脊椎结核CT扫描的评价

本文介绍30例脊椎结核的CT表现。在CT图上可以见到反映本病病理基础的终板骨毁蚀、中心性穿凿状骨破坏、局限性骨硬化和破坏区内死骨形成。作者认为这些征象对诊断脊椎结核具有特征性。CT还能显示因慢性骨结核感染造成的局限性骨凝缩和修补性骨赘,能精确地确定椎旁和椎管内脓肿的范围。作者认为CT在诊断早期和可疑结核,优于常规放射。作者对鉴别诊断、指征和限度,作了讨论。     

18F-FDG和 68Ga-DOTA-SSA双示踪剂PET/CT在神经内分泌肿瘤中的临床应用

与常规CT和MRI影像学检查相比,68Ga-1,4,7,10-四氮杂环十二烷-1,4,7,10-四乙酸（DOTA）-生长抑素类似物（SSA）PET/CT在神经内分泌肿瘤（NEN）的诊断中具有较高的灵敏度和特异度,同时,在疗效评价和预后评估等方面也有重要的指导价值。18F-氟脱氧葡萄糖（FDG）PET/CT虽然在NEN的诊断中未被常规推荐,但其在良恶性肿瘤的鉴别诊断和预后评估中可提供额外的信息。笔者就近年来18F-FDG和68Ga-DOTA-SSA双示踪剂PET/CT在NEN中的临床应用进行综述。     

降钙素原检测方法学和临床意义的研究进展

降钙素原(PCT)是降钙素的前体肽,是近年来发现全身严重感染性疾病的标志物,在细菌所致炎症或感染性疾病中可特异性升高。尤其对败血症、脓毒症、全身严重细菌感染、细菌性与非细菌性的鉴别及其他感染性疾病的早期诊断和鉴别诊断、治疗中抗生素的合理使用及预测疾病的预后方面有重要的作用。与其他传统实验室指标相比,在诊断细菌感染性疾病中PCT有更好的特异性,是一个非常有应用价值的诊断感染状态的微生物学指标。PCT在多种感染性疾病的早期快速诊断、鉴别诊断、病程监测、指导用药等方面发挥着重要作用。其检测方法发展迅速,可进行快速定性或准确定量检测。     

18F-FDG-PET对恶性淋巴瘤临床分期和治疗决策的影响

目的:为了进一步证实18F-FDG-PET在恶性淋巴瘤临床分期和治疗决策中的价值,回顾性比较了18F-FDG-PET、67Ga-显像以及常规检查(CT、消化道造影及骨髓穿刺)对恶性淋巴瘤的诊断效能,同时比较了18F-FDG-PET和67Ga-显像在恶性淋巴瘤临床分期和治疗决策上对常规检查的补充增值作用。方法:33例淋巴瘤患者(其中29例为初发,4例为复发)在开始治疗前接受了18F-FDG-PET以及67Ga-显像和常规检查,根据所有检查结果和治疗结束后6个月以上的随访结果最终确定淋巴结病灶个数、结外病灶个数和病期,比较18F-FDG-PET、67Ga-显像和常规检查对淋巴瘤的诊断效能。结果:33例患者全部561个淋巴组织区域中,共有113个被最终诊断为淋巴瘤病灶;此外,有10个淋巴结外病灶被最终确定。113个淋巴结组织病变中,常规检查诊断出78处病变,18F-FDG-PET又追加诊断出35处病变,而67Ga-显像仅追加诊断出9处;常规检查、常规检查 67Ga和常规检查 18F-FDG诊断恶性淋巴瘤淋巴组织浸润的灵敏度分别为69.0%、77.0%和100%。10个淋巴结外病变中,常规检查诊断出9处,18F-FDG-PET追加诊断了1处病变,而67Ga-显像未能提供追加诊断信息;常规检查、常规检查 67Ga、常规检查 18F-FDG诊断恶性淋巴瘤淋巴结外浸润的灵敏度分别为90%、90%和100%。常规检查、常规检查 67Ga和常规检查 18F-FDG进行淋巴瘤病期的准确性分别为72.7%、75.8%和84.8%。最终,18F-FDG-PET改变了6例(18.2%)患者的临床分期和治疗方案。结论:在淋巴瘤诊断上,18F-FDG-PET比67Ga提供了更多的追加诊断信息,同时18F-FDG-PET在制定淋巴瘤治疗方案上发挥了重要的作用。     

PET在帕金森病病理机制研究中的应用近况

PET是目前研究分子水平人体医学的最佳手段,PET检查在PD(帕金森病)的发病机制、早期诊断、鉴别诊断及治疗中发挥着重要的作用。尤其为PD的早期诊断提供了更科学的手段,为PD的治愈提供了条件。     

骨盆骨巨细胞瘤影像特征分析

目的:分析骨盆骨巨细胞瘤X线平片、CT及MRI征象,探讨其影像特征及鉴别诊断要点。方法:分析总结经手术及病理证实的29例(包括7例复发)骨盆骨巨细胞瘤患者的X线平片、CT、MRI表现。结果:①X线平片表现:囊状骨质破坏15例,单纯溶骨性破坏8例,"多房性"骨质破坏6例。②CT表现:18例呈囊样膨胀性骨质破坏,11例呈单纯溶骨性破坏,未见骨膨胀扩张征象;增强扫描肿瘤实质部分均出现轻度至中度的强化。③MRI表现:6例MRT1WI上均呈等信号、低信号,T2WI上呈低信号、等信号、高混杂信号。结论:骨盆巨细胞瘤的影学表现为膨胀性溶骨破坏,与长骨巨细胞瘤比较除膨胀更为显著外,余无明显差异;骨盆骨巨细胞瘤诊断需综合运用X线平片、CT及MRI并与临床表现相结合,且能够提高骨盆骨巨细胞瘤诊断及鉴别诊断的准确性。     

原发性软骨肉瘤影像表现分析

目的探讨原发性软骨肉瘤的影像表现,提高对本病的诊断水平。方法回顾分析11例经病理确诊原发软骨肉瘤临床及影像学资料。结果11例患者年龄范围13～63岁,中位年龄41岁,其中40岁以上7例。10例行x线平片检查,表现为溶骨/混合性骨质破坏,5例病灶内见钙化,仅1例见骨膜反应;3例行CT检查,病灶内均可见环一弧状钙化及骨内膜“扇贝样”压迹;9例行MRI平扫＋增强检查,T2WI上以高信号为主,内可见低信号间隔,部分病灶内散在斑片状钙化低信号影,增强后病灶均呈较明显的弓一环形强化;其中3例行动态增强扫描,表现为早期明显强化。结论原发性软骨肉瘤具有一定的特征,综合分析影像表现可提高本病诊断及鉴别诊断水平。     

原发性骨淋巴瘤CT及MRI诊断

目的探讨原发性骨淋巴瘤CT及MRI表现,以提高对该病的诊断水平。方法回顾性分析12例经临床病理证实的原发性骨淋巴瘤的影像学资料。结果12例原发性骨淋巴瘤中10例为B细胞源性,2例为T细胞源性。侵犯骨盆3例,椎体3例,肋骨2例,胸骨2例,颅骨2例。CT及MRI扫描中,9例原发性骨淋巴瘤单发。3例原发性骨淋巴瘤多骨发生。其中溶骨型7例,浸润型3例,混合型2例,均合并有病理性骨折。颅骨2例均部分形成软组织肿块。MRI表现为T1wI呈等或低信号,T1wI呈等或稍高信号。结论原发性骨淋巴瘤的CT和MRI表现具有一定特征性,有助于诊断和鉴别诊断。     

68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量的估算

目的 估算68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量。 方法 采用简单随机抽样的方法选取2021年10至12月于北京大学肿瘤医院接受68Ga-奥曲肽PET/CT显像的20例患者进行前瞻性研究,其中男性15例、女性5例,年龄30~68（49.0±12.2）岁。在患者静脉注射68Ga-奥曲肽0 h后,使用辐射监测剂量仪测量距患者1.0 m处的空气吸收剂量率,注射1.0 h后测量距患者0.3 m处的空气吸收剂量率,注射1.5 h后测量距患者0.3、0.5、1.0和1.5 m处的空气吸收剂量率。依据美国国家辐射防护和测量委员会第155号报告提出的人类社会活动模式,采用积分法估算68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量。 结果 注射68Ga-奥曲肽0 h后,距患者1.0 m处的空气吸收剂量率为12.97~33.67 （20.24±6.57） μSv/h;注射1.0 h后,距患者0.3 m处的空气吸收剂量率为32.73~57.69（48.98±6.20） μSv/h;注射1.5 h后,距患者0.3、0.5、1.0、1.5 m处的空气吸收剂量率分别为24.04~42.39（35.98±4.56） μSv/h、11.83~28.83（20.70±4.55） μSv/h、5.17~13.42（8.07±2.61） μSv/h、1.51~7.01（3.75±1.72） μSv/h。与68Ga-奥曲肽显像患者白天接触的家庭成员受照的有效剂量为8.22~21.33（12.83±4.15） μSv,夜间同床共睡的家庭成员受照的有效剂量为38.92~68.62（58.25±7.38） μSv,单位同事受照的有效剂量为8.37~21.73（13.06±4.23） μSv,同车邻座乘客受照的有效剂量为32.97~58.15（49.36±6.26） μSv。每接触一例患者,操作人员受照的有效剂量为2.66~4.69（3.98±0.50） μSv,陪护护士受照的有效剂量为9.70~25.17（15.13±4.90） μSv。 结论 68Ga-奥曲肽PET/CT显像患者对周围人群产生的有效剂量远低于国家标准规定的有效剂量限值。     

骨梗死的影像学诊断

目的探讨骨梗死的影像学特征.方法搜集经临床随访及病理证实的骨梗死13例,男5例,女8例.所有病例均行X线检查,其中同时行CT检查者4例,行MR检查者7例,3种检查都进行者2例.将骨梗死分为早、中、晚期,分析X线、CT及MRI表现,总结其影像学特征.结果骨梗死早、中期X线、CT表现为局部的骨质疏松及斑点状钙化,MR T1WI骨梗死灶中央部分呈等或略低信号,边缘为迂曲匐行的低信号带,T2WI中央部分呈等或略高信号,边缘呈迂曲的高信号带;晚期X线及CT呈不规则、迂曲状骨质硬化,MR T1WI及T2WI均呈低信号..结论MRI是诊断早期骨梗死最有效的方法,可以发现早期病变,X线平片对中晚期病变有帮助,CT较平片敏感,骨梗死的诊断应三者相结合.     

Myositis ossificans demonstrated by positive gallium-67 and technetium-99m-HMDP bone imaging but negative technetium-99m-MIBI imaging.

Gallium-67-citrate and 99mTc-diphosphate bone imaging agents are localized in myositis ossificans, a tumor-like benign soft-tissue mass that makes it impossible to differentiate between malignant tumor and the infection/inflammatory process. We present such a myositis ossificans patient whose bone and 67Ga-citrate imagings showed increased uptake in the left thigh and two foci of the right gluteal region leading to inconclusive results. Technetium-99m-MIBI imaging showed the absence of substantial uptake in these regions. ACT scan confirmed myositis ossificans. The lack of 99mTc-MIBI uptake in myositis ossificans means that 99mTc-MIBI imaging may be useful in the differential diagnosis.     

MR imaging of septic sacroiliitis

Septic sacroiliitis is difficult to diagnose, causing delayed treatment and increased morbidity. The traditional imaging techniques for diagnosis have been CT and nuclear medicine. Our purpose was to determine the ability of MR imaging to detect septic sacroiliitis, to evaluate the features of septic sacroiliitis with MR, and to compare the relative detection rate of MR, CT, and nuclear medicine. All patients with a discharge diagnosis of septic sacroiliitis who were evaluated by MR imaging of the pelvis were retrospectively evaluated. Five patients were collected with six septic sacroiliac joints, which were also evaluated with CT, 99mTc-methylene diphosphonate bone scans, and 67Ga-citrate scans. Abnormalities consistent with sacroiliitis were seen in all sacroiliac joints both prospectively (impression from the initial report) and retrospectively on MR. In addition to the nonspecific MR findings of inflammation and/or fluid in the sacroiliac joint space, bone marrow of the sacrum and/or ilium, and iliopsoas muscle, fluid/inflammation was uniquely identified tracking posterior to the iliopsoas muscle in each of these patients with septic sacroiliitis. Even in retrospect, a definite diagnosis of sacroiliitis could be made in only five of six joints by 67Ga-citrate scans, three of six joints by CT scans, and one of six joints by 99mTc-methylene diphosphonate bone scans. These results suggest MR imaging may be a sensitive modality in the early diagnosis of septic sacroiliitis.     

An experimental study on differential diagnosis of tumor from inflammation by using 125I labeled Pisum sativum agglutinin

We have reported that Pisum sativum agglutinin (PSA), a plant lectin which recognizes mannosyl residues, accumulates markedly in Ehrlich solid tumor (EST) and suggested the possibility of applying PSA to tumor imaging radiopharmaceuticals. In the present work, an inflammation was induced by implantation of cotton thread in the left rear leg skeletal muscle of ddY mice and Ehrlich ascites tumor cells were inoculated into the right rear leg. 67Ga-citrate accumulated in the tumor tissue and the inflammatory lesion to almost equal extents. On the other hand, 125I-PSA preferentially accumulated in tumor tissues in mice bearing both tumor and inflammation. The results suggest that differential diagnosis of tumor from inflammation using radiolabeled PSA may be possible.     

<Superscript>68</Superscript>Ga-DOTAVAP-P1 PET imaging capable of demonstrating the phase of inflammation in healing bones and the progress of infection in osteomyelitic bones

Purpose Differentiation between bacterial infection and nonbacterial inflammation remains a diagnostic challenge. Vascular adhesion protein 1 (VAP-1) is a human endothelial protein whose cell surface expression is induced under inflammatory conditions, thus making it a highly promising target molecule for studying inflammatory processes in vivo. We hypothesized that positron emission tomography (PET) with gallium-68-labeled 1,4,7,10-tetraazacyclododecane-N′,N″,N′′′,N″″-tetraacetic acid-peptide targeted to VAP-1 (⁶⁸Ga-DOTAVAP-P1) could be feasible for imaging the early inflammatory and infectious processes in healing bones. Materials and methods Thirty-four Sprague–Dawley rats with diffuse Staphylococcus aureus tibial osteomyelitis and 34 rats with healing cortical bone defects (representing the inflammation stage of healing) were PET imaged using ⁶⁸Ga-DOTAVAP-P1 as a tracer. In addition, peripheral quantitative computed tomography and conventional radiography were performed. Bone samples for quantitative bacteriology and specimens were also processed for histomorphometry of inflammatory and infectious reactions. Results PET imaging showed an uptake of ⁶⁸Ga-DOTAVAP-P1 in both the osteomyelitic bones and the healing cortical bone defects during the first 36 h after surgery. Thereafter, only the osteomyelitic tibias were delineated by PET. The osteomyelitic and control animals showed a similar uptake of the ⁶⁸Ga-DOTAVAP-P1 at 24 h, whereas a significant difference was observed at 7 days (p < 0.0001). Conclusions The current study showed that PET imaging with the new ⁶⁸Ga-DOTAVAP-P1 is capable of accurately demonstrating the phase of inflammation in healing bones and the progress of bacterial infection in osteomyelitic bones. Consequently, this novel imaging agent allowed for the differentiation of bone infection due to S. aureus and normal bone healing as soon as 7 days after onset.     

Radiopharmaceuticals to image infection and inflammation

Scintigraphic imaging of infection and inflammation is a powerful diagnostic tool in the management of patients with infectious or inflammatory diseases. Most infectious and inflammatory foci can be visualized accurately with radiolabeled autologous leukocytes. However, the preparation of this radiopharmaceutical is laborious and requires the handling of potentially contaminated blood. A few radiopharmaceuticals are available that could be used instead of radiolabeled leukocytes to scintigraphically visualize infectious and inflammatory foci, such as 67Ga-citrate and 99mTc-labeled antigranulocyte antibody preparations. Various agents labeled with 99mTc are currently developed for this application. Most of these newly developed agents are ligands that bind receptors on white blood cell subpopulations, ie, monoclonal antibodies, chemotactic peptides, and cytokines. Furthermore, agents are developed that potentially could distinguish between infection and nonmicrobial inflammation. In addition, 18F-fluorodeoxyglucose positron emission tomography imaging was proposed to visualize inflammatory foci when a high spatial resolution is required. In this article, the characteristics and diagnostic potential of established and experimental radiopharmaceuticals for infection and inflammation imaging are reviewed.     

Kohler disease: diagnoses and assessment by bone scintigraphy

Limping is a frequent occurrence in children and may be caused by various conditions, including trauma, inflammation, infection, and malignancy. Nontraumatic avascular necrosis of the tarsal bones should be included in the differential diagnosis. Accumulated data have supported the superiority of bone scans to radiography in the early diagnosis of avascular necrosis. Bone scintigraphy is a useful tool for investigating pain when symptoms, laboratory examinations, and radiography do not point to a specific diagnosis. In the early phase of disease, bone scans may demonstrate decreased tracer uptake (photopenic region), subsequently a hot area is seen during the reparative process. Although magnetic resonance imaging has important implications in the diagnosis of avascular necrosis, bone scintigraphy with its ready availability has a significant role as a primary tool in the evaluation of a limping child.     

99Tcm-MDP, 67Ga-citrate and 111In-leucocytes for detecting prosthetic hip infection

An assessment was made of the roles of 99Tcm-MDP, 67Ga-citrate and 111In-leucocytes in identifying infected hip prostheses. Fifty painful prosthetic hips were investigated with a 99Tcm-MDP bone scan and an 111In-labelled leucocyte scan (ILLS). In 32 cases, a 67Ga-citrate scan was also performed. Normal or focal MDP uptake was obtained only in uninfected hips. Diffuse uptake of MDP was obtained only in infected hips and in one case of non-septic synovitis which also produced a false positive ILLS. A focal MDP uptake superimposed on a diffuse pattern was obtained in both infected and uninfected hips. The ILLS was abnormal in eight out of 11 cases of infection and in two out of 39 cases without infection. The 67Ga scan was abnormal in five out of six cases of infection and in five out of 26 cases without infection. It was concluded that a 99Tcm bone scan should be performed first on a painful prosthetic hip, and that for detecting infection, an ILLS was more specific but less sensitive than a 67Ga-citrate scan.     

Orbital inflammatory disease: Pictorial review and differential diagnosis

Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagnosis including infection, systemic inflammatory conditions, and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cellulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously thought to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an important role in elucidating any underlying etiology behind orbital inflammation and is critical for ruling out other conditions prior to a definitive diagnosis of OID. In this review, we will explore the common sites of involvement by OID and discuss differential diagnosis by site and key imaging findings for each condition.     

The bone scan in inflammatory osseous disease

The 99mTc-phosphate bone scan has become a sensitive, reliable, and safe method for evaluating the patient with suspected inflammatory disease of bone. The scan may become positive as early as the first 24 hr after the symptoms and 10-14 days before roentgenographic changes occur. It can be used to differentiate successfully a variety of diseases from osteomyelitis, and in conjunction with 67Ga-citrate scan has become a mainstay in the work-up of the patient with infectious disease. Applications of the bone scan to infectious diseases in pediatric practice are especially helpful, since these diseases are common problems in this age group. Increased experience with the 99mTc-phosphate bone scan has already defined several areas of "limitations" in evaluating inflammatory disease. "Cold" defects, negative scans in early stages of osteomyelitis, and "extended uptake" may all pose problems in interpretation, but careful correlation of the bone scan results with clinical history and physical findings, blood cultures, and roentgenography will significantly reduce these problems.     

Using Ga-67 scintigraphy in prostatic abscess

The use of Ga-67 scintigraphy (Ga) in prostate inflammatory diseases may be restricted by the difficulty in distinguishing between the accumulation of Ga-67-citrate (Ga-citrate) in the lesion and feces. The diagnosis of prostatic abscess has been mainly made by other radiologic methods without scintigraphic studies and no finding of Ga has been reported. This patient demonstrated that coordinating the findings of Ga-citrate accumulation can be helpful in making a prompt diagnosis of a possibly fatal prostatic abscess, especially in those patients with poorly defined clinical symptoms and high risk factors.