局部脑血流断层显像在小儿癫痫中的应用分析

目的探讨利用放射性核素99m锝-乙撑双半胱氨酸二乙酯(99mTc-ECD)局部脑血流断层显像对小儿癫痫诊断的临床应用价值。方法对14例癫痫患儿进行99mTc-ECD单光子发射型计算机断层显像(SPECT),了解患儿脑局部血流灌注情况。结果放射性核素99mTc-ECD脑局部血流灌注显像阳性率高(78.57%)。结论99mTc-ECD局部脑血流断层显像是诊断小儿癫痫病灶的有效方法,对制订癫痫的治疗方案有一定帮助。     

99mTc-MIBI 显像及定量分析定位诊断甲状旁腺腺瘤的临床应用

目的根据高功能甲状旁腺对MIBI摄取增高的原理,应用SPECT和平面显像定量分析评价术前定位原发性甲旁亢的诊断价值。方法对21例原发性甲旁亢患者采用99mTc-MIBI平面双时相显像及定量分析作术前定位;其中4例加作SPECT断层显像。检测所有病人血清PTH水平及血清钙水平。定量分析采用靶甲状旁腺腺瘤与最大甲状腺放射性(ROI)平均计数比率和靶甲状旁腺腺瘤(T)与对侧相应甲状腺(NT)比值计算。结果双时相平面显像的敏感性为81%(17/21);其中4例平面显像假阴性者2例经SPECT断层获得阳性定位(1例异位腺瘤、1例腺瘤虽然位置正常但同时存在多发结节性甲状腺肿);另2例假阴性者为位置正常但摄取99mTc-M IB I低的腺瘤。甲状旁腺腺瘤对最大甲状腺放射性计数的平均摄取比值和T/NT比值分别为0.95±0.41和2.51±1.76。结论99mTc-MIBI显像是最有效的探测甲状旁腺腺瘤的方法;对探测异位性甲状旁腺腺瘤或同时存在多发结节性甲状腺肿时SPECT断层的敏感性比平面显像更高。     

99mTc-TRODAT-1脑半定量分析鉴别帕金森氏病与血管帕金森样征的研究

目的 应用99mTc-TRODAT-1脑SPECT半定量分析鉴别血管性帕金森样征与帕金森氏病.方法 11例VP病人、26例PD病人、12例健康志愿者接受740MBq(20mCi)99mTc-TRODAT-1静脉注射3～4h后,作脑SPECT显像和半定量分析.通过计算机处理获得纹状体99mTc-TRODAT-1特异结合比率,即S/O摄取比值.结果 通过对VP病人、PD病人和健康志愿者脑SPECT感兴趣区半定量分析,S/O比值在VP病人略低于健康对照者但无明显统计学差异;在PD病人,S/O比值则明显下降(P<0.01).PD病人双侧纹状体摄取99mTc-TRODAT-1明显不对称, VP病人无此现象(P<0.05);VP病人组与健康志愿组S/O摄取比值随年龄增长而下降(P<0.05);PD病人组则无此现象.结论 99mTc-TRODAT-1脑SPECT半定量分析是一种帕金森氏病早期诊断、用于鉴别VP和PD的可靠而实用的方法 .     

骨骼系统PET/CT显像和核医学平面显像对比研究

目的:探讨单光子发射计算机断层(SPECT)骨显像和PET/CT骨显像结果的差异及可能的原因。方法:对2例病例均先后行SPECT骨显像和PET/CT骨显像,并对图像进行对比分析。结果:骨骼对18F-fluoride(PET/CT骨显像剂)和99mTc-MDP(SPECT骨显像剂)的摄取机理类似,均可以反映局部血流量及骨代谢更新的活跃程度,由于18F-fluoride与骨的亲和力强于99mTc-MDP,因此PET/CT图像具有比SPECT更高的系统分辨率和系统灵敏度。结论:PET/CT骨显像灵敏度和分辨率均高于SPECT,但由于其检查费用较高及自身受18F的短半衰期限制,因而其在临床应用受到一定的限制。     

~（99m）Tc-MDPSPECT/CT同机图像融合在骨转移肿瘤显像中的诊断价值

目的：探讨99mTc-MDP SPECT/CT同机图像融合在骨转移肿瘤显像中的诊断价值。方法：对81例可疑转移性骨病变和不明原因骨痛的患者均行全身骨平面显像和SPECT/CT断层同机图像融合,所有患者结果均通过CT、MRI和病理检查、随访等方式确诊。将平面显像和SPECT/CT结果进行回顾性分析并加以比较。结果：81例患者骨转移55例,201处骨转移灶;良性骨病变26例,42处病灶。全身骨显像及同机图像融合对骨转移病例的诊断符合率分别为67.3%、100%,对良性骨病变病例的符合率分别为61.5%、96.2%。SPECT/CT同机图像融合排除了SPECT平面显像中的10处放射性污染及12处骨外软组织显影造成的假阳性病灶以及14处良性骨病变,另外,SPECT/CT同机图像融合新诊断出肿瘤骨转移病灶51处。同机图像融合诊断符合率明显优于平面骨显像,差异有统计学意义（P〈0.01）。结论：99mTc-MDP SPECT/CT同机图像融合可对肿瘤骨转移病灶进行准确定位,并同时提供功能与解剖断层图像,在肿瘤骨转移的临床诊断中具有重要价值。对于平面骨显像中一些可疑的患者,尤其是可疑的骨病变部位均应使用SPECT/CT同机图像融合。     

99Tc^m-MIBI乳腺亲肿瘤显像对乳腺癌的诊断价值分析

目的:研究锝99-甲氧基异丁基异腈(99Tc^m-MIBI)乳腺亲肿瘤显像在乳腺癌诊断中的价值。方法:选取80例乳腺肿瘤患者病例资料,其中乳腺癌56例、良性病灶24例。采用单光子发射型电子计算机断层扫描(SPECT/CT)机同机融合功能,将核素断层图像与CT断层扫描图像进行融合分析,对比乳腺癌与良性病灶的显像靶与非显像靶摄取比值(T/N);对比乳腺亲肿瘤显像与超声诊断的检出率。结果:乳腺癌病侧、对侧的T/N(1 h)值均高于良性病灶,乳腺癌患者病侧T/N(1 h)值与良性病灶比较,差异有统计学意义(t=3.650,P<0.05)。99Tc^m-MIBI乳腺亲肿瘤显像诊断的灵敏度、特异度、阳性预测值、阴性预测值及符合率分别为92.9%、87.5%、94.5%、84.0%和91.3%,与超声诊断比较差异无统计学意义。4例乳腺癌漏诊者均为T/N值较低的患者。结论:99Tc^m-MIBI乳腺亲肿瘤显像对乳腺癌具有较高的检出率高,T/N值偏低可能是导致漏诊的主要原因。     

18F-FDG符合线路显像诊断肺癌的临床应用

目的通过18F-FDG符合线路显像,评价其诊断肺癌的价值。方法用双探头符合线路SPECT对64例疑似肺癌的患者进行18F-FDG符合线路显像检查,观察其摄取18F-FDG的情况,计算分析T/N比值,观察该方法诊断肺癌的灵敏度和特异性。结果①64例病例经随访证实其中肺癌46例,显像阳性42例,良性肺病18例,显像阴性11例。②肺癌的T/N比值平均为3.5±1.8,良性肺部疾病的T/N比值为1.8±1.3,两者间差异存在显著性(P<0.01)。③目测法诊断肺癌的灵敏度和特异性分别为91.3%和61.1%。结论18F-FDG符合线路显像是诊断肺癌的简便易行的方法,但该方法的特异性低,仍需结合肿瘤标志物和其他影像学检查来提高其准确性。     

99m Tc-HL91肺癌乏氧显像的临床应用

目的探讨核素99mTc-HL91乏氧显像对肺癌诊断和治疗的临床价值.方法 72例原发性肺癌患者行SPECT 99m Tc-HL91显像,根据早期(1h)显像和延迟(3h)显像结果进行定性和半定量分析.并对其中接受化疗的65例患者按延迟显像T/N值分组进行疗效随访.结果 99mTc-HL91早期和延迟显像对肺癌诊断的灵敏度分别为86.1%(62/72)、98.6%(71/72).不同病理类型的肺癌半定量分析结果比较差异无显著性.65例化疗患者低摄取组疗效较高摄取组好,差异有显著性(P＜0.05).结论 99mTc-HL91乏氧显像对原发性肺癌的诊断具有较高的灵敏度,并在预测治疗效果方面具有一定的应用价值.     

^131I SPECT／CT显像结果、血浆Tg与甲状腺癌去分化的相关性研究

目的：SPECT／CT可同时进行CT和SPECT检查,实现了解剖学图像和功能图像的同机融合,本研究回顾性分析197例次在本院核医学科接受^131II治疗的分化型甲状腺癌（DTC）患者的影像学资料掣ISPECT／CT、^131I全身显像、和FDGSPECT／CT显像）及血浆Tg、TSH测定结果,探讨^131I SPECT／CT融合图像对分化型甲状腺癌疾病疾病进程和去分化的判断价值,以期指导临床施治。材料与方法：（1）对象：98位2001年3月至2007年12月期间在我院核医学科接受^131I治疗的分化型甲状腺癌（DTC）患者的197例次影像学资料,乳头状癌77例,滤泡癌15例,滤泡乳头混合性癌6例。197例次^131I显像结果和断层SPECT显像结果,13例次同期FDG显像结果,大部分患者具有同期血浆Tg和TSH测定结果。（2）方法：分化型甲状腺癌患者停服T4四周,治疗前测定血浆TSH和Tg水平。患者口服^131I后5～7天做全身平面显像（^131I全身显像）和局部^131I SPECT／CT断层显像。结合患者的临床表现,综合分析患者同期的各项影像学检查结果（^131I SPECT／CT断层显像、^18F-FDG显像、CT、B超、MRI等）及血浆甲状腺球蛋白测定值,对患者是否发生分化型甲状腺癌术后转移复发进行判断,并以此做诊断结果。血浆Tg水平诊断肿瘤复发转移的判断阈值为〉10ng／ml。（3）^131I影像学分期标准：不同于DTC的临床分期,根据图像显示的病灶摄取量、位置、数量及波及范围将病人分为4个期别：I—摄取范围局限于甲状腺床;II-甲状腺床＋颈部淋巴结摄取或甲状腺床＋纵隔淋巴结摄取;III－颈部淋巴结或纵隔淋巴结摄取＋肺摄取;IV－颈部淋巴结和纵隔淋巴结＋肺部弥漫性摄取,或,颈部淋巴结和纵隔淋巴结＋骨等其它脏器摄取。（4）统计学分析方法：SPSS软件包和EXCEL统计表,非参数秩合检验和相关性分析。结果：以Tg血浆水平〉10ng／ml做为肿瘤复发转移判断界值的灵敏度为85．6％,特异性为66％,准确度为66％。阳性预测值为77％。阴性预测值为50％;^131I WBS显像诊断的灵敏度为83％,特异性为84％,准确度为83％。阳性预测值为93％。阴性预测值为67％;^131ISPECT／CT显像诊断的灵敏度为95％,特异性为84％,准确度为92％。阳性预测值为94％。阴性预测值为87％;ROC曲线分析^131I SPECT／CT显像的诊断效能较高;血浆甲状腺球蛋白水平与^131I SPECT／CT断层显像的影像学分期呈正相关关系。结论：^131I SPECT／CT融合图像结果,改善了病灶的定位,使对肿瘤分期和预后评价更趋准确,为临床正确施治提供了有力帮助。     

SPECT~(99)Tc~m-EHIDA动态显像对胆囊收缩功能的评价

目的探讨胆囊结石疾病患者胆囊的收缩功能。方法应用SPECT99Tcm–EHIDA动态显像,用ROI技术测定胆囊放射性记数,计算出脂肪餐后排胆分数(GBEF),判断胆囊收缩功能。结果胆囊结石疾病患者GBEF<25%,提示胆囊丧失收缩功能。结论 SPECT99Tcm–EHIDA动态显像及测定GBEF值可以判断胆囊收缩功能,对于手术是否保留胆囊具有重要参考价值。     

脑血流灌注显像对难治性发作性癫痫诊断的研究

目的 评价99mTc-单光子发射计算机断层(SPECT)脑血流灌注显像对难治性发作性癫痫的诊断价值,并分析其影像学特点.方法 对难治性发作性癫痫患者共238例分别进行SPECT、MRI、CT和脑电图(EEG)检查,并对诊断结果进行统计分析和比较.结果 SPECT对强直性发作、失神发作、单纯部分性发作和复杂部分性发作的癫痫病灶检出率分别为85.7%、95.7%、89.8%和90.9%,显著高于其他检查方法(P＜0.01);接受SPECT病灶定位诊断进行伽马刀治疗的36例患者中,23例随访1年以上,有效率为78.26%.结论 SPECT对癫痫病灶的检出率较高,对立体定向放射外科靶区的确定具有重要的临床价值.     

Clinical application of brain perfusion SPECT imaging to dementia

Brain perfusion SPECT imaging has been applied to patients with dementia using 123I-IMP and 99mTc-HM-PAO. Brain blood flow closely parallels regional brain metabolism or brain function with normal cerebrovascular function. Therefore neuronal activity can be indirectly evaluated by in vivo brain perfusion imaging in dementia. This nuclear medicine technique is quite useful for the differential diagnosis, assessment of the degree and localization of the affected area, disease course, and therapeutic effect. IMP seems to be superior to HM-PAO in detecting focal decreased perfusion and quantitative analysis. Hereafter the brain perfusion SPECT study will be more widespread. Neuroreceptor imaging is highly expected as the next step of a brain SPECT study.     

Current developments in SPECT/CT systems using 99mTc-radiopharmaceuticals

The 3 foundations of nuclear medicine are radiation conscious personnel, specific radiopharmaceuticals and equipment. The trend in molecular radiopharmacy is to develop new radiopharmaceuticals targeting peptides and receptors. 99mTc-radiopharmaceuticals give important clinical and molecular information especially in endocrinology, oncology and cardiology. The basic equipment has relied on crystal scintillation detector gamma cameras and the obtained images represent organ function provided by the specific radiopharmaceutical. Gamma cameras for single emission computed tomography (SPECT) can be added to an X-ray computed tomography (CT) equipment to form a hybrid (SPECT/ CT). The system is coupled to computer algorithms and special software to acquire and process the separate studies and fuse the two images to give a 3-D image of organ function plus anatomy. The new semiconductor or solid state detectors are a big improvement in commercial hybrid scintillation cameras and micro-SPECT/CT. Fused images obtained with SPECT/CT have been very useful in almost all medical areas and play an important role in preclinical research. The aim of this work is to present the current status and future trends of SPECT/CT systems in the clinical practice of nuclear medicine using technetium-99m radiopharmaceuticals. The development of molecular, functional and genetic imaging tools aided by new technology and SPECT/CT image fusion will enhance accurate diagnoses, and understanding of molecular mechanisms of disease and their respective response to radiopharmaceutical therapy.     

The early and delayed SPECT images of 123I-IMP and rCBF measurement

The early and delayed SPECT images of 123I-IMP, and rCBF measurement were discussed in the diagnosis of ischemic cerebral vascular disorders (CVD). On early SPECT image of 123I-IMP in the CVD, the low perfusion area usually consists of three or four parts differing in severity. The regional blood flow (rCBF) of the area corresponding to the low density area, peri-low density area and normal density and low perfusion area on X-ray CT are 15 ml/100 g.brain/min, 34 ml/100 g.brain/min and 46 ml/100 g.brain/min, respectively. The redistribution phenomenon is frequently observed on delayed 123I-IMP SPECT images. This phenomenon is observed in the area in which rCBF is 25 to 35 ml/100 g.brain/min.     

SPECT follow-up of cerebral blood circulation after stroke]

rCBF SPECT investigations with 99mTc-HMPAO were performed in 22 completed ischemic stroke patients on average 2.5, 16.8 and 38.0 days after stroke onset. As control group, 12 neurologically healthy volunteers were examined with the same method. The overall sensitivity of the rCBF SPECT method in the detection of cerebral blood flow abnormalities was 91%, with a specificity of 83% and an accuracy of 88%. The rCBF study was highly effective, particularly in the acute phase of the disease. Regional increased tracer uptake or a false normal 99mTc-HMPAO distribution due to the developing hyperemia mostly complicated the rCBF image interpretations in the subacute period. In the chronic phase, the spatial resolution of the SPECT system limited the detection of the continuously retracted stroke lesions.     

磁共振图像分割算法研究

本文提出一种基于图像灰度值的K-均值聚类算法,并利用这种算法对脑部核磁图像分割进行测试。K-均值聚类算法是一种自动数据分类的方法,该类算法仅依据图像像素点的灰度值将其分为不同的点群。我们使用这种图像分割算法,在针对脑部核磁图像的分割中得到了理想的分割结果,可以清晰地看到白质,灰质,皮质,第三脑室及背景的分割结果。     

Clinical evaluation of SPECT in cerebrovascular disease

In 131 patients with cerebrovascular disease, regional cerebral blood flow was determined by 123I-IMP (N-isopropyl (123I)-iodoamphetamine) or 99mTc-HM-PAO (99mTc (d, l)-hexamethyl propyleneamine oxime) SPECT and findings were compared with those of X-CT or MRI. The perfusion deficit detected by SPECT was larger than the deficit by X-CT or MRI in every cases. The perfusion deficit area was more clearly demonstrated by SPECT than by X-CT or MRI in patients with acute cerebral infarction. The hypoperfusion area determined by 123I-IMP SPECT was wider than that by 99mTc-HM-PAO SPECT. The crossed cerebellar diaschisis was observed in 56 out of 131 cases (43%). The results of operation were quantitatively evaluated by 123I-IMP SPECT in 25 patients.     

Effect of extra- and intra-cranial vascular anastomosis on regional blood flow, studied by SPECT using 99m-Tc HMPAO

Thirty-two patients suffering from occlusive cerebrovascular disease were investigated by means of 99mTc-HMPAO brain SPECT before and one month after EC-IC bypass operation. The regional cerebral blood flow was unchanged postoperatively in 19 patients, increased in 7 cases, and deteriorated in 6 patients. One patient died in the postoperative period and in another no follow-up SPECT could be performed. It is concluded that the regional cerebral blood flow, even in the absence of a morphological deficit on CT, was not improved by the operation in the majority of cases.