18F-FDG PET综合指标鉴别诊断孤立性肺结节良恶性

目的 探讨¹⁸F-FDG PET中联合放射性摄取程度、形态及双时相显像标准摄取值（SUV）改变情况诊断孤立性肺结节（SPN）良恶性的效能。方法 回顾性分析64例经病理或临床随诊确诊的SPN患者¹⁸F-FDG PET/CT资料。根据SPN放射性摄取程度、形态及双时相显像SUV改变情况制定诊断标准,比较该标准与“2.5标准”（早期显像SUV_max≥2.5诊断为恶性）诊断恶性SPN的灵敏度、特异度、准确率、阳性预测值和阴性预测值。结果 按本组标准和“2.5标准”¹⁸F-FDG PET诊断恶性SPN的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为85.71%（42/49）、72.73%（8/11）、83.33%（50/60）、93.33%（42/45）、53.33%（8/15）和51.92%（27/52）、75.00%（9/12）、56.25%（36/64）、90.00%（27/30）、26.47%（9/34）,灵敏度和准确率二者差异有统计学意义（P均<0.05）。结论 ¹⁸F-FDG PET中,联合放射性摄取程度、形态及双时相显像SUV改变情况制定诊断标准可提高鉴别诊断SPN良恶性的准确率,具有一定临床应用价值。     

剪切波弹性成像与18F-FDG PET/CT显像诊断甲状腺微小癌的对比

目的 比较剪切波弹性成像与¹⁸F-FDGPET/CT显像诊断甲状腺微小癌的价值。方法 回顾性分析经病理证实的甲状腺小结节患者超声剪切波弹性成像及¹⁸F-FDGPET/CT显像资料,计算并比较2种方法诊断甲状腺微小癌的灵敏度、特异度、准确率、阳性预测值及阴性预测值。结果 48个甲状腺小结节中,37个为恶性结节,11个为良性结节,剪切波弹性成像与¹⁸F-FDGPET/CT显像诊断甲状腺微小癌的灵敏度、特异度、准确率、阳性预测值及阴性预测值结果分别为91.89%（34/37）、81.82%（9/11）、89.58%（43/48）、94.44%（34/36）、75.00%（9/12）和29.73%（11/37）、72.73%（8/11）、39.58%（19/48）、78.57%（11/14）、23.53%（8/34）;两种方法的灵敏度、准确率及阴性预测值差异有统计学意义（P均<0.05）,特异度、阳性预测值差异无统计学意义（P均>0.05）。结论 剪切波弹性成像对甲状腺微小癌的诊断价值优于¹⁸F-FDGPET/CT。     

剪切波弹性成像与99Tcm-MIBI SPECT显像对比诊断甲状腺癌

目的 比较剪切波弹性成像与⁹⁹Tc^m-MIBI SPECT显像诊断甲状腺癌的价值。方法 以118个甲状腺结节作为研究对象,行剪切波弹性成像及⁹⁹Tc^m-MIBI SPECT显像。以病理为金标准,计算并比较两种方法对甲状腺癌结节的诊断敏感度（灵敏度）、特异度、准确度、阳性预测值及阴性预测值,并进行率的比较。结果 剪切波弹性成像与⁹⁹Tc^m-MIBI SPECT显像诊断甲状腺癌的敏感度（灵敏度）、特异度、准确率、阳性预测值及阴性预测值分别为88.57%（31/35）和62.86%（22/35）、89.16%（74/83）和65.06%（54/83）、88.98%（105/118）和64.41%（76/118）、77.50%（31/40）和43.14%（22/51）、94.87%（74/78）和80.60%（54/67）,差异均有统计学意义（P<0.05）。结论 剪切波弹性成像对甲状腺癌的诊断效能优于⁹⁹Tc^m-MIBI SPECT显像。     

对比99Tcm-DX与99Tcm-HAS显像诊断小肠淋巴管扩张症

目的 比较⁹⁹Tc^m-DX与⁹⁹Tc^m-HSA显像对小肠淋巴管扩张症的诊断效能。方法 收集56例低蛋白血症患者,均在7天内接受⁹⁹Tc^m-DX与⁹⁹Tc^m-HSA显像;以病理检查、胶囊肠镜或临床最终诊断作为“金标准”,评价2种检查方法的诊断效能,应用Kappa检验分析这两种方法的一致性。结果 38例（38/56,67.86%）最终诊断为IL,其中原发性IL34例,继发性IL4例;余18例中,10例诊断为乳糜性单或多浆膜腔积液,1例为肾病综合征,2例为不明原因失蛋白性肠病,5例为不明原因低蛋白血症。⁹⁹Tc^m-DX与⁹⁹Tc^m-HSA显像诊断IL的灵敏度分别60.53%（23/38）、94.73%（36/38）,特异度为88.89%（16/18）、61.11%（11/18）,准确率为69.64%（39/56）、83.93%（47/56）,阳性预测值为92.00%（23/25）、83.72%（36/43）,阴性预测值为51.61%（16/31）、84.62%（11/13）;两者诊断符合率为67.85%（38/56,Kappa=0.392,P<0.05）。结论 ⁹⁹Tc^m-HSA显像诊断IL的灵敏度较高,而⁹⁹Tc^m-DX显像的特异度较高,两者结合可能有助于提高诊断IL的准确性。     

对比增强MRA鉴别脊髓血管畸形及脊髓非血管畸形所致继发性血管纡曲

目的 观察¹⁸F-FDG PET/CT显像对¹³¹I-治疗剂量全身显像（¹³¹I-RxWBS）阴性且甲状腺球蛋白（Tg）阳性分化型甲状腺癌（DTC）复发或转移的诊断价值及对治疗方案的影响。方法 对72例接受¹³¹I清除残留甲状腺并接受大剂量¹³¹I治疗后随访中发现Tg阳性而¹³¹I-RxWBS阴性DTC术后患者行¹⁸F-FDG PET/CT显像,将显像结果与手术病理或6~36个月临床随访结果进行对照,评价¹⁸F-FDG PET/CT显像对Tg升高而¹³¹I-RxWBS阴性DTC复发或转移的诊断效能。结果 ¹⁸F-FDG PET/CT诊断Tg升高而¹³¹I-RxWBS阴性的DTC复发或转移的准确率、灵敏度、特异度、阳性预测值和阴性预测值分别为83.33%（60/72）、89.47%（34/38）、76.47%（26/34）、80.95%（34/42）和86.67%（26/30）。¹⁸F-FDG PET/CT显像改变了35例（35/72,48.61%）患者的治疗方案,其中23例（23/35,65.71%）接受手术者在临床随访中均未见甲状腺癌复发及转移,其余12例（12/35,34.29%）随访期内均显示病情进展。结论 对于¹³¹I-RxWBS阴性而Tg阳性的DTC患者,¹⁸F-FDG PET/CT有助于诊断和定位复发及转移病灶,指导后续治疗。     

99Tcm-MDP SPECT/CT融合显像诊断骨纤维异常增殖症

目的 探讨⁹⁹Tc^m-MDP SPECT/CT融合显像诊断骨纤维异常增殖症（FD）的临床应用价值。方法 回顾性分析13例FD患者的临床和⁹⁹Tc^m-MDP SPECT/CT融合显像资料,其中11例经病理证实为FD,2例经随访确诊。所有患者均有原发肿瘤病史。结果 13例FD均为单发,位于颅面骨10例,位于肋骨、坐骨及胫骨骨干各1例。全身骨显像定性诊断准确率为38.46%（5/13）,SPECT/CT断层融合显像定性诊断准确率为69.23%（9/13）;92.31%（12/13）的患者全身骨显像表现为中-高代谢;CT征象中,磨玻璃密度影（GGO）和骨质膨胀分别占84.62%（11/13）和76.92%（10/13）,溶骨性破坏、硬化边分别占53.85%（7/13）、30.77%（4/13）,13例均未见骨皮质破坏。结论 ⁹⁹Tc^m-MDP SPECT/CT断层融合显像可综合提供功能和解剖学信息,有助于FD的诊断。骨显像中-高代谢及GGO和骨质膨胀的CT征象常提示FD。     

99Tcm-MDP SPECT/CT显像诊断乳腺癌骨转移

目的 评价⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以确诊的乳腺癌骨转移的诊断价值。方法 回顾分析⁹⁹Tc^m-MDP全身骨显像难以确诊的132例乳腺癌患者共210个骨转移灶的影像资料。以临床随访及病理检查获得最终诊断结果,计算⁹⁹Tc^m-MDP SPECT/CT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 210个病灶中, ⁹⁹Tc^m-MDP SPECT/CT正确诊断骨转移灶82个,良性病灶112个,诊断准确率为92.38%(194/210),灵敏度为94.25%(82/87),特异度为91.05%(112/123),阳性预测值为88.17%(82/93),阴性预测值为95.72%(112/117)。⁹⁹Tc^m-MDP SPECT/CT对脊椎病灶的诊断准确率明显高于肋骨病灶(χ²=7.81,P<0.05)。结论 利用⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以诊断的乳腺癌骨转移灶进行诊断,具有较高的诊断效能。     

对比实时超声与核素显像诊断儿童美克尔憩室

目的 对比观察实时超声与核素显像诊断儿童美克尔憩室的价值。方法 收集临床拟诊为美克尔憩室或因其并发症而接受外科手术治疗的156例患儿,行实时超声检查和⁹⁹Tc^m-高锝酸盐腹部平面显像。以手术病理结果作为金标准,比较两种检查方法的诊断价值。结果 156例中,105例经病理检查证实为美克尔憩室。超声诊断美克尔憩室的敏感度、特异度和准确率为87.62%（92/105）、88.24%（45/51）和87.82%（137/156）,核素显像为71.43%（75/105）、72.55%（37/51）和71.79%（112/156）,超声均高于核素显像。结论 超声诊断儿童美克尔憩室及其并发症准确率较高,可作为临床诊断美克尔憩室的首选辅助方法。     

99Tcm-MDP全身骨显像联合SPECT/CT诊断骨外肿瘤

目的 观察⁹⁹Tc^m-亚甲基二磷酸盐（MDP）全身骨显像联合SPECT/CT诊断骨外肿瘤的价值。方法 回顾性分析68例骨外肿瘤患者94处病灶,观察其全身骨显像及SPECT/CT表现,并分析二者联合诊断效能。结果 单纯全身骨显像准确诊断52处骨外肿瘤,准确率55.32%（52/94）;其余42处病灶中,35处（35/94,37.23%）因影像学表现与骨骼存在重叠而误诊为转移性骨肿瘤,7处（7/94,7.45%）因病灶⁹⁹Tc^m-MDP摄取低于邻近骨骼而致漏诊。全身骨显像联合SPECT/CT诊断全部94处骨外肿瘤,准确率100%（94/94）。94处病灶中,49处接受病理学检查,其中33处（33/49,67.35%）病灶内见粗大钙化、9处（9/49,18.37%）见细微钙化;CT检出61处（61/94,64.89%）钙化,未显示9处细微钙化。结论 ⁹⁹Tc^m-MDP全身骨显像联合SPECT/CT可提高诊断骨外肿瘤的准确性。     

水灌肠18F-FDG PET/CT鉴别诊断良恶性结直肠病变

目的 探讨水灌肠PET/CT鉴别结直肠良恶性病变的价值。方法 对常规PET/CT检查发现的45例直肠及乙状结肠局灶性或弥漫性FDG浓聚患者行水灌肠PET/CT显像,与肠镜或术后病理结果进行对照。结果 水灌肠PET/CT扫描后诊断生理性摄取准确率为100%（15/15）;诊断恶性肿瘤的敏感度为100%（18/18）,特异度为92.59%（25/27）,准确率为95.56%（43/45）,阳性预测值为90.00%（18/20）,阴性预测值为100%（27/27）。结论 水灌肠PET/CT可有效排除结直肠生理性摄取¹⁸F-FDG,准确鉴别常规PET/CT难以诊断的良恶性结直肠病变。     

The predictive value of chronic kidney disease for assessing cardiovascular events under consideration of pretest probability for coronary artery disease in patients who underwent stress myocardial perfusion imaging

Pretest probability of coronary artery disease (CAD) facilitates diagnosis and risk stratification of CAD. Stress myocardial perfusion imaging (MPI) and chronic kidney disease (CKD) are established major predictors of cardiovascular events. However, the role of CKD to assess pretest probability of CAD has been unclear. This study evaluates the role of CKD to assess the predictive value of cardiovascular events under consideration of pretest probability in patients who underwent stress MPI. Patients with no history of CAD underwent stress MPI (n = 310; male = 166; age = 70; CKD = 111; low/intermediate/high pretest probability = 17/194/99) and were followed for 24 months. Cardiovascular events included cardiac death and nonfatal acute coronary syndrome. Cardiovascular events occurred in 15 of the 310 patients (4.8 %), but not in those with low pretest probability which included 2 CKD patients. In patients with intermediate to high pretest probability (n = 293), multivariate Cox regression analysis identified only CKD [hazard ratio (HR) = 4.88; P = 0.022) and summed stress score of stress MPI (HR = 1.50; P < 0.001) as independent and significant predictors of cardiovascular events. Cardiovascular events were not observed in patients with low pretest probability. In patients with intermediate to high pretest probability, CKD and stress MPI are independent predictors of cardiovascular events considering the pretest probability of CAD in patients with no history of CAD. In assessing pretest probability of CAD, CKD might be an important factor for assessing future cardiovascular prognosis.     

320排动态容积CT冠状动脉成像诊断冠心病:ROC曲线分析

目的应用ROC曲线分析方法评价320排动态容积CT冠状动脉成像(CCTA)诊断冠心病(CHD)的价值。方法回顾性分析临床疑似冠心病的37例患者的CCTA和冠状动脉造影(CAG)资料,以冠状动脉狭窄≥50%作为冠心病诊断标准,对结果采用配对t检验及ROC曲线分析。结果 CCTA诊断冠心病的敏感度为78.57%(55/70),特异度为95.13%(391/411),阳性预测值为73.33%(55/75),阴性预测值为96.31%(391/406),准确率为92.72%(446/481);CCTA和CAG结果呈高度相关性;CCTA的ROC曲线下面积为0.962。CCTA诊断的斑块数量较CAG多(68vs 45)。结论 320排动态容积CCTA诊断冠状动脉狭窄具有较高的准确性,能有效识别斑块及其危险程度。     

组织多普勒与脉冲多普勒成像评价新生儿缺氧缺血性脑病心肌做功指数的比较

目的 对比应用组织多普勒(TDI)和脉冲多普勒技术(PW)检测心肌做功指数(MPI),评价足月新生儿缺氧缺血性脑病(HIE)的心功能损伤。方法 回顾分析75例缺氧缺血性脑病新生儿超声心动图结果。HIE重度25例(重度组)、中度25例(中度组)、轻度25例(轻度组),分别应用TDI和PW检测MPI,并与34名健康足月新生儿(对照组)的MPI比较。结果 左、右心室侧房室环MPI-PW随HIE的严重程度增加而增大(F=25.331、21.072,P均<0.01);左、右心室侧和室间隔房室环MPI-TDI随HIE的严重程度增加而增大(F=40.661、40.652、41.617,P均<0.01)。左、右心室侧及室间隔房室环MPI-TDI与HIE程度相关(r=0.721、0.717、0.724,P均<0.01);左、右心室侧房室环MPI-PW与HIE程度相关(r=0.631、0.589,P均<0.01);MPI-TDI与HIE的相关性高于MPI-PW。观察者内和观察者间的一致性良好。结论 MPI-TDI与MPI-PW均可定量评价HIE的心功能;MPI-TDI对轻度HIE的心功能检测更敏感。新生儿HIE心功能MPI检测应首选TDI。     

Prevalence of noncardiac findings on low dose 64-slice computed tomography used for attenuation correction in myocardial perfusion imaging with SPECT

Electrocardiogram (ECG)-triggered, low dose computed tomography (CT) is increasingly used for attenuation correction in myocardial perfusion imaging (MPI) with SPECT. The purpose of the study was to assess the prevalence of relevant noncardiac findings in the field-of-view of such attenuation correction CT scans. Five hundred and eighty-two consecutive patients (211 female, 371 male; mean age: 64 ± 11 years; BMI: 27.7 ± 5.3 kg/m²) underwent 64-slice, ECG-triggered CT scanning for attenuation correction of MPI with SPECT. Relevant findings were defined as abnormalities that required clinical or radiological follow-up. Noncardiac findings were detected in 400 patients (68.7%). In 196 patients (33.7%) 226 relevant findings were detected. Findings included noncalcified pulmonary nodules (n = 156), interstitial lung disease (n = 6), pleural effusion (n = 20), pneumonia (n = 1), aortic aneurysm (n = 5), aortic dissection (n = 4), enlarged mediastinal lymph nodes (n = 5), mediastinal tumor (n = 3), breast abnormalities (n = 3), liver cirrhosis (n = 5), liver mass (n = 5), ascites (n = 5), splenomegaly (n = 2), renal mass (n = 1), hydronephrosis (n = 1), adrenal mass (n = 3), and bone metastasis (n = 1). As low dose 64-slice CT scans used for attenuation correction in MPI with SPECT reveal a high prevalence of noncardiac pathologic findings with potential clinical relevance, a systematic review of the CT scans appears mandatory.     

多层螺旋CT血管成像评价胰腺癌侵犯胰周血管

目的 观察多层螺旋CT血管成像(MSCTA)评价胰腺癌胰周血管受侵的价值.方法 对49例胰腺癌患者行螺旋CT增强扫描,结合多平面重建、最大密度投影、最小密度投影、曲面重建、三维容积再现等后处理技术对胰周主要血管进行成像.结果 49例患者中胰头、胰颈部癌33例,钩突癌8例,胰体癌5例,胰尾癌2例,全胰腺癌1例.胰周主要血管受侵包括腹腔干3 例,肝总动脉7例,肠系膜上动脉6例,脾动脉8例,门静脉16例,肠系膜上静脉24例, 脾静脉11例, 下腔静脉2例.MSCTA判断血管受侵准确率为87.75%,敏感度为88.57%,特异度为85.71%,阳性预测值为93.94%,阴性预测值为75.00%.结论 MSCTA能直观准确地显示胰腺癌对胰周血管的侵犯,术前MSCT多期增强扫描判断胰腺癌的胰周血管是否受侵对手术具有指导意义.     

Factors Influencing Non-cardiac Side Effects of Dipyridamole When Used for Myocardial Perfusion Stress Testing

PurposeThis study evaluates whether patient demographic information can be used to predict the non-cardiac side effects experienced during myocardial perfusion imaging (MPI) procedures using dipyridamole.BackgroundHeart disease is a major cause of death in the industrialized world. MPI of coronary blood flow using radiopharmaceuticals is frequently used to assess coronary artery disease. Pharmacological methods can be used to increase coronary blood flow with vasodilators such as dipyridamole or adenosine, or inotropic and chronotropic agents such as dobutamine or arbutamine. The side effects of these agents are recognized, but little is known about the factors that influence their frequency and severity.MethodsOne hundred and nineteen patients scheduled for myocardial perfusion pharmacological stress testing using dipyridamole participated in the study. Patient demographic data, which included age, sex, body mass index (BMI), diabetic status, smoker status, and daily aspirin usage, were collected before the start of the procedure. Patients underwent a 1-day rest and stress MPI procedure. The radiopharmaceuticals used were ^99mTc-Myoview or ²⁰¹Tl. The pharmacological stress procedure used dipyridamole injections based on body weight. Aminophylline was injected at the end of the stress session. Gated single photon emission computed tomography was performed for both rest and stress images. Once the patients completed the procedure, they were given a questionnaire that asked them to report the severity of any side effects experienced from the dipyridamole. Specific data types determined the statistical test best suited for analysis. The Chi-square test was used to evaluate the nominal scale data (sex, diabetic status, aspirin usage, and smoker status), Mann-Whitney test was used to compare nominal scale data and ordinal scale data (side effect severity), Student’s t-test r was used for ratio scale data (age, BMI, and percent of population), and multiple linear regression and multiple logistic regression tests were used to evaluate multiple variables.ResultsA total of 119 patients were surveyed (58 male, 61 female). The average age was 67.7 years (10.7 year standard deviation). There were no statistically significant differences in the male and female demographics except for daily aspirin usage (more common with males). Headaches were the most common side effect (50% of all patients), followed by dizziness (26%), flushing (24%), chest pain (19%), and nausea (18%). Correlations were found between patients experiencing no side effects with age (r = −0.607) and sex (P = .034); headaches with age (r = −0.706) and BMI (r = 0.464); chest pain with diabetic status (P = .017); dizziness with diabetic status (P = .039); and nausea with age (r = −0.612).ConclusionSide effects of dipyridamole are generally known, but the factors influencing incidence and severity are not. This study has shown that patient demographic information normally gathered before MPI procedures can help determine the frequency and severity of some side effects. Providing more accurate information to a patient on the possible side effects could help reduce patient anxiety and improve patient cooperation.     

超声诊断复杂心脏畸形心室襻及心室手型

目的 分析不同类型复杂先天性心脏病(先心病)心室襻的图像特征,探讨应用超声心动图判定心室襻或心室手型的方法学及价值。方法 回顾性分析45例复杂先心病患者的超声图像,包括右心室双出口7例,完全型大动脉转位5例,矫正型大动脉转位11例,解剖矫正型大动脉异位2例,单心室15例,十字交叉心4例和楼上楼下心室1例。全部病例均由外科手术或CT检查证实。结果 7例右心室双出口中,心室右襻4例,心室左襻3例。5例完全型大动脉转位均为心室右襻。11例矫正型大动脉转位患者中,心室右襻1例,心室左襻10例。2例解剖矫正型大动脉异位患者均为心室右襻。15例单心室患者中,心室右襻8例,心室左襻4例,心室不定襻3例。4例十字交叉心和1例楼上楼下心室中,右手型心室3例,左手型心室2例。结论 超声心动图对复杂先心病的心室襻或手型定位具有重要价值,超声判定心室手型可以帮助分析复杂的心室构型。     

Epicardial adipose tissue parameters for predicting coronary atherosclerotic heart disease and the degree of coronary artery stenosis in HIV infected patients北大核心CSCD

目的观察以心外膜脂肪组织(EAT)各参数预测HIV感染者冠状动脉粥样硬化性心脏病(CHD)及冠状动脉狭窄程度的价值。方法将149例HIV感染者根据存在CHD与否分为CHD组(n=97)与非CHD组(n=52),再根据冠状动脉狭窄程度将CHD组分为轻度(n=60)、中度(n=23)及重度狭窄亚组(n=14);选取52名非HIV、非CHD志愿者作为对照组。计算各组及亚组冠状动脉左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)周围脂肪衰减指数(FAI)、EAT体积和EAT密度;观察上述各参数预测HIV感染者CHD及冠状动脉狭窄程度的效能。结果CHD组中,各亚组RCA、LAD和LCX周围FAI差异均有统计学意义(P均<0.05),重度狭窄亚组FAI明显高于轻度狭窄亚组(P<0.05)。非CHD组RCA、LAD和LCX周围FAI均明显高于对照组(P均<0.05)。以-87.74 HU为RCA周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为83.30%,特异度为63.00%,曲线下面积(AUC)为0.75;以-72.29 HU为LAD周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为75.00%,特异度为80.20%,AUC为0.95;二者AUC差异有统计学意义(Z=2.86,P<0.01)。结论冠状动脉周围FAI可用于评估冠状动脉狭窄程度,尤以LAD周围FAI的价值最高。     

Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: a prospective,randomized, multicenter study

A multicenter, double-blind, randomized study was conducted to assess the effect of caffeine on regadenoson stress myocardial perfusion imaging (MPI). Subjects with a high likelihood of coronary artery disease underwent a rest single-photon emission computed tomography MPI on day 1 (MPI-1) and a stress MPI with regadenoson on day 3 (MPI-2). Individuals with ≥1 segment with a reversible defect received double-blind caffeine tablets (200 or 400 mg) or placebo 90 min before a repeat regadenoson stress MPI (MPI-3) on day 5. Overall, 207 subjects completed the study (caffeine 200 mg, n = 70; caffeine 400 mg, n = 71; placebo, n = 66). The mean number of segments with reversible defects decreased from MPI-2 to MPI-3 in the caffeine 200 and 400 mg groups versus no significant change in the placebo group [mean ± standard deviation: ?0.61 ± 1.097, ?0.62 ± 1.367, and 0.12 ± 0.981, respectively (overall treatment effect, P < 0.001)]. The majority of subjects who received caffeine shifted to a lower ischemia size category from MPI-2 to MPI-3, with no clear pattern observed in subjects who received placebo. For caffeine exposed patients with ≥3 segments with reversible defects at MPI-2, 21/23 had fewer detected at MPI-3. Both the 200 and 400 mg doses of caffeine significantly reduced the number of segments with reversible defects detected by regadenoson stress MPI.     

颈动脉粥样硬化斑块MDCT定量分析

目的 探讨采用颈动脉粥样硬化斑块平扫CT值和强化幅度预测脑血管症状的价值。方法 纳入87例拟诊为颈动脉粥样硬化接受MDCT平扫及CTA的患者,根据有无脑血管症状分为有症状组(n=38)及无症状组(n=49),通过手动勾画ROI的方法测量CT平扫及CTA图像上斑块非钙化部分的CT值,采用独立样本t检验比较组间差异。应用ROC曲线分析采用平扫CT值及强化幅度判定是否引起脑血管症状的效能,并采用Z检验对曲线下面积进行比较。结果 有症状组和无症状组颈动脉斑块平扫CT值分别为(45.58±8.94)HU和(31.09±6.83)HU,二者差异有统计学意义(t=-8.569,P<0.001);有症状组颈动脉斑块强化增幅大于无症状组(t=-3.421,P=0.001)。ROC曲线阈值分析显示,平扫CT值最佳临界值为37.20 HU,判定是否引起脑血管症状的敏感度为92.10%(35/38),特异度为81.63%(40/49),准确率86.21%(75/87),ROC曲线下面积为0.937。强化幅度最佳临界值为10.1 HU,其敏感度为76.32%(29/38),特异度为63.27%(31/49),准确率为68.97%(60/87),曲线下面积为0.735;二者曲线下面积的差异有统计学意义(Z=3.613,P<0.01)。结论 颈动脉斑块非钙化部分平扫CT值和强化幅度与脑血管症状有关;斑块平扫CT值对判断是否引起脑血管症状的效能优于斑块强化幅度。