放射性核素脑脊液显像的临床应用

目的：评价放射性核素脑脊液显像临床应用价值。材料和方法：对190例核素脑脊液显像的随访病史，部分结合CT和(或)MRI进行回顾性图像分析。结果：交通性脑积水，脑池显像均可见脑室返流明显；正常脑压脑积水，示踪剂缓慢上升到大脑凸面，上矢状窦放射性分布少，即使伴脑室返流，但其程度较轻。脑脊液漏诊断的灵敏度在持续性、间歇性、可疑或无明显脑脊液鼻漏三组中分别为100％(19/9)，90％(27/30)及71％(17／24)。其他，脊髓空洞症12例中无阳性发现4例，脑脊液吸收缓慢5例，脊髓段有放射性缺损区3例。颅内压增高21例中脑脊液吸收缓慢9例，吸收正常12例。脑室分流术后11例，放射性核素分流显像可以显示分流管是否畅通。本组与脑脊液相通的蛛网膜囊肿5例均能显示。结论：脑池显像有助于正常脑压脑积水的诊断，及估测手术预后；结合棉拭放射性计数测定，是诊断脑脊液漏有效而灵敏的方法。还可用于脑室分流术后随访、脊髓空洞症与蛛网膜下腔相交通的蛛网膜囊肿等的诊断。     

放射性核素显像在骨肉瘤诊断中的应用

目的　评价骨肉瘤的核素显像特征,以利于骨肉瘤的诊断和疗效评估。方法　133例骨肉瘤患者做了174次99Tcm-亚甲基二膦酸(MDP)全身骨显像和33次201Tl三时相局部显像,观察骨肉瘤的显像特征和对显像剂的摄取情况。结果　108例骨肉瘤单发病灶的99Tcm-MDP显像特征为病灶部位的高摄取,在放射性浓集的热区病灶中可见大小不等的减低区,伴或不伴有软组织浓集,半定量分析摄取比值为5.40±3.42(n=33);33例骨肉瘤201Tl三时相显像血流曲线明显升高,15min比值为3.38±2.12,3h为2.03±0.87。报告了放射性核素显像在骨肉瘤多发病灶、肺转移灶及术后复发和骨转移诊断中的应用。结论　放射性核素显像可示踪骨肉瘤成骨的生物学行为,在骨肉瘤的基础和临床研究中有重要意义。     

放射性核素显像诊断实验性肺挫伤的价值

肺挫伤是意外事故特别是交通事故中最常见的损伤,诊断主要依靠病史和临床体征,Ｘ线检查在肺挫伤诊断中有较重要的地位,但灵敏度较低。本研究采用放射性核素显像观察肺挫伤后肺部出现的变化,并与Ｘ线平片、ＣＴ及尸检结果对照,探讨核素显像在肺挫伤诊断中的应用价值。...     

间接法放射性核素输卵管显像在不孕症诊断中的应用

对７５例患者进行了间接法放射性核素输卵管显像（ＲＮＨＳＧ）。结果４２例原发性不孕病人共８４条输卵管中６１．９５％出现功能性阻塞图形，继发性不孕２５例共４９条输卵管中仅为１６．３３％。两组病人的ＲＮＨＳＧ提示通畅分别为２３．８１％和６３．２７％，而对照组为１００％。因此认为输卵管ＲＮＨＳＧ功能检查是一种简便可靠的方法。     

放射性核素显像在帕金森病鉴别诊断中的应用

帕金森病（PD）的鉴别诊断在临床上是一大难题,放射性核素显像能够为PD的鉴别诊断提供分子水平和代谢水平的信息,有助于PD与非典型帕金森综合征和特发性震颤（ET）等疾病的鉴别。笔者就放射性核素显像在PD鉴别诊断中的应用做一综述。     

正常颅压脑积水分流术前后核素脑池显像的意义

临床通常把痴呆、尿失禁和走路不稳作为正常颅压脑积水分流术的适应证 ,但部分患者行分流术无效。核素脑池显像有助于脑积水的诊断、鉴别诊断、手术适应证的选择和疗效判定。我们于1987～ 1997年收治了交通性正常颅压脑积水 2 1例 ,在脑室 腹腔分流术前后分别行放射性核素脑池显像 ,探讨该检查在临床中的价值。资料与方法2 1例患者 ,男 12例 ,女 9例 ,年龄 5 4～ 6 7(平均 6 1 2 )岁。病程 0 5～ 5ａ ,平均 3 1ａ。 2 1例中脑膜炎后脑积水 8例 ,蛛网膜下腔出血后脑积水 6例 ,脑外伤后脑积水 4例 ,原因不明脑积水 3例 ,均经ＣＴ或ＭＲＩ证…     

放射性核素显像诊断儿童Meckels憩室

对传统的＾９９ｍＴｃＯ４＾－消化道显像方法作了部分技术改进，２１例反复便血的患儿接受了放射性核素检查，结果示Ｍｅｃｋｅｌｓ憩室１０例，肠重复畸形２例，并全部补手术所证实，其显像表现具有独特的时间，强度和形态特征。该法可为临床诊治提供有力的手段。     

小儿消化道出血的放射性核素显像诊断

对１７例小儿消化道出血的患儿作了（９９ｍ）ＴｃＯ４腹部显像．结果显示９例手术证实为Ｍｅｃｋｅｌ憩室的患儿中８例腹部有异常放射性浓聚，１例阴性．１例肠重复畸形，其腹部也有异常放射性浓聚区．另有升结肠息肉，出血性小肠炎．慢性结肠炎等７例均呈阴性．其诊断小儿消化道出血的灵敏度、特异性及准确率分别为９０．０％、１００．０％及９４．１％，表明放射性核素显像诊断消化道出血是一种简便、安全、准确性较高的方法．     

放射性核素显像在糖尿病足诊治中的应用

早期、准确地诊断糖尿病的微血管、血流改变以及感染是取得治疗成功的关键。放射性核素显像可以为糖尿病足的发生、发展提供重要信息,在对糖尿病足的早期改变、糖尿病足部骨髓炎的诊断以及对溃疡的预后估计具有重要作用。     

唾液腺放射性核素显像在干燥综合征诊断中的应用研究进展

唾液腺功能的评估在干燥综合征(SS)患者的诊断、治疗决策和随访中起着重要作用。唾液腺放射性核素显像是评估唾液腺功能的一种无创的、易操作的方法,该方法已被欧洲专家组作为SS的一个诊断标准。该文就唾液腺放射性核素显像在SS定性、定量诊断中的应用研究进展进行综述。     

Evaluation of radionuclide cerebrospinal fluid scintigraphy as a guide in the management of patients with hydrocephalus

PurposeRadionuclide cerebrospinal fluid scintigraphy (RCFS) has long been clinically applied in the diagnosis of hydrocephalus. This study aims to evaluate the clinical value of RCFS as a guide in the management of patients with hydrocephalus.MethodsThirteen patients with hydrocephalus were investigated. They underwent RCFS scanning and computed tomography/magnetic resonance imaging examination in our hospital. Follow-up treatment was performed, and prognosis was made.ResultsFour of seven patients diagnosed with obstructive hydrocephalus by RCFS underwent endoscopic third ventriculostomy, and five of six patients diagnosed with obstructive hydrocephalus underwent ventriculoperitoneal shunt. All patients who underwent operation had good prognosis on follow-up after at least 1 year.ConclusionRCFS can definitely differentiate obstructive hydrocephalus from communicating hydrocephalus and had significance as a guide in the treatment of patients with hydrocephalus.     

Hawkeye SPECT仪融合图像用于脑脊液鼻漏诊断和定位

目的探讨HawkeyeSPECT仪融合图像对脑脊液鼻漏诊断和定位的临床价值。方法选择33例确诊脑脊液鼻漏的患者,术前腰椎穿刺注射^99Tc^m-DTPA后120和180min行脑池平面显像,然后分别在同一床位进行SPECT和CT扫描,扫描结束后,进行图像处理及图像融合,通过图像分析确定脑脊液鼻漏的漏口、漏道,并做对比分析。采用SAS6．12软件进行统计学处理,对平面和融合显像的2组数据比较行x^2检验。结果33例患者中,融合显像31例、平面显像30例颅底至鼻部有异常放射性浓聚影,其中融合显像有30例、平面显像有18例与手术证实漏口完全一致,其诊断灵敏度和定位准确性分别为93．9％（31／33）,90．9％（30／33）和93．5％（29／31）,78．3％（18／23）。2种方法的诊断灵敏度差异无统计学意义（x^2=0．65,P〉0．05）,定位准确性差异有统计学意义（x^2=10．30,P〈0．05）。结论^99Tc^m-DTPA脑池SPECT显像与同机定位CT图像融合作为灵敏、简便和定位准确的检查手段,可用于诊断和定位脑脊液鼻漏的漏口、漏道。     

肺通气/灌注显像预测肺癌术后肺功能

目的 利用肺通气/灌注显像预测肺癌切除术后残余肺功能及评价手术适应证.方法 26例原发性肺癌患者：21例行肺灌注/通气显像,其中13例行手术治疗;5例行肺灌注显像行手术治疗;所有患者于术前1周左右行肺功能检查,其中18例手术治疗患者于术后2个月再次行肺功能检查.采用Neuhaus公式计算术后肺功能：第1秒用力呼气量预测值（ppoFEV1）.对通气、灌注显像2种方法计算所得的ppoFEV1值进行t检验,并分别与术后2个月肺功能实测值进行t检验和相关性分析.结果 21例患者通气法ppoFEV1为（1.347±0.539）L,灌注法ppoFEV1为（1.410±0.543）L,差异无统计学意义（t=0.062,P＞0.05）;13例手术者其中术前通气ppoFEV1为（1.545±0.588）L,术后2个月实测值为（1.450±0.521）L,差异无统计学意义（t=0.092,P＞0.05）.所有18例手术者术前灌注ppoFEV1为（1.697±0.546）L,术后2个月实测值为（1.457±0.488）L,差异无统计学意义（t=0.017,P＞0.05）.13例肺通气法ppoFEV1与术后2个月实测值显著相关,r=0.950,P＜0.01;肺灌注法ppoFEV1值与术后2个月实测值也显著相关,r=0.937,P＜0.01.18例肺灌注法ppoFEV1与术后2个月实测值也显著相关（r=0.922,P＜0.01）.结论 肺通气/灌注显像结合肺功能测定有利于判断肺癌患者尤其合并低肺功能患者能否进行手术及确定手术部位和范围,能用于预测肺癌切除术后残余肺功能.     

肺通气/灌注显像结合血浆D-二聚体分析对肺栓塞的诊断价值

目的　探讨肺通气 灌注 (V Q)显像结合血浆D 二聚体 (dimer)分析在肺栓塞 (PE)诊断中的临床价值。方法　疑有PE的患者 10 4例进行肺V Q显像和血浆D dimer分析。以临床诊断为依据 ,分别评价肺V Q显像、D dimer分析及V Q显像结合D dimer分析对PE的诊断价值。结果　 4 4例确诊为PE ,6 0例排除PE。肺V Q显像对 86例 (82 .7% )明确诊断 ,另 18例 (17. 3% )为非确定性诊断。V Q显像诊断PE的灵敏度、特异性和准确性分别为 84. 1%、75 .0 %和 78. 8%。血浆D dimer分析诊断PE的灵敏度、特异性和准确性分别为 93. 2 %、6 0 . 0 %和 74 . 0 %。以D dimer <5 0 .0mg L作为V Q显像中非确定性诊断病例排除PE的依据 ,则诊断的特异性和准确性分别提高到 85. 0 %和 84 . 6 %。结论　在V Q显像中出现非确定性诊断结果时 ,血浆D dimer测定可作为排除PE的依据 ;V Q显像结合血浆D dimer测定可提高诊断的特异性和准确性。     

The use of radionuclide cisternography in the diagnosis of pleural cerebrospinal fluid fistulae

Radionuclide cisternography (RNC) is an excellent method of studying cerebrospinal fluid (CSF) dynamics and fistulous communications. Two patients are described in which pleural cerebrospinal fluid fistulae were found by this technique. In addition, marking the area presurgically reduced operating room time in one patient. Such communications are important to locate since they can cause significant loss of CSF as well as provide a pathway for pathogens to enter the central nervous system.     

Apparent diffusion coefficient and cerebrospinal fluid flow measurements in patients with hydrocephalus

OBJECTIVE: To evaluate the efficacy of diffusion magnetic resonance imaging and compare with cerebrospinal fluid (CSF) flow imaging in patients with hydrocephalus before and after treatment. METHODS: Twenty patients with hydrocephalus (group 1, pediatric, with primary aqueductal stenosis, n = 10; group 2, adult, with normal-pressure hydrocephalus, n = 10) and 20 age-matched healthy subjects that served as controls were examined. Cerebrospinal fluid flow velocity interval was calculated as the mean absolute values of the peak craniocaudal velocity and caudocranial velocity on CSF flow measurements. On diffusion magnetic resonance imaging, apparent diffusion coefficient (ADC) values from 8 regions were evaluated. RESULTS: The decrease in ADC values after treatment was significant in both groups (P < 0.001 for both). Preoperative mean CSF flow velocity interval value was significantly lower in group 1 and significantly higher than postoperative and control group values in group 2 (P < 0.001 for all). CONCLUSION: The ADC values increase in hydrocephalus and decrease significantly after treatment. Preoperative ADC value may serve as baseline, and the change in ADC may be an indicator of response to treatment and CSF flow measurements.     

Intestinal activity visualized on radionuclide cisternography in patients with cerebrospinal fluid leak

Several methods are used in conjunction with radionuclide cisternography for detecting cerebrospinal fluid (CSF) rhinorrhea or otorrhea, including positioning of the patient to induce drainage, placing cotton pledgets in the nostrils and ears for scintillation counting, and increasing the CSF pressure within the subarachnoid space. Presented here are three surgically proven cases of CSF leak where intestinal activity was detected at different intervals following the lumbar intrathecal administration of indium-111-DTPA for radionuclide cisternography. We recommend the addition of an abdominal image during radionuclide cisternography for CSF liquorrhea.     

Diffusion-weighted magnetic resonance imaging of cerebrospinal fluid in patients with and without communicating hydrocephalus

Background: Recent concepts about cerebrospinal fluid (CSF) circulation in communicating hydrocephalus (CoHy), which is also termed “restricted arterial pulsation hydrocephalus,” suggest reduced arterial pulsations of subarachnoid vessels with a smaller amount of CSF shifted in subarachnoid spaces during the early systole. The postulated restriction of subarachnoid arterial pulsations in CoHy should induce a smaller motion artifact and reduced local stream effects in CSF in magnetic resonance (MR) diffusion-weighted imaging (DWI).

Purpose: To investigate the maximum diffusivity in CSF in patients with and without CoHy using DWI.

Material and Methods: 12 patients without CSF circulation disturbances and six cases with proven CoHy were assessed. Diffusion was measured in six noncollinear directions without triggering the arterial pulse wave (scan time 6:45 min, voxel size 2×2×2 mm). Due to expected artifacts, the calculated maximum diffusivity was called apparent diffusivity. Regional high and low apparent diffusivity was assessed in CSF spaces on newly created 3D CSF motion maps.

Results: Patients with regular CSF circulation exhibited high apparent diffusivity in CSF in basal subarachnoid spaces, whereas apparent diffusivity was low there in patients with CoHy.

Conclusion: DWI opens a feasible approach to study CSF motion in the neurocranium. Restricted arterial pulsations seem to be involved in CoHy.     

Relationship between cerebrospinal fluid and blood dynamics in healthy volunteers and patients with communicating hydrocephalus

RATIONALE AND OBJECTIVES: Using magnetic resonance imaging (MRI), we investigated cerebral blood and cerebrospinal fluid (CSF) flows in patients with communicating hydrocephalus (CH) and in healthy volunteers to determine the contribution of CSF flow to brain pressure regulation in CH patients. METHODS: Cine phase-contrast MRI data from 16 healthy volunteers and 12 patients with CH characterized by hyperdynamic aqueductal CSF flow were analyzed using in-house image-processing software that automatically measured flow curves. Amplitude and temporal CSF and blood flow parameters were compared in the 2 groups. RESULTS: Jugular peak flow occurred significantly earlier (P < 0.01) in the CH patients than in the healthy volunteers. Cervical CSF oscillations were not significantly different between the 2 groups. CONCLUSION: Venous vessel compression and/or changes in intracranial subarachnoid CSF flow produce an increase in ventricular CSF flush that compensates for vascular brain expansion in patients with CH.     

Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus

The authors blindly reviewed the charts of 20 patients with normal-pressure hydrocephalus (a disease of unknown cause characterized radiologically as chronic communicating hydrocephalus and clinically by gait apraxia, dementia, and incontinence) who had undergone creation of a ventriculoperitoneal shunt. The initial clinical response to surgery was graded excellent, good, fair, or poor; 5-year follow-up was available in 55% of cases. The magnetic resonance (MR) images obtained in these patients were also blindly reviewed for the magnitude of cerebrospinal fluid (CSF) flow void (graded on the basis of extent rather than degree of signal loss) in the cerebral aqueduct. A significant (P less than .003) correlation existed between good or excellent response to surgery and an increased CSF flow void. The presence of associated deep white matter infarction on MR images did not correlate with a poor response to surgery. On the basis of these findings, it is suggested that patients who fulfill the clinical criteria of NPH and have an increased CSF flow void undergo creation of a shunt.