SPECT结合SPECT/CT骨显像对乳腺癌骨转移的诊断价值

目的探讨SPECT结合SPECT/CT骨显像对乳腺癌骨转移的诊断价值。方法对259例患者进行SPECT及SPECT/CT骨显像,并对骨显像确诊骨转移的61例乳腺癌患者进行统计分析。结果 1)行SPECT/CT骨显像的259例乳腺癌患者中61例出现骨转移,骨转移率为23.55%,单发骨转移率27.87%,多发骨转移率72.13%。其中有10例因确诊时即发现骨转移而未行手术治疗,占16.39%;2)行手术治疗的51例乳腺癌患者分别于术后第1年至第33年不同时间行骨显像复查,术后第1年、第2年、第3年、第4年、第5年及5年以上骨转移数占受检者总数的比率分别为1.54%(4/259)、2.70%(7/259)、2.32%(6/259)、3.47%(9/259)、2.32%(6/259)及7.34%(19/259),术后2~5年骨转移占转移总数的54.90%(28/51),是骨转移高峰期;3)61例骨转移患者共发现转移灶660处,平均每例10.82处。其中胸部骨发生骨转移的病灶数最多,为244处,占36.97%;其次为脊柱骨34.85%,骨盆骨15.30%,颅骨8.18%,四肢骨4.70%,而以肋骨(29.24%)和胸椎(17.88%)最易受累;4)伴骨痛者32例,占52.46%,无骨痛者29例,占47.54%;5)SPECT结合SPECT/CT骨显像诊断溶骨性转移30例,占49.18%,成骨性转移19例,占31.15%,混合性转移12例,占19.67%。结论SPECT结合SPECT/CT骨显像对乳腺癌骨转移的诊断具有重要的临床价值。     

肺癌脊柱骨转移ECT检查76例分析

目的:探讨肺癌脊柱骨转移患者全身静态骨显像(ECT)的特点及规律。方法:收集用ECT检查发现的35~85岁肺癌脊柱骨转移76例患者临床资料,将其分为49岁以下组及50岁以上组(包括50岁),分析其临床特点及ECT表现,并结合X线检查结果分析其早期诊断优势。结果:50岁以上组61例,占80.3%;49岁以下组15例,占19.7%;76例脊柱转移患者中50例为多发病灶(占65.8%),26例为单发病灶(占34.2%)。转移灶尤以胸腰椎最多见。全组病例的78.9%表现为溶骨性破坏,14.5%表现为蜂窝状溶骨性骨破坏,5.3%表现为小片状、斑片状成骨性改变,1.3%表现为斑片状溶骨及成骨混合性改变。结论:肺癌脊柱骨转移的发生有一定的规律及特点,较之X线检查,核素全身骨显像对于肺癌脊柱骨转移的早期临床诊断及治疗决策有重要的意义。     

18F-FDG PET/CT对原发灶不明的骨转移瘤的诊断价值

目的探讨18F-FDGPET/CT对原发灶不明的骨转移瘤的诊断价值。资料与方法回顾性分析经病理证实的72例原发灶不明的骨转移瘤患者的PET/CT资料,记录原发灶部位、骨转移部位及骨外转移部位(包括前哨淋巴结及脏器)并按CT骨转移诊断标准进行分类,测量其最大标准摄取值。结果 PET/CT显像检查确定61例原发灶,11例未找到原发灶。66例为多发骨转移,6例为单发骨转移;原发灶部位依次为肺癌(31例)、前列腺癌(6例)、胃癌(4例)、结肠癌(3例)、甲状腺癌(3例)等;溶骨性转移以肺癌(22例)、胃肠癌(7例)多见,成骨性骨转移以前列腺癌(5例)、肺癌(4例)多见,混合性骨转移以肺癌(5例)、鼻咽癌(2例)多见;胸部骨及脊柱转移多见肺癌(31例),骨盆及脊柱转移多见肺癌(23例)、前列腺癌(6例)。结论 PET/CT诊断原发灶不明的骨转移瘤时,需根据骨转移的类型、部位及前哨淋巴结和脏器转移的位置找出原发灶,必要时进一步行穿刺活检明确诊断。     

乳腺癌患者骨病灶SPECT/CT融合显像的临床价值

目的 探讨SPECT/CT融合显像诊断与鉴别乳腺癌患者全身骨显像放射性异常浓聚灶的临床价值。 方法 对25例乳腺癌患者的99Tcm-MDP全身骨显像显示的骨异常放射性浓聚灶行SPECT/CT融合显像。4~8个月后再次行全身骨显像及SPECT/CT融合显像复查。图像由两名有经验的核医学科医师独立分析, 部分CT图像由有经验的放射科医师分析指导。 结果 在25例乳腺癌患者的37个异常放射性浓聚灶中, 确定29(29/37, 78. 38%)个病灶为骨转移灶, 其中有2个椎体病灶在初次检查中判读为良性病灶; 8(8/37, 21. 62%)个病灶为良性病灶, 其中1个肋骨病灶在初次检查中判读为骨转移灶, 比较全身骨显像和SPECT/CT融合显像, 二者之间差异有统计学意义(χ2=6.975, P < 0.05)。骨转移灶主要分布于椎骨及肋骨。全身骨显像和SPECT/CT融合显像的诊断灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为82.76%、75.00%、92.31%、54.55%、81.08%和93.10%、87.50%、96.43%、77.78%、91.89%。采用受试者操作特性曲线(ROC)进行分析, 结果:全身骨显像曲线下面积为0. 860±0. 056, SPECT/CT融合显像曲线下面积为0. 974±0. 020。SPECT/CT融合显像曲线下面积大于全身骨显像曲线下面积, 两者之间差异具有统计学意义(χ2=9. 924, P < 0.001)。 结论 SPECT/CT融合显像较全身骨显像能更好地鉴别出乳腺癌骨病灶的性质, 能够提高诊断准确率, 具有重要的临床价值; 必要时应在4~8个月后复查SPECT/CT。     

胃癌132例核素骨显像结果分析

目的 探讨胃癌患者骨显像结果与不同临床分期和病理类型的关系,以及胃癌骨转移的特点和规律。方法 回顾性分析132例胃癌患者骨显像结果,从病理、临床分期、骨转移灶数目和分布部位进行讨论和分析。结果 132例患者中骨转移21例,占15.9%,其中多发性骨转移19例,占转移患者90.5%;低分化腺癌及未分化癌、黏液腺癌骨转移率分别为15.2%和20%,Ⅲ、Ⅳ期胃癌骨转移率18.4%和26.6%;骨转移的部位以椎体最常见,其次是肋骨、骨盆。结论 胃癌较少转移至骨,一旦发生骨转移,一般转移病灶范围较广泛,已属肿瘤晚期。对分期晚、分化差胃癌患者应定期进行骨核素显像,以早期发现骨转移。     

~(18)F-FDG PET/CT、~(99m)Tc-MDP全身骨显像及其联合CT对肺癌骨转移的诊断价值比较

目的探讨~(18)F-FDG PET/CT,~(99m)Tc-MDP全身骨显像(BS)及BS联合CT这三种方法对肺癌骨转移诊断价值的比较。方法回顾性分析2014年1月~2016年8月间行~(18)F-FDG PET/CT及BS检查并经病理证实的56例肺癌患者,将BS与~(18)F-FDG PET/CT同机CT图像进行联合诊断,以病理及临床随访为诊断依据,比较BS、BS联合CT及~(18)F-FDG PET/CT对肺癌骨转移的诊断价值。数据分析采用χ~2检验,P﹤0.05为差异有统计学意义。结果 56例患者中骨转移28例共138处骨转移灶。基于患者,~(18)F-FDG PET/CT(96.4%及94.6%)与BS联合CT(89.3%及91.1%)诊断肺癌骨转移的特异性及准确性均高于BS(60.7%及75.0%)(均P0.01与均P0.05),~(18)F-FDG PET/CT(92.9%)与BS(89.3%)灵敏度差异无统计学意义。~(18)F-FDG PET/CT与BS联合CT之间差异均无统计学意义。基于骨转移灶,~(18)F-FDG PET/CT对骨转移灶的检出率(92.0%)高于BS联合CT(79.0%)(X~2=9.473,P0.01),BS联合CT高于BS(68.1%)(X~2=4.191,P0.05)。~(18)F-FDG PET/CT对CT无形态异常(骨髓转移)及溶骨性转移灶的检出率高于BS联合CT(X~2=16.261及15.300,均P0.01),BS联合CT对溶骨性转移灶的检出率高于BS(X~2=6.711,P0.01),BS对成骨性转移灶的检出率高于~(18)F-FDG PET/CT(X~2=8.892,P0.01)。~(18)F-FDG PET/CT更容易发现位于胸椎、骶椎、骨盆及股骨的转移灶。结论~(18)F-FDG PET/CT与BS联合CT诊断肺癌骨转移的价值优于BS,~(18)F-FDG PET/CT能更早发现BS联合CT无法检出的骨髓及小的溶骨性转移灶。     

NSCLC溶骨型脊柱转移瘤21例放疗前后CT影像对比

目的探讨NSCLC溶骨型脊柱转移瘤放射治疗前后在CT表现的变化特点。方法回顾性分析21例NSCLC溶骨型脊柱转移瘤患者的放射治疗及影像学资料,观察溶骨型脊柱转移瘤CT影像特点及其放疗后1月、3月、6月的椎体转移瘤CT值及体积值变化,总结其特征。结果所有患者均顺利完成治疗及影像学CT检查,溶骨型椎体转移病灶放疗后1个月病灶内未见明显钙化,CT值变化差异无统计学意义(P 0. 05); 3个月、6个月后病灶同部位CT值与放疗前相比显著升高(P=0. 04,P=0. 017)。本组中所有病灶在放疗6个月后CT检查评价为CR 2例,PR 9例,NR 8例,PD 2例,总有效率52. 3%,38. 1%的患者病灶表现稳定。结论在NSCLC溶骨型脊柱转移病灶的治疗中,放射治疗可以有效杀灭肿瘤细胞、促进溶骨性病灶钙化修复,对患者具有相当肯定的疗效; CT检查是一种观察骨转移灶放疗后影像学变化的安全有效的常规检查手段。     

第三代双源双能CT虚拟去钙骨髓成像在椎体成骨性骨转移瘤评价中的价值

目的 探讨第三代双源双能CT虚拟去钙骨髓成像(简称骨髓成像)用于评价椎体成骨性骨转移瘤的临床价值。方法 回顾性分析2017年11月至2018年9月在山西医科大学第一医院就诊的48例骨外恶性肿瘤患者[男性27例、女性21例,年龄(62.4±10.5)岁]的椎体骨转移情况,所有患者同期均行双源双能CT成像与9 Tcm-亚甲基二膦酸盐(MDP)全身骨显像,以临床随访诊断或病理诊断结果为标准,比较99Tcm-MDP全身骨显像、常规CT及骨髓成像3种方法在椎体成骨性骨转移瘤中的诊断价值。在骨髓成像图像上测量骨髓密度(CT值),3种方法诊断椎体成骨性骨转移瘤的灵敏度、特异度、阳性预测值、阴性预测值和准确率的比较采用χ2检验,采用t检验比较椎体转移灶的骨髓CT值和正常椎体的骨髓CT值,采用受试者工作特征曲线分析骨髓CT值。结果 48例患者共计598个椎体,确诊成骨性骨转移瘤的椎体135个。99Tcm-MDP全身骨显像诊断数为127个,常规CT诊断数为119个,骨髓成像诊断数为129个,骨髓成像诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为95.56%、94.82%、84.31%、98.65%和94.98%。99Tcm-MDP全身骨显像、常规CT、骨髓成像的阴性预测值(98.17%、96.60%、98.65%)和准确率(92.81%、95.82%、94.98%)间的差异均无统计学意义(χ2=4.891、5.591,P=0.087、0.061);99Tcm-MDP全身骨显像与骨髓成像的灵敏度(94.07%vs. 95.56%)、特异度(92.44%vs. 94.82%)及阳性预测值(78.40%vs. 84.31%)间的差异均无统计学意义(χ2=0.301、2.190、1.811,P=0.583、0.139、0.178);病变椎体转移灶的骨髓密度较正常椎体的骨髓密度低[(-588.96±332.37) HUvs.(-55.03±75.62) HU],差异有统计学意义(t=31.906,P=0.000)。骨髓密度的曲线下面积为0.99,临界值为-119.6 HU(灵敏度和特异度分别为97.80%和96.50%)。结论 第三代双源双能CT虚拟去钙骨髓成像可用于检测椎体成骨性骨转移瘤。     

脊柱溶骨性转移瘤的CT诊断

目的　分析脊柱溶骨性转移瘤的CT表现 ,探讨CT对该病的诊断及鉴别诊断价值。方法　分析 46例 72个椎骨溶骨性转移瘤的CT表现 ,并与其中 2 8例的X线平片结果进行比较。结果　 46例脊柱溶骨性转移瘤的 72个转移椎骨中 ,椎体破坏 45例共 74个病灶 ,椎弓根破坏 2 2例 ,累及横突 15例 ,椎板和棘突 (受累 )各 11例。微转移病灶集中在椎体 ( 4 5 /4 9)。CT发现骨破坏、椎管受累及椎旁软组织肿块分别为 10 0 %、67.85 %及 71.4% ,而X线对三者的发现率仅为 5 3 .6%、14 .3 %及 3 2 .1%。结论　脊柱转移瘤首先侵犯椎体 ,椎体转移瘤是椎弓根、椎板、横突和棘突破坏的基础。CT扫描在发现和评估病变方面较X线平片检查敏感     

18F-FDG hPET/CT显像与99Tcm-MDP骨显像探测骨转移瘤的价值

目的　探讨1 8F 脱氧葡萄糖 (FDG)hPET CT与99Tcm 亚甲基二膦酸盐 (MDP)骨显像探测骨转移瘤的临床价值。方法　临床拟诊恶性肿瘤或肿瘤术后复发合并骨病变患者 34例 ,均于 2周内分别行FDG和MDP骨显像 ,其中 31例经手术或活组织病理检查证实为原发肿瘤患者 ,余 3例为原发灶不明但广泛骨转移者。结果　 34例患者中 2 6例有骨转移 ,共探测到 75个骨病灶 ,其中骨转移灶 6 3个 ,良性病灶 12个 (其中骨退行性变 8个 ,肋骨骨折 2个 ,结核和慢性炎症各 1个 )。1 8F FDGhPET CT显像探测骨转移瘤灵敏度为 90 5 % ,特异性为 83 3% ,准确性为 89 3% ;99Tcm MDP骨显像分别为 79 4 % ,75 0 %和 78 7% (P均 >0 0 5 )。结论　99Tcm MDP骨显像仍为诊断骨转移瘤的首选方法 ,1 8F FDGhPET CT显像对鉴别诊断骨转移瘤具有一定临床价值。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.