SPECT/CT融合骨显像在乳腺癌患者改良根治术后脊柱转移中的评估分析

目的 探讨乳腺癌患者改良根治术后脊柱转移中应用SPECT/CT融合骨显像评估的价值.方法 选择2019年9月-2021年5月首都医科大学附属北京潞河医院行改良根治术后的103例乳腺癌患者作为研究对象,均行SPECT/CT融合骨显像检查,并以临床随访及穿刺病理检查获得最终评估结果为金标准,统计SPECT/CT融合骨显像评...     

SPECT/CT同机图像融合诊断股骨头缺血性坏死

目的 评价SPECT/CT同机图像融合技术诊断股骨头缺血性坏死的临床应用价值.方法 53例临床可疑股骨头缺血性坏死患者行全身骨显像及骨盆局部SPECT/CT断层显像并对SPECT和CT同机图像进行重建与融合.结果 ①融合图像诊断阳性率高于断层图像及平面图像,差异具有显著性;②融合图像对早期病变诊断阳性率高于断层显像及平面显像,差异具有显著性.结论 SPECT/CT同机图像融合技术对于股骨头缺血性坏死的早期诊断、鉴别诊断及疾病分期均有一定的临床价值.     

单光子发射型计算断层显像仪与MRI对膝关节半月板损伤诊断价值的对比研究

目的探讨比较SPECT(单光子发射型计算机断层显像仪)、MRI对膝关节半月板损伤的诊断价值。方法对18例膝关节半月板损伤术前SPECT、MRI检查结果与关节镜手术结果进行对照分析,并对检查结果进行比较。结果关节镜术前正确诊断半月板损伤的SPECT为14例,MRI为15例。结论SPECT及MRI检查均是对膝关节半月板损伤的诊断好方法。SPECT可在缺乏MRI或患者不能接受MRI检查的情况下,作出正确的诊断。     

18F-FDG符合线路SPECT显像诊断胃癌

目的 探讨^18F-FDG符合线路SPECT显像在胃癌诊断中的应用价值。方法对18例经组织病理学证实的胃癌患者的^18F-FDG符合线路SPECT显像进行分析，并与近期CT结果比较。结果①符合线路SPECT检出原发性胃癌的敏感性、特异性和阳性预测值分别为88．9％、100％和88．9％。②18例手术患者中，胃局部淋巴结转移12例，符合线路SPECT显像检出7例，其敏感性、特异性和阳性预测值分别为58．3％、100％和58．3％。③符合线路显像检出远处转移6例，CT仅检出2例。④对6例同时行^18F-FDG符合线路SPECT显像与锝[^99Tc^m]-亚甲基二膦酸盐(^99Tc^m-MDP)骨显像的患者进行分析，发现两者所示骨病灶部位不尽一致。结论^18F-FDG符合线路SPECT显像诊断胃癌较为灵敏，检出胃癌局部淋巴结及远处转移可能优于CT。     

SPECT-PET显像在分化型甲状腺癌~(131)I治疗预后中的应用价值

目的探讨SPECT及PET显像在诊断甲状腺癌放射治疗后复发和转移中的应用价值。方法对103例接受131I治疗的分化型甲状腺癌(DTC)患者的核医学显像资料、影像学资料及血浆Tg、TSH的水平测定结果进行分析,其中的85例为有效病例,作为本研究的研究对象,分为实验组和对照组,实验组行131I SPECT/CT、131I-WBS显像,对照组行124I-PET和FDG SPECT/CT显像,并同期测定患者的血浆Tg、TSH水平及常规检查,同时让患者口服重组人促甲状腺激素(rhTSH)后再次显像,分析其显像资料及血浆Tg、TSH水平,结合患者的临床表现,综合分析患者同期的各项影像学检查结果(131I SPECT/CT断层显像、18F-FDG显像、CT、B超、MRI等)及血清TSH、Tg水平测定值,对患者是否发生分化型甲状腺癌术后转移复发进行判断,并以此做出诊断。血浆Tg水平诊断肿瘤复发转移的判断阈值为>10 ng/mL。结果以Tg血浆水平>10 ng/mL做为肿瘤复发转移判断界值得出SPECT/CT较131I全身显像具有更高的灵敏度;124I-PET较131 I-WBS有着更好的空间分辨率和灵敏度,可提高DTC定位诊断的准确性;18F-FDGPET/CT显像对Tg水平明显增高的甲状腺癌复发和转移患者有重要的诊断价值;服rhTSH可进一步提高18F-FDG检查的准确性。结论 131I SPECT-PET显像,可提高病灶定位的准确性,为肿瘤预后的评价提供了更准确的判断依据,将进一步推动分化型甲状腺癌临床诊疗水平的提升。     

SPECT/CT核素骨显像在肋骨外伤伤残鉴定中的应用

[目的]探讨核素SPECT/CT骨显像在肋骨外伤伤残鉴定中的作用和意义。[方法]统计本科于2015～2017年38例外伤患者,均为经CT或X线平片检查难以进行伤残等级鉴定者,所有患者均在伤后2个月内行胸部骨骼SPECT/CT断层同机融合显像,由两名以上医师对断层及融合图像进行分析。并与法医最终伤残鉴定结果进行对比,统计其符合率。[结果]38例患者SPECT/CT发现66个疑似骨折病灶,判断为新近骨折32个,可疑新近骨折26个,排除新近骨折8个,与司法鉴定结论相同者60个,不同者6个,两者符合率为90.91%(60/66),差异率为9.09%(6/66)。[结论]SPECT/CT同机融合显像能够提高肋骨外伤诊断的准确性,为外伤伤残鉴定的公正性和公信度提供可靠依据。     

~(99)Tc~m-MIBISPECT-MIBISPECT双时相显像、B超及CT在原发性甲状旁腺功能亢进症中的诊断价值

目的探讨~(99)Tc~m-甲氧基异丁基异腈单光子发射计算机断层显像(~(99)Tc~m-MIBI SPECT)双时相显像、B超及CT检查诊断原发性甲状旁腺功能亢进症(PHPT)的意义及与血清钙(CA)水平的关系。方法回顾性分析73例血清甲状旁腺激素(PTH)均大于130 pg/m L甲状旁腺功能异常患者的临床资料,73例患者均行~(99)Tc~m-MIBI SPECT双时相显像检查,63例行颈部B超检查,16例行CT检查;根据血清钙(CA)水平将患者分为CA2.7 mmol/L组和CA2.7mmol/L组,并以术后病理学检查及随访结果为标准,比较不同血清CA水平下~(99)Tc~mMIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值。结果 ~(99)Tc~mMIBI SPECT双时相显像、B超和CT检查诊断PHPT的灵敏度分别为87.6%、81.8%及35.7%,特异度分别为87.5%、75.5%及50.0%,阳性预测值分别为98.2%、93.7%及83.3%,阴性预测值分别46.7%、33.3%和10.0%。~(99)Tc~mMIBI SPECT双时相显像和B超检查诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值均明显高于CT检查(P0.05);~(99)Tc~m-MIBI SPECT双时相显像诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值高于B超检查,但差异无统计学意义(P0.05)。在CA2.7 mmol/L组,~(99)Tc~m-MIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度分别为91.1%、84.7%和37.9%,特异度分别为80.2%、72.9%及49.7%,阳性预测值分别为96.8%、96.0%和79.4%,阴性预测值分别为50.0%、37.5%及10.0%;在CA2.7mmol/L组,~(99)Tc~m-MIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度分别为87.9%、83.9%及42.8%,特异度分别为83.3%、79.2%及50.0%,阳性预测值分别为96.9%、94.1%及75.0%,阴性预测值分别为50.0%、40.5%及20.0%,2组间3种检查方法的诊断准确性的差异均无统计学意义(P0.05)。结论 ~(99)Tc~m-MIBI SPECT双时相显像和B超在PTH大于130 pg/m L的PHPT患者中(尤其甲状旁腺腺瘤)其诊断准确性明显高于CT,且与血清CA浓度无关。     

分化型甲状腺癌术后肺转移的SPECT/CT平面与断层显像诊断研究

目的比较分化型甲状腺癌术后肺转移的单光子/正电子发射断层成像术(SPECT/CT)平面与断层显像诊断价值。方法回顾性分析中山大学附属第三医院2012年1月至2016年10月收治的64例疑似分化型甲状腺癌术后肺转移患者的临床资料,所有患者均同时接受SPECT/CT平面与断层显像,对显像诊断结果进行统计分析。结果 64例患者中确诊为分化型甲状腺癌术后肺转移48例,未发生肺转移16例。SPECT/CT平面显像诊断40例为肺转移,其中12例为假阳性;24例未发生肺转移,其中20例为假阴性。SPECT/CT断层显像诊断52例为肺转移,其中48例为真阳性;12例未发生肺转移,其中4例为假阳性。分化型甲状腺癌术后肺转移的SPECT/CT断层显像的敏感度、特异度、准确性、阳性预测值、阴性预测值均显著高于SPECT/CT平面显像(χ2=12.63、4.00、11.14、3.92、11.25,P=0.032、0.033、0.024、0.042、0.013)。结论分化型甲状腺癌术后肺转移的SPECT/CT断层显像诊断价值较SPECT/CT平面显像高,值得在临床推广。     

18F-FDG hPET/CT显像诊断结直肠癌术后复发转移

目的 评价^18F-FDG hPET／CT代谢显像对结直肠癌患者术后复发转移的诊断价值。方法 对81例结直肠癌术后临床可疑肿瘤复发或转移的患者采用GEHAWKEYE符合线路SPECT进行^18F-FDG显像，获得经X线衰减校正后的三维断层图像，由计算机完成各断层图像的融合，以目测法进行诊断分析，并与CT、病理学检查、临床随访作出的最后诊断进行对比。结果 ^18F-FDG hPET／CT代谢显像对结直肠癌术后复发、转移诊断的灵敏度为93％（57／61），特异性为80％（16／20），阳性预测率为93％（57／61），阴性预测率为80％（16／20）；而常规CT对结直肠癌术后复发转移诊断的灵敏度、特异性、阳性预测值、阴性预测值分别为67％（37／55）、73％（19／26）、84％（37／44）、51％（19／37）；^18F-FDG hPET／CT代谢显像共检出病灶126个，65例相同视野hPET／CT代谢显像与诊断CT常规影像检查复发转移病灶检出数分别为91个和46个。结论 ^18F-FDG hPET／CT显像对结直肠癌术后复发转移的诊断价值优于CT；通过与同机定位CT图像融合可有效地对病变进行定性定位。     

130例脊柱疾病核素骨显像与MRI、CT、X线诊断的比较研究

目的 比较核素全身骨平面显像和MRI、CT及X线在脊柱转移瘤及其他脊柱疾病诊断中的价值。方法 130例经手术病理诊断的脊柱疾病患者行^99mTc-MDP全身骨平面显像．显示局部异常浓聚、局部异常稀疏和局部加其他部位异常浓聚或稀疏为阳性结果。所有患者均行MRI、CT、X线片三种影像检查的一种以上．其中104例行MRI、61例行CT、107例行X线片检查。结果 骨显像诊断脊柱疾病的灵敏度为：转移瘤91．7％，原发恶性肿瘤73．3％，良性肿瘤54．2％．瘤样病损81．8%，炎性病变100％．压缩性骨折100％。61．1％的转移瘤患者伴有其他部位骨骼的异常浓聚或稀疏灶(58．3％可明确诊断为骨转移瘤)。非转移瘤的其他脊柱痰病．20．2％伴有异位异常浓聚或稀疏灶。MRI、CT和X线的灵敏度分别为：转移瘤96．8％、100％和79.3％；原发恶性肿瘤95．7％、93．3％和78．3％；良性肿瘤95．0%、92．3％和54．5％；瘤样病损100％、100%和80．0％；炎性病变100％、100％和69．2％；压缩性骨折均为100％。结论 核素骨显像是诊断骨转移瘤的最佳方法。对其他脊柱疾病，几种影像技术各有其优势。而核素骨显像对判断病灶是单发抑或多发及是否伴发其他骨骼病变有较大价值。     

Added value of SPECT/CT in patients suspected of having bone infection: preliminary results

AIM: We evaluated the contribution of SPECT/CT as an adjunct to combined three-phase bone scintigraphy (planar and SPECT) for diagnosing and localizing bone infection. Subsequently, the diagnostic performance of SPECT/CT was compared to visual fusion of SPECT with data of additional CT, X-ray, or MRI studies (SPECT + CT/X-ray/MRI). MATERIALS AND METHODS: Thirty-one patients suspected of bone infection, presenting pathological findings on triple-phase bone scintigraphy, underwent additional SPECT/CT. The SPECT/CT-technology combines the acquisition of SPECT and CT data with the same imaging device enabling perfect overlay of anatomical and functional images. (99m)Tc-DPD was used as radiopharmaceutical in all patients. For data analysis findings of bone scintigraphy (planar scans as well as SPECT) were categorized as positive, negative, or equivocal for the presence of osteomyelitis. In a second step, they were compared with SPECT/CT and SPECT + CT/X-ray/MRI with respect to localization and classification of lesions. Validation was achieved by surgery, biopsy, or by clinical follow up over at least 9 months including microbiological and radiological findings. RESULTS: Three-phase bone scan (incl. SPECT) correctly classified 7 lesions as positive and 11 lesions as negative for osteomyelitis. Six scans were interpreted false positive, two false negative, and five as equivocal. Rating the latter as positive for osteomyelitis, sensitivity of bone scan was (78%), specificity (50%). SPECT/CT was true positive in 7 patients, and true negative in 19. There were two false positive and two false negative findings, one scan was equivocal (sensitivity 78%, specificity 86%). Definition of anatomical localization of inflammatory foci was much easier by SPECT/CT due to better depiction of underlying anatomical details. SPECT + CT/X-ray/MRI yielded the highest sensitivity (100% compared to 78% of SPECT/CT), if equivocal findings (5/31 compared to 1/31 for SPECT/CT) are rated as true positive for osteomyelitis. Among radiological techniques, MRI (2 x FP) and CT (2 x FN) proved equal and expectedly superior to X-ray in delivering the correct diagnosis. CONCLUSION: SPECT/CT improves the diagnostic performance of three-phase bone scan for osteomyelitis by avoiding false positive or equivocal results. An additional benefit over visual fusion of SPECT with X-ray, CT, or MRI studies could not be confirmed in our study.     

高场强磁共振与CT扫描对急性硬膜下血肿的诊断效果比较

目的分析对比高场强磁共振与CT扫描对急性硬膜下血肿的诊断效果。方法选取2012-07—2013-07收治的130例颅脑损伤患者,对患者进行高场强磁共振和CT扫描,分析患者急性硬膜下血肿扫描结果。结果高场强磁共振扫描阳性血肿169处,而CT扫描为123处,差异有统计学意义(P0.05)。随着血肿块厚度的减少,CT扫描的显示率逐步低于高场强磁共振扫描,当血肿≥6.0 mm时,CT扫描显示率为75.0%～86.7%,当血肿6.0 mm时,显示率57.1%～69.7%。结论高场强磁共振可有效显示急性硬膜下血肿情况,扫描清晰度显著优于CT扫描,且随着血肿厚度的减少扫描优势逐步加大。     

CT perfusion imaging for childhood moyamoya disease before and after surgical revascularization

Summary Moyamoya disease is a progressive occlusive disease of the circle of Willis with prominent collateral arterial formation. We report on a 12-year-old girl with moyamoya disease presenting with transient ischemic attacks (TIAs). Surgical indirect revascularization was performed. The patient did not suffer further TIAs at 12 month follow-up. Pre and postoperative cerebral perfusion were studied in quantitative single photon emission computerized tomography (SPECT) and CT perfusion imaging. CT perfusion imaging demonstrated postoperatively increased cerebral blood flow as well as SPECT before and after revascularization. Furthermore, the area of decreased vascular reserve in SPECT with acetazolamide corresponded to areas of increased cerebral blood volume in CT perfusion imaging. CT perfusion imaging was equivalent to SPECT in accuracy, and superior in spatial resolution. CT perfusion imaging is likely to become more widely available as an easy-to-perform technique for assessing cerebral perfusion in a patients with moyamoya disease.     

Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage

Purpose: To investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling. Methods: Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-ofinterest in two groups were analyzed and compared before and after treatment. Results: Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group. Conclusion: External ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.     

Cerebral perfusion defects, dysautoregulation and carotid stenosis

Single Photon Emission Computed Tomography (SPECT), imaging of cerebral blood flow was carried out in ten patients with haemodynamically significant carotid stenosis. Before and after carotid endarterectomy each patient was investigated by 3--dimensional SPECT brain scanning using technetium--hexamethyl propyleneamine oxine (99 mTcHMPAO, ceretec). Brain blood flow was normal before and after operation in 3 patients whose autoregulation was kept intact. Seven patients received acetazolamide to limit cerebral vascular reactivity and in four of these, preoperative perfusion defects were visible. After carotid endarterectomy the ipsilateral perfusion defects were abolished and it is concluded that carotid stenosis can reduce perfusion in the dysautoregulation brain and that carotid reconstruction can restore normal flow.     

艾滋病继发弓形体脑炎的CT及MRI表现

目的探讨艾滋病(AIDS)继发弓形体脑炎的CT及MRI表现。方法收集经临床及病理证实的AIDS继发弓形体脑炎患者30例,其中21例接受CT平扫,增强16例;24例接受常规MR检查,增强18例;15例同时接受CT和MR检查。结果本组25例病灶多发,5例单发;病灶部位多位于灰白质交界处(21例),其次为侧脑室周围(16例)、半卵圆中心(6例)、小脑(5例)、脑干(4例)、基底节区(4例)。CT平扫表现为多发斑片状、片状低密度灶,部分夹有混杂密度影;MRI表现为斑片状、块状及结节状长T1长T2信号,FLAIR序列多为高信号;增强后表现为斑片状、环状强化,以环状强化多见(13例)。本组所有病例经抗弓形体治疗后症状均有好转。结论 CT及MRI对AIDS继发弓形体脑炎有重要的诊断价值。根据MRI的特征性表现,结合临床及血清HIV、弓形体IgG及IgM抗体阳性,可对本病进行确诊。     

Relationship between Pathological Characteristics and Radiological Findings on Perfusion MR Imaging of Meningioma

Few studies have reviewed the roles of perfusion magnetic resonance (MR) imaging in the histopathological examination of meningiomas. We analyzed the relationships between radiological findings on perfusion MR imaging and pathological characteristics such as origin of the tumor, mitotic activity, pathological subtype, and perifocal edema formation. The subjects were 21 surgical cases of meningioma preoperatively evaluated by perfusion MR imaging. A region of interest (ROI) was set inside of the tumor, and perifocal edema of the same size, cerebral blood volume (CBV), and cerebral blood flow (CBF) on perfusion MR and diffusion-weighted (DW) imaging were analyzed. These radiological data were evaluated in comparison with histopathological characteristics. On perfusion MR imaging, the average ratio of CBV against the contralateral side was 6.43 (1.13–20.0) and that of CBF was 7.73 (1.34–11.3). There was no significant relationship with perfusion MR imaging data, tumor volume, or perifocal edema volume. However, the large peritumoral edema group often had a higher CBV and CBF than the non-large peritumoral edema group. The skull base group had a significantly higher CBV and lower signal intensity on DW images than the non-skull base group. Signal intensity on DW images was higher in grade II or III than in grade I. Perfusion MR imaging data revealed that the higher ratio of peritumoral edema against tumor size was associated with higher blood flow and blood volume under intratumoral circulatory conditions, and that skull base meningioma had a higher blood volume than non-skull base meningioma.     

99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: Compared with CT—a prospective study

Single photon emission computed tomography (SPECT) with Technetium-99m hexamethyl propylenamine oxime (Tc-99m-HMPAO) was used in 20 patients with mild to moderate traumatic brain injury (TBI) to evaluate the effects of brain trauma on regional cerebral blood flow (rCBF). SPECT scan was compared with CT scan in 16 patients. SPECT showed intraparenchymal differences in rCBF more often than lesions diagnosed with CT scans (87 -5% vs. 37-5%). In five of six patients with lesions in both modalities, the area of involvement was relatively larger on SPECT scans than on CT scans. Contrecoup changes were seen in five patients on SPECT alone, two patients with CT alone and one patient had contrecoup lesions on CT and SPECT. Of the eight patients (50%) with skull fractures, seven (43-7%) had rCBF findings on SPECT scan and five (31.3%) demonstrated decrease in rCBF in brain underlying the fracture. All these patients with fractures had normal brain on CT scans. Conversely, extra-axial lesions and fractures evident on CT did not visualize on SPECT, but SPECT demonstrated associated changes in rCBF. Although there is still lack of clinical and pathological correlation, SPECT appears to be a promising method for a more sensitive evaluation of axial lesions in patients with mild to moderate TBI.     

腹膜假性粘液瘤的影像诊断(附3例报告及文献复习)

【摘要】 目的 探讨腹膜假性粘液瘤(PMP)的影像学表现,以提高对本病的鉴别诊断水平。方法 我院自2003年1月-2012年4月经手术、病理证实腹膜假性粘液瘤3例,2例术前行超声及MRI检查,1例行多层螺旋CT检查,对其临床及影像学资料进行回顾性分析。结果 3例患者原发肿瘤分别为卵巢囊肿、胃癌、卵巢交界性囊腺瘤。CT、MRI检查均呈分房状改变囊实性病变,增强扫描后囊壁、网膜、腹膜轻度强化。其中1例肝脏、脾脏等实质脏器边缘呈“扇贝样”压迹,脏器周围、网膜间隙、腹膜、盆腔见大量粘液性腹水,腹膜、大小网膜弥漫增厚呈饼状改变,肠管受压移位。结论 PMP在CT及MRI上病变部位和形态有其特殊的影像学表现,术前影像学评价对临床治疗方案的制定具有一定价值。     

Posterior reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity. Neurotoxicity with characteristic watershed CT/MR imaging features characterize this condition. This case report describes PRES syndrome in a 35-year-old patient admitted with eclampsia. On the first postpartum day; she developed severe headache, generalized tonic-clonic seizures and visual symptoms including transient visual loss. MRI scan of the brain showed symmetric areas of hyperintense signal on T2-weighted images in the occipital lobes bilaterally. Patient improved symptomatically. Repeat MRI of the brain 4 months after initial admission showed resolution of the previous abnormalities.