50例冠心病患者99Tcm-MIBI心肌灌注显像和心电图与冠状动脉造影对比

目的:99Tcm-MIBI心肌灌注显像和心电图与冠状动脉造影的对照及临床诊断意义.方法:患者均于住院期间作99Tcm-MIBI心肌灌注显像与冠状动脉造影检查,静息心肌灌注显像前描记静态心电图,运动显像的同时记录心电图.结果:50例冠心病患者99Tcm-MIBI心肌灌注显像和心电图与冠状动脉造影对照,两者总的符合率分别为94.0%及80.0%(P＜0.05),两者对陈旧性心肌梗塞的检出率相似,而99Tcm-MIBI静态与运动心肌灌注显像对检出冠状动供血不足比静息与运动心电图特异性高.结论:99Tcm-MIBI心肌灌注显像对陈旧性心肌梗塞病变的检出率和对病变范围的估价优于心电图,是判断心肌缺血敏感、可靠、无创性的检查方法.     

早期帕金森病患者99Tcm-TRODAT-1多巴胺转运蛋白显像研究

目的 研究早期帕金森病（parkinson disease,PD）患者99Tcm—TRODAT—1多巴胺转运蛋白SPECT显像的特点和诊断价值。方法 15例早期PD患者和10例对照者,分别进行99Tcm—TRODAT—1多巴胺转运蛋白（dopamine transporter,DAT）显像,观察其放射性分布特点,并利用半定量分析法,分别计算纹状体（striatum,ST）、尾状核（caudate nucleus,CN）及壳核（putamen,PT）与小脑（cerebellum,CB）的放射性计数比值。比较对照组和早期PD患者两侧纹状体及主要区域DAT功能差异。结果 对照组ST／CB、PT／CB、CN／PD组对侧ST／CB、PT／CB、CN／CB分别为1.23±0．13、1.80±0．15、1．13±0.13;PD组同侧ST／CB、PT／CB、CN／CB分别为1．79±0．13、1．86±0．15、1．78±0.14。PD组对侧与对照组比较,其中ST／CB、PT／CB差异均有统计学意义（t=10．83、15．21,P均〈0.05）;而CN／CB差异无统计学意义（t=1.96,P〉0．05）。PD组对侧与PD组同侧比较,其中ST／CB、PT／CB差异均有统计学意义（t=10.55、11．69,P均〈0.05）;而CN／CB差异无统计学意义（t=1．08,P〉0．05）。结论 早期PD患者存在着惠肢对侧ST、PT区的DAT放射性摄取值的下降,因此99Tcm—TRODAT—1多巴胺转运蛋白SPECT显像可作为PD早期诊断的客观诊断指标之一。     

99mTC-二乙烯三胺五乙酸眼眶SPECT/CT在甲状腺相关性眼病分型及活动度评价中的作用

目的 探讨根据^99mTC-二乙烯三胺五乙酸(diethylenetriaminepentaacetic acid,DTPA)眼眶单光子发射计算机断层扫描(single photon emission computed tomography,SPECT)/计算机断层扫描(computed tomography,CT)图像分析进行甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)分型,并通过计算其显像剂摄取比值(uptake rate,UR)评价在TAO活动度评估中的作用。方法 分析205例TAO患者,根据^99mTC-DTPA 眼眶SPECT/CT图像分析结果将TAO患者分为两种类型:Ⅰ型以球后病变为主,Ⅱ型以眶周病变为主,进行临床指标比较,并分析与临床活动性评分(clinical activity scores,CAS)的相关性。结果 Ⅰ型TAO球后部位显像剂摄取比值(uptake rate of retrobulbar region,URR)明显高于Ⅱ型TAO患者,而Ⅱ型TAO眶周部位显像剂摄取比值(uptake rate of periorbital region,URP)明显高于Ⅰ型,差异具有统计学意义(P<0.001);Ⅰ型和Ⅱ型TAO在性别(P=0.001)、年龄(P<0.001)、CAS评分(P<0.001)、复视评分(P<0.001)、促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)(P=0.004)等方面差异均有统计学意义;Ⅱ型TAO患者中,UR值与CAS呈正相关(r=0.407,P<0.001),受试者操作特征曲线(receiver operating characteristic curve,ROC)显示,Ⅱ型TAO中当UR≥1.596判断疾病处于活动期的灵敏度为68.4%,特异度为64.3%,临床应用价值有限。TRAb与CAS呈正相关(r=0.215,P=0.007),但相关性较弱。结论 ^99mTC-DTPA 眼眶SPECT/CT可以为甲状腺相关性眼病患者分型提供客观依据,但用于活动度评价效果不理想。     

Surveillance study for creating the national clinical database relating to ECG-gated myocardial perfusion SPECT of asymptomatic ischemic heart disease in patients with type-2 diabetes mellitus: J-ACCESS 2 study design

Objective Diabetes mellitus is an independent risk factor for acute myocardial infarction. Thus, a surveillance study was conducted as part of studies to create a national database related to electrocardiogram (ECG)-gated myocardial perfusion single-photon emission computed tomography (SPECT) of ischemic heart disease. Methods Single-photon emission computed tomography was conducted in patients with type 2 diabetes mellitus and their prognoses will be followed for 3 years, stratified by patients’ clinical background and SPECT findings. Results A total of 513 patients from 50 institutions were enrolled in this study, 297 of whom were men (age 66.2 ± 0.4 years, mean ± SEM) and 261 women (age 67.8 ± 0.5 years). They have a history of retinopathy (25.3%), neuropathy (19.9%), cerebrovascular disorder, chronic obstructive pulmonary disease, and photocoagulation. Major risk factors for present disease were hypertension (82.3%) and hyperlipidemia (79.7%). In 244 patients (129 men and 115 women), body mass index (BMI) was 25 or more. Fifty-two of them (10.1%) underwent coronary angiography; of these, 26 (50.0%) had no coronary artery lesions with 75% or more stenosis, and only 1 (1.9%) had a left main trunk with 50% or more stenosis. An overwhelming majority of patients (94.3%) underwent SPECT imaging by a 1-day stress-followed-by-rest procedure. Stress procedure was exercise in most (70.8%) patients, followed by dipyridamole infusion in 14.6%, adenosine infusion in 6.6%, and adenosine triphosphate infusion in 5.7%. Endpoint of stress examination was most often fatigue in lower limbs (40.7%), followed by completion of pharmacological stress protocol (28.7%), and achievement of target heart rate (26.3%). The largest number of patients (198, 38.6%) received ^99mTc-tetrofosmin at an initial dosage of 200–300 MBq (mean 331 ± 3 MBq) followed by a second dosage of 700–800 MBq (mean 748 ± 8 MBq). Among them, 491 (95.7%) received some kind of therapeutic drug: hypoglycemic drugs were used by the largest number (83.2%), followed by hypotensive (66.7%), hypolipidemic (40.7%), and antiplatelet drugs (27.7%), vasodilators (5.5%), and antioxidants and others (2.3%). Conclusions This study was designed to clarify the correlation between coronary artery disease and diabetes mellitus as its risk factor based on the clinical and imaging findings. Patient enrollment was closed on September 30, 2005, and follow-up is now under way.     

多巴酚丁胺负荷核素心肌显像在冠心病诊断中的应用

目的 药物负荷核素心肌显像在冠心病诊断中的价值。方法 选取本院胸痛可疑冠心病，且能耐受平板运动试验的住院患者55例，进行多巴酚丁胺(DBA)负荷99m^Tc-MIBI门控心肌灌注断层显像(SPECT)，平板运动试验检查，部分行冠脉造影检查。结果DBA-SPECT结果40％(22／55)的患者DBA负荷SPECT结果呈可逆性放射性稀疏(即心肌缺血改变)。20例有冠脉造影对照的患者中，DBA负荷SPECT诊断冠心病的灵敏度87．5％(7／8)，特异性75％(9／12)，准确率80％(16／20)。结论DBA负荷SPECT是诊断冠心病的一种敏感性及特异性较高的非创伤性方法。     

Current trends in imaging evaluation of acute cholecystitis

This study was designed to retrospectively determine recent clinical trends of initial radiological evaluation in patients pathologically proven to have acute cholecystitis (AC) and to assess the methodology that led to its diagnosis. Over a 28-month period, the medical records and imaging studies of 117 consecutive patients who had pathologically confirmed AC were retrospectively analyzed. The sensitivities of ultrasound (US) and hepatobiliary ^99mTc-iminodiacetic acid (HIDA) were computed. The false-negative scans were retrospectively reviewed by a blinded radiologist to determine the limitations and advantages of each modality. The 117 patients were grouped into six categories based on the type of imaging examination they underwent prior to cholecystectomy: initial US evaluation only (n=80, 68.4%), initial US followed by HIDA (n=17, 14.5%), initial HIDA only (n=2, 1.7%), initial HIDA followed by US (n=3, 2.6%), initial CT (n=5, 4.3%), and no imaging evaluation (n=10, 8.6%). HIDA scan had a calculated sensitivity of 90.9% (20 true-positive, 2 false-negative) while US had a sensitivity of 62% (62 true-positive, 38 false-negative). Current practice in the initial radiological evaluation of acute cholecystitis remains outdated. The vast majority of patients in our study group were initially worked up using US, although HIDA scan has been shown to have greater sensitivity for the diagnosis of acute cholecystitis.     

Diagnostic angioscintigraphic evaluation of malignant hepatic tumors before catheter embolization: Determination of shunt,flow distribution,and reflux

Purpose: The aim of this study was to evaluate quantitatively arteriovenous shunts in malignant liver tumors by injection of ^99mTc macroaggregates of albumin (MAA) into the tumor-feeding artery after selective catheterization. Methods: In 40 patients with malignant liver tumors (33 hepatocellular carcinomas and 7 metastases of colorectal cancer), a mean dose of 200 MBq ^99mTc MAA was injected arterially during angiography. The embolized area and the lungs were then visualized using a gamma camera. A dedicated computer program calculated pulmonary shunt rates. Results: The majority of patients (n= 30) with hepatocellular carcinoma showed small shunts varying from 0 to 15%; only 3 of these patients had shunts ranging from 18% to 37%. In patients with colorectal carcinoma metastases (n= 7) the shunt varied from 0 to 3% (2 ± 1%), probably due to a physiological shunt in normal liver tissue in the embolized area. Importantly, the degree of shunt found bore no correlation to the tumor volume or to the pattern of vascularity on angiography. Conclusion: Diagnostic angioscintigraphy is a useful tool for pretherapeutic evaluation of the capacity of an individual tumor to retain particles and to measure extratumoral shunting; these are essential for therapy planning, as they can help to increase the safety and effectiveness of embolization.     

~(99)Tc~m-亚甲基二膦酸盐联合甲泼尼龙冲击治疗甲状腺相关眼病的效果观察

目的探讨99Tcm-亚甲基二膦酸盐(云克)联合甲泼尼龙冲击治疗甲状腺相关眼病(TAO)的疗效。方法 TAO患者共112例分为3组,99Tcm-亚甲基二膦酸盐+甲泼尼龙组(A组)40例,99Tcm-亚甲基二膦酸盐组(B组)34例,甲泼尼龙组(C组)38例,观察治疗后突眼度、临床活动性积分。结果 99Tcm-亚甲基二膦酸盐+甲泼尼龙组在改善突眼度、临床活动性积分方面均明显优于99Tcm-亚甲基二膦酸盐组及甲泼尼龙组(有效率分别为93%、65%、68%,P<0.01)。结论 99Tcm-亚甲基二膦酸盐联合甲泼尼龙治疗甲状腺相关性眼病安全、有效,优于单纯99Tcm-亚甲基二膦酸盐及甲泼尼龙冲击治疗。     

经直肠－门脉放射性核素成象测定肝硬变大鼠门脉系统分流

应用四氯化碳法制作大鼠肝硬变门脉高压症模型。采用￣（９９ｍ）Ｔｃ－甲氧基异丁基异腈经直肠－门脉放射性核素成象法对８例肝硬变大鼠和８例对照大鼠的门脉系统侧支循环进行了研究。结果表明：肝硬变组门体分流率（ＳＩ∶２０．０±１１．８％）明显高于对照组门体分流率（ＳＩ：７．７±８．２％）（Ｐ＜０．０１），ＳＩ与门静脉压力之间的相关关系无统计意义（ｒ＝０．２９，Ｐ＞０．０５）。     

99mTcO4^-甲状腺双时相显像在甲状腺机能亢进诊断中的价值

目的：探讨甲状腺双时相显像在鉴别甲亢与桥本氏病、亚甲炎甲亢期的价值。方法：对甲亢、桥本氏病、亚甲炎甲亢期患者进行９９ｍＴｃＯ４－甲状腺血流和静态显像。结果：３８例甲亢患者摄９９ｍＴｃＯ４－曲线均未见颈动脉峰,其中,８４．２％的患者５ｍｉｎ摄９９ｍＴｃＯ４－曲线为速升型（≥５０％）,１５．８％为缓升型（４０％－４９％）。桥本氏病、亚甲炎甲亢期的患者,摄９９ｍＴｃＯ４－曲线均可见颈动脉峰,曲线为缓升型或低平型（＜５０％）。结论：甲状腺双时相显像鉴别甲亢和非甲亢疾病方法简便、安全,影响因素少,特异性高,可作为一种常规方法。