核素唾液腺显像的定量分析软件开发与应用

目的开发定量分析唾液腺功能及其图象显示的程序。方法应用Aladdin语言编写ROI模块提取各唾液腺及甲状腺区域的摄取数据及本底,用曲线函数生成各ROI的时间-放射性活度曲线,对曲线数据处理,计算唾液腺摄取、排泌指数等指标,然后把图象、曲线及计算结果显示在一个模板内。结果同一幅输出界面图可显示唾液腺的形态、ROI示意图、唾液腺的摄取与排泌功能数值及其曲线,以标准化的显示格式提供给临床医师。不同操作者处理同一资料的功能指标结果基本一致,软件计算的功能指数与图象显示结果及临床诊断基本相符。结论开发的唾液腺功能定量分析软件,程序运行稳定,结果重复性好。     

心肌核素断层显像定量分析系统

介绍了开发设计的计算机心肌核素断层显像定量分析系统.该系统可进行原始数据的读取和格式转换,自动分割左心室,完成SPECT心肌灌注靶心图定量分析、PET心肌代谢靶心图定量分析,对病人数据进行9分区靶心图定量计算等临床数据处理任务.并将结果同医师半定量诊断结果进行对比.     

唾液腺显像常见影响因素分析

目的 探讨唾液腺显像过程中是否有影响显像结果的因素存在,以确保诊断的准确性.方法 对30例患者进行唾液腺显像,受检者仰卧于检查床上并固定头部.静脉“弹丸”注射99TcmO4-洗脱液5mCi,即刻行前位唾液腺动态显像,每分钟采集1帧图像,连续采集30分钟.在采集到20分钟时,让受检者口含并嚼碎维生素C 400mg,刺激唾液腺的分泌,然后继续按照同样条件采集10分钟,获得唾液显像图像和时间-放射性曲线.分析该30例患者的唾液腺显像图像和时间-放射性曲线结果对诊断准确性影响的相关因素.结果 显像剂注射渗漏、显像过程中受检者体位变动、给予维生素C时间的早晚及感兴趣区（ROI）的勾画等是影响唾液腺显像质量和摄取率、排泌分数等结果的主要因素.结论 唾液腺显像的影响因素很多,建立严格的操作规范和工作流程是确保取得准确结果的前提.     

干燥综合征唾液腺核素动态显像的临床价值

目的 探讨干燥综合征(SS)唾液腺核素动态显像的影像特点及临床价值.方法 32例SS患者,其中男性2例,女性30例,年龄23～65岁;12例健康对照者,其中男性1例,女性11例,年龄20～57岁.对所有患者静脉注射99TcmO4-370MBq(10mCi),行唾液腺动态显像,连续采集40min.于30min时,受检者含服维生素C(VitC)0.2g,刺激唾液腺分泌.根据时间-放射性曲线,计算相关功能参数并进行定量分析,将SS组和对照组的指标进行比较分析.结果 对照组双侧唾液腺核素动态显像结果及时间-放射性曲线正常.SS患者腮腺和颌下腺的摄取比值(UR)分别为3.1±1.0和1.4±0.6,正常对照组为6.0±1.3和3.4±1.0,两组比较差异有统计学意义(P<0.05);SS组最大浓聚率(MAR)、最大排泌率(MSR)等参数均低于对照组,差异有统计学意义(P<0.05);SS患者Vit C刺激后,腮腺及颌下腺放射性由最高峰降至最低的时间(Tmin)分别为(4.5±1.9)min和(4.7±1.6)min,正常对照组为(2.0±1.3)min和(2.3±1.0)min,两组比较差异有统计学意义(P<0.01);SS组唾液腺放射性计数达到最高值的时间(Tmax)与对照组比较差异无统计学意义(P>0.05).结论 UR、Tmin、MAR、MSR等参数是判断SS患者唾液腺功能重要的灵敏指标,而测定Tmax临床意义不大.唾液腺核素动态显像定量分析是一种诊断SS的最有价值的方法,能方便、无创、经济、客观地评价唾液腺功能.     

影响唾液腺功能ROI分析的技术因素

目的通过分析鼻咽癌患者腮腺和颌下腺的时间-放射性曲线的形态探讨影响唾液腺功能分析的技术因素.方法对450例次鼻咽低分化鳞癌患者放疗前、放疗后行唾液腺功能显像,显像剂为99mTc-高锝酸钠,剂量370MBq,静脉"弹丸"注射后以60秒/帧,连续动态采集32帧,至20帧时给患者服食维生素C片200mg进行酸刺激,用ROI技术得出时间-放射性曲线,分析其摄取及排泌功能.结果正常时间-放射性曲线呈平滑的坪曲线型,10～20min达到坪值,酸刺激后迅速下降,有176例,异常的时间-放射性曲线不平滑,酸刺激后下降不明显或出现异常变化,有274例,根据功能和形态的不同可将异常曲线分为抛物线型、水平型、双峰型和锯齿型,分别有162例、107例、5例、123例,结合临床与检查过程分析,抛物线型和水平型曲线多数由于腺体放射性损伤引起,双峰型曲线由于静脉注射渗漏引起,而锯齿型曲线多与患者精神状况和体位改变有关.结论唾液腺功能动态显像过程中各种技术因素对唾液腺显像的时间-放射性曲线的形态和变化均有影响,对其进行分析与总结,可帮助提高图像结果的准确性,保证评估结果可靠.     

影响唾液腺功能ROI分析的技术因素

目的　通过分析鼻咽癌患者腮腺和颌下腺的时间—放射性曲线的形态探讨影响唾液腺功能分析的技术因素.方法　对4 5 0例次鼻咽低分化鳞癌患者放疗前、放疗后行唾液腺功能显像,显像剂为99mTc -高锝酸钠,剂量370MBq ,静脉“弹丸”注射后以6 0秒/帧,连续动态采集32帧,至2 0帧时给患者服食维生素C片2 0 0mg进行酸刺激,用ROI技术得出时间—放射性曲线,分析其摄取及排泌功能.结果　正常时间-放射性曲线呈平滑的坪曲线型,10～2 0min达到坪值,酸刺激后迅速下降,有176例,异常的时间-放射性曲线不平滑,酸刺激后下降不明显或出现异常变化,有2 74例,根据功能和形态的不同可将异常曲线分为抛物线型、水平型、双峰型和锯齿型,分别有16 2例、10 7例、5例、12 3例,结合临床与检查过程分析,抛物线型和水平型曲线多数由于腺体放射性损伤引起,双峰型曲线由于静脉注射渗漏引起,而锯齿型曲线多与患者精神状况和体位改变有关.结论　唾液腺功能动态显像过程中各种技术因素对唾液腺显像的时间—放射性曲线的形态和变化均有影响,对其进行分析与总结,可帮助提高图像结果的准确性,保证评估结果可靠.     

核素静脉和淋巴显像在下肢浮患者中的应用

目的：探讨核素静脉和淋巴显像在下肢浮肿患者诊治中的价值。方法：对190例下肢浮肿患者和49例正常对照者行^99Tc^m-大颗粒聚合白蛋白（MAA）或（和）^99Tc^m-右旋糖酐（DX）双下肢静脉或（和）淋巴显像，其中35例行肺部多体位静态显像。结果：190例下肢浮肿患者中：下腔静脉栓塞4例（2．1％）；下肢深静脉血栓形成（DVT）146例（76．8％），血栓性静脉炎为20例（10．5％）；浅静脉曲张7例（3．7％），共177例中同时肺部显像异常35例（19．8％），最后确诊肺栓塞29例（16．4％）；13例（6．8％）浮肿患者下肢静脉显像正常或基本正常，双下肢－腹腔淋巴显像均见淋巴回流障碍。正常对照组49例患者下肢静脉和淋巴显像均正常。结论：核素静脉显像对下肢浮肿患者病变的定位和定性诊断有很高的临床实用价值，对肺栓塞的早期诊断有一定价值。对静脉显像正常的浮肿患者，应常规加做下肢－腹腔淋巴显像。     

鼻咽癌IMRT前后唾液腺功能变化及与受照剂量的关系

目的:探讨鼻咽癌患者调强放射治疗（IMRT）前后唾液腺的功能变化及与受照剂量的关系。方法:选取广西医科大学第一附属医院接受IMRT初治鼻咽癌患者30例为研究对象,在放疗前、放疗后3个月采用99mTcO4-SPECT唾液腺动态显像测定腮腺、颌下腺的时间-放射性曲线（TAC）、最大浓聚率（MAR）和酸刺激最大分泌率（MSR）,研究唾液腺的功能变化及与受照剂量的关系。结果:放疗后3个月出现1~2级口干症状,腮腺、颌下腺TAC曲线主要表现为轻中度受损,口干程度、TAC曲线与唾液腺受照剂量正相关。放疗后3个月较放疗前腮腺MAR、MSR和颌下腺MSR明显减低（P<0.05）,而颌下腺的MAR无减低（P>0.05）,但两组唾液腺的MAR、MSR对比差异无统计学意义（P>0.05）,两组唾液腺照射剂量均合理。结论:鼻咽癌患者IMRT后出现唾液腺摄取和排泄功能轻中度受损,引起1~2级口干,IMRT能够将唾液腺的受照射剂量控制在合理范围内。     

核素肝胆显像在婴儿胆汁淤积诊断中的应用

胆汁淤积临床鉴别诊断较为困难 ,我们采用单光子发射计算机断层装置 (ＳＰＥＣＴ)进行99ｍＴｃ -ＥＨＩＤＡ肝胆动态显像 2 0例 ,现报告如下。资料与方法1 临床资料我院自 1993年以来住院及门诊病人共 2 0例 ,男 13例 ,女 7例 ,年龄 2 8天 - 3个半月 ,平均为 2 3月 ,表现为皮肤粘膜黄染 ,大便黄白或灰白色 ,肝肋下 2 .5 - 4.0ｃｍ不等 ,血总胆红素 86 - 2 6 5 .4μｍｏｌ/Ｌ ,直接胆红素 44 .8- 148μｍｏｌ/Ｌ ,谷丙转氨酶升高 16例 ,为 5 0 - 174ｕ/Ｌ。Ｂ超示胆总管中下段探查不清 4例 ,胆囊不显影 1例 ,肝实质回声增加 4例。2 方法患…     

核素静脉和淋巴显像在下肢浮肿患者中的应用

目的探讨核素静脉和淋巴显像在下肢浮肿患者诊治中的价值. 方法对190例下肢浮肿患者和49例正常对照者行99Tcm-大颗粒聚合白蛋白(MAA)或(和)99Tcm-右旋糖酐(DX)双下肢静脉或(和)淋巴显像,其中35例行肺部多体位静态显像.结果 190例下肢浮肿患者中:下腔静脉栓塞4例(2.1%);下肢深静脉血栓形成(DVT)146例(76.8%),血栓性静脉炎20例(10.5%);浅静脉曲张7例(3.7%),共177例中同时肺部显像异常35例(19.8%),最后确诊肺栓塞29例(16.4%);13例(6.8%)浮肿患者下肢静脉显像正常或基本正常,双下肢-腹腔淋巴显像均见淋巴回流障碍.正常对照组49例患者下肢静脉和淋巴显像均正常.结论核素静脉显像对下肢浮肿患者病变的定位和定性诊断有很高的临床实用价值,对肺栓塞的早期诊断有一定价值.对静脉显像正常的浮肿患者,应常规加做下肢-腹腔淋巴显像.     

Molecular advances in salivary gland pathology and their practical application

The review summarizes the new findings in salivary gland pathology with particular reference to molecular genetic developments. In particular, newly recognized entities and specific chromosomal translocations associated with salivary gland carcinomas are discussed. Firstly, there are three types of salivary gland carcinomas which harbour important oncogenic translocations: mucoepidermoid carcinoma with the translocation t(11; 19)(q21; p13) CRTC1-MAML2 (as well as several other less frequent ones), adenoid cystic carcinoma with the translocation t(6; 9)(q22–23; p23–24) MYB-NFIB, and the recently described entity of mammary analogue secretory carcinoma (MASC) characterized by the translocation t(12; 15)(p13; q25) ETV6-NTRK3. Secondly, sclerosing polycystic adenosis was described in 1996 as possibly a salivary counterpart to benign fibrocystic disease of the breast, but recent molecular evidence of clonality suggests it is neoplastic in nature. Finally, new molecular developments in salivary duct carcinoma and molecular mechanisms responsible for high grade transformation and tumour progression in other neoplasms will be addressed.     

Constrained optimisation and its application to scintigraphy.

Any instrument that records data will produce a distorted or degraded version of the input signal. For example, imaging equipment will produce a blurred image of the object, and in the case of scintigraphic imaging the blurs may be comparable to the size of the physiological structures being investigated. The process of refocusing is called, in mathematical terms, deconvolution. In scintigraphy most workers have implemented deconvolution based on Wiener filtering. The shortcomings of the Wiener method when applied to scintigraphy are identified and an alternative approach to deconvolution using constrained optimisation is presented. The mathematical derivation of the new restoring filter is given in terms of the discrete Fourier transform. The practical implementation of the method on a digital computer is described and, as an example, the result of deconvolving a brain scan is presented.     

Cytogenetic analysis of myoepithelial cell carcinoma of salivary gland

Myoepithelial cell carcinoma (MCC) of the salivary gland is a rare entity. Here, we describe the karyotype of MCC. The patient was a 53-year-old man, with a rapidly growing lesion of the palate. Despite complete surgical excision, radio- and chemotherapy, the lesion rapidly harboured local and distant metastases leading to the death of the patient, 4 months after the diagnosis. On histological and ultrastructural examination, the primary tumour and the related metastases were composed of oval and spindle cells, with features of myoepithelial cell differentiation reported in the literature. Cytogenetic analysis showed a composite karyotype in the primary tumour: 45~46,XY, +3[cp3]/ 44~45,XY, -17[cp4]/ 46,XY[5]. The lymph-node metastasis was near-triploid and showed a complex karyotype. Our cytogenetic data differ from those described in benign or slowly growing salivary gland tumours showing myoepithelial cell differentiation. It is suggested that highly aggressive tumours might follow a different pathway of malignant transformation.     

Localization of prostate-specific antigen-like immunoreactivity in human salivary gland and salivary gland tumors

Immunoreactivity of prostate-specific antigen (PSA), a kallikrein-like enzyme present in the seminal plasma, was demonstrated by indirect immunoperoxidase staining using a PSA antiserum in the apical cytoplasm along the luminal border of small-sized duct epithelial cells of the major salivary (parotid and submandibular) gland of both sexes (56/56, 100%). No PSA-like immunoreactivity was seen in large-sized duct epithelial cells and acinar cells. Minor salivary gland ducts were negative. When inflammatory and atrophic changes were observed, ductal expression of PSA-like immunoreactivity was decreased (12/37, 32%) and the site of intracellular localization often became diffusely cytoplasmic. The immunoreactivity was absorbed by human seminal plasma. Immunoreactivities of prostatic acid phosphatase and sex hormone receptors were undetectable in the salivary gland. Twenty-nine (34%) of 86 salivary gland tumors with ductal differentiation were immunoreactive for PSA mainly in the cytoplasm. A PSA monoclonal antibody ER-PR8 detected immunoreactivity in the prostate but not in the salivary glands or their tumors. Prostate-specific antigen-like immunoreactivity in small-sized (intercalated) duct epithelial cells of the major salivary gland and their tumors may be due to cross-reactivity of the antiserum with kallikrein-like substances.     

Cytogenetic analysis of a primary salivary gland myoepithelioma.

Myoepithelioma, a rare benign salivary gland neoplasm, is a tumor composed entirely of myoepithelial cells. Unlike pleomorphic adenoma, these tumors lack any ductal epithelial differentiation, and manifest a minor stromal element. Previous cytogenetic and molecular genetic studies have mainly investigated pleomorphic adenomas and reported recurring specific chromosomal alterations at 8q12 and 12q13-q15 regions. The cell origin of these alterations, however, remains speculative. We report the cytogenetic analysis of a parotid myoepithelioma and discuss the putative origin for the cells with cytogenetic alterations. Our analysis shows 12q12 involved in a translocation with a previously unreported partner (1q), and nonrandom del(9)(q22.1q22.3) and del(13)(q12q22). Our results indicate that the myoepithelial cell is the source of those cells with chromosomal alterations, and that myoepithelioma shares 12q alterations reported in a subset of pleomorphic adenomas.     

涎腺粘液表皮样癌78例临床分析

目的探讨涎腺粘液表皮样癌的诊断、治疗和减少术后复发率有效方法。方法回顾性总结分析经病理证实的78例涎腺粘液表皮样癌患者的临床资料,对发病年龄、临床表现、手术方法和诊断等进行总结分析。结果涎腺粘液表皮样癌术后随访1~10年,腮腺区复发5例(11.3%),腭部区复发1例(6.25%),发生在颌下区和其他部位的无复发。结论涎腺粘液表皮样癌术前诊断困难,易造成误诊。术中快速冰冻明确诊断、确定手术范围是减少术后复发率有效方法。     

The pathobiology of salivary gland

Summary In the transgenic TG.SH (mouse mammary tumour virus/v-Ha-ras) mouse, designed to develop mammary tumours, occasional spontaneous salivary gland tumours have been reported, predominantly in males. The incidence and histomorphology of salivary gland tumours in 73 TG.SH mice were surveyed and in total, 21.9% developed both overt and microscopic parotid tumours. The majority developed between 73 and 150 days of age. In 31.5% of the TG.SH mice, occasional unilateral, but more frequently bilateral exophthalmos due to hyperplasia of the intraorbital (Harderian) lacrimal gland was observed. In 70% of these animals, parotid tumours developed later. Since Harderian gland hyperplasia, occurring as early as 5 weeks of age, preceded the development of palpable salivary gland lesions, this stigma is useful for the early selection of animals likely to progress to tumour formation. Before tumour-bearing transgenic mice are considered to be suitable models of human neoplastic disease, morphological characterization is necessary to ensure that the tumours are histologically representative of the human lesions for which they are potential models. In this study, all parotid tumours consisted of acinar-like glandular structures with central lumina discernible by electron microscopy. Ultrastructurally, secretory granules evident in the apical cytoplasm of the tumour cells resembled the zymogen granules of the normal parotid acinar cell, and some cells had a prominent complement of rough endoplasmic reticulum. These features, along with focal amylase expression detected immunohistochemically in some parotid tumours, identified these neoplasms as acinic cell carcinomas that mimic the human salivary gland acinic cell carcinoma faithfully.