基于核素心肌影像数据心室模型的研究

介绍了一种单光子发射型计算机断层显像(SPECT)、正电子发射计算机断层显像(PET)心肌核素断层显像左心室提取及优化算法研究,选用"半球加圆柱"模型,提出应用左心室心肌最大放射性计数值采样。采用多参数Powell最优化方法进行模型参数的拟合,并将拟合结果同医师诊断结果进行对比,高度相关评分的一致率为83.2%。     

早期刺激与局部心室壁收缩状态的实验研究

本文应用超声测量技术,在清醒犬研究了早期刺激与局部心室壁收缩状态的关系。刺激左室前壁时,前壁的总收缩期室壁厚度增大率(TPT)由对照的19.6±3.2%降低到6.7±6.6%(P<0.01),而等容收缩期室壁厚度增大率(IWT)由对照的2.2±2.8%增加到95.3±10.5%(P<0.001);刺激左室后壁时,后壁的TPT从对照的26.7±14.4%减少到10.0±4.8%(P<0.05),而IWT由对照的1.9±2.7%增大到87.0±18.1%(P<0.001),同时,无论刺激前壁或后壁,每搏量都明显减少。LVdp/dt随着连结间隔的缩短也明显减少。因此,早期刺激引起的心肌收缩异常,可能与心泵功能及收缩性能的降低有关。     

白细胞介素-2对大鼠心室肌细胞收缩功能的影响及其机制探讨

白细胞介素 2 (interleukin - 2 ,IL - 2 )是机体复杂免疫网络中起调节作用的重要细胞因子之一。越来越多的资料表明IL -2与心血管系统的生理活动和病理过程之间存在密切关系。但目前有关IL - 2对心脏的直接作用及其机理的研究尚不够深入。目的 :研究细胞因子白细胞介素 - 2对心肌细胞收缩功能的影响及其可能机制。方法 :采用酶解分离成年大鼠心室肌细胞模型 ,用视频跟踪计算机系统记录测定单个心室肌细胞收缩反应。心肌细胞收缩参数包括最大收缩幅度 (dL)、细胞最大收缩速度 (+dL/dtmax)、细胞最大舒张速度 (-dL/dtmax)、舒张末期细胞…     

青年人正常颈椎旋转功能的CT研究

目的探讨正常各颈椎的旋转角度及旋转时横突孔移位、寰枢外侧关节活动情况。方法选择16~20岁健康自愿者50例,分别在正位、最大左旋和右旋位行螺旋CT扫描,测量枕骨和各颈椎与水平线所成角度、各横突孔的坐标值、寰椎侧块下关节面总面积及其与枢椎侧块上关节面未重合的面积,计算各颈椎实际旋转角度及占枕骨与第1胸椎间角度的百分比、横突孔在旋转时的实际移位距离及寰枢外侧关节的脱位百分比。结果颈椎向左、右作最大限度旋转时,枕骨相对第1胸椎的旋转角度分别为（69.9°±4.6°）、（69.6°±7.1°）,第1颈椎分别占（60.57±7.64）%、（56.28±10.0）%;第1颈椎左、右侧横突孔分别后移（13.03±4.03）mm、（9.80±3.08）mm,内移（15.74±2.76）mm、（13.97±5.90）mm,对侧分别前移（18.57±3.72）mm、（16.27±2.79）mm,内移（17.72±6.49）mm、（18.47±4.09）mm;左、右侧寰枢外侧关节分别脱位（57.34±7.06）%、（60.28±8.51）%,对侧分别脱位（75.53±8.54）%、（77.49±8.13）%。结论 CT是对活体颈椎旋转功能进行研究的简便、准确的方法,从青年人正常颈椎所测得数值对颈椎退行性变等异常情况下旋转功能的研究具有参考价值。     

超声心动图对扩张型心肌病左室收缩功能的研究

应用二维超声心动图对50例不同心功能级别的扩张型心肌病(DCM)患者左室收缩功能进行检测,并与40例健康查体者对照,结果:DCM全组及各组EF、FS均明显下降,其中心功能Ⅲ、Ⅳ级组相差非常显著;心功能Ⅱ级组SV、CO、CI略增高;Ⅲ级组SV下降,CO、CI正常;Ⅳ级组SV、CO、CI均下降明显,相差显著。提示:DCM心功能Ⅱ、Ⅲ级时心肌收缩力下降,但心脏代偿功能好,心排量正常;Ⅳ级时心肌纤维收缩无力,心排严重不足,处于失代偿状态。     

~(99m)Tc-MIBI心肌断层显像与冠状动脉造影的相关性研究

目的定量评价核素心肌断层显像（ＳＰＥＣＴ）与冠状动脉造影血管病变的相关性方法对５０例冠心病（ＣＡＤ）病变血管狭窄程度、狭窄面积与ＳＰＥＣＴ心肌缺血程度、缺血面积进行双定量分析比较．结果病变血管直径、血管面积和血管狭窄程度、血管狭窄面积相关性很高, ｒ＝０．９８、０．９３;血管狭窄程度、血管狭窄面积与ＳＰＥＣＴ心肌缺血程度、心肌缺血面积相关性较低（ｒ＝－０．２６、０．３３）;病变血管直径与 ＳＰＥＣＴ心肌缺血面积不相关（ｒ＝０．０４）;病变血管狭窄面积与ＳＰＥＣＴ心肌缺血程度负相关（ｒ＝０．１２）结论冠脉造影病变血管缺血程度、病变血管面积与ＳＰＥＣＴ心肌缺血程度、心肌缺血面积两种检查的相关性较低,但其间有内在联系,供临床参考．     

左心室三维应力与左心室收缩功能的相关性研究

目的研究左心室三维应力与反映左心室收缩功能的生物力学指标——最大心肌劲度(maxEav)的相关性,以获得反映左心室收缩功能的简单且实用的生物力学指标。方法选取34例健康人为研究对象,其中男性19例,女性15例;年龄34～75岁,平均年龄49.2岁。应用超声心动图测定心脏左心室收缩末期内径和后壁厚度及射血分数;左心室收缩末期中壁长短径、室壁厚度;联合袖带肱动脉血压值计算左心室收缩末期压力。应用上述各测值计算maxEav及左心室收缩末期径线、圆周、长轴应力(σr、σθ、σm),进行相关性统计学分析。结果σr=(-62.55±0.53)N/cm2;σθ=(27.81±1.36)N/cm2;σm=(62.58±2.88)N/cm2;maxEav=(226.52±9.36)N/cm2;LVEF=(63.13±1.01)%。maxEav与σr无相关性(r=0.067,P>0.05);maxEav与σθ有极显著负相关性(r=-0.510,P<0.01);maxEav与σm有极显著正相关性(r=0.563,P<0.01)。LVEF与三向应力无相关性(P>0.05)。结论应用左心室收缩末期圆周及长轴应力两项生物力学指标评价左心室收缩功能较为简便实用且准确。     

甲状腺单发结节摄锝比与血清TSH测定的临床相关分析

目的 探讨甲状腺单发结节摄锝比与血清TSH检测结果之间的相关性,及二者对结节良恶性判断的诊断价值.方法 以术后或穿刺病理结果为标准,回顾性分析2016年2月至2016年10月在我院行甲状腺99Tcm-SPECT/CT 检查及血清TSH测定的76例甲状腺单发结节.结果 甲状腺恶性结节摄锝比明显低于良性结节(P<0.05),血清TSH水平明显高于良性结节(P<0.05),摄锝比与血清TSH具有负相关性.结论 99Tcm-SPECT/CT甲状腺显像结合血清TSH水平,可能有助于对甲状腺单发结节的良恶性判断.     

不同清甲剂量131I对中低危分化型甲状腺癌患者治疗后临床反应和免疫功能的影响

目的 探讨不同清甲剂量¹³¹I对中低危分化型甲状腺癌(differentiated thyroid carcinoma, DTC)患者治疗效果和免疫功能的影响。方法 选取2019年10月至2020年9月四川省肿瘤医院收治的已行甲状腺全切除术和颈部淋巴清扫术,且术后采用¹³¹I清甲治疗的54例DTC患者为研究对象。根据¹³¹I清甲剂量大小分为小剂量治疗组(1.11GBq, 21例)和大剂量治疗组(3.70GBq, 33例),比较两组间清甲治疗效果和免疫功能变化差异。结果 治疗后6个月左右,两组间治疗后反应完全比率差异无统计学意义(χ²=0.006,P=0.936);清甲治疗后5～7天与治疗前比较,免疫功能均有降低(P<0.001),大剂量组比小剂量组的免疫功能降低幅度更大(P<0.05);治疗后6个月左右,两组间免疫细胞百分比值(Treg细胞除外)基本恢复到治疗前水平(P>0.05)。结论 对于中低风险DTC患者而言,大剂量和小剂量清甲治疗后反应完全率接近,而小剂量治疗组在短期内对免...     

V—EEG与SPECT联合应用在顽固性癫痫术前致痫灶定位中的价值

目的：探讨视频脑电图（V—EEG）与单光子发射计算机断层扫描（SPECT）联合应用在顽固性癫痫术前致痂灶定位中的价值。方法：对103例顽固性癫痫患者,在MRI扫描的基础上,术前行V—EEG和SPECT检查,联合定位致痫灶,通过术中皮层脑电图（ECoG）检查验证致痫灶定位的准确性。结果：103例患者发作间期V—EEG检查均有异常,85例患者检查过程中有癫痫发作1～3次。SPECT检查异常95例,其中表现为放射性核素稀疏区86例,放射性核素浓聚区9例。术前两者联合定位致痫灶91例,与术中ECoG所确定的致痫灶部位一致者85例,符合率为93．4％。结论：术前V-EEG与SPECT的联合应用可以较准确地定位顽固性癫痫的致痫灶,该法对于MRI无异常的癫痫患者之术前致痫灶定位尤其具有重要意义。     

Pilot Study: Evaluation of Dual-Energy Computed Tomography Measurement Strategies for Positron Emission Tomography Correlation in Pancreatic Adenocarcinoma

We sought to determine whether dual-energy computed tomography (DECT) measurements correlate with positron emission tomography (PET) standardized uptake values (SUVs) in pancreatic adenocarcinoma, and to determine the optimal DECT imaging variables and modeling strategy to produce the highest correlation with maximum SUV (SUV_max). We reviewed 25 patients with unresectable pancreatic adenocarcinoma seen at Mayo Clinic, Scottsdale, Arizona, who had PET–computed tomography (PET/CT) and enhanced DECT performed the same week between March 25, 2010 and December 9, 2011. For each examination, DECT measurements were taken using one of three methods: (1) average values of three tumor regions of interest (ROIs) (method 1); (2) one ROI in the area of highest subjective DECT enhancement (method 2); and (3) one ROI in the area corresponding to PET SUV_max (method 3). There were 133 DECT variables using method 1, and 89 using the other methods. Univariate and multivariate analysis regression models were used to identify important correlations between DECT variables and PET SUV_max. Both R² and adjusted R² were calculated for the multivariate model to compensate for the increased number of predictors. The average SUV_max was 5 (range, 1.8–12.0). Multivariate analysis of DECT imaging variables outperformed univariate analysis (r = 0.91; R² = 0.82; adjusted R² = 0.75 vs r < 0.58; adjusted R² < 0.34). Method 3 had the highest correlation with PET SUV_max (R² = 0.82), followed by method 1 (R² = 0.79) and method 2 (R² = 0.57). DECT thus has clinical potential as a surrogate for, or as a complement to, PET in patients with pancreatic adenocarcinoma.     

健康成人左右心室整体心功能的64排螺旋CT研究

探讨健康国人左右心室整体心功能,建立功能参数的CT参考值。对58例成人健康(男女各28例)心脏行64层螺旋CT检查,重建心动周期十个时相心脏短轴位,用心功能软件勾画左右室心内外膜边界,计算左右心室整体功能指标。左右心室舒张末期容积、收缩末期容积、每搏量及心肌质量男性均大于女性,有显著性差异(P<0.05);但心输出量、射血分数男女无显著性差异。在同一性别组中,左室的心肌质量大于右室(P<0.01)。左右心室收缩末期容积与体重指数呈负相关,相关系数为-0.54和-0.53;左右心室每搏量、射血分数与体重指数呈正相关,相关系数分别为0.87/0.97和0.69/0.62。正常左右心室整体收缩功能与性别、个体大小有关。     

Study of ^99mTc-TRODAT-1 Imaging on Human Brain with Children Autism by Single Photon Emission Computed Tomography

Objective ： Evaluate the application values of ^99mTc-2 β [ N, N＇-bis （ 2-mercaptoethyl ） ethylenediamiino ] methyl, 3 β -（4-chlorophenyl） tropane （ TRODAT-1 ） dopamine transporter （DAT） SPECT imaging in children autism, and offer the academic foundation to etiology, mechanism and clinical therapy of autism. Methods：Ten autistic children and ten healthy controls were examined with ^99mTc-TRODAT-1 DAT SPECT imaging. Striatal specific uptake of ^99mTc-TRODAT-1 was calculated with region of interest analysis according to the ratios between striaturn and cerebellum [ （ STR-BKG）/BKG ]. Results ： There was no difference in semiquantitative dopamine transporter between bilateral striatum in autistic children （ P = 0. 562） and in normal controls （ P = 0. 573 ） ; dopamine transporter in brain of patients with autism increased more significantly than that in normal controls （ P = 0. 017）. Conclusion ： Dopaminergic nervous system is dysfunction in human brain with children autism, and DAT ^99mTc-TRODAT-1 SPECT imaging on human brain will help the imaging diagnosis of children autism.     

Safety and Effectiveness of F-18 Fluoroestradiol Positron Emission Tomography/Computed Tomography: a Systematic Review and Meta-analysis

BackgroundWe conducted a pooled analysis of the diagnostic accuracy of F-18 fluoroestradiol (F-18 FES) positron emission tomography/computed tomography (PET/CT) assessing estrogen receptor expression of patients who have recurrent or metastatic breast cancer.MethodsTwo investigators and seven related experts (from the departments of nuclear medicine, hematological oncology, surgery, and evidence-based medicine) evaluated the effectiveness of F-18 FES PET/CT according to diagnostic accuracy and correlation with immunohistochemistry tests via systematic literature review, and safety according to test-related side effects. The present study was conducted in accordance with the Scottish Intercollegiate Guidelines (SIGN), and the Cochrane, and Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The SIGN tools were used for quality assessment.ResultsOf the 512 articles retrieved in the literature search, 8 were deemed to be eligible for inclusion. Results of the evaluation indicated that the F-18 FES PET/CT test was safe because patients who reported pain in the injection site in the analyzed articles are most likely to be caused by mechanical injury from needle injection not by administration of radioactive materials. Assessment of diagnostic accuracy based on data from seven studies revealed a pooled sensitivity and specificity of 0.86 and 0.85, respectively.ConclusionAs such, the test was evaluated to be a safe and effective and, considering the anatomical site where only invasive tests are possible, the test was deemed to have high clinical utility.     

Positron Emission Tomography in the Study of Aging and Senile Dementia

¹⁸F-2-deoxy-2-fluoro-D-glucose (¹⁸FDG) is a positron emitting tracer for rate of glucose utilization in brain. When used in conjunction with positron emission tomography (PET), the PET-FDG technique permits in vivo quantitation of regional brain metabolism in man. We have applied this technique to the study of regional brain function in normal aging and senile dementia. Preliminary results for 7 patients with senile dementia of the Alzheimer's type (SDAT) and 3 elderly normal subjects indicated a large, statistically significant (p < 0.01) diminution in rate of glucose utilization in SDAT. Furthermore, the degree of diminution in metabolic activity in SDAT was highly correlated with objective measures of degree of cognitive impairment. These results demonstrate the feasibility and potential utility of the PET-FDG technique for studying regional brain function in normal aging and dementia.     

Positron Emission Tomography in the Study of Aging and Senile Dementia

¹⁸F-2-deoxy-2-fluoro-D-glucose (¹⁸FDG) is a positron emitting tracer for rate of glucose utilization in brain. When used in conjunction with positron emission tomography (PET), the PET-FDG technique permits in vivo quantitation of regional brain metabolism in man. We have applied this technique to the study of regional brain function in normal aging and senile dementia. Preliminary results for 7 patients with senile dementia of the Alzheimer's type (SDAT) and 3 elderly normal subjects indicated a large, statistically significant (p < 0.01) diminution in rate of glucose utilization in SDAT. Furthermore, the degree of diminution in metabolic activity in SDAT was highly correlated with objective measures of degree of cognitive impairment. These results demonstrate the feasibility and potential utility of the PET-FDG technique for studying regional brain function in normal aging and dementia.     

Early Changes by 18Fluorodeoxyglucose Positron Emission Tomography Coregistered with Computed Tomography Predict Outcome after Mycobacterium tuberculosis Infection in Cynomolgus Macaques

Cynomolgus macaques infected with low-dose Mycobacterium tuberculosis develop both active tuberculosis and latent infection similar to those of humans, providing an opportunity to study the clinically silent early events in infection. ¹⁸Fluorodeoxyglucose radiotracer with positron emission tomography coregistered with computed tomography (FDG PET/CT) provides a noninvasive method to measure disease progression. We sought to determine temporal patterns of granuloma evolution that distinguished active-disease and latent outcomes. Macaques (n = 10) were infected with low-dose M. tuberculosis with FDG PET/CT performed during infection. At 24 weeks postinfection, animals were classified as having active disease (n = 3) or latent infection (n = 6), with one “percolator” monkey. Imaging characteristics (e.g., lesion number, metabolic activity, size, mineralization, and distribution of lesions) were compared among active and latent groups. As early as 3 weeks postinfection, more pulmonary granulomas were observed in animals that would later develop active disease than in those that would develop latent infection. Over time, new lesions developed in active-disease animals but not in latent animals. Granulomas and mediastinal lymph nodes from active-disease but not latent animals consistently increased in metabolic activity at early time points. The presence of fewer lesions at 3 weeks and the lack of new lesion development in animals with latent infection suggest that innate and rapid adaptive responses are critical to preventing active tuberculosis. A greater emphasis on innate responses and/or rapid recruitment of adaptive responses, especially in the airway, should be emphasized in newer vaccine strategies.     

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Predicting the Adverse Effects of Chimeric Antigen Receptor T Cell Therapy in Patients with Non-Hodgkin Lymphoma

CD19-targeting chimeric antigen receptor (CAR)-T cell therapy has shown great efficacy in patients with relapsed/refractory non-Hodgkin lymphoma (NHL) but has been associated with serious adverse effects, such as cytokine release syndrome (CRS). It has been speculated that NHL baseline disease burden might affect clinical outcome and CRS, but this has not been explored in detail in any previous study. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as measured by fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT), are quantitative indicators of baseline tumor burden. Using FDG PET-CT, we calculated baseline and post-CAR-T cell therapy MTV and TLG in 19 patients with NHL. The median MTV was 72 cm³ (range, .02 to 1137.7 cm³), and the median TLG was 555.9 (range, .011 to 8990.3). After a median follow-up of 5 months (range, 1 to 12 months), the best overall response rate was 79.0%. The baseline MTV and TLG did not differ significantly between patients with response and those without response (P = .62 and .95, respectively). On Cox regression analysis, baseline MTV and TLG were not significantly associated with overall survival (P = .67 and .45, respectively). Patients with mild and moderate CRS (grade 0 to 2) had significantly lower MTV and TLG than those with severe CRS (grade 3 to 4) (P = .008 for MTV comparison, P = .011 for TLG comparison). Using FDG PET-CT, we also demonstrated that CAR-T cell therapy in patients with NHL was associated with pseudoprogression and local immune activation. Our data indicate that patients with higher baseline disease burden have more severe CRS, and that CAR-T cell therapy is associated with lymphoma pseudoprogression and local immune activation.     

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m²) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

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