99Tcm-MIBI动态血流灌注显像和双时相核素显像对甲状腺冷结节良恶性的诊断价值研究

目的 探讨99Tcm-MIBI动态血流灌注显像和双时相显像对甲状腺冷结节良恶性的诊断价值.方法 回顾性分析甲状腺冷结节行手术治疗的患者28例,所有患者使用配备低能高分辨准直器的SPECT仪行99Tcm-MIBI动态血流灌注、30 min早期相及120 min延迟相静态平面显像,并用T/NT值等综合分析显像结果.结果 9例甲状腺癌患者在动态血流灌注、30 min早期相和120 min延迟相显像中阳性数分别为5例、6例、7例;19例良性病变患者在动态血流灌注、30 min早期相和120 min延迟相显像中阴性数分别为14例、11例、16例.99Tcm-MIBI动态血流灌注显像诊断甲状腺癌的灵敏度为55.56%,特异度为73.68%,准确率为67.85%;30 min早期相显像诊断甲状腺癌的灵敏度为66.67%,特异度为57.89%,准确率为67.85%;120 min延迟相显像诊断甲状腺癌的灵敏度为77.78%,特异度为84.21%,准确率为82.14%.结论 99Tcm-MIBI的双时相显像对甲状腺冷结节的诊断和鉴别诊断具有一定价值,通过对动态血流灌注和99Tcm-MIBI的双时相显像中T/NT值等综合分析,可以降低假阳性和假阴性的发生.     

Clinical evaluation of SPECT/CT fusion imaging for the diagnosis and determination of localisation of cerebrospinal rhinorrhea

ObjectiveThe objective was to evaluate the clinical value of the single photon emission computerized tomography/computed tomography (SPECT/CT) fusion imaging for the diagnosis and determination of localisation of cerebrospinal rhinorrhea.MethodsA total of 33 patients with cerebrospinal rhinorrhea were preoperatively injected with ^99mTc-diethylenetriamine pentaacetic acid (DTPA) through lumbar puncture and then subjected to planar imaging of the cistern 120 min and 180 min after operation. CT and ECT were then performed. Finally, the rhinorrhea ventage and leaking path were confirmed by fusion image analysis.ResultsThirty-one patients who underwent fusion imaging and 30 patients who underwent planar imaging showed abnormal nuclide activity in the cavity between the basis cranii and the nose. After operation, 30 patients who underwent fusion imaging and 18 patients who underwent planar imaging showed complete correction of the leakage. The diagnosis sensitivity and positional accuracy of fusion imaging were 93.9% (31/33) and 90.9% (30/33) at P> .05. The values of planar imaging were 93.5% (29/31) and 79.3% (23/29) at P< .05.Conclusion^99mTc-DTPA SPECT/CT fusion imaging of the cistern is an efficient, simple, and accurate method that may be used for diagnosing and determining the localisation of cerebrospinal rhinorrhea ventage and leakage path.     

Predicting Vascularized Bone Graft Viability Using 1-Week Postoperative Bone SPECT/CT After Maxillofacial Reconstructive Surgery

PurposeWe aimed to evaluate the performance of hybrid bone single-photon emission computed tomography (SPECT)/computed tomography (CT) in predicting bone graft viability after maxillary or mandibular reconstructive surgery with vascularized bone grafts.MethodsWe retrospectively reviewed 46 bone planar scintigraphy and SPECT/CT images of 45 adult patients taken at 1 week (5–8 days) after maxillary or mandibular reconstructive surgery with vascularized bone grafts. By visual analysis, two nuclear medicine physicians scored the uptake degrees of each bone graft segment compared with the calvarium uptake on planar bone scintigraphy and SPECT/CT, respectively (0 = absence of uptake, 1 = less uptake, 2 = similar uptake, and 3 = more uptake). The imaging results were compared with clinical follow-up for assessing bone graft viability.ResultsDuring follow-up, five bone graft segments were surgically removed and confirmed as nonviable—one had a score of 0, although the other four had a score of 1–3 on planar bone scintigraphy. All five bone graft segments were scored 0 on SPECT/CT and eventually confirmed as nonviable. All other graft segments with a score of > 1 on SPECT/CT were viable and uneventful. The anatomical CT information on SPECT/CT images was helpful in discriminating bone graft uptake from adjacent bone or soft tissue uptake.ConclusionsThe absence of tracer uptake by the vascularized bone graft on bone SPECT/CT at 1 week after maxillary or mandibular reconstructive surgery can predict graft failure. Bone SPECT/CT can be used to predict vascularized bone graft viability postoperatively.     

Impact of <Superscript>131</Superscript>I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma

Purpose The purpose of the study was to determine the diagnostic impact of ¹³¹I-SPECT/CT imaging compared with conventional scintigraphic evaluation in the follow-up of patients with thyroid carcinoma.Methods Seventy-one patients with thyroid carcinoma underwent concurrent ¹³¹I-SPECT/CT, using an integrated imaging system, at various stages of their disease in order to evaluate foci of uptake detected on planar whole-body images.Results SPECT/CT imaging had an incremental diagnostic value in 57% (41/71) of patients. Uptake in the neck was evaluated in 61 patients, and SPECT/CT imaging in this region had an incremental diagnostic value in 27% of the whole patient population (19/71). Low-resolution integrated CT images allowed for the precise characterization of equivocal neck lesions on planar imaging in 14/17 patients and changed the assessment of the lesion location in five patients as compared with planar studies. Thirty-six patients underwent SPECT/CT for evaluation of foci of uptake distant from the neck. SPECT/CT imaging improved characterization of equivocal foci of uptake as definitely benign in 13% (9/71) of patients. Precise localization of malignant lesions to the skeleton was possible in 17% (12/71) and to the lungs versus the mediastinum in 6% (5/71) of patients.Conclusion Integrated ¹³¹I-SPECT/CT was found to have an additional value over planar imaging in patients with thyroid cancer for correct characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization of malignant lesions in the neck, chest, and skeleton. SPECT/CT optimized the localization of ¹³¹I uptake to lymph node metastases versus remnant thyroid tissue, to lung versus mediastinal metastases, and to the skeleton. It also had a further clinical impact on patient management by influencing referral for ¹³¹I treatment, tailoring of the administered radioiodine dose, and/or the addition of surgery or external radiation therapy when indicated.     

放射性核素显像与常规CT对肝局灶性结节增生的诊断价值

目的分析放射性核素显像和常规CT诊断肝局灶性结节增生（FNH）的各自优势,探讨二者结合对FNH的诊断价值。方法回顾性分析32例（男15例,女17例,年龄22～59岁）FNH患者的病理及影像资料。32例患者均行常规CT（平扫及增强）检查。其中24例行放射性核素显像,在肝胶体显像时加做融合图像采集,经计算机处理后得到SPECT及定位CT的融合图像。对显像发现病灶的患者行肝胆动态显像,包括血流灌注相、早期相及延迟相。检查结果的比较采用四格表∥检验或四格表Fisher确切概率法检验。结果32例患者共切除32个病灶,均为单发。病理均为FNH,其中25个为病理经典型,7个为病理非经典型;大病灶（最大径〉3cm）20个,小病灶（最大径≤3cm）12个。32例患者常规CT检出所有病灶,确诊病理经典型FNH15个,其中大病灶10个,小病灶5个;其余病灶均误诊或诊断不明确。24例患者进行放射性核素显像,结果示大病灶11个,其中病理经典型7个,病理非经典型4个;其余病灶诊断不明确或未检出。常规CT与放射性核素显像对病理经典型病灶确诊率分别为60．0％（15／25）和38．9％（7／18）,病理非经典型为0／7和4／6;大病灶为50．O％（10／20）和73．3％（11／15）,小病灶为41．7％（5／12）和0／9;对FNH的总确诊率为46．9％（15／32）和45．8％（11／24）。24例行放射性核素显像患者同时行常规CT检查,2种方法结合共确诊FNH18个,总确诊率75．0％（18／24）。在病理非经典型、小病灶FNH的诊断方面,常规CT与放射性核素显像比较,差异有统计学意义（P=0．02,0．04）;2种方法结合对FNH的总确诊率与单种方法的确诊率比较,差异均有统计学意义（χ2=4．48和4．27,P均〈0．05）。结论常规CT与放射性核素显像对FNH的诊断各有优势;二者结合可提高对FNH的总确诊率。     

99Tcm-MDP SPECT/CT融合显像在钙化防御诊断中的增益价值

目的探讨99Tcm-MDP SPECT/CT融合显像较常规平面骨显像在钙化防御诊断中的增益价值.资料与方法回顾性分析2019年3月—2020年9月东南大学附属中大医院核医学科42例临床疑诊钙化防御患者,均行全身骨显像和SPECT/CT融合显像,并经皮肤活检确诊.观察全身骨显像和SPECT/CT融合显像(均42例)诊断的...     

Hawkeye SPECT仪融合图像用于脑脊液鼻漏诊断和定位

目的探讨HawkeyeSPECT仪融合图像对脑脊液鼻漏诊断和定位的临床价值。方法选择33例确诊脑脊液鼻漏的患者,术前腰椎穿刺注射^99Tc^m-DTPA后120和180min行脑池平面显像,然后分别在同一床位进行SPECT和CT扫描,扫描结束后,进行图像处理及图像融合,通过图像分析确定脑脊液鼻漏的漏口、漏道,并做对比分析。采用SAS6．12软件进行统计学处理,对平面和融合显像的2组数据比较行x^2检验。结果33例患者中,融合显像31例、平面显像30例颅底至鼻部有异常放射性浓聚影,其中融合显像有30例、平面显像有18例与手术证实漏口完全一致,其诊断灵敏度和定位准确性分别为93．9％（31／33）,90．9％（30／33）和93．5％（29／31）,78．3％（18／23）。2种方法的诊断灵敏度差异无统计学意义（x^2=0．65,P〉0．05）,定位准确性差异有统计学意义（x^2=10．30,P〈0．05）。结论^99Tc^m-DTPA脑池SPECT显像与同机定位CT图像融合作为灵敏、简便和定位准确的检查手段,可用于诊断和定位脑脊液鼻漏的漏口、漏道。     

Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: Implications for planning 90Y radioembolization?

Purpose

To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization.

Material and methods

From August 2008 to November 2010, 79 patients (range 23–83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed.

Results

A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p < 0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively.

Conclusion

The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.     

SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A ^99mTc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast-enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.     

Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw

Purpose

The aim of this study was to evaluate the performance of a novel flat-panel single photon emission computed tomography (SPECT)/CT in patients with suspicion of osteomyelitis (OM) of the jaw in comparison with conventional orthopantomography (OPT), planar bone scintigraphy (PS) and CT alone.

Methods

Forty-two patients (21 female, 21 male, mean age 52, range 10–84 years) with suspected OM (n?=?38) or exacerbation of a known OM (n?=?4) were investigated with OPT, CT alone, PS and combined SPECT/CT. Images were separately reviewed by a nuclear physician/radiologist and jaw surgeon regarding presence of OM. Additionally, the different methods were rated regarding their usefulness for diagnosis (5-point scale: from 1 = diagnostic to 5 = useless). Biopsy served as the standard of reference in 30 patients and clinical/imaging follow-up of at least 6 months in 12 patients.

Results

In 35 of 42 patients the final diagnosis of OM was established according to the reference standard. Sensitivity, specificity and accuracy for OPT was 59, 100 and 66 %, for CT alone 77, 86 and 79 %, for PS 100, 71 and 95 % and for SPECT/CT 100, 86 and 98 %. SPECT/CT was significantly more accurate compared with CT alone (p?=?0.0078) and OPT (p?=?0.001). SPECT/CT was rated as the most useful imaging modality (mean value 1.2) compared with PS (2.2), CT (2.5) and OPT (3.2).

Conclusion

SPECT/CT is an accurate method to assess the presence of OM of the jaw and superior to CT alone and OPT. SPECT/CT slightly improved the specificity of PS. However, SPECT/CT in this study was not significantly more accurate compared with PS and whether the advantages to the patient of a one-stop study as opposed to doing separate CT and PS justifies its routine use in terms of cost requires further study.     

SPECT和CT融合骨显像在小儿神经母细胞瘤中的应用

目的探讨SPECT和CT融合骨显像在探测小儿神经母细胞瘤（NB）转移性骨肿瘤中的临床价值。方法回顾性分析24例NB患儿,均行全身平面骨显像及局部SPECT和CT融合骨显像。将骨病灶显示的清晰度分为5级（不可见、模糊、可见、清晰、非常清晰）,良恶性诊断的确定性分为3级（不确定、可以确定、十分确定）,诊断效能指标包括灵敏度、特异性及准确性。对显像图像在骨病灶的清晰度显示、良恶性确定性诊断及探测恶性骨病灶的诊断效能方面进行分析,采用秩和检验及χ^2检验进行比较。结果24例NB患儿,全身平面骨显像发现骨病灶72个,有5个骨病灶未能显示,SPECT和CT融合显像和单独SPECT显像均分别发现骨病灶77个。对骨病灶的清晰度显示SPECT和CT融合显像,单独SPECT显像均优于平面显像（日值均为69．000,P均〈0．05）。平面显像和SPECT显像诊断恶性骨病灶的准确性分别为45．45％（35／77）和62．34％（48／77;χ^2=4．416,P〈0．05）,SPECT和CT融合诊断恶性骨病灶的灵敏度、特异性和准确性均较平面显像有提高,分别为82．35％（42／51）和53．19％（25／47）、88．46％（23／26）和40．00％（10／25）、84．42％（65／77）和45．45％（35／77）,χ^2=12．571,14．016和25．667,P均〈0．01。与SPECT显像的特异性（14／26,53．85％）和准确性（48／77,62．34％）相比,SPECT和cT融合诊断恶性骨病灶的特异性和准确性提高（χ^2=7．589,9．606,P均〈0．01）,两者间灵敏度差异无统计学意义（χ^2=2．942,P〉0．05）。SPECT和CT融合显像骨病灶良恶性的确定性诊断优于SPECT（H=28．000,P〈0．05）和平面显像（H=21．000,P〈0．05）。结论SPECT和CT融合骨显像能探测到NB患儿更多的骨病灶,是一种较好的探测NB患儿转移性骨肿瘤的显像方法。     

The hidden sentinel node and SPECT/CT in breast cancer patients

Purpose  In a minority of breast cancer patients, lymphoscintigraphy shows no lymphatic drainage and ‘hidden’ sentinel nodes may remain undiscovered. The purpose of this study was to explore the additional value of the recently introduced hybrid SPECT/CT in breast cancer patients with axillary non-visualisation on planar images. The role of blue dye and careful palpation of the axilla was evaluated in patients in whom axillary sentinel nodes remained hidden after SPECT/CT. Methods  Fifteen breast cancer patients with non-visualisation on planar lymphoscintigraphy and 13 women with only extra-axillary sentinel nodes underwent SPECT/CT following late planar imaging without re-injection of the radiopharmaceutical. Results  SPECT/CT visualised lymphatic drainage in eight of the 15 patients (53%) with non-visualisation on planar imaging, depicted nine of the 14 harvested sentinel nodes (64%) and three of five tumour-positive sentinel nodes. In two of the 13 patients (15%) with only extra-axillary sentinel nodes on their planar lymphoscintigram, SPECT/CT showed an axillary sentinel node that appeared to be uninvolved. Careful exploration of the axilla with the combined use of blue dye, a gamma probe and intra-operative palpation revealed an axillary sentinel node in the remaining 18 patients. SPECT/CT showed the exact anatomical location of all visualised sentinel nodes. Conclusion  SPECT/CT discovered ‘hidden’ sentinel nodes in the majority of patients with non-visualisation, but was less valuable in patients with only extra-axillary lymphatic drainage on the planar images. Exploration of the axilla in patients with persistent non-visualisation improved the identification of axillary (involved) sentinel nodes.     

Planar and tomographic imaging with technetium 99m-labeled tetrofosmin: Correlation with thallium 201 and coronary angiography

This study compared the results of planar and single-photon emission computed tomographic (SPECT) imaging with tetrofosmin with those of²⁰¹Tl and coronary angiography. In three normal volunteers the images were normal by both²⁰¹Tl and tetrofosmin (planar and SPECT). In 23 patients with coronary artery disease, the images were abnormal in 20 patients by SPECT tetrofosmin, in 19 by planar tetrofosmin, in 20 by SPECT thallium, and in 18 by planar thallium (difference not significant). Both planar and SPECT images were divided into five segments per patient. There were 58 perfusion defects by SPECT tetrofosmin, 50 by planar tetrofosmin (difference not significant), 47 by SPECT thallium, and 42 by planar thallium (difference not significant). Perfusion defects were reversible in 47 segments (36%) by SPECT tetrofosmin, 35 (27%) by planar tetrofosmin, 31 (24%) by SPECT thallium (p<0.05 vs SPECT tetrofosmin), and 31 (24%) by planar thallium (difference not significant). Among the 23 patients with coronary artery disease, 19 underwent coronary angiography. In these patients there were 32 diseased coronary arteries. Perfusion defects were present in 21 territories (66%) by SPECT tetrofosmin, 19 (59%) by planar tetrofosmin, 20 (63%) by SPECT thallium, and 18 (56%) by planar thallium. There was agreement between thallium and tetrofosmin in 108 of 130 segments (κ statistics=0.69±0.06). The images, especially with SPECT, are better with tetrofosmin than with²⁰¹Tl. Thus myocardial imaging with tetrofosmin provides results that are at least as good as those of²⁰¹Tl. Slightly more abnormal segments and more reversible defects are detected by tetrofosmin than by thallium imaging, especially with SPECT imaging. Supported in part by Mediphysics, Inc., Arlington Heights, Ill.     

Clinical application of <Superscript>99m</Superscript>Tc-HYNIC-TOC SPECT/CT in diagnosing and monitoring of pancreatic neuroendocrine neoplasms

Objective

Our aim of this research was to determine the value of SPECT/CT with ^99mTc-HYNIC-TOC for evaluation of the pancreatic masses which were suspected as neuroendocrine neoplasms and follow-up of patients with pancreatic neuroendocrine neoplasms.

Methods

We retrospectively analyzed 184 patients who performed ^99mTc-HYNIC-TOC SPECT/CT. All the patients were divided into two groups: one for assessment of diagnostic efficiency for pancreatic suspected masses (n?=?140) and another for monitoring recurrence after surgery (n?=?44). The image findings acquired at 2 h postinjection were compared to final diagnoses from pathological results and clinical follow-up. Then, the correlation between ratios of tumor-to-background (TBR) and tumor grade was analyzed.

Results

In group 1, 95/140 (67.9%) patients were confirmed as neuroendocrine neoplasms including 85 neuroendocrine tumors and 10 neuroendocrine carcinomas. Patient-based analysis showed that the sensitivity, specificity and accuracy of diagnosing neuroendocrine neoplasms with SPECT/CT were 81.1, 84.4 and 82.1%. There was significant difference of TBRs among G1, G2 and G3 (F?=?3.175, P?=?0.048). In group 2, 22/44 (50.0%) patients occurred metastasis mainly in liver. The sensitivity, specificity and accuracy of monitoring recurrence were 87.0, 100 and 93.2%.

Conclusions

^99mTc-HYNIC-TOC SPECT/CT is a reliable method of diagnosing and monitoring of pancreatic neuroendocrine neoplasms, especially neuroendocrine tumors.

     

The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT.

The aim of this study was to compare the detection of bone metastases by 99mTc-methylene diphosphonate (99mTc-MDP) planar bone scintigraphy (BS), SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT in patients with high-risk prostate cancer. METHODS: In a prospective study, BS and 18F-Fluoride PET/CT were performed on the same day in 44 patients with high-risk prostate cancer. In 20 of the latter patients planar BS was followed by single field-of-view (FOV) SPECT and in 24 patients by multi-FOV SPECT of the axial skeleton. Lesions were interpreted separately on each of the 4 modalities as normal, benign, equivocal, or malignant. RESULTS: In patient-based analysis, 23 patients had skeletal metastatic spread (52%) and 21 did not. Categorizing equivocal and malignant interpretation as suggestive for malignancy, the sensitivity, specificity, positive predictive value, and negative predictive value of planar BS were 70%, 57%, 64%, and 55%, respectively, of multi-FOV SPECT were 92%, 82%, 86%, and 90%, of (18)F-Fluoride PET were 100%, 62%, 74%, and 100%, and of 18F-Fluoride PET/CT were 100% for all parameters. Using the McNemar test, 18F-Fluoride PET/CT was statistically more sensitive and more specific than planar or SPECT BS (P < 0.05) and more specific than 18F-Fluoride PET (P < 0.001). SPECT was statistically more sensitive and more specific than planar BS (P < 0.05) but was less sensitive than 18F-Fluoride PET (P < 0.05). In lesion-based analysis, 156 lesions with increased uptake of 18F-Fluoride were assessed. Based on the corresponding appearance on CT, lesions were categorized by PET/CT as benign (n = 99), osteoblastic metastasis (n = 46), or equivocal when CT was normal (n = 11). Of the 156 18F-Fluoride lesions, 81 lesions (52%), including 34 metastases, were overlooked with normal appearance on planar BS. SPECT identified 62% of the lesions overlooked by planar BS. 18F-Fluoride PET/CT was more sensitive and more specific than BS (P < 0.001) and more specific than PET alone (P < 0.001). CONCLUSION: 18F-Fluoride PET/CT is a highly sensitive and specific modality for detection of bone metastases in patients with high-risk prostate cancer. It is more specific than 18F-Fluoride PET alone and more sensitive and specific than planar and SPECT BS. Detection of bone metastases is improved by SPECT compared with planar BS and by 18F-Fluoride PET compared with SPECT. This added value of 18F-Fluoride PET/CT may beneficially impact the clinical management of patients with high-risk prostate cancer.     

SPECT／CT对脊柱病变鉴别诊断的价值

目的评价SPECT／CT显像在脊柱病变鉴别诊断中的应用价值。方法对53例^99Tc^m-MDP全身骨显像脊柱呈放射性浓聚患者进行SPECT／CT显像,获得SPECT、CT及两者的融合图像。所有病灶均以病理学诊断及6个月以上的影像学随访为最终诊断结果,计算SPECT／CT融合图像的诊断效能。结果SPECT／CT骨显像诊断骨转移肿瘤的灵敏度为96．00％（24／25）,特异性为96．43％（27／28）,准确性为96．23％（51／53）,假阳性率为3．57％（1／28）,假阴性率为4．00％（1／25）,阳性预测值为96．00％（24／25）,阴性预测值为96．43％（27／28）。对脊柱浓聚灶诊断非转移性骨病变的灵敏度为96．43％（27／28）,特异性为96．00％（24／25）,准确性为96．23％（51／53）,假阳性率为4．00％（1／25）,假阴性率为3．57％（1／28）,阳性预测值为96．43％（27／28）,阴性预测值为96．00％（24／25）。结论SPECT／CT同机融合显像结合了CT的解剖定位功能与^99Tc^m-MDP骨显像的高灵敏度,可提高诊断的特异性和准确性,有助于对脊柱病变的鉴别诊断。     

SPECT定义活性骨髓优化宫颈癌术后调强放疗计划的剂量学研究

目的 探讨单光子发射计算机断层扫描（SPECT）骨髓显像结合宫颈癌骨髓保护调强放疗计划的剂量学特点。方法 20例宫颈癌术后患者放疗前行⁹⁹Tc^m硫胶体SPECT骨髓显像确定盆骨中活性骨髓,采用图像融合技术将SPECT与定位CT融合。根据SPECT和盆骨外轮廓定义的骨髓体积,分别制定SPECT-IMRT（SPECT-intensity modulated radiotherapy）和骨髓剂量保护的调强放疗（bone marrow sparing-intensity modulated radiotherapy,BMS-IMRT）计划,比较两种计划的靶区和危及器官（骨髓、小肠、直肠和膀胱）剂量分布。靶区处方剂量45 Gy/25次。结果 SPECT-IMRT计划和BMS-IMRT计划定义的骨髓体积分别为（238.15±36.82）和（1 100.61±109.92）cm³（t=33.273,P<0.05）;SPECT-IMRT计划的骨髓高剂量辐射区V₃₀、V₄₀和V₄₅的平均体积较BMS-IMRT计划分别降低6.9%、5.7%和2.6%,差异有统计学意义（t=3.540、3.426、3.448,P<0.05）;而低剂量辐射区V₁₀和V₂₀的平均体积比较差异无统计学意义（P>0.05）;两种计划PTV的覆盖率和其他危及器官（膀胱、小肠和直肠）的受照剂量差异均无统计学意义（P>0.05）。结论 SPECT骨髓显像能较清晰地在CT断层图像上显示活性骨髓的范围。与BMS-IMRT比较,SPECT-IMRT能进一步降低高剂量辐射的剂量体积（V₃₀、V₄₀和V₄₅）。     

Molecular imaging in musculoskeletal infections with <Superscript>99m</Superscript>Tc-UBI 29-41 SPECT/CT

Objective

To determine the added value of CT over planar and SPECT-only imaging in the diagnosis of musculoskeletal infection using ^99mTc-UBI 29-4.

Materials and methods

184 patients with suspected musculoskeletal infection who underwent planar and SPECT/CT imaging with ^99mTc-UBI 29-41 were included. Planar, SPECT-only and SPECT/CT images were reviewed by two independent analysts for presence of bone or soft tissue infection. Final diagnosis was confirmed with tissue cultures, surgery/histology or clinical follow-up.

Results

^99mTc-UBI 29-41 was true positive in 105/184 patients and true negative in 65/184 patients. When differentiating between soft tissue and bone infection, planar?+?SPECT-only imaging had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 95.0, 74.3, 84.8, 91.3 and 86.9%, respectively, versus 99.0, 94.5, 92.5, 98.5 and 94.5% for SPECT/CT. SPECT/CT resulted in a change in reviewers’ confidence in the final diagnosis in 91/184 patients. Inter-observer agreement was better with SPECT/CT compared with planar?+?SPECT imaging (kappa 0.87, 95% CI 0.71–0.85 versus kappa 0.81, 95% CI 0.58–0.75).

Conclusion

Addition of CT to planar and SPECT-only imaging led to an increase in diagnostic performance and an improvement in reviewers’ confidence and inter-observer agreement in differentiating bone from soft tissue infection.

     

SPECT／CT显像诊断转移性骨肿瘤的临床意义

目的探讨SPECT／CT显像在肿瘤骨转移诊断中的临床价值。方法选择237例可疑肿瘤骨转移和不明原因骨痛的患者,注射99Tcm亚甲基二膦酸盐（MDP）后180min行全身骨显像,对发现的可疑病灶立即行同机CT扫描,再行图像融合和分析。对患者资料进行回顾性分析,平面显像和SPECT／CT显像结果与病理结果对照21例,与2种以上影像技术（MRI、CT、X线）诊断结果对照106例,与随访2年结果对照110例,计算平面显像和SPECT／CT与这些对照方法的诊断符合率。采用SAS6．12软件进行统计学处理,对平面和SPECT／CT显像的诊断符合率行／检验。结果平面显像237例中142例诊断和对照方法诊断结果符合,其中72例良性病变,70例骨转移,肯定性诊断总符合率95．30％（142／149）。SPECT／CT显像237例中224例结果和对照方法诊断结果符合,其中104例为良性病变,120例为骨转移,SPECT／CT诊断总符合率94．51％（224／237）,其中肯定性诊断总符合率为99．48％（192／193）。平面显像和SPECT／CT对骨转移的肯定性诊断符合率差异有统计学意义（x2=5．37,P=0．024）。结论SPECT／CT显像不仅可以精确定位,而且还可补充单独CT检查获得的诊断信息,明显提高对骨病变诊断的价值。     

Viral encephalitis in children: detection with technetium-99m HMPAO brain single-photon emission CT and its value in prediction of outcome.

PURPOSETo assess the role of regional cerebral blood flow measured by technetium-99m hexamethyl propyleneamine oxime (HMPAO) brain single-photon emission CT (SPECT) in viral encephalitis of children.METHODSEighteen children diagnosed as having viral encephalitis (12 Epstein-Barr virus, 4 herpes simplex virus, and 2 Japanese B virus) underwent Tc-99m HMPAO brain SPECT and brain MR and/or CT.RESULTSDuring the acute episode, 4 (22%) of the 18 patients had localized abnormality on brain MR and/or CT. Tc-99m HMPAO brain SPECT in the acute phase showed that 17 (94%) of the 18 patients had increased regional cerebral blood flow and 1 (6%) of the 18 children had a normal brain SPECT. Follow-up brain SPECT was performed at least 15 days after the acute episode. In 17 patients with abnormal first brain SPECT, 12 (71%) had normal second brain SPECT and 5 (29%) had decreased regional cerebral blood flow. The group of patients with normal regional cerebral blood flow on the follow-up brain SPECT had a better outcome than the group of patients with decreased regional cerebral blood flow.CONCLUSIONS(a) The Tc-99m HMPAO brain SPECT was abnormal more often than CT or MR in children with acute viral encephalitis and provided better location. (b) In acute episodes of encephalitis, most patients showed locally increased regional cerebral blood flow. (c) After acute episodes, the regional cerebral blood flow returned to normal in most cases. (d) A normal Tc-99m HMPAO brain SPECT in the subacute phase usually indicates a good clinical outcome (no neurologic defect) 1 year after the acute illness in children with viral encephalitis.