^99mTc—ECD SPECT断层影像采血法和非采血法定量测定rCBF和C …

目的：应用＾９９ｍＴｃ－ＥＣＤ ＳＰＥＣＴ断层影像采血和非采血法定量测定ｒＣＢＦ和ＣＢＦ。材料和方法。正常对照组１５例,疾病组１０例;采血法用动脉化静脉血样求得血中＾９９ｍＴｃ－ＥＣＤ的浓度。非采血法用头颈平面像求得血中＾９９ｍＴｃ－ＥＣＤ浓度。结果;正常对照组采血法ｒＣＢＦ２５．０±４．０－５９．１±７．６１ｍｌ．ｍｉｎ＾－１．（１００ｇ）＾－１,ＣＢＦ４３．０±３．６ｍｌ．ｍｉｎ＾－１．（１０     

~(99)Tc~m-ECD SPECT显像定量测定rCBF的简便方法及其应用

目的　建立一种简便、实用、可靠、易于普及的定量测定rCBF方法。方法　①测定颅脑衰减系数 (δ) ;②平面像与断层像之间计数率转换比例因子 (ρ) ;③测定SPECT仪漏计 ;④测定肺滞留率 (Rl) ;⑤改良Nickel等的数学模型 ,编写计算机处理程序 ;⑥对正常志愿者 15例、患者组 9例 ,共2 4例定量测定rCBF。结果　δ =1 7,ρ =2 2 3 ,Rl<1% ;对照组rCBF范围为 (42 3± 4 6～ 5 7 5± 6 4 )mL·min-1·10 0g-1,8例癫痫患者病灶rCBF 2 2 5～ 3 4 2mL·min-1·10 0g-1,脑梗死病灶rCBF 7 2mL·min-1·10 0g-1。结论　方法简便实用 ,易于掌握 ,结果可靠 ,具有较高的临床应用价值。     

正常人~(99m)Tc-ECD脑血流灌注显像与Wisconsin卡片分类试验的关系

目的探讨不同年龄组正常人基础状态、激活状态局部脑血流（ｒＣＢＦ）灌注的特征及其与Ｗｉｓｃｏｎｓｉｎ卡片分类试验（ＷＣＳＴ）的关系。方法研究对象分两组：中青年组１８例，年龄２１～５０岁；老年组１７例，年龄６０～７２岁，受教育程度匹配。均为健康人，老年组ＣＴ结果均正常。均行双日法基础与认知激活脑ｒＣＢＦ显像。认知激活脑ＳＰＥＣＴ：采用ＷＣＳＴ进行认知激活，ＷＣＳＴ设９项评分：①完成作业时间；②分类次数；③总正确数；④概括力水平（％）；⑤坚持性反应数；⑥总错误数；⑦坚持性错误数；⑧坚持性错误（％）；⑨非坚持性错误数。结果①中青年组激活后双额叶、左颞叶、左顶叶的ｒＣＢＦ比值均较基础值增高，激活前后比较差异有显著性；②老年组激活后右额叶的ｒＣＢＦ值较基础值增高，但激活前后比较差异无显著性；③老年组的ＷＣＳＴ成绩较年轻人差；④基础及激活额叶、扣带前回ｒＣＢＦ与ＷＣＳＴ成绩相关。结论①９９ｍＴｃ乙撑双半胱氨酸二乙酯在不同年龄组的脑皮质中分布不同；②ＷＣＳＴ的完成与额叶的激活密切相关，轻度额叶皮层血流灌注减低可能是老年人分类概括能力较差、思维惰性和粘着性较强的原因之一；③初步观察到扣带前回与ＷＣＳＴ有相关关系     

健康人~(99m)Tc-ECD和~(99m)Tc-HMPAO的对比研究

对7名健康志愿者用~(99m)Tc-ECD和~(99m)Tc-HMPAO进行平面和SPECT脑显像,研究药物动力学和图像质量之关系。主要观察两种显像剂的生物学分布、动力学和SPECT图像特征。     

99mTc-ECD SPECT显像定量测定平均脑血流的临床应用研究

目的 :应用显像剂99mTc 半双胱乙酯寻求建立一种非侵入性、便于临床应用的定量方法 ,以定量评价大脑及各部位的平均脑血流量。方法 :应用99mTc ECD放射性核素心脑血管造影术和图形法技术测量脑血流灌注指数 ,据经验方程获得大脑半球的平均血流量 ,并进行重复性研究 ;然后根据断层显像和经验公式获得局部平均脑血流量。共分析了正常对照组 2 5例 ,脑血管病组 3 3例 ;且将正常对照组的脑血流量与文献报道的结果进行了比较。结果 :本方法获得的脑血流灌注指数 (BPI)重复性好 ,正常对照组和脑血管病组BPI的平均值分别为 10 .6± 1.4和 6.2± 1.2 ,差异存在显著性意义(P <0 .0 0 1) ;而脑血流量平均值分别为 ( 4 7.41± 3 .2 9)ml/( 10 0g·min)和 ( 3 5 .3 1± 3 .0 6)ml/( 10 0g·min) ,差异亦存在显著性意义 (P <0 .0 1)。正常对照组大脑半球的平均脑血流量与文献报道的结果差异无显著性意义 (P >0 .0 5 )。结论 :研究结果表明 ,该定量计算平均脑血流量的方法 (不需要抽取动脉血液样本 ) ,简便易行 ,且具有潜在的临床应用前景和实用价值。     

大剂量硝酸甘油介入~(99m)Tc-MIBI心肌SPECT判定存活心肌的研究

目的：探讨大剂量硝酸甘油介入（大剂量硝充法）99mTc-MIBI心肌SPECT对存活心肌判定的价值。材料和方法：对44例大剂量硝充组和31例小剂量硝充组的心肌梗塞患者均行静息和硝充法心肌显像。采用9节段评分法对两次显像进行了比较。其中两组中分别有18例和17例于冠脉血管再通术（PTCA或CABG）后半年内再次复查了静息心肌显像并与术前比较。结果：大剂量硝充组静息心肌显像灌注异常节段为154个，硝充后有77个节段呈现了再分布，总再分布率为50．0％（77／154）；小剂量硝充组静息心肌显像灌注异常节段为110个，硝充后有35个节段呈现了再分布，总再分布率为31．8％（35／110）。大剂量和小剂量组中18例和17例PTCA和CABG患者术后静息心肌显像与硝充法心肌显像比较阳性符合率分别为85．7％和68．8％．预测准确率为对71．9％和50．9％。结论：大剂量硝酸甘油介入99Tc-MIBI心肌SPECT具有较高的存活心肌检出率和预测准确性。     

~(99m)锝-甲氧基异丁基异腈心肌灌注显像对左心室功能的评价

~(99m)锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)的心肌摄取量不但依赖于心肌血流灌注量,更主要的是依赖于心肌细胞的摄取能力及其完整性。测量~(99m)Tc-MIBI在心肌内的活性,可直接     

~(99m)Tc-MIBI运动加静态心肌灌注断层显像的初步临床应用

本文报告60例运动+静态心肌灌注断层显像,其中冠心病44例,心肌梗塞16例,并与心电图作了对比,结果表明,~(99m)Tc-MIBI心肌灌注断层显像对缺血性心脏病诊断的灵敏度为86.6％,高于ECG(68.3％),差异有非常显著意义(P<0.01),同时用靶心图对异常52例病人作了定量分析,在冠心病心肌缺血及梗塞定位诊断和鉴别诊断中具有与~(201)TL相似的灵敏性及特异性,而且心/肝比值高,图像质量佳,值得临床大力推广。     

~(99m)Tc-Teboroxime和~(201)TI SPECT连续显像方案的临床对照

~(99m)Tc标记的Teboroxime是一种新的心肌灌注显像剂,它与~(201)T1显像和冠状动脉造影有良好的相关性。实验研究采用单探头型SPECT作临床动态连续显像。方法:~(201)T1运动和再分布:在运动高峰给患者静注~(201)T1 111～129.5MBq(3～3.5mCi),继续     

Quantifying CBF with arterial spin labeling

The basic principles of measuring cerebral blood flow (CBF) using arterial spin labeling (ASL) are reviewed. The measurement is modeled by treating the ASL method as a magnetic resonance imaging (MRI) version of a microsphere study, rather than a diffusible tracer study. This approach, particularly when applied to pulsed ASL (PASL) experiments, clarifies that absolute calibration of CBF primarily depends on global properties of blood, rather than local tissue properties such as the water partition coefficient or relaxation time. However, transit delays from the tagging region to the image voxel are a potential problem in all standard ASL methods. The key to quantitative CBF measurements that compensate for this systematic error is to create a well-defined bolus of tagged blood and to ensure that all of the bolus has been delivered to an imaging voxel at the time of measurement. Two practical technical factors considered here are 1) producing a tagged bolus with a well-defined temporal width and 2) accounting for reduction in magnitude of the tagged magnetization due to relaxation. The ASL approach has the potential to provide a robust estimation of CBF, although the timing of water exchange into tissue and the effects of pulsatile flow require further investigation.     

A new method to estimate rCBF using IMP and SPECT without any blood sampling

We developed and evaluated a method to measure rCBF without any blood sampling by using iodine- 123 IMP and SPECT. An integral of arterial input function, the integral taken from the value 0 to T of the variable Ca(t)dt, can be expressed as TC(T)/CO, where TC(T) is radioactivity delivered to the body in T minutes and CO is cardiac output. If T is acceptably small, rCBF can be determined by means of a microsphere model analysis with IMP as Cb(T)/(TC(T)/CO), where Cb(T) is cerebral radioactivity at T minutes. We derived TC(T) and CO from a chest dynamic scan. The method was applied to 45 patients who underwent rCBF studies (58 studies) with arterial blood sampling (ABS). Data from the chest scan were analyzed in comparison with ABS data in the first 28 studies, and equations for correction yielding an accurate TC(T)/CO were derived. The validity of the proposed method was evaluated in the subsequent 30 studies. The method yielded rCBF (rCBF-test) which agreed well with rCBF obtained by a two-compartment model analysis of dynamic SPECT and ABS data (rCBF-ref) with the mean and SD of differences between rCBF-test and rCBF-ref being 1.0 and 2.7 ml/100 g/min, respectively. In eleven subjects who underwent more than two studies, a percentage change in rCBF-test between the studies also closely approximated that of rCBF-ref (y = 1.11 x + 2.63, r = 0.92). The method can be used with acceptable reliability to measure rCBF without any blood sampling.     

脑肿瘤SPECT阳性显像与CT影像的对照研究

目的 :探讨99mTc MIBISPECT与CT在脑肿瘤的影像特征及其应用价值。材料和方法 :对 5 0例脑肿瘤、10例脑内非肿瘤病变患者行99mTc MIBISPECT及CT扫描 ,对其影像特点进行分析比较。结果 :99mTc MIBISPECT术前诊断脑肿瘤的灵敏度、特异性和准确性分别为 96.9%、90 .0 %和 95 .2 % ,而CT分别为 90 .6%、80 .0 %和 88.1% ,两者均无显著性差异(P >0 .0 5 ) ;99mTc MIBISPECT诊断胶质瘤术后残留与复发的灵敏度、特异性和准确性均为 10 0 % ,而CT分别为 3 0 %、75 %和 5 0 % ,前者比后者高 (P <0 .0 1)。结论 :99mTc MIBISPECT在诊断胶质瘤术后残留与复发方面可作为CT的一种有效补充手段 ;二者结合 ,对确定脑肿瘤的诊断具有重要的应用价值。     

MR relative cerebral blood flow mapping of Alzheimer disease: correlation with Tc-99m HMPAO SPECT

RATIONALE AND OBJECTIVES: To evaluate the value of magnetic resonance (MR) perfusion imaging for diagnosis of Alzheimer disease (AD), the authors compared relative cerebral blood flow (CBF) maps obtained with MR perfusion imaging and technetium-99m hexamethyl-propyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) in patients with AD. MATERIALS AND METHODS: Eight patients with AD were studied with MR perfusion imaging and HMPAO SPECT. The relative CBF maps from the two techniques were spatially coregistered, and relative CBF values in 13 cerebral gray matter regions (total, 26 regions of interest) were compared with regression analysis. To evaluate the degree of deviation of each brain region from the regression line, a P value for the residual was calculated for each region. RESULTS: A significant overall correlation was seen between the relative CBF values produced by the two techniques (r = .68, P < .0001). Smaller P values for the residuals were obtained in the anterior cingulate cortex (P = .05) and posterior cingulate cortex (P < .001), indicating larger deviations in these regions. When data from these two regions were eliminated, the correlation coefficient rose to 0.80 (P < .0001). CONCLUSION: Despite fairly large discrepancies in the anterior and posterior cingulate cortices, the relative CBF map obtained with MR imaging is generally in close agreement with the HMPAO SPECT map, suggesting that MR perfusion imaging can provide clinically useful information regarding CBF abnormalities in patients with AD.     

乙酰唑胺负荷试验脑SPECT显像在缺血性脑血管疾病的临床应用

目的 建立乙酰唑胺（ＡＣＺ）负荷试验的方法及脑血流量的正常值，提出评价因管储备功能的指标。方法 正常对照者６例，脑血管疾病（ＣＶＤ）患者４３例，用＾９９ｍＴｃ－乙撑双半胱氨酢一忆是（ＥＣＤ）先做基态脑血流（ＣＢＦ）及ＳＰＥＣＴ显像，３６－４８小时后做负荷显像（静脉注射ＡＣＺ１ｇ，２０分钟后按基态同样条件进行）。病人均有ＣＴ检查，部分有ＭＲＩ、经颅多普勒超声（ＴＣＤ）、ＤＳＡ检查。７例病人治疗后进行     

Quantifying CBF with pulsed ASL: technical and pulse sequence factors

We summarize here current methods for the quantification of CBF using pulsed arterial spin labeling (ASL) methods. Several technical issues related to CBF quantitation are described briefly, including transit delay, signal from larger arteries, radio frequency (RF) slice profiles, magnetization transfer, tagging efficiency, and tagging geometry. Many pulsed tagging schemes have been devised, which differ in the type of tag or control pulses, and which have various advantages and disadvantages for quantitation. Several other modifications are also available that can be implemented as modules in an ASL pulse sequence, such as varying the wash-in time to estimate the transit delay. Velocity-selective ASL (VS-ASL) uses a new type of pulse labeling in which inflowing arterial spins are tagged based on their velocity rather than their spatial location. In principle, this technique may allow ASL measurement of cerebral blood flow (CBF) that is insensitive to transit delays.     

A multi-institutional study of interobserver agreement in the evaluation of dementia with rCBF/SPET technetium-99m exametazime (HMPAO)

Although specific patterns of technetium-99m exametazime [^99mTc-hexamethylpropylene amine oxime (HMPAO)] brain single-photon emission tomography (SPET) uptake have been described for patients with dementia, no multi-institutional study has evaluated interobserver agreement. Interobserver agreement for ^99mTc-HMPAO brain SPET uptake patterns in 50 clinically diagnosed demented subjects from four institutions were studied. Neurologists classified these subjects as presumed Alzheimer's disease (n=21), confirmed Alzheimers's disease (n=10), multi-infarct dementia (n=9), HIV-related dementia (n=7), or mixed (n=3). In addition 20 normal (five per institution) ^99mTc-HMPAO studies were included in a randomized blinded evaluation by three readers each from a different institution. Readers classified the general appearance of the images in one of four categories: normal, globally decreased uptake, focal areas of decreased uptake, and patchy changes in uptake. Consensus results show a sensitivity of 72% and specificity of 79% for identifying abnormalities in scans of demented subjects. Readers also rated ^99mTc-HMPAO uptake in eight designated regions in each hemisphere. Significant reader agreement (P < 0.01) for the classification by general appearance and the ratings of regional uptake was obtained. This study demonstrates that interpretation of regional cerebral blood flow/SPET images is concordant across multiple institutions and readers.Subject studies performed at St. Vincent's Hospital, New York     

运动静息介入三步^99mTc—MIBI心肌显像预测PTCA疗效

目的：探讨组合方案的ＳＰＥＣＴ ９９ｍＴｃＭＩＢＩ 心肌显像术前预测ＰＴＣＡ 疗效的价值。材料与方法：采用运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像对１２２ 例拟行ＰＴＣＡ 治疗的患者进行监测,并以术后１ ～２ 周的运动、静息显像作为疗效指标进行比较。结果：术前心肌显像显示的缺损变化与ＰＴＣＡ 疗效有重要关系。以运动与ＮＴＧ 显像组合反映的缺损变化作为预测指标,则与疗效指标呈正相关（ｒ ＝ ０ ．９３６６） 。结论：运动、静息、静滴硝酸甘油介入三步９９ｍＴｃＭＩＢＩ 心肌显像能够在术前全面准确地预测ＰＴＣＡ 的疗效。