~(99)Tc~m-甲氧基异丁基异腈SPECT评价非小细胞肺癌化疗疗效

目的 探讨~(99)Tc~m-氧基异丁基异腈(~(99)Tc~m-MIBI)SPECT评估非小细胞肺癌(NSCLC)化疗疗效的价值.方法 71例NSCLC患者根据胸部CT分为化疗有效组(完全缓解+部分缓解)和无效组(病情稳定+疾病进展),于化疗前行~(99)Tc~m-MIBI SPECT,静脉注射~(99)Tc~m-MIBI 740 MBq后10～30 min及2～3 h分别行早期及延迟显像,在~(99)Tc~m-MIBI显像图上用感兴趣区(ROI)的方法勾画出病灶,然后选取镜像ROI于健侧肺的相应部位,由此分别获得早期相肿瘤,正常肺组织摄取比值(ER)和延迟相肿瘤/正常肺摄取比值(DR),并计算滞留指数(RI).采用t检验及秩和检验分析化疗有效组与化疗无效组ER、DR和RI之间的差别.结果 ~(99)Tc~m-MIBI显像结果中,化疗有效组的ER、DR分别为2.39±0.21、2.50±0.19,均显著高于化疗无效组的1.89±0.19、2.05±0.21,统计学差异有意义(t=8.311、8.480,P＜0.05).化疗有效组的RI中位值为6.63%,高于化疗无效组的5.13%,统计学差异有意义(Z=2.416,P＜0.05).结论 ~(99)Tc~m-MIBI显像在评估NSCLC化疗疗效方面具有重要的临床价值.     

^99mTc-MIBI甲状腺显像半定量分析鉴别甲状腺结节的价值

目的评价99mTc-MIBI甲状腺显像半定量分析法鉴别甲状腺结节的价值.材料和方法36例Na99mTcO4甲状腺显像为单发"冷结节"患者,行99mTc-MIBI甲状腺双时相显像,分别计算15和120min甲状腺结节摄取比值(ER、DR),以良性结节组的DR均值+标准差(0.90+0.21)为诊断恶性病变的阈值.结果手术证实良性病变22例,ER与DR值分别为0.89±0.33、0.90±0.21,恶性病变14例,ER和DR值分别为1.16±0.51、1.34±0.64,ER值两组间比较无差异(p＞0.05),DR两组间比较有显著性差异(p＜0.01).99mTc-MIBI甲状腺显像DR值诊断良恶性病变的灵敏度85.7%,特异性86.4%,阳性预测值80.0%,阴性预测值90.5%.结论99mTc-MIBI甲状腺显像半定量分析能较好的鉴别甲状腺结节的性质,DR比ED更有价值.     

肺良恶性病变99Tcm-MIBI显像与肺癌DNA含量分析

目的探讨99Tcm-甲氧基异丁基异腈(MIBI)诊断肺部良恶性病变的价值及肺癌摄取99Tcm-MIBI比值与癌细胞DNA含量的关系.方法 27例肺良性病变及46例肺恶性病变患者均行99Tcm-MIBI早期和延迟肺显像,并测定病变靶/非靶(T/NT)摄取比值(UR).对肺恶性病变组中的24例手术标本进行DNA含量测定,计算DNA含量指数(DI),并与术前99Tcm-MIBI UR进行相关分析.结果良性病变组延迟UR为1.13±0.19,肺癌组为1.45±0.21,两者比较P<0.01;延迟相目测观察及UR诊断肺癌的灵敏度、特异性、准确性分别为91.3%,55.6%,78.1%和80.4%,62.9%,73.9%;正常支气管黏膜上皮(二倍体)细胞DI=0.68±0.21,肺腺瘤DI=0.51±0.27,肺癌组DI=1.43±0.33(与前两者比较,P均<0.01).肺癌组异倍体细胞出现率为83.3%.肺癌组DI与延迟UR的r为0.32.结论 99Tcm-MIBI不是理想的鉴别诊断肺部良恶性病变的显像剂;延迟相UR有可能间接反映癌细胞DNA含量.     

99Tcm-HL91肺癌显像的临床应用

目的 探讨~(99)Tc~m-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮后(HL91)显像对肺部肿瘤定性的价值。方法 对32例肺部肿瘤患者注射~(99)Tc~m-HL91后10 min,2、4 h进行显像,将显像结果分为~(99)Tc~m-HL91显像阳性组和阴性组,对~(99)Tc~m--HL91显像阳性患者利用感兴趣区(ROI)技术分别勾画各时相肿瘤(T)与对侧相应部位(N)ROI,计算T/N比值。所有患者均经手术病理检查证实,将显像结果与CT和病理检查结果对照。结果 ~(99)Tc~m-HL91显像灵敏度为82.6％,特异性为100％,准确性为87.5％。CF灵敏度为69.6％,特异性为100％,准确性为78.1％。CT提示肺癌16例中,~(99)Tc~m-HL91显像均阳性。随~(99)Tc~m-HL91显像时间延长,T/N比值增高,10 min为1.620±0.320,2 h为1.737±0.416,4 h为1.909±0.491。10 min与2 h差异无显著性(P>0.05),10 min与4 h差异有显著性(P<0.05)。肺腺癌组与肺鳞癌组各时相T/N比值差异无显著性(P>0.05)。结论 ~(99)Tc~m-HL91显像判断肺肿瘤良恶性有较好价值。     

99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值

目的探讨99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结的诊断价值.方法以术后病理诊断为依据,对57例肺部占位性病变患者的99Tcm-MIBI SPECT/CT显像结果分良性和肺癌两组进行分析,计算其5min、60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR);以肺部良性病灶组UR值的+1s为诊断阈值,对肺癌原发灶及其转移淋巴结的诊断效能进行评价.结果17例肺部良性病灶组其5min和60min平面以及60min SPECT/CT三维融合断层显像的摄取比值(UR)分别为1.05±0.16、0.97±0.22、1.51±0.39,而40例肺癌组其UR值分别为1.41±0.22、1.37±0.23、2.18±0.61同组两时相比较P>0.05,而组间两时相比较P<0.05.以良性结节+1s为诊断阈值,99Tcm-MIBI对肺癌诊断的灵敏度、特异度和准确度分别为90%(36/40)、82.35%(14/17)和87.72%(50/57);假阳性率和假阴性率分别为17.65%(3/17)和10%(4/40);阳性预测值和阴性预测值分别为 92.31%(36/39)和77.78%(14/18).40例恶性病变患者共检出转移淋巴结19个,其CT/SPECT断层融合图像的UR值为1.82±0.37.结论99Tcm-MIBI SPECT/CT同机融合断层显像对肺癌及其转移淋巴结具有较高的诊断价值.     

99Tcm-PPM及99Tcm-MIBI肺显像诊断原发性肺癌

目的 探讨99Tcm－培普利欧霉素（PPM）及99Tcm-甲氧基异丁基异腈（MIBI）肺显像诊断原发性肺癌的临床价值。方法 对28例临床诊断肺肿瘤患者进行99Tcm-PPM ey 99T0-MIBI肺肿瘤显像并进行比较。结果 肺癌与良性病变对99T -PPMey 99T-MIBI观的摄取差异有显著性（P＜0．01）,以肺癌晚期显像摄取比值（T／NT,X－S）作为判断良恶性阈值,99Tcm-PPM及99Tcm-MIBI对肺癌诊断的灵敏度,准确性分别为90％,89．3％,和80％,82．1％,两者结合显像阳性率为95％,病灶对放射性药物的摄取与肿瘤大小无明显相关（P＞0．05）,结论 99Tcm-PPM ey 99T-MIBI肺显像对肺癌的诊断,鉴别诊断有一定的临床价值。两者联合应用可提高肺癌的阳性检出率,单独使用99Tcm-PPM优于99Tcm-MIBI。     

肺肿瘤99Tcm-N(NOEt)2SPECT显像与P-糖蛋白和增殖细胞核抗原表达的关系

目的探讨肺肿瘤99Tcm-氮-二(N-乙基-N-乙氧基二硫代氨基甲酸盐)[N(NOEt)2]SPECT显像病变部位与对侧对应正常肺组织放射性比值(T/N)与术后病理组织中P-糖蛋白(P-gp)和肿瘤增殖细胞核抗原(PCNA)表达间的关系.方法对22例(20例为术前未经药物治疗的肺癌,2例为肺良性病变)患者进行手术,取肿瘤标本,经常规石蜡切片,用免疫组织化学技术检测病变组织P-gp和PCNA表达,并与术前99Tcm-N(NOEt)2 SPECT显像T/N比值对比.结果22例患者中,20例肺恶性肿瘤99Tcm-N(NOEt)2 SPECT显像均表现为异常放射性浓聚,T/N比值为1.29±0.04;2例肺良性病变99Tcm-N(NOEt)2显像T/N比值为1.08±0.13,其中1例为假阳性.22例患者除1例肺腺癌仅P-gp表达阴性外,其余患者P-gp、PCNA均呈阳性表达.22例患者99Tcm-N(NOEt)2SPECT延迟显像T/N比值与术后病理组织中P-gp和PCNA表达程度均无关(r值分别为0.123和-0.145,P均＞0.05,双侧),且病理组织中P-gp与PCNA表达程度也无关(r=0.062,P＞0.05,双侧).结论肿瘤细胞摄取99Tcm-N(NOEt)2与其P-gp和PCNA表达程度无关.     

肺肿瘤99Tcm-N(NOEt)2 SPECT显像研究

目的 探讨~(99)Tc~m-氮-二(N-乙基-N-乙氧基二硫代氨基甲酸盐)[N(NOEt)_2]SPECT显像诊断肺肿瘤的临床价值。方法 对38例临床疑肺肿瘤患者行~(99)Tc~m-N(NOEt)_2 SPECT显像,并与手术、病理检查结果对照。结果 38例疑肺肿瘤患者经病理检查或临床随访证实肺恶性肿瘤29例,肺良性肿瘤或病变9例。29例肺恶性肿瘤有31个病灶,~(99)Tc~m-N(NOEt)_2 SPECT显像示异常28个,正常3个;9例肺良性肿瘤或病变有9个病灶,显像示异常3个,正常6个。~(99)Tc~m-N(NOEt)_2 SPECT显像诊断肺恶性肿瘤的灵敏度为90.32％,特异性为66.67％,阳性预测值为90.32％,阴性预测值为66.67％,假阳性率为33.33％,假阴性率为9.68％,准确性为85.00％,阳性似然比为2.71,阴性似然比为0.15。9例肺良性肿瘤或病变患者病变部位与对侧对应正常肺组织放射性比值(T/N)为1.08±0.08,明显低于29例肺恶性肿瘤(1.30±0.19,t=3.38,P<0.01)。结论 ~(99)Tc~m-N(NOEt)_2 SPECT显像在肺肿瘤显像诊断中有一定的临床价值。     

~(99)Tc~m-HL91乏氧细胞分子显像对甲状腺冷结节的诊断价值

目的 :探讨99Tcm-HL91乏氧细胞分子显像对甲状腺冷结节的诊断价值。方法 :对30例99TcmO4-甲状腺扫描提示为冷结节的患者术前行99Tcm-HL91早(10 min)、中(2 h)、晚(4 h)三时相显像,对显像结果进行定性和半定量分析,并对照病理结果。30例中,经病理或细针穿刺活检证实恶性病变18例,良性病变12例。结果 :根据病理检查结果 ,99Tcm-HL91乏氧细胞定性诊断的灵敏度、特异度及准确度分别为88.9%(16/18)、83.3%(10/12)、86.7%(26/30)。半定量分析:延迟4 h诊断的灵敏度、特异度及准确度分别为94.4%(17/18)、91.7%(11/12)、93.3%(28/30);良性组与恶性组三时相的靶本比值(T/N)、早期摄取比值(ER)、延迟2 h摄取比值(DR1)、延迟4 h摄取比值(DR2)差异均有统计学意义,良性组与恶性组的延迟2 h滞留指数(RI1)差异无统计学意义,延迟4 h滞留指数(RI2)差异有统计学意义。结论:99Tcm-HL91乏氧细胞分子显像对甲状腺孤立冷结节良恶性的鉴别诊断有一定的临床价值;半定量分析较定性分析更能准确鉴别结节性质;延迟4 h显像较2 h更能提高诊断的灵敏度、特异度和准确度。     

用受试者工作特征曲线分析99Tcm-MIBI显像对甲状腺冷结节的诊断效能

目的探讨受试者工作特征（ROC）曲线分析99^Tc^m-MIBI显像对甲状腺冷结节的诊断效能。方法68例99^Tc^mO4^-甲状腺显像为单发冷结节的患者，行99^Tc^m-MIBI甲状腺显像，分别计算肿瘤和对侧正常甲状腺组织（T／N）15min（ER）和120min（DR）摄取比值，以TIN的DR=0．8作为诊断恶性病变的阈值。同时还计算肿瘤和颌下腺（T／S）、肿瘤和心脏（T／n）ER、DR，用ROC曲线分析法找出上述指标对甲状腺癌诊断的最佳阈值。结果经活组织检查或手术病理检查证实良性病变60例，恶性病变8例。半定量分析99^Tc^m-MIBI显像的灵敏度、特异性和准确性分别为100．0％、76．7％和79．4％，从ROC曲线的界值点找到DR最佳界点（TIN=0．995、T／S=0．995、T／H=1．005），以其作为诊断良恶性的阈值，三者的灵敏度分别为100．0％、87．5％、75．0％，特异性各为90．0％、85．0％、83．3％，其曲线下面积（AUC）分别为0．949，0．876，0．867，均大于相应的ER AUC。TIN阈值0．8和0．995对甲状腺癌诊断结果差异有统计学意义（χ^2=6．125，P〈0．05）。结论ROC曲线分析法能提高99^Tc^m-MIBI对甲状腺结节的诊断效能。     

Differentiation of infiltrates between lung cancer and noncancerous lung disease by 123I-IMP lung imaging

Lung imaging with N-isopropyl-p-123I-iodoamphetamine (123I-IMP) was performed to estimate the pulmonary lesion imaging findings in 3 patients with bronchogenic carcinoma (2: bronchioloalveolar carcinoma and 1: adenocarcinoma) and 18 with noncancerous lung diseases (10: bacterial pneumonia, 1: viral pneumonia, 1: aspiration pneumonia, 1: radiation pneumonitis, 4: pulmonary tuberculosis and 1: obstructive pneumonitis due to an endobronchial lipoma) at 30 min and 4 hr after i.v. injection of 111 MBq of 123I-IMP. These patients all exhibited infiltrates only in the chest radiograms. Decreased uptake of 123I-IMP was observed in the cancerous infiltrating lesions in 3 patients with bronchogenic carcinoma at 30 min and 4 hr, while the uptake of 123I-IMP was normal or increased at 30 min and intense at 4 hr in all 18 noncancerous infiltrating lesions. Therefore 123I-IMP lung imaging can be used to differentiate bronchogenic carcinoma from noncancerous lung disease in patients who exhibit infiltrates only in the chest radiograms.     

Prospective comparison of MR lung perfusion and lung scintigraphy

This study attempted to assess the accuracy and potential of lung magnetic resonance (MR) perfusion imaging compared with perfusion scintigraphy in the evaluation of patients with suspected lung perfusion defects. The technique, which uses an inversion recovery turbo-FLASH sequence with ultra-short TE (1.4 msec), was tested in 24 patients suspected clinically of having acute pulmonary embolism (n = 19) and in patients with severe pulmonary emphysema (n = 5). Perfusion lung scintigraphy was performed within 48 hours prior to the MRI examination in both groups of patients. The dynamic study was acquired in the coronal plane and consisted of 10 images of 6 slices (a total of 60 images per series). Gadopentetate dimeglumine (0.1 mmol/kg) was manually injected as a compact bolus during the acquisition of the first image. Three senior radiologists reviewed all unprocessed two-dimensional coronal sections. They were blinded to clinical data and other imaging modalities. For the three observers, the average sensitivity and specificity of MR were 69% and 91%, respectively. The overall agreement between MR and scintigraphy appears to be good, with a good correlation between the two modalities (kappa = 0.63). However, the data showed variability depending on the location of the perfusion defect, with higher accuracy in the upper lobes. The agreement between MR perfusion and scintigraphy appears to be moderate in the left inferior lobe (kappa = 0.48). The data showed an overall good interobserver agreement (kappa = 0.66). MR perfusion of the lung is a promising technique in detecting lung perfusion defects.     

CT引导下经皮肺穿刺活检对肺部病变的诊断价值

目的 探讨CT引导下经皮肺穿刺活检的效果及临床价值.方法 回顾性分析60例行CT引导下经皮肺穿刺活检术患者的临床与影像资料.结果 60例患者中,57例经病理明确诊断,其中原发性肺癌47例(腺癌21例,鳞癌18例,小细胞癌3例,肺泡癌5例),转移性肺癌7例,结核3例.3例病理报告为慢性炎症,未做出明确诊断, 术后病理证实干酪性肺炎2例,真菌感染1例.60例患者穿刺成功率100.0%,诊断准确率95.0%,并发症发生率21.7%(气胸7例,占11.7%,出血5例,占8.3%,针道出血1例,占1.7%).结论 CT引导下经皮肺穿刺活检术是一种安全、准确、有较高临床应用价值的诊断和鉴别肺内病变的方法.     

123I-IMP clearance of the lung with diffuse lung disease

N-isopropyl-I-123-p-iodoamphetamine (123I-IMP) is taken up by the capillary endothelial cells during the first pulmonary pass and is released from the lung. To evaluate the effect of the 123I-IMP retention on diffuse lung disease, we studied prolonged 123I-IMP clearance from lung in 5 non-smoking control volunteers and 15 patients with various diffuse lung diseases. The time-activity curve for 60 min after the injection of 111 MBq of 123I-IMP was described as follows: C(t) = A1e-k1t + A2e-k1t (A1, A2: intercepts; K1, K2: slopes of the exponential components). 123I-IMP clearance was delayed in the patient group and K2 was significantly lower. There was a significant correlation between K2 and Ga-computer activity index on the 67Ga scintigraphy in the patient group. K2 was also correlated with %Dlco on the pulmonary function test. Our study suggests that the delayed clearance and retention of 123I-IMP in the diseased lung are influenced by the pathological activity in the lung lesion.     

超声引导经皮肺穿刺活检在肺外周型病变诊断中的价值

目的探讨超声引导下经皮肺穿刺活检对肺外周型病变定性诊断的应用价值。方法在超声引导下对80例胸部影像学检查显示的肺周边型肿块需明确诊断者行超声引导下经皮肺穿刺活检术。结果 80例病人均穿刺成功,成功率100%。病理诊断结果:恶性肿瘤64例,其中鳞癌38例,腺癌20例,大细胞癌2例,小细胞癌2例,恶性淋巴瘤1例,恶性间皮瘤1例;良性病变16例,其中良性错构瘤1例,结核8例,炎症7例。并发气胸、咯血各1例,并发症发生率为3%。结论超声引导下经皮肺穿刺活检术具有定位准确、操作简便、安全性好、并发症少及重复性强等优点,可作为肺外周型病变定性诊断的首选诊断方法。