肿瘤分子核医学

近年来以分子靶向为主导的分子核医学在肿瘤诊断和治疗的研究和应用中发展迅速。许多病变的标志物或其天然配体有不少能直接转换为显像剂。这些显像剂可用于：建立肿瘤诊断方法；指导治疗(因能显示肿瘤中相应靶分子的存在)；证实肿瘤基因治疗制剂的传送；评价肿瘤治疗后的反应；评价肿     

Applications of nuclear medicine in pediatric oncology.

Nuclear medicine is important in the diagnosis, staging, and long-term surveillance of a number of pediatric cancers. Skeletal scintigraphy is used to evaluate primary skeletal cancers, such as osteosarcoma and Ewing sarcoma, and nonskeletal cancers such as neuroblastoma, lymphoma, medulloblastoma, rhabdomyosarcoma, and retinoblastoma. Metaiodobenzylguanidine scintigraphy is valuable in examinations of children with neuroblastoma. The therapeutic response of primary bone and brain tumors can be assessed using Tl-201 and Tc-99m MIBI scintigraphy. Imaging strategies for staging and monitoring the therapeutic response of Hodgkin's lymphoma include Ga-67 citrate scintigraphy. Pediatric oncologic applications of positron emission tomography are being investigated extensively.     

The radiographer and role expansion in nuclear medicine

With the introduction and wide application of Clinical Governance to all clinical areas, all healthcare professionals including radiographers/technologists working in Nuclear Medicine need to gain skills required for implementation. New professional and legal obligations demand that relevant expertise is developed. This article examines the potential for role expansion of radiographers/technologists in Nuclear Medicine with emphasis on the training and development aspects. The key areas addressed include clinical audit, risk management, research, management and continuing professional development.     

The role of nuclear medicine in pulmonary neoplastic processes

It has been demonstrated that the single most important factor in determining survival in patients with bronchogenic carcinoma is the extent of spread of metastasis from the primary lesion. This explains the extensive efforts in developing accurate staging tests for pulmonary tumors, both primary and metastatic, with special emphasis on the determination of pulmonary hilar and mediastinal spread of disease. Continued improvements in nuclear medicine instrumentation along with the development of tumor specific radiopharmaceuticals, as well as agents that have the capability of tracking tumor viability, have changed the orientation of scintigraphic techniques in the evaluation of pulmonary neoplastic processes. Gallium scintigraphy is no longer considered as a primary imaging modality in the staging of pulmonary tumors, and in most institutions has been replaced by computed tomography (CT) for this purpose. It has been demonstrated that gallium, relative to other imaging modalities, is a sensitive indicator of hilar spread of tumor. However, because of the normally high background activity within the sternum and spine, mediastinal abnormalities are poorly detected. Since most pulmonary tumors metastasize via regional nodes to the pulmonary hilum and then to the mediastinum, the high sensitivity for the detection of pulmonary hilar abnormalities and the high specificity for mediastinal lesion detection suggest that gallium scintigraphy is a valuable adjunctive test when used appropriately. Thallium 201 as a tumor agent is being studied by several institutions. Preliminary results indicate a high degree of sensitivity for the detection of pulmonary hilar and mediastinal lesions and there are early indications that thallium is a promising agent to evaluate tumor viability. With the development of new generation monoclonal antibodies, the prospects for highly sensitive and specific agents for detecting hilar and mediastinal spread of tumor is extremely encouraging. CT and NMR have made major contributions to the noninvasive workup of patients with bronchogenic carcinoma. Neither modality has been demonstrated to be accurate enough to adequately evaluate this patient population. Thus, there is a critical need for new noninvasive tests that will accurately assess the status of the patient so that appropriate therapy can be instituted.     

核医学技术在肿瘤治疗中的应用与进展

核医学功能代谢显像与放射性粒子种植治疗是目前肿瘤治疗研究的前沿问题之一,为肿瘤治疗提供了有力的武器。核医学功能代谢显像较CT能更早地显示肿瘤部位和扩散范围,对肿瘤临床分期、制定手术和放射治疗计划具有重要意义,是常规CT和MRI的有益补充。放射性粒子植入治疗安全且疗效肯定,是肿瘤综合治疗的手段之一。     

The role of nuclear medicine in monitoring treatment in skeletal malignancy

The nuclear medicine bone scan has historically been one of the most common investigations to stage and monitor skeletal malignancy. Current guidelines for using radiographs to assess the response of skeletal metastases to systemic therapy are limited in their ability to give a timely result. Despite some minor limitations caused by the flare phenomenon, skeletal scintigraphy remains widely used for this purpose, both clinically and in trials of new cancer treatments. Nuclear medicine has also played an important role in the posttherapy evaluation of primary bone tumors, both with bone agents and nonspecific tumor agents, such as 201Tl. In the future, it is possible that positron emission tomography radiopharmaceuticals such as 18F-fluorodeoxyglucose may prove to be superior in predicting and measuring treatment response in primary and metastatic bone and bone marrow disease, but further work is required in this area.     

The diagnostic role of nuclear medicine in the acquired immunodeficiency syndrome

This paper is a review of (a) the pathophysiology of the autoimmune deficiency syndrome (AIDS), and (b) the diagnostic procedures nuclear medicine has to evaluate human immunodeficiency virus related disorders. This article is organized in an organ system approach to AIDS pathology. The application of [67Ga]citrate, 111In-labeled white blood cells, [201Tl]chloride, single photon emission computed tomographic, and positron emission tomographic brain agents, [99mTc]sulfur colloid and [99mTc]methylene diphosphonate to the pulmonary, nervous, gastrointestinal, dermatologic, musculoskeletal, and renal systems is discussed. These radioisotopes allow earlier diagnosis than routine radiographic studies, and can monitor the effect of therapy on disease activity. In this review an attempt is made to provide clinically useful algorithms to suggest a specific pathogen based on the pattern of radionuclidic uptake.