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乳腺癌是女性发病率最高的恶性肿瘤。99Tcm-联胼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体(99Tcm-3PRGD2)是近年来人工合成的可用于乳腺癌分子显像的一种SPECT示踪剂。99Tcm-3PRGD2 SPECT/CT可用于早期诊断乳腺癌并进行准确的分期及分子分型,据此进行诊疗方案的选择,有助于降低患者的病死率,并提高患者的生活质量。笔者就99Tcm-3PRGD2 SPECT/CT在乳腺癌诊疗过程中的应用进展进行综述,并作出展望。 相似文献
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^99^Tc^m-硫胶体不同制备条件及注射部位对乳腺癌前哨淋巴结检出的影响 总被引:1,自引:0,他引:1
目的 观察99^Tc^m-SC不同配置条件及注射部位对乳腺癌前哨淋巴结(SLN)检出的影响,探讨进行乳腺癌SLN活检术(SLNB)的最佳方法.方法 制备99^Tc^m-SC时将煮沸时间分别控制在3 min(显像剂1)和5 min(显像剂2),分别测定显像剂1和显像剂2放置10 min、1h、2h和4h的放化纯及胶体大小分布.将147例乳腺癌患者用抽签法分成3组:A组40例,于乳晕周围乳腺组织内注射显像剂1;B组40例,于乳晕周围乳腺组织内注射显像剂2;C组67例,于肿块周围乳腺组织内注射显像剂2.所有患者均于术前0.5~1 h行SPECT/CT显像,并在肿块上方皮下注射蓝染料.比较3组患者腋窝及内乳SLN显像成功率及术中检出率.分别采用两独立样本t检验、单因素方差分析和r检验对相关数据进行统计学分析.结果 显像剂1和显像剂2的放化纯在放置10 min、1h、2h及4h时差异均无统计学意义(t=-0.267、-0.794、0.826和-0.977,均P>0.05);显像剂2与显像剂1相比,粒径<100nm的粒子所占百分比明显减少[(65.25±3.56)%与(73.72±2.36)%;t=6.436,P<0.05],平均有效粒径明显增大[(75.59±7.04) nm与(45.27±6.42) nm;t=7.315,P<0.05).3组患者内乳SLN的检出率分别为70.0% (28/40)、47.5% (19/40)和17.9% (12/67),差异有统计学意义(x2=29.525,P<0.05);3组患者腋窝SLN的检出率分别为100% (40/40)、95.0%(38/40)及97.0%(65/67),差异无统计学意义(r=2.686,P>0.05).结论 通过缩短煮沸时间减小99^Tc^m-SC胶体粒径,经肿瘤上方皮下注射蓝染料、乳晕周围乳腺组织内注射核素及SPECT/CT断层显像,可获得较好的乳腺癌腋窝和内乳SLN检出效果. 相似文献
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目的 评价SPECT/CT融合显像对^99Tc^m-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值.方法 对^99Tc^m-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异.结果 ①210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个(39.0%),良性病灶112个(53.3%),诊断准确率为92.4%(194/210),灵敏度为94.3%,特异度为91.1%,阳性预测值为88.2%,阴性预测值为95.7%.②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9%(94/97),肋骨最低,为83.7%(36/43),其差异有统计学意义(χ^2=7.81,P<0.05).结论 SPECT/CT同机融合显像能够对^99Tc^m-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低. 相似文献
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目的 合成新型凋亡显像剂^99Tc^m-半胱氨酸-膜联蛋白V(TP5-3),研究其在小鼠体内生物分布和药代动力学特点,探讨^99Tc^m-TP5-3 microSPECT/CT检测乳腺癌单次化疗后肿瘤早期细胞凋亡的可行性.方法 以直接还原法对TP5-3进行^99Tc^m标记,HPLC检测产物的标记率;进行正常小鼠体内^99Tc^m-TP5-3的生物分布及药代动力学研究.建立荷MDA-MB-231人乳腺癌裸鼠模型,取10只分为2组,化疗组单次腹腔内注射紫杉醇(每只40 mg/kg),对照组注射等体积生理盐水,48 h后由尾静脉注射37 MBq ^99Tc^m-TP5-3,进行microSPECT/CT图像采集,显像后立即处死、取材,比较2组肿瘤的放射性摄取(%ID/g)、T/NT(NT取肌肉);采用流式细胞术和病理学检测肿瘤凋亡细胞.采用单因素方差分析、两样本t检验和直线相关分析数据.结果^99Tc^m-TP5-3标记率>95%,室温放置4h放化纯仍保持在(96.0±1.5)%,稳定性好.正常小鼠注射显像剂后30 min肾脏放射性摄取最高[(8.48±1.07) %ID/g],其他脏器分布较少;血液清除快,注射后4h血液放射性摄取[(2.07±0.35) %ID/g]较注射后5 min[(13.74±4.21) %ID/g]减少了85%(F=11.310,P<0.05);显像剂主要浓聚于肾、肝和胃,经肾脏排泄.化疗后99^Tc^m-TP5-3 microSPECT/CT显像示化疗组T/NT为4.21±0.06,对照组T/NT仅1.57±0.67(f=12.820,P<0.05);化疗后生物分布实验示,化疗组肿瘤放射性摄取明显高于对照组,分别为(4.82±0.54) %ID/g和(1.44±0.38) %ID/g(t=0.679,P<0.05).肿瘤放射性摄取与流式细胞仪测定的凋亡细胞百分比呈正相关(r=0.985,P<0.05).HE染色示化疗后肿瘤组织有大量凋亡细胞,而对照组仅有少量.结论 ^99Tc^m-TP5-3标记方法简单,生物分布理想,具备优良的药代动力学特性;^99Tc^m-TP5-3 microSPECT/CT可用于早期检测荷乳腺癌裸鼠模型化疗后的肿瘤细胞凋亡水平. 相似文献
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目的:探讨99Tcm-tetrofosmin(99Tcm-TF)SPECT亲肿瘤显像诊断肺部肿瘤的临床价值。方法收集在我科进行99Tcm-TF肺亲肿瘤显像的患者41例;所有患者均在治疗前一周行胸部CT检查及99Tcm-TF SPECT肺亲肿瘤显像。对照最终结果,评价两种方法鉴别肺肿瘤病变性质的诊断效能。以肿瘤3 cm大小为界,分≥3 cm组和<3 cm组,评价99Tcm-TF SPECT显像在两组中的诊断效能。结果99Tcm-TF SPECT肺亲肿瘤显像的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为66.7%、35.7%、56.1%、66.7%和35.7%;CT肺扫描的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为92.6%、50.0%、78.0%、78.1%和77.8%。CT较99Tcm-TF SPECT的灵敏度(χ2=5.594, P<0.05)和准确率(χ2=4.473,P<0.05)高,而特异度两者间的差异无统计学意义,(χ2=0.583,P>0.05)。同时,肿瘤≥3 cm和<3 cm组中,99Tcm-TF检查肺肿瘤的灵敏度、特异度、准确率分别为78.9%、25.0%、69.6%和37.5%、40.0%、38.9%,而两组的特异度差异无统计学意义(χ2=0.28,P>0.05),灵敏度(χ2=4.352,P<0.05)和准确率(χ2=3.858,P<0.05)有差异。结论 CT对于肺癌诊断有一定的价值,相比而言,99Tcm-TF的诊断价值有限。临床医生在行该项检查之前需经过筛选才有可能提高其临床价值。 相似文献
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缺血心肌99Tcm-MIBI清除率变化的临床研究 总被引:1,自引:0,他引:1
目的 探讨缺血性心脏病(IHD)患者心肌99Tcm-甲氧基异丁基异腈(MIBI)早期、晚期清除率的变化及其评估缺血心肌细胞功能障碍的价值.方法 对临床诊断为IHD并满足冠状动脉三支主要分支狭窄均≥50%、除外心肌梗死的16例患者行99Tcm-MIBI静态平面及门控心肌灌注断层显像.用t检验比较99Tcm-MIBI早期(注药后90 min)、晚期(注药后4 h)清除率及左心室射血分数(LVEF)与健康对照组(10名)的差异,并对早期、晚期清除率与LVEF行直线相关分析.结果 IHD组早期、晚期心肌清除率及LVEF分别为(13.44±2.87)%、(19.24±4.71)%和(55.71±7.97)%,健康对照组分别为(17.32±4.92)%、(15.23±3.81)%和(67.75±5.43)%,2组相比差异均有统计学意义(t值分别为2.384,-2.246及-4.418,P均<0.05).早期及晚期清除率与LVEF不具有相关性,r值分别为-0.212(P>0.05)及0.352(P>0.05).结论 IHD患者心肌99Tcm-MIBI清除率异常可反映缺血引起的细胞功能损伤. 相似文献
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467例乳腺癌患者^99Tc^m-利妥昔单抗前哨淋巴结显像结果分析 总被引:1,自引:0,他引:1
目的探讨应用前哨淋巴结(SLN)显像剂^99Tc^m-利妥昔单克隆抗体(简称利妥昔单抗,美罗华)进行乳腺癌SLN活组织检查(SLNB)的可行性与可靠性,以及不同因素对SLN显像及SLNB的影响。方法467例乳腺癌患者在超声引导下于乳腺肿块周围及肿块表面皮下注射^99Tc^m-利妥昔单抗后行SLN显像。术中凭显像结果行腋窝区SLNB,将切取的SLN行常规HE染色及免疫组织化学检查。结果SLN显像成功率99.14%(463/467),共显示SLN837枚,人均1.79枚(837/467),分布于腋窝区、内乳区、乳腺组织内及锁骨下区。腋窝区SLNB成功率99.57%(465/467),手术共探测到SLN1182枚,人均2.53枚。病理检查发现腋窝SLN有转移者131例,转移SLN194枚。其中1例单纯由免疫组织化学法发现微小转移灶。患者年龄、显像时间、病理类型、临床分期、显像前是否行乳腺肿块手术切取活组织检查对SLN显影率、SLNB成功率及SLN转移率均无影响。不同病理类型及临床分期的患者其SLN转移率的差异有统计学意义(χ^2=14.134,29.184,P均〈0.05)。结论应用^99Tc^m-利妥昔单抗行乳腺癌SLN显像及SLNB成功率较高,具有较好的临床应用前景。 相似文献
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Thomas Wendler Ken Herrmann Andreas Schnelzer Tobias Lasser Joerg Traub Olivier Kutter Alexandra Ehlerding Klemens Scheidhauer Tibor Schuster Marion Kiechle Markus Schwaiger Nassir Navab Sibylle I. Ziegler Andreas K. Buck 《European journal of nuclear medicine and molecular imaging》2010,37(8):1452-1461
Purpose
Freehand SPECT is a 3-D tomographic imaging modality based on data acquisition with a hand-held detector that is moved freely, in contrast to conventional, fixed gamma camera systems. In this pilot study, the feasibility of freehand SPECT for 3-D lymphatic mapping in breast cancer was evaluated.Methods
A total of 85 patients (age: 29–88 years) with an initial diagnosis of invasive breast cancer and no clinical evidence of nodal involvement prospectively underwent sentinel lymph node (SLN) biopsy. Preoperative lymphatic mapping (35–87 MBq 99mTc-Nanocoll) included tomographic imaging with a SPECT/CT device (Siemens Symbia T6) serving as reference. Initially, the freehand SPECT approach was assessed in a pilot study consisting of 50 patients. The quality of each freehand SPECT acquisition was assessed and ranked as good, intermediate or poor. In another series comprising a further 35 patients (validation study), a guidance system for the acquisition was implemented based on the results of the pilot study, ensuring acquisitions with good quality. For 3-D tomographic image reconstruction, ad hoc models and iterative reconstruction algorithms were used in all 85 patients. To allow for adequate comparison, SPECT/CT data and freehand SPECT data were registered within the same coordinate system.Results
In the pilot study, freehand SPECT enabled mapping of 24 of 83 SLNs in 20 of 44 patients (3 dropouts, 3 patients without SLN either in SPECT/CT or in freehand SPECT). Using SPECT/CT as reference, the accuracy of freehand SPECT was 77.8% (7/9 nodes) in scans with good quality, while for intermediate and poor quality scans, the accuracy was reduced to 34.3 and 12.8%, respectively. In the validation study, quality feedback improved the results significantly and freehand SPECT enabled the mapping of at least one SLN in 87.5% of the patients (28/32 ? 3 dropouts). Compared to the reference method, freehand SPECT showed a sensitivity of 83.3% (35/42 nodes). False-negative findings were related to insufficient scanning time, insufficient coverage of the axillary region, close proximity of the SLN to the injection site and low tracer uptake in the SLNs.Conclusion
In this preliminary study, we could demonstrate that 3-D localization of SLNs is feasible using freehand SPECT technology. Prerequisites for acquisition of a good scan quality, most likely allowing precise SLN mapping, have been defined. This approach has high potential to allow image-guided biopsy and further standardization of SLN dissection, thus bringing 3-D nuclear imaging into the operating room. 相似文献16.
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Chang Ju Na Jeonghun Kim Sehun Choi Yeon-Hee Han Hwan-Jeong Jeong Myung-Hee Sohn Hyun Jo Youn Seok Tae Lim 《Nuclear Medicine and Molecular Imaging》2015,49(1):26-32