SPECT/CT在骨显像骨外放射性分布异常诊断中的增益价值

目的 评价⁹⁹Tc^m-MDP SPECT/CT在骨显像中骨外放射性分布异常诊断中的增益价值。方法 回顾性分析2016年1月至2023年2月在我院行全身骨显像检查并同时行SPECT/CT检查的35例骨外放射性分布异常患者的临床资料,以病理、影像或临床随访为依据,分析⁹⁹Tc^m-MDP平面显像及SPECT/CT断层融合显像对骨外放射性分布异常的定位、定性诊断能力。结果 本文35例患者共41处骨外放射性分布异常病灶,其中全身平面骨显像定位准确14处(34.1%,14/41),SPECT/CT定位准确41处(100%,41/41),两者比较差异有统计学意义(χ²=40.26,P<0.05);SPECT/CT确定诊断35处(85.4%,35/41),全身平面骨显像确定诊断仅8处(19.5%,8/41),两者诊断准确率比较差异有统计学意义(χ²=35.65,P<0.05)。结论 与全身平面骨显像比较,SPECT/CT显像在骨显像骨外放射性分布异常诊断中能够...     

SPECT/CT断层融合显像在分化型甲状腺癌转移灶诊断中的临床价值

目的 探讨131I-SPECT/CT断层融合显像技术在分化型甲状腺癌（DTC）转移灶定性、定位诊断中的临床价值.方法 选择69例确诊DTC患者,甲状腺全切或次全切术后,口服碘化钠（131I）治疗剂量3.70～7.40 GBq后5～7d,行全身平面显像（131 I-WBS）,随后在同一床位进行SPECT断层扫描和CT扫描,扫描结束后进行图像融合处理.检查结果与病理或其他影像学检查以及临床随访结果对比,分析确定DTC转移灶的定性、定位诊断,并做对比分析.结果 69例患者中,临床证实转移灶共计186处;平面显像170处、融合显像179处发现异常摄碘浓聚灶;其中平面显像有160处,融合显像有174处与病理、螺旋CT、MRl以及超声等检查结果一致,其诊断灵敏度分别为86％ （160/186）、93.5％ （174/186）,定性、定位准确性分别为81.6％ （160/196）、91.1％ （174/191）;两种方法的诊断灵敏度差异有统计学意义（x2=5.74,P＜0.05）,定性、定位准确性差异也有统计学意义（x2=7.33,P＜0.01）.结论 131I-SPECT/CT断层融合显像能够精准的定性、定位DTC的复发和转移,克服污染灶、组织重叠等因素的影响,较平面显像具有更高的灵敏度和准确性,用于DTC患者的临床分期、疗效和治疗方案的制定,具有重要的临床价值.     

降压治疗对高血压脑出血患者局部脑血流量及预后的影响

目的探讨不同程度药物降压对高血压脑出血患者局部脑血流量及预后的影响。方法经头颅CT确诊的30例高血压脑出血患者,测得首次入院血压,根据MAP降低程度不同分为A组(<10%)、B组(10～20%)、C组(>20%),并分别于入院24h内、3～5d、12～15d行单光子发射断层扫描和临床疗效评定。结果(1)C组局部脑血流量下降比值在各期均明显高于A组、B组(P<0.05);(2)C组神经功能下降在各期均较A、B组明显(P<0.05);(3)A组在急性期发生HD或HR机会多于B、C组(P<0.05)。结论在高血压脑出血早期,当收缩压>185mmHg或舒张压>95mmHg时,MAP降低约15%较为安全,对患者局部脑血流量和预后影响较小。     

SPECT/CT显像对131I治疗分化型甲状腺癌患者的临床意义

目的 探讨131I治疗量SPECT/CT显像对分化型甲状腺癌(DTC)患者诊断和分期等的价值.方法 回顾性分析73例首次接受131I治疗的DTC术后患者,其中男16例,女57例,平均年龄45.7±14.4岁,131I治疗剂量平均为 122.88±34.54 mCi.口服131I后80~96h内完成131I全身显像(RxWBS)和颈胸部131I-SPECT/CT融合显像,分别对颈部、胸部和骨骼等部位进行图像判读并进行临床随访.结果 对于颈部,平面图像示可疑和明确甲状腺残留(残甲)分别为10例和37例,可疑和明确淋巴结转移(LNM)分别为19例和7例.根据131I-SPECT/CT融合图像,颈部明确残甲50例,可疑和明确LNM分别为2例和21例.对于胸部和骨骼等,平面图像示明确和可疑纵膈LNM分别为7例和2例,明确和可疑肺转移分别为8例和1例;131I-SPECT/CT融合图像仅见7例为明确纵膈LNM、9例明确肺转移;两种显像方法均示明确骨转移5例.131I-SPECT/CT融合图像共下调14例患者的临床分期,临床随访结果均为阴性.结论 131I-SPECT/CT融合显像与131I全身显像相比能提供额外有价值信息,有助于患者的诊断、临床分期和诊疗策略的正确制定.     

无痴呆综合症的艾滋病患者局部脑血流的变化

目的:观察无痴呆综合症的艾滋病(AIDS)患者局部脑血流(rCBF)的变化。方法:对4例无痴呆综合症的男性AIDS患者(IV期)进行了^99mTc-双半胱乙脂(ECD)脑血流灌注断层显像, 并定量测定rCBF。16例性别、年龄匹配的健康者作正常对照。结果:4例无痴呆综合症的AIDS患者双侧额、顶、颞叶、基底节和丘脑、以及直回和桥脑rCBF明显低于正常对照组(P＜0.01)。结论:无痴呆综合症的AIDS患者存在脑皮层和皮层下rCBF减少。     

SPECT重建滤波函数的选择与图像效果

要获得高品质ＳＰＥＣＴ重建图像，图像重建过程中滤波函数的选择是极为重要的。本文就ＳＰＥＣＴ中常用数字滤波函数进行了数学分析和临床应用的比较，认为Ｂｕｔｅｒｗｏｒｔｈ滤波器确为较理想的滤波函数，其它许多滤波函数都可通过改变Ｂｕｔｅｒｗｏｒｔｈ的滤波参数推导出来。并在此基础上提出了部分脏器的ＳＰＥＣＴ断层影像重建处理时，Ｂｕｔｔｅｒｗｏｒｔｈ滤波函数较合理的变量参数。     

治疗剂量131I SPECT/CT显像评价分化型甲状腺癌骨转移

目的 探讨131I SPECT/CT断层融合显像在评价分化型甲状腺癌(DTC)骨转移中的价值.方法 30例确诊为骨转移的DTC患者纳入本研究,其中男14例,女16例,平均年龄54.3±12.6岁.在口服治疗剂量131I后的80～ 96小时完成131I全身平面显像和SPECT/CT断层融合显像.结果 30例患者中单发性骨转移8例,多发性骨转移22例.单发性骨转移的病灶分别位于胸骨、颈椎、胸椎、股骨、锁骨、颅骨和肋骨.22例多发骨转移患者的病灶主要位于脊柱、肋骨、胸骨和骨盆骨等.所有患者的SPECT/CT图像上均可见131I异常放射性浓聚,同机CT示24例为骨破坏,1例为成骨性改变,CT结果为阴性者5例.多发骨转移组的血清甲状腺球蛋白(Tg)明显高于单发骨转移组(P=0.018),两组血清甲状腺球蛋白抗体(A-Tg)并无明显差别(P=0.212).结论 131I SPECT/CT断层融合显像可以较好的将代谢信息和解剖结构信息相结合,更好的评价DTC患者的骨转移.     

腺苷负荷脑血流灌注显像的可行性研究

目的 数为参照,分别计算两侧大脑额叶、颞叶、顶叶、枕叶ROI放射性计数与其比值,比较同一组ROI在腺苷负荷状态下与静息状态下放射性计数比值.对视为异常部位的大脑ROI按其对腺苷负荷后脑血流灌注变化的反应进行分类.结果 所有患者进行腺苷负荷显像,没有因出现严重不良反应而终止,部分患者出现轻微不良反应并在腺苷注射结束后迅速消失.共获得视为正常的174组大脑ROI,静息显像的比值与负荷显像的比值比较显示,额叶、颞叶、顶叶差异有统计学意义(0.901±0.100比0.956±0.149,0.923±0.070比0.981±0.090,0.840±0.126比0.887±0.091,均P＜0.05),枕叶差异无统计学意义(1.102±0.146比1.010±0.124,P＞0.05).获得视为异常的49处ROI,其中静息状态局部脑血流量正常,腺苷负荷后局部脑血流量减低的有10处;静息状态局部脑血流量减低,腺苷负荷后局部脑血流量减低更加明显的有9处;静息状态局部脑血流量减低,腺苷负荷后局部脑血流量减低改善的有27处;静息状态局部脑血流量减低,腺苷负荷后局部脑血流量减低区无明显变化的有3处.结论 腺苷能用于负荷脑血流灌注显像,且不良反应少.     

PSA、SPECT骨显像在前列腺癌诊断和治疗中的临床价值

目的:探讨PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床应用.方法:对72例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像,并对部分患者治疗后进行了随访.结果:前列腺癌组PSA明显高于正常对照组、良性前列腺疾病组;前列腺癌骨转移组PSA明显高于非骨转移组;72例前列腺癌初诊患者骨显像发现24例骨转移瘤,阳性率33.3%.结论:血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义.     

Statistical mapping analysis of brain metabolism in patients with subcortical aphasia after intracerebral hemorrhage: a pilot study of F-18 FDG PET images

Purpose

This study was aimed to evaluate the brain metabolism in patients with subcortical aphasia after intracerebral hemorrhage (ICH) and the relationship between the severity of aphasia and regional brain metabolism, by using statistical mapping analysis of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) images.

Materials and Methods

Sixteen right-handed Korean speaking patients with subcortical aphasia following ICH were enrolled. All patients underwent Korean version of the Western Aphasia Battery and the brain F-18 FDG PET study. Using statistical parametric mapping analysis, we compared the brain metabolisms shown on F-18 FDG PET from 16 patients with subcortical aphasia and 16 normal controls. In addition, we investigated the relationship between regional brain metabolism and the severity of aphasia using covariance model.

Results

Compared to the normal controls, subcortical aphasia after ICH showed diffuse hypometabolism in the ipsilateral cerebrum (frontal, parietal, temporal, occipital, putamen, thalamus) and in the contralateral cerebellum (P _corrected<0.001), and showed diffuse hypermetabolism in the contralateral cerebrum (frontal, parietal, temporal) and in the ipsilateral cerebellum (P _{FDR corrected}<0.001). In the covariance analysis, increase of aphasia quotient was significantly correlated with increased brain metabolism in the both orbitofrontal cortices, the right hippocampal and the right parahippocampal cortices (P _uncorrected<0.01).

Conclusion

Our findings suggest that frontal, parietal, and temporal cortices, which are parts of neural network for cognition, may have a supportive role for language performance in patients with subcortical aphasia after ICH.     

Functional neuroanatomy of human sleep states after zolpidem and placebo: a H215O-PET study

Changes in the functional organization of the brain during the course of sleep and waking are reflected by different patterns of regional cerebral blood flow (rCBF). To investigate the effect of the hypnotic zolpidem, a benzodiazepine receptor agonist, drug or placebo were administered to eight young, healthy men prior to bedtime. The subjects were sleep-deprived to promote sleep during the 4-h recording period in the positron emission tomography scanner. Intravenous injections of labelled water were administered during pre-drug wakefulness, and during Stage 2, Stage 4 and rapid eye movement (REM) sleep, each injection being followed by an emission scan. Statistical parametric mapping was used to investigate the effects of treatment and sleep states. During sleep (combined Stages 2 and 4, and REM sleep) relative rCBF was lower after zolpidem than after placebo in the basal ganglia and insula, and higher in the parietal cortex. A 'multiple study' analysis of REM sleep revealed that rCBF in the anterior cingulum was lower after zolpidem than after placebo, whereas rCBF in the occipital and parietal cortex, parahippocampal gyrus and cerebellum was higher. When the pooled data (drug and placebo) of Stages 2 and 4 were compared with wakefulness, rCBF was lower in prefrontal cortex and insula, and higher in the occipital and parietal cortex. The results indicate that some differences in rCBF from wakefulness to non-REM sleep are further augmented by zolpidem.     

18F-FDG SPECT/CT脑显像诊断老年性痴呆初步应用

目的探讨老年性痴呆（AD）的^18F—FDGSPECT／CT显像图特点。方法10例AD患者、10例血管性痴呆（VD）患者及20例正常对照行^18F—FDGSPECT／CT脑显像。患者禁食6h以上，戴眼罩安静休息20min后肘静脉注射^18F—FDG185—296MBq，60min后开始SPECT和X线CT透射扫描。先进行X线透射扫描，CT连续采集10min，然后进行符合线路PET连续采集30min。透射和发射图像进行衰减校正和叠代重建（COSEM），得到横断面、冠状面、矢状面及其CT与SPECT的融合图像。半定量分析取横断面图像，在双侧顶叶、颢叶、额叶和小脑划取感兴趣区（ROI），并获取单位像素放射性计数。将各脑叶分别与同侧小脑进行比较，即可得放射性摄取比值（Rcl／cb）。结果对10例患者、10例VD患者和20例正常对照的^18F-FDG显像图进行X线衰减校正前后比较和与CT扫描图的同机图像融合。结果表明，经过X线衰减校正后的^18F—FDG正电子图像比校正前的图像明显清晰，校正后的图像由发散、模糊变为细腻、清晰。融合后的图像与融合前的图像比较，在解剖学定位方面有了很大的改善，特别表现在大脑的沟回、基底节的辨认方面。在10例AD患者中，图像呈双侧颞叶、额叶或顶叶对称性放射性摄取减低者8例，占80％。图像呈单侧额叶或顶叶放射性减低者2例，占20％。在10例VD患者中，图像均呈多发性非对称性放射性稀疏区，且部位可位于基底节、丘脑或脑皮质区。AD组双侧顶叶、额叶和颞叶与同侧小脑的放射性摄取比值（Rcl／cb）明显低于正常对照组（P〈0．01）。结论AD患者的特征性^18F—FDG显像图改变对于AD的诊断及与VD的鉴别诊断有十分重要的临床意义。     

Reduced frontal perfusion in depressed postmenopausal women: a SPECT study with WCST

OBJECTIVES: To investigate frontal cerebral blood flow (CBF) in depressed postmenopausal women and its relation to cognitive function and the severity of depressive symptoms. METHODS: Regional CBF of 20 unmedicated depressed postmenopausal women was measured using Tc-99m HMPAO SPECT, both at rest and during frontal activation using the Wisconsin card sorting test (WCST). Frontal CBF was semi-quantified by comparing the radioactivity in the prefrontal region to the cerebellum (F/C ratio). We measured the severity of the symptoms of depression using the hospital anxiety and depression scale (HADS) and cognitive function using the mini-mental status examination (MMSE). RESULTS: At rest, there was no difference in frontal CBF between patients with moderate or severe (HADS> or =11) and patients with mild depressive symptoms (HADS<11). During the WCST, however, the HADS> or =11 group did not score as well as the HADS<11 group (P=0.03). The changes in F/C ratios were inversely correlated with HADS scores (r=-0.43, P=0.05) and positively correlated with MMSE scores (r=0.58, P=0.004). After adjusting for age, F/C ratios were significantly correlated with MMSE (P=0.002), but not with HADS scores. CONCLUSIONS: Frontal CBF did not increase in postmenopausal women with moderate/severe symptoms of depression during the WCST activation task, and reduced frontal CBF was related to the impairment of cognitive function. The combination of the functional activation test and SPECT imaging powerfully revealed this functional disease, which remains undetectable using more common baseline measurements.     

A voxel-based morphometric analysis of cerebral gray matter in subcortical ischemic vascular dementia patients and normal aged controls

BACKGROUND AND PURPOSE: The present study was designed to detect the abnormalities of the cerebral grey-matter density in subcortical ischemic vascular dementia patients by FSL-VBM method to promote the early diagnosis of it.METHODS: Nine subcortical ischemic vascular dementia patients and nine age-matched normal controls underwent MRI brain structure scanning that was performed on a SIEMENS AVANTO 1.5 Tesla scanner and standard T1-weighted high-resolution anatomic scans of MPRAGE sequence were obtained. The 3-demensional MPRAGE images were processed with FSL-VBM package and the cerebral gray matter density was compared between the subcortical ischemic vascular dementia patients and normal controls.RESULTS: Compared with the normal control group, the cerebral gray matter density of subcortical ischemic vascular dementia patients was found significantly decreasing, including brain regions of thalamus, parietal lobe, frontal lobe and temporal lobe (P<0.05).CONCLUSIONS: The cerebral gray matter density alterations have closed correlation with cognitive dysfunction in subcortical ischemic vascular dementia patient and can be detected by MRI. MRI has some potential value in the diagnosis of them.     

大鼠脑血栓形成时心功能不全发生机制的探讨

以脑水含量、局部脑血液、全血血小板聚集、心输出量、每搏出量、心率、平均血压、外周总阻力及心、肝、脾。肾和肾上腺局部血流量为指标，探讨 光化学法诱导的实验性血栓形成性局部脑缺血时全血血小板功能改变对心功能的影响及其机理。结果表明，光化学反应后４小时，全血血小板聚集明显增强（Ｐ＜０．０１），ＣＯ、ＳＶ降低（Ｐ＜０．０５）；２４小时ｒＣＢＦ，ＣＯ，Ｓ及心肌ｒＢＦ均明显减少，ＴＰＲ及脑水含量明显增加（Ｐ＜     

单光子发射型计算机断层成像与CT融合图像评价125I粒子在靶器官中的分布

目的 结合全身扫描,探讨单光子发射型计算机断层成像(SPECT)与CT融合图像对植入的放射性125I粒子在体内分布的评价.方法 2008年5月至2009年6月复旦大学附属中山医院核医学科接受治疗的47例125I粒子植入患者中,6例前列腺癌患者实施了超声诱导下125I粒子植入,另41例有明确肿瘤病史并伴有门静脉或上腔静脉癌栓患者,在数字减影血管成像(DSA)诱导下行支架和125I粒子链条植入到血管腔内.所有患者在125I粒子植入24 h后行全身扫描,再根据125I粒子所在部位行SPECT与CT显像检查.结合全身扫描图像和SPECT与CT图像对植入125I粒子的分布情况进行评价.结果 全身扫描图像为SPECT与CT检查提供准确定位,但无法显示粒子的准确解剖部位.6例前列腺癌患者中,SPECT与CT融合图像显示5例患者植入粒子在前列腺内分布较好,而1例患者粒子植入到右侧精囊腺内;41例有明确肿瘤病史并伴有门静脉或上腔静脉癌栓患者中,SPECT与CT融合图像显示40例血管腔内的粒子链条位于合理的位置,1例植入到上腔静脉内的粒子链条脱离到右心腔内.结论 结合全身扫描,SPECT与CT融合图像可以评价125I粒子在靶器官的分布情况,能及时发现位置偏离的粒子.