44例室性心律失常患者99mTc-MIBI心肌灌注显像分析

目的　探讨99mTc -MIBI心肌灌注显像对室性心律失常患者心肌缺血诊断的临床应用价值。方法　对 4 4例室性心律失常患者进行99mTc -MIBI心肌灌注显像分析 ,并根据其结果将患者分为缺血组和非缺血组。结果　缺血组频发室性心律失常的发生率 (70 0 % )明显高于非缺血组 (33.3% ) ,两组相比有显著性差异 (P <0 .0 5 ) ;对于复杂性心律失常 (室性心动过速 )缺血组 (30 0 % )亦明显高于非缺血组 (12 .5 % ) ;缺血组经抗血小板聚集 (阿司匹林 ) ,纠正心肌缺血 (硝酸酯类药物 )等治疗 ,效果显著 (95 %症状消失或减轻 )。结论　99mTc -MIBI心肌灌注显像对判断室性心律失常患者是否存在心肌缺血有临床价值。     

硝酸甘油介入99mTc-MIBI心肌显像对存活心肌的评价

目的探讨含服硝酸甘油(NTG)介入99mTc甲氧基异丁基异晴(99mTc-M IB I)心肌断层显像在估测心肌存活中的价值。方法对66例不稳定型心绞痛患者按心电图无/有病理性Q波分为非合并陈旧性心肌梗死组(A组)和合并陈旧性心肌梗死组(B组),分别进行静息心肌显像,于次日再进行NTG介入99mTc-M IB I心肌显像,采集图像经计算机测定并进行对比分析。结果在66例594个心肌节段中,静息心肌显像有242个节段(40.7%)灌注异常,而经NTG介入后显像中有114个节段(47.1%)灌注得到改善。其中非合并陈旧心梗组改善率为56.6%,合并陈旧心梗组为31.6%,差异有统计学意义。结论NTG介入99mTc-M IB I心肌断层显像对存活心肌评价简便无创,客观准确,为不稳定心绞痛患者冠脉血管重建术前选择适应证及术后评价疗效提供了有力手段。     

硝酸甘油介入99mTc-MIBI心肌显像测定心肌梗死面积与存活心肌的价值

的　观察硝酸甘油(NTG)介入99m锝-甲氧基异丁基异腈(99mTc -MIBI)心肌显像测定心肌梗死(MI)面积与存活心肌的价值。方法　5 0例患者随机分为静息心肌显像组和双密达莫(潘生丁)介入显像组,分别进行静息心肌显像和双密达莫介入显像,于次日再进行NTG介入99mTc-MIBI心肌显像。采集图像经计算机测定相对MI面积,并进行对比分析。结果　NTG介入显像、静息显像、双密达莫介入显像所测得的MI面积分别为18.5 3±3.2 9、2 4 .4 2±3.37、2 9.89±2 .6 3(组间比较P <0 .0 5 ) ,表明静息显像和双密达莫介入显像均过高估测MI面积。结论　NTG介入99mTc-MIBI显像方法简便实用,可减少静息显像、双密达莫介入显像所测得MI面积与实际MI面积的误差,对估测存活心肌有一定的临床价值。     

双核素心肌显像检测心肌梗死患者存活心肌的临床价值

目的：通过^99mTc-MIBI＋^18F-FDG双核素静态心肌灌注-代谢显像评价心梗患者存活心肌对左心功能的影响，以便为临床选择治疗方法和判断预后提供可靠依据。方法：收集临床有心肌梗死并接受冠脉造影及冠状动脉血管重建手术的患者48例，其中，男31例，女17例；年龄39～83（平均60．8）岁。根据超声心动图左心室射血分数（LVEF）分为心功能不全组（A组）27例，心功能正常组（B组）21例。静脉注射^99mTc-MIBI 20mCi（740MBq）和^18F-FDG 8～10mCi（296～370MBq）后行双核素静态心肌灌注-代谢（DISA）显像。扫描仪器采用GE公司Discovery VH型双探头SPECT仪。结果：48例心肌梗死患者中，超声心动图示A组左心室舒张末期内径（LVEDD）较B组明显扩张，左心室射血分数（LVEF）较B组明显减低；冠脉造影（CAG）2组冠脉病变支数差异无统计学意义（P〉0．05）；静态心肌灌注-代谢显像缺损节段数与LVEF均呈负相关（r=-0．37，P〈0．05；r=-0．40，P〈0．05），LVEF与病变冠状动脉的支数无明显相关关系；术前静态心肌灌注-代谢显像提示梗死区存活心肌愈多，术后心功能改善愈明显，而梗死区无存活心肌患者术后心功能无明显改善。结论：^99mTc-MIBI＋^18F-FDG双核素静态心肌灌注-代谢显像是评价心梗后存活心肌的理想方法，可以为临床选择治疗方法、血管重建术的风险评估和判断预后提供可靠依据。     

局部脑血流断层显像在小儿癫痫中的应用分析

目的探讨利用放射性核素99m锝-乙撑双半胱氨酸二乙酯(99mTc-ECD)局部脑血流断层显像对小儿癫痫诊断的临床应用价值。方法对14例癫痫患儿进行99mTc-ECD单光子发射型计算机断层显像(SPECT),了解患儿脑局部血流灌注情况。结果放射性核素99mTc-ECD脑局部血流灌注显像阳性率高(78.57%)。结论99mTc-ECD局部脑血流断层显像是诊断小儿癫痫病灶的有效方法,对制订癫痫的治疗方案有一定帮助。     

99mTc—MIBI甲状腺亲肿瘤显像临床价值探讨

目的：探讨99mTc—MIBI甲状腺亲肿瘤显像对甲状腺结节良恶性诊断与鉴别诊断的价值。方法：选择42例甲状腺癌患者作为观察组,行99mTc—MIBI甲状腺亲肿瘤显像,同时选择101例甲状腺良性结节患者作为对照组,将显像结果与手术病理结果进行对照。结果：观察组阳性显像3l例,阴性显像11例;对照组阳性显像21例,阴性显像80例;99mTc—MIBI亲肿瘤显像诊断甲状腺恶性肿瘤灵敏度为73．81％（31／42）,特异度为79．21％（80／101）,准确性为77．62％（111／143）。两组患者阳性率比较差异具有统计学意义（P〈0．05）。结论：99mTc—MIBI甲状腺亲肿瘤显像对甲状腺结节的诊断具一定的临床价值。     

急性心肌梗死急诊介入治疗后心肌组织水平再灌注评价方法对比研究

目的 应用TIMI心肌灌注分级(TMPG)、单个导联ST段回落幅度(单导STR)、单个导联ST段最大偏移幅度(MaxSTE)三种方法评价急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)后心肌组织水平再灌注情况.方法 42例AMI患者急诊PCI后采用TMPG、单导STR、MaxSTE方法评价心肌组织水平再灌注情况,并于术后行99mTc-甲氧基异丁基异腈(MIBI)单光子发射型计算机体层摄影(SPECT)心肌灌注显像.结果 与99mTc-MIBI SPECT心肌灌注显像对比,TMPG灵敏度93.75%,特异度20.00%,准确度76.19%;单导STR灵敏度87.50%,特异度80.00%,准确度85.71%;MaxSTE灵敏度81.25%,特异度80.00%,准确度80.95%.单导STB、MaxSTE与99MTc-MIBI SPECT心肌灌注显像检查均存在一致性(P<0.05),且一致性良好;TMPG未显示与99MTc-MIBI SPECT心肌灌注显像检查存在一致性.结论 单导STR和MaxSTE可较好地评价AMI后心肌组织水平再灌注情况.     

核素心肌灌注断层显像诊断冠心病的临床应用

目的评估核素心肌灌注断层显像在冠心病（CAD）临床诊断中的价值。方法对30例冠心病和可疑冠心病患者进行^99m锝-甲氧基异丁基异晴（^99mTc-MIBI）心肌灌注断层显像，同时采用半定量方法分析患者左心室心肌血流灌注情况，其中15例患者行冠状动脉造影术（CAG）。结果心肌灌注断层显像冠心病和可疑冠心病患者检查的阳性率为46．7％。结论。^99mTc-MIBI心肌灌注断层显像是安全、无创伤、方便及费用低的检查方法，临床联合应用对冠心病的诊断、治疗和预后判断有重要的价值。     

核素乏氧显像和亲肿瘤显像及CT检查诊断肺癌的对比研究

目的探讨^99mTc-HL91乏氧显像、^99mTc—MIBI亲肿瘤显像及CT检查诊断肺癌的价值。方法50例经病理确诊的肺肿瘤患者行^99mTc—HL91乏氧显像、^99mTc—MIBI亲肿瘤显像及cT检查，比较分析诊断特性。结果3种方法诊断肺癌的灵敏度相互比较差异无统计学意义^99mTc—HL91乏氧显像的特异性明显高于^99mTc—MIBI亲肿瘤显像和CT，准确率高于^99mTc—MIBI亲肿瘤显像，与CT比较差异无显著性。3种方法联合诊断肺癌的灵敏度、特异性和准确率分别为96．9％、100％和98％。结论^99mTc—HL91乏氧显像诊断肺癌有较高的临床价值，联合^99mTc—MIBI亲肿瘤显像和CT检查可进一步提高诊断的准确性。     

多巴酚丁胺负荷超声对比硝酸甘油介入^99mTc—MIBI心肌灌注显像评价存活心肌

目的评价多巴酚丁胺超声心动图负荷试验（DSE）和硝酸甘油介入^99mTc—MIBI心肌灌注显像（SPECT）评价心肌存活性的价值。方法48例可疑冠心病患者，行CAG、DSE及SPECT检查，其中25例冠心病患者成功行经皮冠脉介入治疗（PCI），以PCI术后3个月室壁运动改善为检验标准，比较多巴酚丁胺超声心动图负荷试验及硝酸甘油介入SPECT检测存活心肌的准确性。结果多巴酚丁胺负荷超声与硝酸甘油介入的心肌灌注显像均可敏感的检测存活心肌。与DSE相比，硝酸甘油介入的SPECT具有较高的敏感性但特异性较低，差异有统计学意义（P〈0．05）。结论多巴酚丁胺负荷超声与硝酸甘油介入的SPECT检测存活心肌各有特点，但DSE更具临床应用价值。     

Recent advances in nuclear cardiology

Nuclear cardiology is an essential part of functional, non-invasive, cardiac imaging. Significant advances have been made in nuclear cardiology since planar (201)thallium ((201)TI) scintigraphy was introduced for the evaluation of left ventricular (LV) perfusion nearly 40 years ago. The use of nuclear cardiology has been steadily increasing over the last 20 years with important steps being the introduction of (99m)technetium- ((99m)Tc)-labelled perfusion radiotracers, the change from only planar to now much more single photon emission computed tomography (SPECT) and positron emission tomography (PET), electrocardiogram gating of nuclear perfusion imaging, and finally introducing nuclear hybrid imaging using either SPECT or PET together with either computed tomography or magnetic resonance imaging. The indications have extended from nearly only coronary artery diseases to several non-coronary cardiac diseases. The advances in nuclear cardiology are discussed under the four headlines of: 1) myocardial perfusion, 2) cardiac performance including LV and right ventricular (RV) function, 3) myocardial metabolism, and 4) experimental nuclear cardiology.     

核素心肌灌注显像与冠状动脉造影的对比分析

目的评价核素心肌灌注显像诊断冠心病的准确性,分析核素心肌灌注显像与冠状动脉造影结果。方法分析近两年来核素心肌灌注显像检查及冠脉造影的患者46例,所有患者均进行了心肌灌注显像,负荷显像异常者于24h后再行静息心肌灌注显像。结果核素显像与冠状动脉造影结果不相符的患者共5例,核素心肌灌注断层显像阴性而冠状动脉造影阳性者1例,核素心肌灌注断层显像阳性而冠状动脉造影正常者4例。结论这两种检查方法有高度的一致性,但核素心肌灌注断层显像更具有优势。     

SPECT/CT融合显像在甲状旁腺功能亢进症术前诊断中的应用价值

目的:探讨SPECT/CT融合显像在原发性甲状旁腺功能亢进症(PHPT)术前诊断中的应用价值。方法:回顾性分析2017年2月~2019年1月就诊于本院的52例PHPT患者临床资料,术前30d均接受99TCm-MIBI SPECT/CT融合显像检查。以病理诊断为金标准,分析99TCm-MIBI SPECT/CT融合显像检查PHPT的检出率和不同病灶的检出率。结果:52例患者经病理诊断共73处病灶,其中异位甲状旁腺腺瘤3例(3处病灶),甲状旁腺腺瘤42例(55处病灶),甲状旁腺增生3例(12处病灶),甲状旁腺癌术后淋巴结转移3例(3处病灶);经99TCm-MIBI SPECT/CT融合显像检查确诊患者52例,检出病灶63个,检出率为86.30%(63/73),其中异位甲状旁腺腺瘤3处(100.00%),甲状旁腺腺瘤52处(94.55%),甲状旁腺增生5处(41.67%),甲状旁腺癌术后淋巴结转移3处(100.00%)。结论:99TCm-MIBI SPECT/CT融合显像是检测PHPT的有效方式,可精确定位病灶,为手术提供重要参考依据。     

Clinical application of brain perfusion SPECT imaging to dementia

Brain perfusion SPECT imaging has been applied to patients with dementia using 123I-IMP and 99mTc-HM-PAO. Brain blood flow closely parallels regional brain metabolism or brain function with normal cerebrovascular function. Therefore neuronal activity can be indirectly evaluated by in vivo brain perfusion imaging in dementia. This nuclear medicine technique is quite useful for the differential diagnosis, assessment of the degree and localization of the affected area, disease course, and therapeutic effect. IMP seems to be superior to HM-PAO in detecting focal decreased perfusion and quantitative analysis. Hereafter the brain perfusion SPECT study will be more widespread. Neuroreceptor imaging is highly expected as the next step of a brain SPECT study.     

Clinical evaluation of SPECT in cerebrovascular disease

In 131 patients with cerebrovascular disease, regional cerebral blood flow was determined by 123I-IMP (N-isopropyl (123I)-iodoamphetamine) or 99mTc-HM-PAO (99mTc (d, l)-hexamethyl propyleneamine oxime) SPECT and findings were compared with those of X-CT or MRI. The perfusion deficit detected by SPECT was larger than the deficit by X-CT or MRI in every cases. The perfusion deficit area was more clearly demonstrated by SPECT than by X-CT or MRI in patients with acute cerebral infarction. The hypoperfusion area determined by 123I-IMP SPECT was wider than that by 99mTc-HM-PAO SPECT. The crossed cerebellar diaschisis was observed in 56 out of 131 cases (43%). The results of operation were quantitatively evaluated by 123I-IMP SPECT in 25 patients.     

乳腺癌患者胸壁放疗后心肌灌注改变及影响因素

目的探讨乳腺癌患者胸壁放射治疗方式、蒽环类药物累积剂量、血脂等因素与心肌灌注改变的相关性。方法选择接受含蒽环类抗癌药方案化疗后的有放疗指征的乳腺癌病人52例,分别于放疗前和放疗后6个月行99mTc-MIBI心肌灌注显像;采用Logistic逐步回归进行多因素分析,探讨胸壁不同照射方式、不同照射部位(左侧胸壁和右侧胸壁)、蒽环类药物累积剂量、血脂等因素对心肌灌注改变的影响。结果本研究52例病人接受放疗前心肌灌注均示正常,而接受放疗后6个月共有18例出现心肌灌注改变,占34.6%(18/52),所有患者均无心脏损伤的临床症状;放射治疗照射方式及部位与心肌灌注改变的发生无显著相关性;病人年龄、紫杉醇、三苯氧胺等因素与心肌灌注改变的发生亦无显著相关性;但蒽环类抗癌药物累积剂量(p=0.020,OR:1.010,95%CI:1.002~1.018)和血脂增高(p=0.028,OR:4.529,95%CI:1.173~11.485)与心肌灌注改变的发生呈正相关。结论乳腺癌根治术后采用6MeV电子束照射胸壁或保乳术后采用6MV光子线切线野照射乳腺/胸壁,对心肌灌注改变的影响均较小。接受含蒽环类抗癌药方案化疗的乳腺癌患者,其心肌灌注改变与蒽环类药物累积剂量呈正相关。高血脂是乳腺癌患者综合治疗后心肌灌注改变发生的危险因素之一。     

Cardiovascular nuclear medicine 1976/'06: 30 years representation in clinical cardiology

Over the past 30 years, cardiovascular nuclear medicine has become an important diagnostic tool in patients with known and suspected coronary artery disease. Myocardial perfusion scintigraphy is indicated in: patients with suspected coronary artery disease and an intermediate likelihood of disease to detect myocardial ischemia, patients with a sustained myocardial infarction to assess myocardial viability, patients following revascularization for risk stratification, and coronary patients to assess prognosis. Gated SPECT myocardial perfusion imaging offers the potential of assessing left ventricular function and myocardial perfusion simultaneously. Information on left ventricular function and volumes significantly improves the diagnostic accuracy of myocardial perfusion imaging. The gated SPECT technique is a valuable tool for risk stratification because it offers the potential of assessing left ventricular function and volumes, which are both important prognostic parameters.     

脑血流灌注显像对难治性发作性癫痫诊断的研究

目的 评价99mTc-单光子发射计算机断层(SPECT)脑血流灌注显像对难治性发作性癫痫的诊断价值,并分析其影像学特点.方法 对难治性发作性癫痫患者共238例分别进行SPECT、MRI、CT和脑电图(EEG)检查,并对诊断结果进行统计分析和比较.结果 SPECT对强直性发作、失神发作、单纯部分性发作和复杂部分性发作的癫痫病灶检出率分别为85.7%、95.7%、89.8%和90.9%,显著高于其他检查方法(P＜0.01);接受SPECT病灶定位诊断进行伽马刀治疗的36例患者中,23例随访1年以上,有效率为78.26%.结论 SPECT对癫痫病灶的检出率较高,对立体定向放射外科靶区的确定具有重要的临床价值.