99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值

目的探讨99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值.方法以术后病理诊断为依据,对57例肺部占位性病变患者的99Tcm-MIBI SPECT/CT显像结果分良性和肺癌两组进行分析,计算其5min、60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR);以肺部良性病灶组UR值的+1s为诊断阈值,对肺癌原发灶及其转移淋巴结的诊断效能进行评价.结果17例肺部良性病灶组其5min和60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR)分别为1.05±0.16、0.97±0.22、1.51±0.39,而40例肺癌组其UR值分别为1.41±0.22、1.37±0.23、2.18±0.61同组两时相比较P>0.05,而组间两时相比较P<0.05.以良性结节+1s为诊断阈值,99Tcm-MIBI对肺癌诊断的灵敏度、特异度和准确度分别为90%(36/40)、82.35%(14/17)和87.72%(50/57);假阳性率和假阴性率分别为17.65%(3/17)和10%(4/40);阳性预测值和阴性预测值分别为 92.31%(36/39)和77.78%(14/18).40例恶性病变患者共检出转移淋巴结19个,其CT/SPECT断层融合图像的UR值为1.82±0.37.结论99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结具有较高的诊断价值.     

PET／CT—功能与解剖结构的同机图像融合

PET/CT为近几年出现的一种新技术,将PET与CT安装在同一机架上,一次扫描可获得PET与CT的融合图像,对定位诊断肿瘤、指导肿瘤放疗计划、选择活检部位及监测疗效等具有重要价值,同时,CT提供了一种PET衰减校正的方法,本文简要介绍PET/CT的结构设计与性能、优势及目前尚存在的技术问题。     

PET/CT——功能与解剖结构的同机图像融合

PET/CT为近几年出现的一种新技术,将PET与CT安装在同一机架上,一次扫描可获得PET与CT的融合图像,对定位诊断肿瘤、指导肿瘤放疗计划、选择活检部位及监测疗效等具有重要价值,同时,CT提供了一种PET衰减校正的方法。本文简要介绍PET/CT的结构设计与性能、优势及目前尚存在的技术问题。     

肺通气/灌注显像与HCTPA诊断肺动脉栓塞的价值

目的　评价核素肺通气 灌注(V Q)显像、螺旋CT肺动脉造影(HCTPA)及血浆D 二聚体在诊断肺动脉血栓中的作用。方法　临床疑为肺动脉栓塞(PE)患者4 2例,男2 6例,女16例,平均年龄( 4 9 18±16 5 6 )岁,均行核素肺V Q显像、HCTPA及血浆D 二聚体测定。其中32例患者在行肺灌注显像时,选择双足背静脉注射肺灌注显像剂,同时完成双下肢静脉显像。结果　4 2例患者中34例经临床诊断为PE ,肺V Q显像诊断PE的灵敏度、准确性和阳性预测值分别为94 12 %、90 4 8%和94 12 % ,HCTPA分别为85 2 9%、83 33%和93 5 5 % ,D 二聚体分别为5 2 94 %、5 7 14 %和90 0 0 %。32例行下肢深静脉显像的PE患者中2 0例有下肢静脉血栓。结论　肺V Q显像无创、安全、简便,诊断PE的灵敏度、准确性高。核素肺显像诊断亚肺段水平PE的能力明显高于HCTPA。     

SPECT／CT在冠心病诊疗中的应用及进展

我国冠心病(CAD)发病率呈逐渐上升趋势,但误诊率和漏诊率仍较高,对冠心病的科学诊断依然是现代医学领域的重要研究课题.     

肺通气血流灌注显像、螺旋CT肺动脉造影及D-二聚体测定对诊断肺栓塞的临床价值

目的探讨放射性核素肺通气血流灌注比值(V/Q)显像和螺旋CT肺动脉造影(SCTPA)以及血浆D-二聚体(dimer)检测对肺栓塞(PE)诊断的临床价值。方法对我院2010年2月—2013年2月可疑肺栓塞的患者,行V/Q显像、SCTPA检查和血浆D-二聚体测定以及相关检查,以最终临床诊断为依据,分别评价V/Q显像、SCTPA和血浆D-二聚体测定对PE的诊断价值。结果 278例高度怀疑PE患者经上述检查确诊PE患者151例,V/Q显像、SCTPA检查和血浆D-二聚体测定诊断PE的灵敏度、特异性、阳性预测值、阴性预测值分别为93.6%(132/141)、96.0%(120/125)、96.4%(132/137)、93.0%(120/129);95.8%(137/143)、96.9%(124/128)、97.2%(137/141)、95.4%(124/130);99.3%(140/141)、43.1%(59/137)、64.2%(140/218)、98.3%(59/60)。结论血浆D-二聚体测定的价值主要用于排除PE。对PE患者的检查应力求全面,V/Q显像、SCTPA检查均有其优点和不足,只有全面掌握各项检查的特点,才能对该项检查对疾病的诊断价值做出正确评价,从而正确运用这一诊断方法更好地服务于临床。     

16层螺旋CT肺血管造影在肺动脉栓塞诊断中的应用

目的　研究 16层螺旋CT肺血管造影在肺动脉栓塞诊断中的应用价值。方法　使用 16层螺旋CT扫描机 (SiemensSensation 16 )对临床拟诊肺栓塞的 4 9例患者进行前瞻性研究。采用层厚 3mm行胸部增强扫描。利用原始数据行层厚 1mm的轴面及多平面重建 (MPR)。比较层厚 3mm、1mm的轴面图像及MPR图像。结果　CT诊断肺栓塞 4 2例。病变共累及肺动脉 35 2支。对于主肺动脉及肺叶动脉栓塞 ,三种图像检出结果一致。但对于肺段及亚段动脉栓塞 ,层厚 1mm较 3mm显示率高 ,差异有显著意义 (P <0 0 1) ,1mm的MPR较轴面图像显示率高 ,但差异无显著性意义 (P >0 0 5 )。结论　 16层螺旋CT肺血管造影无创、快速、敏感性高 ,应当作为肺栓塞的首选检查方法。     

探讨脑SPECT/CT同机图像融合及质量控制

目的:探讨GE HAWKEYE仪器实施脑SPECT灌注显像与CT同机图像融合以及质量控制方法。材料和方法:制作脑SPECT显像的平板头托及其Y轴偏移检测。改变采集模式,手动调节双探头到最小旋转半径,对点源模型及患者进行SPECT/CT采集,以及SPECT/CT同机图像融合处理及其质量控制分析。结果:调整头托及采集技术后,在HAWKEYE仪器实施脑SPECT/CT同机图像融合显像。使用改良头托后,模型及患者进行SPECT/CT显像,能够准确实施同机SPECT/CT图像融合。结论:通过技术改进,可以在GE HAWKEYE仪器上实施脑SPECT/CT同机显像以及准确的图像融合。     

螺旋CT肺动脉造影对于肺动脉栓塞的诊断价值(附8例报告)

目的评价螺旋CT肺动脉造影对于肺动脉栓塞的诊断及随访观察溶栓疗效的可靠性和准确性。方法经我院螺旋CT肺动脉造影诊断的8例肺动脉栓塞患者中有5例进行溶栓治疗。结果8例患者共有17处肺动脉及分支受累。动脉栓子呈偏于管腔一侧的突起状、不规则状和位于管腔中心的柱状及完全堵塞状态。5例溶栓治疗后有3例栓子完全消失，2例栓子明显缩小。结论螺旋CT肺动脉造影在诊断肺动脉栓塞和治疗随访观察疗效过程中都有着重要的价值，可望成为肺动脉栓塞诊断的首选方法。     

多层螺旋CT在肺动脉栓塞诊断中的应用价值

目的：探讨多层螺旋CT肺动脉造影（MSCTPA）对肺动脉栓塞（PE）的诊断及应用价值。方法：用16层及64层螺旋CT对临床疑似肺栓塞的196例病人行MSCTPA检查,采用横断面图像结合多平面重建、容积再现、最大密度投影等多种图像后处理技术综合分析进行诊断。结果：196例病人1～5级肺动脉显示率分别为100．00％、100．00％、100．00％、99．67％、98．00％。PE组中,对16层与64层的5级肺动脉显示率进行比较,χ^2=27．29,P〈0．05,差异有统计学意义;非PE组,对16层与64层的5级肺动脉显示率进行比较,χ^2=3．44,P〉0．05,差异无统计学意义;采用16层CT,对有、无PE组的5级肺动脉显示率进行比较,χ^2=3．50,P〉0．05,差异无统计学意义;采用64层CT,对有、无PE组的5级肺动脉显示率进行比较,χ^2=1．38,P〉0．05,差异无统计学意义。肺动脉栓塞直接征象为肺动脉管腔内充盈缺损,间接征象包括肺动脉高压、胸腔积液及肺梗死等,其各自的发生率分别为50．62％、33．33％、41．97％。结论：MSCTPA是一种无创性的血管成像方法,能够安全、快捷、准确显示肺动脉栓塞,可作为目前PE最主要的影像学检查方法。     

SPECT／CT图像融合显像定位诊断异位或转移性嗜铬细胞瘤的应用价值

目的:为临床手术治疗异位或恶性嗜铬细胞瘤转移灶提供定性和准确解剖定位.材料和方法:对临床怀疑嗜铬细胞瘤的131例患者行131I-MIBG全身显像,发现其中10例肾上腺以外部位有异常放射性浓聚区,对该部位进行SPECT/CT同机图像融合断层显像,分别获得SPECT发射断层图像、CT透射断层图像及准确定位的融合图像.结果:对131I-MIBG全身显像发现异位及恶性嗜铬细胞瘤转移灶,不能明确解剖定位的病例,经SPECT/CT图像融合断层显像后,均获得明确的准确解剖定位.结论:SPECT/CT图像融合显像能够定性并准确定位异位或转移性嗜铬细胞瘤,为临床手术治疗提供重要的依据.     

核素肺灌注显像对急性肺栓塞诊断的临床价值

目的评价放射性核素肺灌注显像在诊断急性肺动脉栓塞中的价值。方法对临床怀疑有急性肺动脉栓塞的25例患者进行了放射性核素肺灌注显像,同时行双下肢深静脉显像。结果25例患者中有23例出现不同程度的多发肺段血流灌注异常,其中41个肺段出现放射性缺损区,84个肺段出现放射性稀疏区。25例患者6例双下肢深静脉血栓形成。结论放射性核素肺灌注显像是诊断急性肺动脉栓塞的一种无创伤性的有效的检查方法。     

Dual Energy CT lung perfusion imaging--correlation with SPECT/CT

Objective

Aims were (1) to determine the diagnostic accuracy of Dual Energy CT (DECT) in the detection of perfusion defects and (2) to evaluate the potential of DECT to improve the sensitivity for PE.

Methods

15 patients underwent Dual Energy pulmonary CT angiography (DE CTPA) and a combination of lung perfusion SPECT/CT and ventilation scintigraphy. CTPA and DE iodine distribution maps as well as perfusion SPECT/CT and inhalation scintigrams were reviewed for pulmonary embolism (PE) diagnosis. DECT and SPECT perfusion images were assessed regarding localization and extent of perfusion defects. Diagnostic accuracy of DE iodine (perfusion) maps was determined with reference to SPECT/CT. Diagnostic accuracies for PE detection of DECT and of SPECT/CT with ventilation scintigraphy were calculated with reference to the consensus reading of all modalities.

Results

DE CTPA had a sensitivity/specificity of 100%/100% for acute PE, while the combination of SPECT/CT and ventilation scintigraphy had a sensitivity/specificity of 85.7%/87.5%. For perfusion defects, DECT iodine maps had a sensitivity/specificity of 76.7% and 98.2%.

Conclusion

DECT is able to identify pulmonary perfusion defects with good accuracy. This technique may potentially enhance the diagnostic accuracy in the assessment of PE.     

宝石CT能谱成像技术在肺栓塞诊断中的价值

目的探讨宝石CT能谱成像技术在肺栓塞诊断中的价值。方法对22例肺栓塞患者行宝石CT能谱增强扫描,通过数据处理同时获得CT肺动脉造影(CTPA)及肺组织碘基图。在CTPA图上观察肺动脉内有无栓子,并记录栓子发生的部位及数量;定量测定肺组织碘基图中碘含量正常区与异常区的碘含量值,并记录碘含量异常区的部位及数量,通过配对t检验观察两组结果间的差异;以CTPA诊断结果为参照,肺组织碘基图与CTPA的诊断一致性采用Kappa检验,同时计算出肺组织碘基图诊断肺栓塞的敏感性、特异性、阳性预测值及阴性预测值。结果22例患者CTPA共诊断124处肺栓塞,其中左右肺动脉6处,肺叶动脉24处,肺段动脉68处,肺亚段动脉26处。肺组织碘基图共检出113处肺组织碘含量降低,碘含量异常区均值0.12±2.11(100μg/cm3),碘含量正常区均值18.56±6.37(100μg/cm3),二者的差异有统计学意义(t=22.43,P<0.05)。以CTPA为参照,肺碘基图诊断了左右肺动脉水平6处,肺叶动脉水平23处,肺段动脉水平59处,肺亚段动脉水平21处肺栓塞;另有4处肺碘基图异常而CTPA诊断为阴性。肺碘基图与CTPA对肺栓塞的诊断经一致性Kappa检验(K=0.913,P<0.001),二者具有良好的一致性。肺碘基图诊断左右肺动脉栓塞的敏感性、特异性、阳性预测值及阴性预测值均为100%;诊断肺叶动脉栓塞的敏感性为95.83%,特异性为100%,阳性预测值为100%,阴性预测值为98.85%;诊断肺段动脉栓塞的敏感性为86.76%,特异性为99.19%,阳性预测值为95.16%,阴性预测值为97.62%;诊断肺亚段动脉栓塞的敏感性为80.77%,特异性为99.88%,阳性预测值为95.45%,阴性预测值为99.42%。结论宝石CT能谱肺碘基图反映了肺组织血流灌注情况,能够显示肺栓塞时肺血管功能的改变,对肺栓塞的早期诊断、病情评估及疗效评价提供重要依据,具有重要的临床应用价值     

Software-Based Hybrid Perfusion SPECT/CT Provides Diagnostic Accuracy When Other Pulmonary Embolism Imaging Is Indeterminate

Purpose

To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans.

Methods

This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up.

Results

In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively.

Conclusions

Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

Electronic supplementary material

The online version of this article (doi:10.1007/s13139-015-0359-8) contains supplementary material, which is available to authorized users.     

Utility of Lung Perfusion SPECT/CT in Detection of Pulmonary Thromboembolic Disease: Outcome Analysis

PurposeTo evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease.MethodsFrom Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21–89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED criteria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging.ResultsQ-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients’ cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41–100%), 78.57% (95% CI, 49.20–95.34%), 84.21% (95% CI, 66.41–93.57%), 100% and 90.00% (95% CI, 73.47–97.89%) respectively.ConclusionsIn the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary thromboembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed.     

16层螺旋CT与核素肺灌注/通气显像对肺动脉栓塞的诊断价值

目的　探讨 16层螺旋CT与核素肺灌注 /通气显像对急性肺动脉栓塞的诊断价值。方法　回顾 3 2例临床确诊的肺动脉栓塞病人的影像资料 (螺旋CT平扫加增强扫描 ,核素肺灌注 /通气显像扫描 ) ,进行对比分析。结果　螺旋CT增强检查的病变检出率为 90 .6% ,段级肺动脉栓塞受累率为 43 .2 % ,核素肺灌注 /通气显像检查病变检出率为 84.4% ,肺段栓塞受累率为 3 6.8%。结论　螺旋CT增强检查是观察肺动脉栓塞直接征象的理想方法 ,与核素肺显像相结合 ,更能全面分析病情。     

超声心动图在肺动脉栓塞诊断中的价值

目的探讨超声心动图在肺动脉栓塞诊断中的应用价值。方法对临床综合检查而诊断的肺动脉栓塞37例患者,进行经胸超声心动图检查,着重观察右房、右室、肺动脉及其分叉、下腔静脉等处,测量三尖瓣返流速度,估测肺动脉压力,观察肺动脉频谱形态的变化,测量肺动脉峰值流速、加速时间、射血时间等。结果右心系统内可见活动或附壁实质性中低等回声。右房、右室增大,主肺动脉及分支增宽,右室壁增厚,运动幅度减低。右心功能减低,下腔静脉增宽,三尖瓣可见不同程度的返流,肺动脉压增高,肺动脉频谱形态见特征性的“指拳征”。肺动脉频谱加速时间及射血时间缩短。结论超声心动图在诊断肺动脉栓塞中具有重要的临床意义,可提高诊断的正确率。     

~(131)I SPECT/CT断层融合显像在分化型甲状腺癌中的临床价值

目的：探讨131^I SPECT/CT断层融合显像在分化型甲状腺癌诊治检测中的临床价值。材料和方法：选择术后病理证实并接受131^I治疗的分化型甲状腺癌（DTC）患者97例,行131^I全身扫描（131^I-WBS）和病灶部位的SPECT断层加同机CT融合显像。将131^I-WBS与断层融合图像进行对比分析,探讨断层融合显像的特点与临床价值。结果：97例分化型甲癌患者共进行131^I-WBS251次,断层融合显像102次,每例患者至少行一次断层融合显像。与131^I-WBS比较,断层融合显像有如下特点：能够获得直观的断层融合显像和三维立体图像;②发现更多的病灶;③更准确地判断病变部位;④定位CT可以发现无摄碘功能的病灶;⑤鉴别病灶和生理显影或污染。结论：131^I SPECT/CT断层融合显像可以直观病变立体形态、大小、摄取程度和毗邻关系,在鉴别病灶与生理显像或污染、确定病灶是否有摄碘功能方面有重要价值,是131^I-WBS的重要补充。     

Fusion imaging of computed tomographic pulmonary angiography and SPECT ventilation/perfusion scintigraphy: initial experience and potential benefit

Purpose The objective of this study was to examine the feasibility of fusing ventilation and perfusion data from single-photon emission computed tomography (SPECT) ventilation perfusion (V/Q) scintigraphy together with computed tomographic pulmonary angiography (CTPA) data. We sought to determine the accuracy of this fusion process. In addition, we correlated the findings of this technique with the final clinical diagnosis. Methods Thirty consecutive patients (17 female, 13 male) who had undergone both CTPA and SPECT V/Q scintigraphy during their admission for investigation of potential pulmonary embolism were identified retrospectively. Image datasets from these two modalities were co-registered and fused using commercial software. Accuracy of the fusion process was determined subjectively by correlation between modalities of the anatomical boundaries and co-existent pleuro-parenchymal abnormalities. Results In all 30 cases, SPECT V/Q images were accurately fused with CTPA images. An automated registration algorithm was sufficient alone in 23 cases (77%). Additional linear z-axis scaling was applied in seven cases. There was accurate topographical co-localisation of vascular, parenchymal and pleural disease on the fused images. Nine patients who had positive CTPA performed as an initial investigation had co-localised perfusion defects on the subsequent fused CTPA/SPECT images. Three of the 11 V/Q scans initially reported as intermediate could be reinterpreted as low probability owing to co-localisation of defects with parenchymal or pleural pathology. Conclusion Accurate fusion of SPECT V/Q scintigraphy to CTPA images is possible. This technique may be clinically useful in patients who have non-diagnostic initial investigations or in whom corroborative imaging is sought.