MDP对小鼠骨摄取^99Tc^m—MDP的影响

目的 为临床应用^99Tc－亚甲基二膦酸盐（^99Tc-MDP,“云克”）治疗类风湿疾病提供实验和理论依据。方法 进行K^99TcO4与Na^99Tc^mO4竞争标记MDP实验、MDP量的增加对^99Tc标记MDP的影响实验、小鼠骨摄取^99Tc^m-MDP与MDP量的依赖关系实验以及重复注射MDP203次对骨摄取^99Tc^m-MDP的影响实验。结果 K^99TcO4可与Na^99Tc^mO4竞争标记MDP,且MDP量的增加对^99Tc^m标记MDP无影响。小鼠骨摄取^99Tc^m-MDP与MDP的量在实验范围（≤2mg MDP/只）内无依赖关系,且重复注射2μgMDP（相当于人5mg/次）20次对小鼠骨摄取^99Tc^m-MDP无影响。结论 “云克”的配方有科学性,其使用方法可行。     

^99Tc—MDP治疗骨质疏松的实验研究

目的采用^99Tc-亚甲基二磷酸盐（MDP）与双磷酸盐类药物帕米磷酸二钠治疗骨质疏松模型动物,比较骨密度及相关指标的变化,评价^99Tc-MDP的治疗价值。方法分别设正常组、骨质疏松组兔。由皮质激素盐酸地塞米松（DX）诱导制作兔骨质疏松模型,模型兔部分行^99Tc—MDP或帕米磷酸二钠治疗,各自疗程时间为15周。取实验兔股骨、腰椎、股骨头部位进行骨密度、骨形态计量、组织病理学等测定。组间数据比较行t检验。结果对除正常组外实验兔予肌内注射DX6周后,骨质疏松模型组股骨头关节表面软骨破坏,骨小梁稀疏、断裂,骨母细胞消失等,股骨头的骨密度降低22．93％（t=7．969,P〈0．01）;正常组基本无骨质破坏征象。表明本次实验骨质疏松的动物模型制作成功。分别经^99Tc-MDP和帕米磷酸二钠治疗15周后,与未治疗骨质疏松模型组比较,其腰椎骨密度分别上升19．30％和12．28％（t=2．649,2．753,P均〈0．05）,股骨头骨密度上升36．70％和20．97％（t=3．497,3．705,P均〈0．01）。同时骨组织病理学、骨形态计量、核素骨显像等结果均也有差异。^99Tc-MDP治疗组和帕米磷酸二钠治疗组比较,骨形态计量和股骨头骨密度前者比后者增高更明显,t=3．499和3．652,P〈0．01;腰椎骨密度相比,t=2．975,P〈0．05。结论^99Tc—MDP与帕米磷酸二钠治疗后骨密度均有上升,^99Tc—MDP疗效更为显著,可能与^99Tc具有清除体内自由基和调节免疫功能有关。     

强直性脊柱炎核素关节显像

目的 探讨^99Tc^m-人免疫球蛋白（HIgG)与99Tc^m-亚甲基二膦酸盐（MDP）关节显像在强直性脊柱炎（AS）中的应用价值。方法 对经确诊的21例AS和18例活动期类风湿关节炎（RA）患者行^99Tc^m-HIgG全身显像，其中12例AS患者行^99Tc^m-MDP显像。结果 ①21例AS患者中20例^99Tc^m-HIgG显像示骶髂关节异常放射性增高；44个有临床症状或体征的外周关节中，32个显像异常，临床符合率75％，无一例累及手部小关节。②18例活动期RA患者^99Tcm-HIgG显像均有手部关节的异常改变，无一例累及骶髂关节。③12例AS患者^99Tc^m-HIgG与^99Tc^m-MDP显像比较显示：前者有11例骶髂关节异常放射性分布增高，而后者显像异常仅7例。31个临床累及的外周关节中，^99Tc^m-HIgG显像阳性24个，^99Tc^m-MDP显像异常16个，与临床符合率分别为77．4％和51．6％，差异有显著性（P＜0．025）。结论 ^99Tc^m-HIgG显像能较^99Tc^m-MDP显像更为准确地探测AS患者病变关节的炎症改变，帮助临床早期明确诊断。     

MDP对小鼠骨摄取99Tcm-MDP的影响

目的　为临床应用99Tc 亚甲基二膦酸盐 (99Tc MDP ,“云克”)治疗类风湿疾病提供实验和理论依据。方法　进行K99TcO4 与Na99TcmO4 竞争标记MDP实验、MDP量的增加对99Tcm 标记MDP的影响实验、小鼠骨摄取99Tcm MDP与MDP量的依赖关系实验以及重复注射MDP 2 0次对骨摄取99Tcm MDP的影响实验。结果　K99TcO4 可与Na99TcmO4 竞争标记MDP ,且MDP量的增加对99Tcm 标记MDP无影响。小鼠骨摄取99Tcm MDP与MDP的量在实验范围 (≤ 2mgMDP/只 )内无依赖关系 ,且重复注射2 μgMDP(相当于人 5mg/次 ) 2 0次对小鼠骨摄取99Tcm MDP无影响。结论　“云克”的配方有科学性 ,其使用方法可行     

全髋关节置换治疗28例髋关节强直的临床体会

目的分析全髋关节置换术治疗强直性脊柱炎髋关节强直临床治疗效果及临床价值。方法对我科2007年3月—2012年1月收治强直性脊柱炎髋关节强直患者28例(37髋)进行人工全髋关节置换术,观察其治疗效果及临床价值。结果根据Harris评分,优:20髋,良12髋,可5髋,优良率86.49%。结论全髋关节置换术治疗强直性脊柱炎髋关节强直安全、有效,疗效肯定,有较高的临床价值,既可纠正髋关节畸形,缓解髋部疼痛,又可恢复髋关节功能,患者生活质量得到明显改善。     

成神经细胞瘤放射性核素骨扫描:~(99m)Tc-MDP显示骨转移及原发瘤定位

本文报告35例共做42次~(99m)Tc—MDP骨扫描,又同时(在30天内)作了骨X线照片以评价,(1)在发现骨转移方面,骨扫描与X线照片的准确性;(2)用较为敏感的CT方法来确定原发瘤的钙化,并观察CT确定的钙化、尿VMA(3-甲氧基-4-羟基杏仁酸)水平与原发瘤摄取~(99m)Tc—MDP(~(99m)锝-亚甲基二磷醪盐)三者的关系。在静脉注入~(99m)Tc—MDP250μCi(9.26MBq)/kg后,用扫描闪烁γ照相机作前后位全身放射性核素骨显像,必要时也作局部(Spot)观察,用低能全     

金雀根粉胶囊与柳氮磺吡啶联合应用治疗活动期强直性脊柱炎的临床疗效观察

目的 探讨金雀根粉胶囊与柳氮磺吡啶联合应用治疗活动期强直性脊柱炎的临床疗效.方法 选取治疗的84例活动期强直性脊柱炎患者,分为对照组42例和观察组42例,对照组患者给予柳氮磺吡啶进行治疗,观察组患者采用金雀根粉胶囊与柳氮磺吡啶联合方案进行治疗,对比观察两组患者的临床疗效.结果 对照组的总有效率为80.95％,观察组的总有效率为95.24％,观察组明显优于对照组,P＜0.05,差异具有统计学意义.结论 金雀根粉胶囊与柳氮磺吡啶联合应用治疗活动期强直性脊柱炎的临床疗效确切,值得临床推广应用.     

全髋关节置换术治疗强直性脊柱炎14例效果观察

目的探讨全髋关节置换术治疗强直性脊柱炎的临床疗效。方法回顾性分析解放军第十八医院收治的14例强直性脊柱炎患者的临床资料,并分析采用全髋关节置换术后的治疗疗效。结果术后,患者后髋关节活动度有明显改善,Harris评分增加,VAS评分降低。结论全髋关节置换术治疗强直性脊柱炎,可改善关节功能,缓解疼痛,疗效肯定。     

~(99m)Tc-DPD、~(99m)Tc-HDP及~(99m)Tc-MDP骨闪烁摄影的临床比较

~(99m)Tc 标记多磷酸盐的应用显著增进了骨闪烁摄影的临床重要性。在继续寻找更为理想的放射性药物过程中,又发现了~(99m)Tc 的焦磷酸盐和磷酸盐。近年来,~(99m)Tc 的甲基双磷酸盐(MDP)已成为应用最普遍的骨显影剂。最近,~(99m)Tc 双羧双磷酸盐(DPD)和羟甲基双磷酸盐(HDP)也已有成品供应。本研究目的为评价DPD、HDP 和MDP 常规骨闪烁摄影的显影特性。为此,选择两组诊断不同的病人,每一病例给予MDP+DPD 或MDP+HDP,对闪烁摄影片进行定性     

99mTc-抗D-二聚体单抗对实验动物陈旧性血栓的放射免疫显像研究

目的研究^99Tc标记的抗D-二聚体单抗在陈旧性动脉血栓和静脉血栓靶向定位诊断中的应用。方法采用机械损伤血管内膜的方法复制家兔股动脉血栓和股静脉血栓模型，血栓形成后3d将^99Tc标记的抗D-二聚体单抗注入动物血管内，以放射免疫显像检测技术观察放射性核素在血流和血栓部位的分布。结果血栓处放射性^99Tc的分布较健侧明显增多，而单纯钳夹血管组及正常对照组未见局部放射性物质的堆积。注入^99Tc标记的单抗后，动物未见不良反应，主要脏器未见病理改变。结论^99Tc标记的抗D-二聚体单抗可以作为血栓导向示踪剂，用于陈旧性动脉血栓和静脉血栓的定位诊断。     

相对低剂量甲泼尼龙联合~(99)Tc-MDP治疗老年Graves眼病的疗效观察

目的 评价相对低剂量甲泼尼龙短程疗法联合99Tc-亚甲基二膦酸盐(99Tc-MDP)治疗老年活动性中重度Graves眼病(GO)的临床疗效及安全性.方法 24例老年活动性中重度GO患者先配对后随机分人对照组及试验组各12例.对照组应用常规大剂量甲泼尼龙间断静脉短程冲击治疗,累积剂量达800～1200 mg.试验组应用相对低剂量甲泼尼龙(累积剂量为300～480 mg)联合99Tc-MDP的治疗方案.治疗前及开始治疗后每1～4周进行定期随访观察,并根据眼病临床活动性评分及美国甲状腺协会提出的甲状腺相关眼病分度分级标准评定眼部病情变化,同时监测治疗后的不良反应.应用Ridit检验进行统计分析,比较两组疗效.结果 试验组10例患者有效,对照组6例患者有效,两组的疗效有统计学差异(t=2.121,P＜0.05).对照组的不良反应明显增多,主要体现于消化道症状,引起或加重水钠潴留与糖代谢紊乱.结论 对于老年活动性中重度GO应用相对低剂量甲泼尼龙短程疗法联合99Tc-MDP是一种临床疗效及安全性较好的治疗方案.     

相对低剂量甲泼尼龙联合99Tc-MDP治疗老年Graves眼病的疗效观察

目的评价相对低剂量甲泼尼龙短程疗法联合99Tc-亚甲基二膦酸盐（99Tc-MDP）治疗老年活动性中重度Graves眼病（GO）的临床疗效及安全性。方法24例老年活动性中重度GO患者先配对后随机分入对照组及试验组各12例。对照组应用常规大剂量甲泼尼龙问断静脉短程冲击治疗,累积剂量达800．1200mg。试验组应用相对低剂量甲泼尼龙（累积剂量为300-480mg）联合99Tc-MDP的治疗方案。治疗前及开始治疗后每1～4周进行定期随访观察,并根据眼病临床活动性评分及美国甲状腺协会提出的甲状腺相关眼病分度分级标准评定眼部病情变化,同时监测治疗后的不良反应。应用Ridit检验进行统计分析,比较两组疗效。结果试验组10例患者有效,对照组6例患者有效,两组的疗效有统计学差异（t=2．121,P〈0．05）。对照组的不良反应明显增多,主要体现于消化道症状,引起或加重水钠潴留与糖代谢紊乱。结论对于老年活动性中重度GO应用相对低剂量甲泼尼龙短程疗法联合99Tc-MDP是一种临床疗效及安全性较好的治疗方案。     

99Tc-亚甲基二膦酸盐与153Sm-乙二胺四亚甲基膦酸对骨侵袭和骨质溶解抑制作用的对比研究

目的 对比观察99c-亚甲基二膦酸盐(99Tc-MDP)与153Sm-乙二胺四亚甲基膦酸(153Sm-EDTMP)对Walker256癌细胞引起的大鼠骨侵袭和骨质溶解的抑制作用及二者对移植瘤细胞的影响.方法 建立Walker 256癌大鼠骨侵袭和骨质溶解模型.设空白对照组、99Tc-MDP治疗组、153Sm-EDTMP治疗组、99Tc-MDP+153Sm-EDTMP治疗组,采用99Tcm-MDP全身骨显像、骨骼X线片及胫骨病理切片方法观察两种药物单独或联合应用对荷瘤大鼠骨侵袭和骨质溶解的抑制作用,并通过流式细胞仪分析两种药物对移植瘤细胞的影响.结果 与对照组相比,99Tc-MDP治疗组、153Sm-EDTMP治疗组、99Tc-MDP+153Sm-EDTMP治疗组均能明显抑制荷瘤大鼠骨侵袭和骨质溶解(确切概率法:P<0.05).两种药物联合应用与单独应用相比未见明显差异.各治疗组移植瘤细胞的凋亡率明显高于对照组,S期的细胞比例明显下降,二者联合应用的作用更明显.结论 ①99Tc-MDP及153Sm-EDTMP对荷Walker 256癌大鼠均有抑制骨侵袭和骨质溶解的作用;②两种药物在诱导移植瘤细胞凋亡、抑制移植瘤细胞增殖方面均有一定作用,二者联合应用的作用更明显.     

99Tc-亚甲基二膦酸盐的临床应用研究进展

99Tc-亚甲基二瞵酸盐(99Tc-MDP)可以抑制炎性反应,发挥抗炎、抗风湿作用;能抑制前列腺素的合成,具有明显镇痛作用.此外,99Tc-MDP还可通过调节人体自身免疫及调节骨代谢而发挥作用.临床上99Tc-MDP主治类风湿性关节炎、强直性脊柱炎、甲亢伴浸润性突眼等自身免疫性疾病,对癌转移痛、股骨头坏死及骨质疏松也有较好疗效.     

99mTc-MDP retention in osteoporosis: Relationship to other indices of bone cell activity and response to calcium and vitamin D therapy

Serum calcium, albumin, phosphorus, and alkaline phosphatase, urinary creatinine and retention of ^99mTc-methylene bisphosphonate (^99mTc-MDP) were measured in 61 subjects with osteoporosis and the values compared with those obtained in normal subjects. ^99mTc-MDP retention was inversely related with urinary creatinine output in normal subjects. In osteoporotic subjects urinary creatinine output was lower and ^99mTc-MDP retention higher even when urinary creatinine output was taken into account. Other measurements were similar. In 21 subjects these measurements together with urinary hydroxyproline were performed before and after treatment with calcium and vitamin D. ^99mTc-MDP and alkaline phosphatase fell; urinary hydroxyproline was unchanged. A single 24 h urine measurement after ^99mTc-MDP injection is a valuable method of predicting whether calcium and vitamin D therapy will be useful in a particular case of osteoporosis.     

Deconvolution analysis of 99mTc-methylene diphosphonate kinetics in metabolic bone disease

The kinetics of ^99mTc-methylene diphosphonate (MDP) and ⁴⁷Ca were studied in three patients with osteoporosis, three patients with hyperparathyroidism, and two patients with osteomalacia. The activities of ^99mTc-MDP were recorded in the lumbar spine, paravertebral soft tissues, and in venous blood samples for 1 h after injection. The results were submitted to deconvolution analysis to determine regional bone accumulation rates. ⁴⁷Ca kinetics were analysed by a linear two-compartment model quantitating short-term mineral exchange, exchangeable bone calcium, and calcium accretion. The ^99mTc-MDP accumulation rates were small in osteoporosis, greater in hyperparathyroidism, and greatest in osteomalacia. No correlations were obtained between ^99mTc-MDP bone accumulation rates and the results of ⁴⁷Ca kinetics. However, there was a significant relationship between the level of serum alkaline phosphatase and bone accumulation rates (R=0.71, P<0.025). As a result deconvolution analysis of regional ^99mTc-MDP kinetics in dynamic bone scans might be useful to quantitate osseous tracer accumulation in metabolic bone disease. The lack of correlation between the results of ^99mTc-MDP kinetics and ⁴⁷Ca kinetics might suggest a preferential binding of ^99mTc-MDP to the organic matrix of the bone, as has been suggested by other authors on the basis of experimental and clinical investigations.     

Is (99m)Tc-labelled pamidronate a better agent than (99m)Tc-medronate for bone imaging?

OBJECTIVE: To evaluate the potential of (99m)Tc-pamidronate ((99m)Tc-APD) against (99m)Tc-medronate ((99m)Tc-MDP) as a new bone-seeking agent using intact bone and fractured femur in a rat model. METHODS: (99m)Tc-APD was prepared by the stannous reduction method. Scintigraphic images were obtained at 2 h and 24 h after intravenous injection of (99m)Tc-APD or (99m)Tc-MDP in rats, then they were culled to estimate activities in various organs. Bone uptake (as percent injected dose/gram weight) was estimated in an intact femur and in 1 week post-fracture model. The urinary excretion dose (as percent injected dose) was also estimated. RESULTS: The bone uptake of (99m)Tc-APD was significantly higher (P<0.05) than (99m)Tc-MDP at 2 h and 24 h post-injection studies. (99m)Tc-APD uptake was further increased (P<0.05) in the fracture model than the intact femur. (99m)Tc-APD uptake in the soft tissues including liver and the kidneys was lower than (99m)Tc-MDP. Renal excretion was faster and the ratios of bone to blood and bone to soft tissues were higher with APD than MDP. APD dose was selected at 1% of MDP, to obviate therapeutic effect, as the former compound is 100 times more potent than MDP. CONCLUSIONS: Our results suggest that (99m)Tc-APD uptake by intact bone and fractured bone was significantly higher than (99m)Tc-MDP. The renal clearance of (99m)Tc-APD was faster and soft tissue uptake was lower than (99m)Tc-MDP. These results suggest that APD has the potential to become an excellent bone-imaging agent.     

A report on the incidence of intestinal 99mTc-methylene diphosphonate uptake of bone scans and a review of the literature

BACKGROUND: In addition to well-known specific conditions for soft-tissue uptake of bone-seeking radiotracers, there is a limited number of reports on intestinal uptake of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) on bone scans. AIM: To describe the incidence of intestinal accumulation of (99m)Tc-MDP on bone scans in adult patients, define the patterns of this unusual finding and review the literature on its causes. METHODS: Two thousand, one hundred and forty-four consecutive patients have been evaluated for intestinal (99m)Tc-MDP uptake on bone scans. Intestinal uptake was observed visually 3-4 h after the administration of the radiopharmaceutical. A whole-body bone scan and various spot views of the abdomino-pelvic region were obtained with a dual-headed gamma camera to evaluate the intestinal uptake. Delayed scans were also obtained as well as co-relative imaging and/or colonoscopic studies in some of intestinal uptake patients. Six patients had delayed scans of the abdomino-pelvic region. Fourteen patients had comparable scans either a year before or a year later. The positive intestinal uptake scans were further grouped according to the localization and intensity (mild uptake: lower than iliac bone; moderate uptake: equal to iliac bone; significant uptake: higher than iliac bone). RESULTS: Twenty-two (17 female, five male) patients out of 2144 with a mean age of 57 years showed intestinal (99m)Tc-MDP uptake. The localization was mainly (20/22) in the right abdomino-pelvic region projecting on and in the configuration of ascending colon while one patient showed intestinal uptake all over the abdomen and one displayed diffuse intestinal radioactivity in his right hemithorax. The majority of the cases showed moderate to intense intestinal uptake (18/22). Six patients showed a decrease, disappearance or alteration in the intestinal uptake on the delayed images. Re-evaluation bone scans in five patients 1 year later showed no intestinal uptake this time. Among nine patients with prior bone scans 1 year before, intestinal uptake was negative in seven at that time. No significant pathology was obtained on the correlative images. CONCLUSION: (99m)Tc-MDP uptake can be observed in the intestines in 1% of bone scans with a prominent localization in the ascending colon and rarely all over the intestines or in thorax due to Chilaiditi's syndrome, as well. The mechanism of intestinal uptake is still unclear in some of the patients. Delayed imaging, additional spot views and SPECT studies help in the differentiation of this finding from possible misinterpretation. Intestinal (99m)Tc-MDP uptake on bone scan could be an intermittent process and should be included among other well-known reasons of soft-tissue uptake.     

Quantitative measurements of bone remodeling using 99mTc-methylene diphosphonate bone scans and blood sampling.

Quantitative studies of bone using (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) have a potentially valuable role in investigating the treatment of patients with metabolic bone disease. In this study we compared 3 different methods of measuring whole-skeleton (99m)Tc-MDP plasma clearance (K(bone)) in 12 osteoporotic postmenopausal women (mean age, 67.3 y) before participation in a clinical trial of an osteoporosis therapy. The aim was to compare the consistency and accuracy of the 3 methods before their use in evaluating the subjects' response to treatment. METHODS: Subjects were injected with 600 MBq (99m)Tc-MDP and 3 MBq (51)Cr-ethylenediaminetetraacetic acid ((51)Cr-EDTA) and whole-body bone scan images were acquired at 10 min, 1, 2, 3, and 4 h. Two-minute static images of the thighs were acquired immediately after the 1- to 4-h whole-body scans. Six blood samples were taken between 5 min and 4 h, and free (99m)Tc-MDP was measured using ultrafiltration. The glomerular filtration rate (GFR) was estimated from the (51)Cr-EDTA plasma curve. The methods used to evaluate K(bone) were (a) the area-under-the-curve (AUC) method, in which the GFR measurement was subtracted from the total (bone plus renal) clearance (K(total)) measured from the free (99m)Tc-MDP plasma curve; (b) the modified Brenner method, in which (99m)Tc-MDP renal clearance estimated from the whole-body counts was subtracted from the total clearance measured from the rate of elimination of tracer from soft tissue; and (c) the Patlak plot method, which was also used to derive regional values of K(bone) for the skull, spine, pelvis, arms, and legs. RESULTS: There was good agreement between the 3 methods of measuring K(bone). (mean K(bone) +/- SD: AUC method, 30.3 +/- 6.4 mL x min(-1); Brenner method, 31.1 +/- 5.8 mL x min(-1); Patlak method, 35.7 +/- 5.8 mL x min(-1)). The correlation coefficients between the methods varied from r = 0.767 (P = 0.004) to r = 0.805 (P = 0.002). Regional measurements of (99m)Tc-MDP clearance gave the following percentages of the whole-skeleton clearance: skull, 13.3%; spine, 16.6%; pelvis, 17.2%; arms, 11.1%; legs, 23.7%. CONCLUSION: The 3 methods gave consistent and accurate measurements of K(bone). The Patlak method can be used to study regional as well as total-skeleton values of K(bone).