which from lungs following inhalation as a radioaerosol correlates inversely with bronchopulmonary multidrug resistance protein 1 (MRP1) expression. Tc‐99m‐MIBI clearance has previously been shown to be delayed in cigarette smokers. The aim of the current study was to determine whether smoking correlates with bronchopulmonary MRP1 expression, to confirm that Tc‐99m‐MIBI disappearance rate from the lungs following inhalation is delayed in smokers, and to determine the effects of gender and age on disappearance rate. Participants underwent dynamic imaging for 40 min over the lungs following inhalation of Tc‐99m‐MIBI using a double‐headed gamma camera. The half‐time of clearance was obtained from geometric mean of anterior and posterior counts and averaged between the two lungs. Paraffin‐embedded tissue obtained from healthy lung during surgery in 13 patients was graded immunohistochemically for MRP1 as negative (0), weak (1), moderate (2) or strong (3). In 4 non‐smokers, grading was 1 in three and 0 in one. In 9 smokers, in contrast, expression was graded 2–3 in 8 and 1 in one (P<0·02). Mean clearance half‐time in smokers (142 ± 29 min; n = 17) was longer than in non‐smokers (91 ± 14 min; n = 18; P<0·0001). In non‐smokers, half‐times were not significantly different between men (96 ± 16; n = 6) min and women (88 ± 12 min; P = 0·2). Combining genders into one group, half‐time correlated with participant age (P = 0·0005). We conclude that smoking upregulates MRP1 and delays clearance of inhaled Tc‐99m‐MIBI. There is no significant gender difference in non‐smokers but ageing is associated with longer clearance half‐times.     

The effect of MRI contrast agents on hepatic and splenic uptake in the rabbit during 99mTc‐MDP bone scintigraphy

The objective of this study was to investigate the effects of Omniscan® and Magnevist® on ^99mTc‐MDP uptake in rabbits during ^99mTc‐MDP bone scintigraphy. In Experiment Group 1, 30 healthy adult rabbits were randomized into six subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min, 360 min, 24 h). All six subgroups were injected first with Omniscan®, then with ^99mTc‐MDP. After 7 days, the same six subgroups were injected with normal saline followed by ^99mTc‐MDP at the same time intervals. In Experiment Group 2, 20 healthy adult rabbits were allocated randomly to four subgroups (n = 5); each subgroup experienced a different time interval between injections (30 min, 60 min, 120 min, 240 min). All four subgroups were injected first with Magnevist®, then with ^99mTc‐MDP. After 7 days, the same four subgroups were injected with normal saline followed by ^99mTc‐MDP. In all experiments, whole‐body skeletal imaging was performed. Liver, spleen, and background were delineated to determine the target‐to‐background (T/B) ratio. Diffusely increased intake of the imaging agent was seen in the liver and spleen when the injection‐time interval between Omniscan® and ^99mTc‐MDP varied from 30 min to 240 min and when the time interval between Magnevist® and ^99mTc‐MDP was 30 min–60 min. The imaging findings are consistent with the results of L/B and S/B ratios in each experiment group. Both Omniscan® and Magnevist® have an effect on ^99mTc‐MDP uptake during bone scanning; the main effect is diffusely increased hepatic and splenic activity. Copyright © 2015 John Wiley & Sons, Ltd.     

The washout rate of a subcutaneous 99mTc-HSA depot in lower extremity lymphoedema

Purpose: Lymphoscintigraphy is currently the leading diagnostic modality of lower extremity lymphoedema but has been criticized for being unreliable. Washout rate constants have been investigated and proven to be of diagnostic value in several studies of breast‐cancer‐related lymphoedema; however, the applicability in lower extremity lymphoedema needs further evaluation. The aim of the study was to verify if washout of ^99mTc‐Human Serum Albumin (^99mTc‐HSA) is a reliable diagnostic tool in lower extremity lymphoedema. Methods: Twenty healthy volunteers and eight patients (11 legs) with lymphoscintigraphy verified lower extremity lymphoedema participated in the study. A depot consisting of 0·1 ml 10 MBq/ml ^99mTc‐HSA was injected subcutaneously into the dorsum of each foot. The depot washout rate was measured using a portable scintillation detector system and time‐activity curves were generated. After 30 min of supine rest and 10 min of standardized ergometric exercise, measurements were recorded for 20 min. Following correction for physical decay of ^99mTc, the depot washout rate constant was calculated using linear regression analysis. Finally depot half‐life was calculated from the washout rate constant. Results: Median half‐life for healthy volunteers was 9·4 h (range 2·5–28·3 h). Median half‐life for lymphoedema patients was 10·7 h (range 1·5–35·1 h). No statistical significant difference could be detected between healthy volunteers and lymphoedema patients (P = 0·78). Conclusions: The washout rate of a subcutaneous ^99mTc‐HSA depot is not a reliable diagnostic tool in examination of lower extremity lymphoedema. Additional examinations revealed in vivo instability of the utilized ^99mTc‐HSA as the likely reason.     

Cica-clamp technique: a method for quantifying parathyroid hormone secretion: a sequential citrate and calcium clamp study

Abstract. Objectives of the present study were to establish and investigate a standardized method for quantifying of intact parathyroid hormone secretion during sequential induction of hypo- and hypercalcaemia, and to explore the applicability to these data of a mathematical model derived from in vitro studies as presented in the literature. Twenty-two healthy volunteers aged 20–80 years participated in one or more experiments. The experiments comprised three different protocols of sequential induction of a regular hypocalcaemic (citrate) clamp followed by increases in blood ionized calcium, ending in a regular hypercalcaemic (calcium) clamp. During protocol I, the induction of hypocalcaemia, blood ionized calcium 0.21 mmol 1^--¹ (SD0.01, n= 76) below baseline, the release of serum parathyroid hormone rapidly increased to a concentration of four to seven times above baseline. The serum parathyroid hormone declined gradually to a steady state of about two to three times above baseline. During stepwise increases in blood ionized calcium, the serum para thyroid hormone rapidly declined to new steady state concentrations. When a hypercalcaemia of 0.20 mmol I^-1 (SD 0.02, n= 76) above baseline was reached, serum parathyroid hormone was suppressed to about one-fourth of baseline concentration. Protocol II, the Cica-clamp, and protocol III, are short versions of protocol I using a slow and gradual increase in blood ionized calcium from hypo- to hypercalcaemia. Proto col II reached a hypocalcaemia of blood ionized calcium 0.22 mmol l^-1 (SD 0.03, n= 57) below baseline and a hypercalcaemia of 0.19 mmol l^-1 (SD 0.04, n= 57) above baseline, whereas protocol III reached a hypocalcaemia of 0.38 mmol l^-1 (SD 0.06, n= 57) below baseline and a hypercalcaemia of 0.34 mmol l^-1 (SD 0.04, n= 57) above baseline blood ionized cal cium. During protocol II and III we obtained identical results of serum parathyroid hormone compared to protocol I (P>0.70), indicating that serum para thyroid hormone could neither be suppressed nor stimulated beyond what was observed applying the more tolerated protocol II (the standard procedure). Blood ionized calcium and serum parathyroid hormone demonstrate an inverse sigmoidal relationship with a blood ionized calcium concentration to the parathyroid hormone-midpoint of 1.13 mmol l^-1 (SD 0.04, n=19), distinctly different from mean baseline blood ionized calcium, 1.25 mmol I ^-1 (SD 0.04, n = 38). Our data suggest an asymmetrical control of blood ionized calcium by serum Parathyroid hormone with a true calcium set-point corresponding to about 85% inhibition of maximal parathyroid hormone secretion. In conclusion, the present data shows that it is possible to establish a standardized test for sequential induction of hypo- and hypercalcaemia suitably for quantifying of serum parathyroid hormone secretion in vivo. The Cica-clamp test is short, easy to handle, reproducible and without discomfort to normocalcemic subjects. Its clinical usefulness remain to be determined.     

Half-Time SPECT Acquisition with Resolution Recovery for Tc-MIBI SPECT Imaging in the Assessment of Hyperparathyroidism

Purpose

Reduced SPECT acquisition time protocols have been recently developed based on collimator-detector response compensation reconstruction. The present study aims to evaluate the potential use of a short-time technetium-99m methoxyisobutylisonitrile (Tc99m-MIBI) SPECT algorithm in the investigation of parathyroid adenoma (PTA).

Procedures

Ninety patients (59 women; age range, 21?C76?years) with biochemical evidence of hyperparathyroidism were referred for Tc99m-MIBI scintigraphy for diagnosis and localization of PTA. Standard full-time and half-time SPECT studies starting at 45?min after injection were performed in random order in all patients. PTA detection rate and overall image quality parameters were evaluated and graded for each study and compared for the two SPECT protocols.

Results

Focal ^99mTc-sestamibi uptake consistent with PTA was reported in 60 out of 90 studies (67%). Congruent results between the full- and half-time SPECT acquisition were found in 73 patients (81%). Minor disagreement between the two SPECT protocols with respect to PTA detectability was found in 17 patients but with no statistically significant difference (p?=?0.67). The correlation coefficient between the two SPECTs was r?=?0.88 (p?p?=?0.155).

Conclusion

Parathyroid MIBI SPECT can be performed using the collimator-detector response compensation reconstruction algorithm for only half of the scanning time without compromising significant diagnostic data.     

Estimating GFR in children with 99mTc‐DTPA renography: a comparison with single‐sample 51Cr‐EDTA clearance

Glomerular filtration rate (GFR) measurement by ⁵¹Cr‐ethylenediaminetetraacetic acid (EDTA) and blood sampling in children is usually cumbersome for the patient, parents and laboratory technicians. We have previously developed a method accurately estimating GFR in adults. The aim of the present study was to evaluate the accuracy of this non‐invasive method in children. We calculated GFR from ^99mTc‐diethylene triamine pentaacetic acid (DTPA) renography and compared with ⁵¹Cr‐EDTA plasma clearance of 29 children between the age of 1 month and 12 years (mean 4·7 years). The correlation between ^99mTc‐DTPA renography and ⁵¹Cr‐EDTA plasma clearance was for all children R = 0·96 (n = 29, P<0·0001), for children above 2 years of age R = 0·96 (n = 18, P<0·0001) and for children <2 years R = 0·84 (n = 11, P<0·001). We conclude that assessment of GFR from ^99mTc‐DTPA renography is reliable and comparable to GFR calculated from ⁵¹Cr‐EDTA plasma clearance. Because our method is non‐invasive and only takes 21 min, it may be preferable in many cases where an assessment of renal function is needed in children especially when renography is performed anyhow.     

Localization of Parathyroid Adenomas by Sonography and Technetium Tc 99m Sestamibi Single‐Photon Emission Computed Tomography Before Minimally Invasive Parathyroidectomy

Objective. The purpose of this study was to determine the utility of radiologist‐performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. Methods. Both sonography and technetium Tc 99m sestamibi single‐photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E.T.), and results were immediately reported. Findings of a subsequent Tc 99m sestamibi study were recorded blinded to the sonographic results. The sensitivity and specificity of sonography and Tc 99m sestamibi SPECT were assessed with the use of surgery and pathology reports as a reference standard. The 2007 global Medicare reimbursement rates were used to assess the costs of preoperative localization. Results. Parathyroidectomy was performed in 144 of 172 patients evaluated by both modalities. The sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74%, 96%, and 90%, respectively. Sonography correctly localized a single adenoma or suggested multiglandular disease in 112 of 144 patients (78%). The sensitivity, specificity, and positive predictive value of SPECT were 58%, 96%, and 89%. Technetium 99m sestamibi SPECT correctly predicted an adenoma or multiglandular disease in 88 of 144 patients (61%). Five patients with negative sonographic findings were shown to have uniglandular disease on Tc 99m sestamibi SPECT. Selective use of Tc 99m sestamibi SPECT (ie, when sonographic findings were negative or equivocal) would have decreased the cost of imaging by 53%. Conclusions. Radiologist‐performed sonography may potentially be used as a principal imaging modality for patients with HPTH. Selective use of Tc 99m sestamibi in cases with negative or equivocal sonographic findings can decrease the cost of imaging before parathyroid resection considerably.     

Quantification of Myocardial Perfusion Defect Size in Rats: Comparison between Quantitative Perfusion SPECT and Autoradiography

Purpose

Ultra-high resolution single-photon emission computed tomography (SPECT) system, using multiple pinhole collimators, has been applied to the imaging of small rodents. We aimed to compare the myocardial infarction (MI) area on quantitative perfusion single-photon emission computed tomography (QPS; Cedars-Sinai Medical Center, USA) with that on high-resolution autoradiography in rat model to determine the accuracy of perfusion defect measurement by QPS.

Procedures

After thoracotomy, rats (n?=?9) had their left coronary arteries occluded and reperfused before injection with 185 MBq [^99mTc] methoxyisobutylisonitrile ([^99mTc]MIBI) for SPECT and autoradiography. Healthy rats (n?=?28) were similarly scanned to create a normal database on which to base QPS. The MI area on SPECT images was analysed automatically by QPS software. For the autoradiography images, regions of interest for MI were set at 1 mm intervals.

Results

In normal rats, [^99mTc]MIBI accumulated throughout the left ventricles, and a polar map of ventricular perfusion showed the lowest and highest uptakes in the inferior (68 %?±?4 %) and anterior (92 %?±?5 %) walls, respectively. In the rat MI model, the percentage of polar map with reduced [^99mTc]MIBI uptake correlated strongly with the percentage of left ventricle with MI on autoradiography (r²?=?0.90).

Conclusions

QPS can quantitatively evaluate MI severity on myocardial perfusion images in rats, with comparable results to autoradiography. This widely available software could promote the development of new techniques for analysing cardiac images in small animals.

     

甲状旁腺肿瘤临床分析

目的 探讨甲状旁腺肿瘤的诊断及外科治疗。方法回顾性分析12例甲状旁腺肿瘤的临床资料。结果12例患者中,腺瘤9例（75％）,囊肿3例（25％）;6例腺瘤（4例伴有甲状旁腺功能亢进症状,2例为无症状甲旁亢）血钙和血清甲状旁腺素（PTH）均高于正常,另3例腺瘤及3例囊肿血钙均正常范围。术前定位检查方法的敏感性和阳性预测值分别为：B超100％（11／11）和91．67％（11／12）,CT83．33％（10／12）和100％（10／10）。9例行单侧颈部探查,3例行双侧颈部探查。结论临床医生应提高对甲状旁腺肿瘤的认识,血钙和血清PTH测定是可靠的定性诊断方法。B超和CT相结合,必要时结合99TmC—MIBI可获得准确的定位诊断。手术切除是治疗甲状旁腺肿瘤最佳的治疗手段,对于定位明确的单侧肿瘤,结合术中冰冻病理检查行单侧颈部探查是可行的。     

99mTc-奥曲肽显像和X线钼靶诊断乳腺癌

目的 比较99mTc-奥曲肽显像和X线钼靶诊断乳腺癌的临床应用价值. 方法 32例临床怀疑乳腺癌的女性患者,均进行99mTc-奥曲肽显像和X线钼靶摄影,以手术病理结果为标准,比较二者对乳腺癌的诊断效能. 结果 99mTc-奥曲肽显像和X线钼靶摄影诊断乳腺癌的灵敏度分别为91.67%、66.67%(χ2=4.54,P<0.05),特异性分别为100%、37.50%(χ2=4.65,P<0.05),准确性分别为93.75%、59.38%(χ2=10.54,P<0.05),阳性预测值分别为100%、76.19%(χ2=5.93,P<0.05),阴性预测值分别为80.00%、27.27%(χ2=3.92,P<0.05).联合两种方法诊断的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为95.83%、100%、96.88%、82.14%和47.06%. 结论 99mTc-奥曲肽显像对乳腺癌的诊断效能高于X线钼靶摄影,两者联合可进一步提高诊断效能.     

Cardiac adrenergic innervation within the first 3 months after acute myocardial infarction

It is widely accepted that myocardial infarction results in adrenergic denervation of the infarcted and peri‐infarcted myocardium. On the contrary, the concept of re‐innervation of adrenergic nerve fibres is less well established. Although there is evidence of partial re‐innervation occuring several months after myocardial infarction, the extent and time scale of re‐innervation are only poorly known. In this study we investigated changes in cardiac adrenergic innervation and myocardial perfusion during the early convalescence period (the first 3 months) after an acute myocardial infarction. Single‐photon emission computed tomographic imaging was conducted in 15 men 1 week and 3 months after an acute myocardial infarction with I¹²³‐metaiodobentzylguanidine (MIBG) and Tc^99m‐sestamibi (MIBI) to determine the extent of adrenergic denervation and impaired perfusion, respectively. A MIBG and MIBI defect was determined as regional uptake ≤30% of maximal myocardial activity. The size of the MIBG defect calculated as a percentage of left ventricular mass remained unchanged between 1 week and 3 months after myocardial infarction (31·1 ± 17·3% vs. 30·5 ± 16·8%, respectively). Accordingly, MIBG activity of the infarct and peri‐infarct zones (expressed as a percentage of MIBG activity of the myocardium with normal perfusion) showed no significant change (23·7 ± 10·0% vs. 25·3 ± 11·0% and 39·0 ± 11·3% vs. 40·8 ± 12·8%, respectively) during the follow‐up. On the other hand, the size of MIBI defect decreased significantly during the follow‐up (14·2 ± 11·5% vs. 11·4 ± 9·7%, P<0·05, respectively) indicating improved myocardial perfusion. The results demonstrate that cardiac adrenergic re‐innervation is a slow process; despite a significant increase in myocardial perfusion we found no evidence of adrenergic re‐innervation during the first 3 months after acute myocardial infarction.     

Flow mediated vasodilation and circulating concentrations of high sensitive C‐reactive protein,interleukin‐6 and tumor necrosis factor‐α in normal pregnancy – The Cardiovascular Risk in Young Finns Study

Background: Traditional risk factors such as hyperlipidemia induce a state of inflammation that impairs vascular function. Despite marked maternal hyperlipidemia, endothelial function improves during pregnancy. In non‐pregnant state increased circulating levels of pro‐inflammatory cytokines and high sensitive C‐reactive protein (hsCRP) lead to attenuated flow mediated vasodilation. Relation between endothelial function and pro‐inflammatory cytokines has not been studied thoroughly in pregnancy. The aim of this study was to evaluate the effect of pregnancy on hsCRP and pro‐inflammatory cytokines and their associations with vascular endothelial function. Methods: As part of population‐based, prospective cohort Cardiovascular Risk in Young Finns study conducted in Finland we measured brachial artery flow mediated dilation (FMD) and serum concentrations of hsCRP, interleukin‐6 (IL‐6) and tumor necrosis factor‐α (TNF‐α) in 57 pregnant Finnish women throughout gestation and 62 control women matched for age and smoking. Results: HsCRP‐concentration was greater in pregnancy compared to non‐pregnant controls (median hsCRP 2·52 mg l^?1 versus 1·21 mg l^?1, P<0·001). IL‐6‐concentration was slightly increased in pregnancy compared with the non‐pregnant controls (median 1·66 versus 1·32 mg l^?1, non‐significant [NS]) and TNF‐α‐concentration was slightly decreased in pregnant group (2·11 versus 2·38 pg ml^?1, NS). FMD increased during pregnancy and IL‐6 had a positive correlation to the FMD in pregnancy (R = 0·288, P = 0·031). Conclusions: Improvement of FMD in normal pregnancy was not affected by increase in hsCRP concentration. We found an association with IL‐6 and FMD but we believe that improvement in endothelial function during normal pregnancy is not caused by variation in hsCRP, IL‐6 or TNF‐α.     

^99mTc—MIBI显像检测乳腺癌腋下淋巴结转移的价值

目的 观察^99mTc-MIBI乳腺显像检测乳腺癌腋下淋巴结转移的临床价值。方法 56例乳腺癌患术前行乳腺核素显像,乳腺内或腋窝区出现异常放射性分布浓聚影为阳性,显像结论与术后病理结果对照。结果 56例乳腺癌腋下淋巴结显像阳性有19例,与病理对照,诊断乳腺癌腋下淋巴结转移的灵敏度为65．52％,特异性为100％,准确率为82．14％,阴性预测值为72．98％,阳性预测值为100％。结论 ^99mTc-MIBI乳腺显像诊断乳腺肿瘤腋下淋巴结有较高的临床价值。