核医学显像在急诊医学中的应用

目的:探讨核素显像在急诊显像中的应用价值。方法:105例急诊核素显像分为4组,A组78例行急诊心肌显像;B组5例行急诊脑显像;C组15例行急诊胃肠道出血显像;D组7例行急诊大血管显像。结果:78例急诊心肌显像中,阳性74例;阴性4例;5例急诊脑显像全部阳性;15例胃肠道出血显像中6例阳性,9例阴性;7例大血管显像全部阳性。结论:核素显像在急诊医学中能发挥重要作用。     

核医学显像在肿瘤心脏病学中的研究进展

近年来,肿瘤心脏病学成为识别、预防和治疗肿瘤本身及肿瘤治疗引发的心血管并发症的一个新兴领域,并随着患者例数的增加逐渐受到人们的关注。核医学显像在肿瘤心脏病学的研究中发挥了重要作用,其可以帮助早期准确地诊断及监测肿瘤治疗引发的心脏毒性,有效改善肿瘤患者的预后。基于此,笔者对核医学显像在肿瘤心脏病学中的研究进展进行综述。     

正电子断层显像在临床心脏核医学的应用

正电子断层显像(PET)及其放射性标记底物为体内生化研究开辟了一个新领域。在心脏学,~(13)NH_3和~(82)Rb有助于检测心肌血流,~(18)F-FDG和~(11)C-软脂酸可分别用于临床检测心肌葡萄糖和脂肪酸代谢。PET的一项主要任务将是确证方法的可信并将这些方法转化为临床可广泛应用的单光子发射示踪剂。     

Annexin V在核医学细胞凋亡显像中的应用

细胞凋亡是细胞内在的决定生物体发育和组织平衡的一个重要机理，如果这个受到严密调控的细胞自杀机理发生功能障碍或失去控制，将导致肿瘤、神经退行性疾病或许多其他的病理性改变。细胞凋亡的测定，已成为评估肿瘤疗效的一项新指标，进一步提高肿瘤细胞凋亡与增殖的比值是临床化疗的新要求；此外，细胞凋亡实验也是筛选抗癌新药的快速、有效方法。     

多巴胺系统核医学显像在帕金森病的诊断和治疗中的应用

帕金森病(Parkinson disease,PD)是一种慢性神经退行性疾病,主要病理变化是黑质致密部多巴胺能神经元变性坏死,进而导致因黑质纹状体系统内多巴胺减少而出现各种临床改变的疾病。多巴胺系统核医学显像就是根据这些病理变化,应用特异性的放射性显像剂来观测多巴胺系统的功能改变,对疾病进行早期诊断,监测疾病进展及各种治疗的疗效,并为进一步认识疾病提供有效的研究工具。1多巴胺系统核医学显像常用显像剂多巴胺系统神经功能的实现主要是通过神经传导来完成的,因此神经突触标记物成为多巴胺系统核医学显像的靶点。根据靶点的位置,大体上把…     

Impact of Emergency Medicine Point-of-Care Ultrasound on Radiology Ultrasound Volumes in a Single Pediatric Emergency Department

PurposePoint-of-care ultrasound (POCUS) is growing, but few data exist regarding its effects on radiology ultrasound (Rad US) volumes. The authors studied changes in Rad US ordered by emergency medicine (EM) as POCUS began and grew at their pediatric hospital.MethodsThis retrospective study included EM POCUS and EM-ordered Rad US volumes between 2011 and 2017, during three 2-year intervals: before POCUS, early POCUS, and expanded POCUS. Changes in overall Rad US and POCUS volumes per visit during these intervals were studied. Changes in skin and soft tissue infection (SSTI) US per SSTI visit, an examination performed diagnostically by both radiology and EM, were also assessed. Volume differences were examined using the Mann-Whitney U test (significance threshold, P < .05), and process control charts were used to identify nonrandom variations.ResultsThe study included 49,908 Rad US and 2,772 POCUS examinations during 647,890 emergency department visits. Rad US volumes per visit remained unchanged during early POCUS (P = .858) but increased with expanded POCUS (P < .005). A transient nonrandom increase in Rad US occurred as POCUS began. SSTI Rad US per SSTI visit significantly increased (P < .001) during early POCUS but did not change with expanded POCUS (P = .143). An SSTI management pathway in the emergency department before expanded POCUS may have affected ordering. Other variation occurred in proximity to practice changes and seasonal patterns.ConclusionsRad US overall and specifically for SSTI increased or remained stable during the introduction and growth of EM POCUS. Rather than decreasing Rad US, EM POCUS had a complementary role.     

99mTc-MIBI心肌灌注显像诊断小儿病毒性心肌炎的临床价值

目的探讨和评价99mTc-MIBI心肌灌注显像诊断小儿病毒性心肌炎的临床价值.材料与方法73例临床诊断为病毒性心肌炎和58例非病毒性心肌炎患儿空腹静息下静脉注射111～740MBq99mTe-MIBI,60min后行常规体位平面/断层显像.结果73例临床确诊病毒性心肌炎患儿中有50例在不同体位的平面影像(36例)、断层影像(2例)和平面+断层影像(12例)有1～3节段呈花斑样改变,其敏感性为68.5%.非病毒性心肌炎组58例,8例有花斑样改变,假阳性率为13.8%,特异性86.2%,诊断准确率为76.3%.结论99mTc-MIBI心肌灌注显像不失为一种诊断小儿病毒性心肌炎的简便、无创、经济而又有较高的辅助诊断价值的检查方法.     

Optimizing Imaging Clinical Decision Support: Perspectives of Pediatric Emergency Department Physicians

PurposeThe aim of this study was to solicit perspectives of pediatric emergency department physicians (PEDPs) to determine how software-based clinical decision support mechanisms (CDSMs) may integrate with existing imaging clinical decision support (ICDS) to optimize imaging utilization at the authors’ institution.MethodsThrough qualitative interviews, the authors explored how PEDPs define ICDS, how they seek and obtain radiologist consultation, and how the rollout of CDSMs at the institution may potentially affect clinical practice. Codes were developed and explicitly defined through literature review and analysis of a subset of interviews. Coding results informed thematic categories used to develop an explanatory model.ResultsAnalysis revealed three major thematic categories: (1) common influences on the decision process, (2) radiology consultation experience, and (3) PEDPs’ perspectives on CDSMs. PEDPs described radiologist consultation as a valuable component of ICDS but reported difficulty in coordinating imaging strategies with radiologists and other subspecialists. PEDPs described the exchange of ideas as especially worthwhile for scenarios that do not fit neatly into clinical pathways. Barriers to radiologist consultation include time, access to radiologists, and not wanting to disrupt radiologists’ workflow. PEDPs expressed optimism that CDSMs may improve their workflow and facilitate effective interaction with radiologists.ConclusionsPEDPs suggested that radiologist consultation will continue to be a valuable component of ICDS after the implementation of CDSMs by providing discussion-driven guidance to complement CDSM recommendations. The results also indicate that radiologists may consider strategies to facilitate effective interaction with PEDPs and reconcile conflicts of CDSMs with clinical practice.     

Patient Race/Ethnicity and Diagnostic Imaging Utilization in the Emergency Department: A Systematic Review

PurposeDiagnostic imaging often is a critical contributor to clinical decision making in the emergency department (ED). Racial and ethnic disparities are widely reported in many aspects of health care, and several recent studies have reported a link between patient race/ethnicity and receipt of imaging in the ED.MethodsThe authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching three databases (PubMed, Embase, and the Cochrane Library) through July 2020 using keywords related to diagnostic imaging, race/ethnicity, and the ED setting, including both adult and pediatric populations and excluding studies that did not control for the important confounders of disease severity and insurance status.ResultsThe search strategy identified 7,313 articles, of which 5,668 underwent title and abstract screening and 238 full-text review, leaving 42 articles meeting the inclusion criteria. Studies were predominately conducted in the United States (41), split between adult (13) and pediatric (17) populations or both (12), and spread across a variety of topics, mostly focusing on specific anatomic regions or disease processes. Most studies (30 of 42 [71.4%]) reported an association between Black, African American, Hispanic, or nonwhite race/ethnicity and decreased receipt of imaging.ConclusionsDespite heterogeneity among studies, patient race/ethnicity is linked with receipt of diagnostic imaging in the ED. The strength and directionality of this association may differ by specific subpopulation and disease process, and more efforts to understand potential underlying factors are needed.