核素显像诊断乳腺癌研究进展

无创伤性诊断乳腺肿瘤一直是临床研究热点。核素显像诊断乳腺癌近几年研究异常活跃,~(99m)Tc-甲氧基异丁基异腈(MIBI)乳腺显像对乳腺癌定性诊断、评价多药耐药现象及预测化疗效果有很高的临床价值；生长抑素受体显像与~(99m)Tc-MIBI显像相比有更广阔的应用前景。~(18)F脱氧葡萄糖正电子发射断层显像有很高的应用价值,但高昂的费用限制了其在临床的广泛应用。     

分化型甲状腺癌术后99Tcm-MIBI显像与131I显像比较及其意义

目的:探讨分化型甲状腺癌( DTC)术后99Tcm-MIBI显像结果的意义.方法:300例DTC术后患者中随机选取69例行99Tcm-MIBI显像.2名有经验核医学医师盲法阅片.将99Tcm-MIBI显像结果与治疗后131 I显像结果比较.另对经高分辨CT或治疗后131I显像诊断肺转移和无肺转移患者行半定量分析,比较靶本底比值(T/B).结果:排除1例死于血管肉瘤者,余按照手术方式及131I治疗情况分为3组(A组:44例甲状腺癌术后拟131I治疗组;B组:22例有再次131I治疗指征组;C组:2例甲状腺大部切除组).A组99Tcm-MIBI显示残余甲状腺34.1％ (15/44),转移灶30.0％(6/20).B组99Tcm-MIBI显示复发及转移灶63.6％(7/11).C组99Tcm-MIBI显示残余甲状腺100.0％(2/2),并为唯一一种发现颈部转移显像方法.5例患者同时存在多种性质转移灶:MIBI+I-,MIBI-I+及MIBI+I+.肺转移与无肺转移患者T/B比值差异无统计学意义.结论:99Tcm-MIBI可发现分化好及失分化病灶,联合131I显像为DTC术后患者选择治疗方式提供重要信息,有临床应用价值.     

分化型甲状腺癌术后^99Tc^m—MIBI显像与^131 I显像比较及其意义

目的：探讨分化型甲状腺癌（DTC）术后^99Tc^m—MIBI显像结果的意义。方法：300例DTC术后患者中随机选取69例行^99Tc^m-MIBI显像。2名有经验核医学医师盲法阅片。将^99Tc^mMIBI显像结果与治疗后^131I显像结果比较。另对经高分辨CT或治疗后^131 I显像诊断肺转移和无肺转移患者行半定量分析,比较靶本底比值（T／B）。结果：排除1例死于血管肉瘤者,余按照手术方式及^131 I治疗情况分为3组（A组：44例甲状腺癌术后拟^131I治疗组;B组：22例有再次^131I治疗指征组;C组：2例甲状腺大部切除组）。A组^99 Tc^m-MIBI显示残余甲状腺34．1％（15／44）,转移灶30．0％（6／20）。B组^9^Tc ^m-MIBI显示复发及转移灶63．6％（7/11）。C组^99Tc^mMI—BI显示残余甲状腺100．0％（2／2）,并为唯一一种发现颈部转移显像方法。5例患者同时存在多种性质转移灶：MI—BI＋I-,MIBI-I＋及MIBI＋I＋。肺转移与无肺转移患者T/B比值差异无统计学意义。结论：^99Tc^m -MIBI可发现分化好及失分化病灶,联合^131 I显像为DTC术后患者选择治疗方式提供重要信息,有临床应用价值。     

分化型甲状腺癌术后99Tcm-MIBI显像与131Ⅰ显像比较及其意义

目的:探讨分化型甲状腺癌(DTC)术后99 Tcm-MIBI显像结果的意义。方法:300例DTC术后患者中随机选取69例行99 Tcm-MIBI显像。2名有经验核医学医师盲法阅片。将99 Tcm-MIBI显像结果与治疗后131I显像结果比较。另对经高分辨CT或治疗后131I显像诊断肺转移和无肺转移患者行半定量分析,比较靶本底比值(T/B)。结果:排除1例死于血管肉瘤者,余按照手术方式及131I治疗情况分为3组(A组:44例甲状腺癌术后拟131I治疗组;B组:22例有再次131I治疗指征组;C组:2例甲状腺大部切除组)。A组99 Tcm-MIBI显示残余甲状腺34.1%(15/44),转移灶30.0%(6/20)。B组99 Tcm-MIBI显示复发及转移灶63.6%(7/11)。C组99 Tcm-MI-BI显示残余甲状腺100.0%(2/2),并为唯一一种发现颈部转移显像方法。5例患者同时存在多种性质转移灶:MI-BI+I-,MIBI-I+及MIBI+I+。肺转移与无肺转移患者T/B比值差异无统计学意义。结论:99 Tcm-MIBI可发现分化好及失分化病灶,联合131I显像为DTC术后患者选择治疗方式提供重要信息,有临床应用价值。     

乳腺专用伽马显像中99Tcm-甲氧基异丁基异腈的摄取与乳腺浸润性导管癌患者临床病理特征的关系

目的分析乳腺浸润性导管癌患者的临床病理特征与乳腺专用伽玛显像(BSGI)中⁹⁹Tc^m-甲氧基异丁基异腈(MIBI)摄取之间的关系。 方法回顾性分析2014年3月至2018年3月就诊于威海市立医院行BSGI检查、未接受新辅助治疗及穿刺活组织检查及术前无肿瘤远处转移的浸润性导管癌患者244例的临床资料。分析患者的BSGI数据,计算病灶的放射性计数与正常组织的比值(T/N),从而评估肿瘤对⁹⁹Tc^m-MIBI的摄取量。T/N为偏态分布数据,用M(P₂₅～P₇₅)表示。用Wilcoxon秩和检验分析患者临床病理特征与T/N之间的关系,用多元线性回归模型分析患者临床病理特征对T/N的影响。 结果全部244例患者BSGI中的T/N范围为1.0～7.5。Wilcoxon秩和检验结果显示T/N与T分期、N分期、组织学分级及Ki67表达有关(Z＝－6.852、5.198、－3.931,P均<0.001;Z＝－3.059, P＝0.002),而与ER、PR、HER-2、P53、EGFR表达及三阴性乳腺癌无关(Z＝ －0.730、－1.526、－1.137、－1.175、－1.224、－1.556, P均>0.050)。多元线性回归分析表明T分期及N分期是T/N的影响因素(t＝5.100, 95%CI：0.414～0.935, P<0.001;t＝ 2.819, 95%CI：0.118～0.668, P＝0.005)。 结论乳腺浸润性导管癌的T分期和N分期可能影响BSGI中肿瘤对⁹⁹Tc^m-MIBI的摄取,因此,可以通过术前测定BSGI的T/N,对肿瘤的恶性程度进行初步评估。     

99mTc-MIBI显像评价乳腺癌新辅助化疗疗效及预后的价值

目的:探讨99mTc-MIBI显像评价乳腺癌新辅助化疗(NCT)疗效及预后的临床价值.方法:57例乳腺癌患者NCT前及Z个周期(30例)、3个周期(57例)NCT后分别行乳腺.99mTc-MIBI显像.肿瘤部位摄取采用靶和非靶比值(T/N)表示,术后行乳腺癌病理化疗反应分析.以NCT后T/N比值降低百分率>30%为判断化疗有效的闭值,将结果与病理检查结果对比,评价其诊断效能.根据该判断阈将患者分为显像有效组和无效组,进行临床随访,分析两组无进展生存时阃(PFS).结果:2个周期NCT后,99mTc-MIBI显像评价疗效的灵敏度、特异性和准确性分别为89%、83%和86%,阴性和阳性预测值分别为88%和83%,与对3个周期NCT疗效评价的效能差异无统计学意义,P>0.05.显像示有效组平均PFS为46.93个月,显像示无效组平均PFS为35.76个月,两组差异有统计学意义,P<0.05.结论:99mTc-MIBI显像对评价乳腺癌NCT反应、估计预后具有临床应用价值.     

^99mTc—MIBI显像诊断恶性肿瘤的研究进展

随着影像核医学技术的飞速发展，肿瘤核医学正在肿瘤诊治研究中发挥日益重要的作用。近年来，＾９９ｍＴｃ－ＭＩＢＩ作为一种新恶性肿瘤显像剂受到人们的普遍关注，采用＾９９ｍＴｃ－ＭＩＢＩ显像诊断多种恶性肿瘤成为国内外研究热点之一。本文对目前国外研究进展及存在的问题进行综述，以期对感兴趣的读者有所启发。     

99Tcm-MIBI SPECT-CT同机图像融合技术在乳腺肿瘤显像及淋巴结转移判断中的应用

目的 探讨99Tcm-MIBI SPECT-CT同机图像融合技术对于乳腺肿瘤显像及淋巴结转移判断的临床应用价值.方法 对80例女性乳腺肿块患者行99Tcm-MlBI乳腺及腋窝淋巴结平面显像及99Tcm-MIBI SPECT-CT显像.所有患者均有手术后病理检查结果做对照.结果 80例患者中SPECT-CT融合图像对乳腺癌诊断的灵敏度88.2%(45/51),高于平面显像的82.4%(42/51).两者差异有统计学意义(P<0.05).SPECT-CT融合图像对原发性乳腺癌诊断的特异度、准确度分别为93.1%(26/29)、90%(71/80),均高于平面显像的79.3%(23/29)、81.3%(65/80).平面显像检测腋淋巴结的灵敏度77.2%(17/22),特异度86.2%(25/29),准确度82.4%(42/51),SPECT-CT融合图像检测腋淋巴结的灵敏度81.8%(18/22),特异度89.7%(26/29),准确度86.3%(44/51).两者比较差异无统计学意义(P0.05).结论 SPECT-CT图像融合显像技术在乳腺癌诊断的灵敏度、特异度和准确度均高于平面显像.在乳腺癌腋窝淋巴结转移探测方面SPECT/CT图像融合与平面显像相似.     

99Tcm-MIBI SPECT-CT同机图像融合技术在乳腺肿瘤显像及淋巴结转移判断中的应用

目的 探讨99Tcm-MIBI SPECT-CT同机图像融合技术对于乳腺肿瘤显像及淋巴结转移判断的临床应用价值.方法 对80例女性乳腺肿块患者行99Tcm-MlBI乳腺及腋窝淋巴结平面显像及99Tcm-MIBI SPECT-CT显像.所有患者均有手术后病理检查结果做对照.结果 80例患者中SPECT-CT融合图像对乳腺癌诊断的灵敏度88.2%(45/51),高于平面显像的82.4%(42/51).两者差异有统计学意义(P<0.05).SPECT-CT融合图像对原发性乳腺癌诊断的特异度、准确度分别为93.1%(26/29)、90%(71/80),均高于平面显像的79.3%(23/29)、81.3%(65/80).平面显像检测腋淋巴结的灵敏度77.2%(17/22),特异度86.2%(25/29),准确度82.4%(42/51),SPECT-CT融合图像检测腋淋巴结的灵敏度81.8%(18/22),特异度89.7%(26/29),准确度86.3%(44/51).两者比较差异无统计学意义(P0.05).结论 SPECT-CT图像融合显像技术在乳腺癌诊断的灵敏度、特异度和准确度均高于平面显像.在乳腺癌腋窝淋巴结转移探测方面SPECT/CT图像融合与平面显像相似.     

99Tcm-MIBI SPECT-CT同机图像融合技术在乳腺肿瘤显像及淋巴结转移判断中的应用

目的 探讨99Tcm-MIBI SPECT-CT同机图像融合技术对于乳腺肿瘤显像及淋巴结转移判断的临床应用价值.方法 对80例女性乳腺肿块患者行99Tcm-MlBI乳腺及腋窝淋巴结平面显像及99Tcm-MIBI SPECT-CT显像.所有患者均有手术后病理检查结果做对照.结果 80例患者中SPECT-CT融合图像对乳腺癌诊断的灵敏度88.2%(45/51),高于平面显像的82.4%(42/51).两者差异有统计学意义(P<0.05).SPECT-CT融合图像对原发性乳腺癌诊断的特异度、准确度分别为93.1%(26/29)、90%(71/80),均高于平面显像的79.3%(23/29)、81.3%(65/80).平面显像检测腋淋巴结的灵敏度77.2%(17/22),特异度86.2%(25/29),准确度82.4%(42/51),SPECT-CT融合图像检测腋淋巴结的灵敏度81.8%(18/22),特异度89.7%(26/29),准确度86.3%(44/51).两者比较差异无统计学意义(P0.05).结论 SPECT-CT图像融合显像技术在乳腺癌诊断的灵敏度、特异度和准确度均高于平面显像.在乳腺癌腋窝淋巴结转移探测方面SPECT/CT图像融合与平面显像相似.     

Development of fluorescent in vivo imaging probes for cancers

Optical techniques are emerging as powerful new modalities for molecular imaging in vivo. Although they are less sensitive and poor in resolution, they have an advantage over other modalities such as PET, CT, and MR in terms of safety, easiness, economy, speed and especially multiplicity. Thus, they are expected to be modalities for the next generation to functionally image diseases. Because of low tissue penetrance, high dispersion and influence of autofluorescence, their application to in vivo imaging had not been successful until recently. Recent technological progression in an ultrasensitive charge-coupled device(CCD)camera and improvement of software have encouraged progress in optical in vivo imaging techniques. Furthermore, the recent advances in fluorescent imaging have been accelerated by near-infrared(NIR)dyes, which have higher tissue-penetrance in addition to lower autofluorescence from nontarget tissue. Studies with optical technologies will show further advances in molecular imaging and clinical medicine by themselves and by fusing with other modalities. This review gives an overview of recent progress in fluorescent in vivo imaging techniques and introduces our study for developing NIR fluorescent probes specific to tumor hypoxia, a hallmark of malignant tumors.     

PET and functional anatomic fusion imaging in lung and breast cancers

Metabolic imaging with PET is an established adjunct to anatomic imaging methods in patients with bronchial and breast cancers. The functional anatomic fusion imaging with PET/CT can further improve staging and restaging of patients. PET/CT can influence the planning of a surgical intervention or radiation treatment at staging and in patients with suspected locoregional recurrence. The use of a PET/CT whole body imaging protocol may identify extended disease earlier than conventional imaging methods and thus influence treatment decisions.     

Computer applications in radionuclide imaging

Computers for display, data manipulation, quantitation, diagnoses, and tomography offer the potential of improving the diagnostic efficacy of radionuclide imaging procedures. Although one may legitimately take issue over the question of expense vs. results using present computer systems and techniques, it remains an undeniable fact that if the demand for quantitative information and its manipulation increases, the computer must eventually come to play a central role in nuclear medicine. Indeed, as the phenomena taken under study increase in complexity, perhaps evolving into multiparameter studies, the computer will necessarily be required to present these data in a form meaningful to the physician. This refinement of technique is readily applicable to oncological studies.     

120例乳腺癌骨转移核素显像特点分析

目的探讨乳腺癌骨转移患者骨显像的特点及规律.方法 120例乳腺癌患者做全身骨核素显像.结果 120例乳腺癌患者中有58例骨显像异常,结合临床及X线检查诊断为骨转移,骨转移发生率为48.3%.其中27例年龄≤40岁乳腺癌患者骨转移8例,骨转移发生率为29.6%;93例年龄>40岁乳腺癌患者骨转移50例,骨转移发生率为53.8%,年龄>40岁的乳腺癌患者骨转移发生率明显增加(P<0.05).58例骨转移患者中49例为多发病灶(占84.5%),9例为单发病灶(占15.5%),每例患者的平均病灶数为4.83个.骨转移的部位以胸部为多见,其余依次为脊柱、骨盆、肢体和颅骨.结论乳腺癌骨转移发生率很高,骨转移的发生有一定的规律及特点,核素全身骨显像对于临床诊断分期及治疗决策有一定的意义.     

Contralateral breast cancers following treatment for initial breast cancers in women

The risk of a second primary cancer arising in the contralateral breast following treatment of an initial breast cancer was evaluated for 1,630 women whose first breast cancers were diagnosed and treated at University of California at Los Angeles between 1955 and 1979. Based on follow-up data ranging from 5 to 30 years, the rate of development of nonsimultaneous contralateral breast cancers was slightly in excess of 2.5 per 1,000 person-years at risk. There was no detectably significant difference in the frequency of second primary cancers related to the type of treatment of the first cancers, whether that was surgery, radiation therapy, or surgery plus radiation therapy.     

Potential limits of physical examination and breast self-examination in detecting small cancers of the breast. An unselected population-based study of 1302 cases

Neither a change in the average or median size of breast cancers, nor in the extent of axillary lymph node involvement, was seen in a total, unselected population study before and after an intensive public and professional education project in San Diego County. Comparison of these data with those from the Breast Cancer Detection Demonstration Project lends strong support for the greatly increased use of mammography if it is to be possible to detect the smaller, more curable cancers of the breast.     

Rim enhancement of breast cancers on contrast-enhanced MR imaging: Relationship with prognostic factors

BACKGROUND: There is little evidence regarding associations between magnetic resonance imaging (MRI) features and other important histopathological prognostic factors of breast cancer. The purpose of our study was to investigate the relationship between rim enhancement on MRI and common histopathological prognostic factors of breast cancers. METHODS: We reviewed the contrast-enhanced MR images of 106 consecutive women with histopathologically verified invasive breast carcinomas. Three radiologists assessed the images of each lesion for the presence of rim enhancement on early and delayed images, which were classified into four patterns. Statistical analyses were performed to explore the associations of these patterns with common histopathological prognostic factors and patient age. RESULTS: Positive ratios of lymph node metastasis and blood vessel invasion and negative ratios of hormone receptors were higher in the invasive cancers with rim enhancement than those without rim enhancement. Rim enhancement was more frequent in invasive ductal cancers with a higher histological grade and larger invasive cancers. The pattern of rim enhancement with centripetal progression showed a significantly increased risk of lymph node metastasis and was associated with a larger size of invasive lesion when compared with the other patterns. Invasive cancers with rim enhancement and little change between the early and delayed images and with centrifugal progression showed significantly less hormone receptor positivity than those without rim enhancement. CONCLUSIONS: Rim enhancement patterns of breast cancers on contrast-enhanced MRI are related to common histopathological prognostic factors and these patterns may be valuable in the preoperative evaluation of breast cancers.     

Synchronous bilateral breast cancers

In application of mammography and aiming biopsy, synchronous carcinoma of contralateral breast may be detected in 2.4% of cases, on the average, 3 years earlier than by clinical examination only. Increased proliferation of contralateral breast tissue (a factor contributing to tumor development) is not a pathognomonic symptom since proliferation rate in ductal and lobular tissues decreases with age and in menopause. At least half metachronous carcinomas of the second breast should be considered synchronous ones overlooked in the course of primary treatment.