PET/CT在评价及观察大鼠肺癌放疗效果中的应用

Objective The aim of this study was to understand the role of PET/CT in monitoring the therapeutic effect of radiotherapy (RT) on lung cancer with Wistar rats. Methods Thirty Wistar in-bred strain rats (6-8 weeks, weighed 180-280 g, female, ordinary) were made into Lewis pulmonary tumor model rats. 18F-fluorodeoxyglucose (FDG) PET/CT was performed when tumor reached 1.5-2.0 cm in greatest diameter (4-6 weeks) as a baseline. In order to get the optimal time point of PET/CT for moni-toring RT effect in rat cancer model, PET/CT was performed at the 3rd day, 1st, 2nd, 3rd, and 4th week after giving single dose of 5 Gy to each rat. Standardized uptake values (SUV) from FDG PET were measured and rats were sacrificed at different time point for validation. Besides, the expressions of glucose transport1 (Glut1) in tumor tissue were studied using immunohistochemistry. The level of tumor cell apoptosis, degra-dation, and necrosis were observed. SPSS 11.0 software was used for data analyses. Results A negative correlation of SUV uptake and time after RT and negative correlation of Glut1 expression and time after RT were observed in rat tumors, respectively. Positive correlation of SUV uptake and Glut1 expression in rat tumors was observed (Spearman rank correlation test, rs = 0.97, P < 0.01). Before RT, the SUV in rat tumor was 1.28 ± 0.31 and was decrease to 1. 00 ± 0.23 at the 3rd day and 0.18 ± 0. 10 at the 4th week after RT (F=15. 126, P<0.05). Before RT, the Glut1 in rat tumor was 0.2558 ±0.03 and was decrease to 0. 2320 ± 0. 01 at the 3rd day and 0. 1320±0.04 at the 4th week after RT. The amounts of tumor cell apopto-sis, degradation, and necrosis increased with time after RT. Conclusion Though FDG PET could monitor the therapeutic effect at the 3rd day after giving single dose of RT to rat lung tumor model, the optimal time was the the 4th week after treatment.     

围套式显微血管减压术治疗面肌痉挛

使用围套式显微血管减压术治疗面肌痉挛５０例。采用耳后斜行小切口，分离压迫血管后，用涤沦片包绕面神经根起始部并用银夹固定，术后４９例痉挛停止。本法并发症少，无死亡。术后随访３个月至１０年均无复发。根据术中发现将“责任血管”分为４型：接触型、压迫型、粘连包绕型和贯穿型。讨论了手术适应证、要求及并发症的预防等。     

核素显像对消化道出血的诊断价值

目的探讨放射性核素胃肠道出血显像及异位胃黏膜显像在消化道出血诊断中的应用价值．方法诊断为消化道出血的患者85例，其中小儿62例（男性34例，女性28例，年龄22天-14岁）。成人23例（男性11例，女性12例．年龄16～63岁）。小儿 儿患者均先行99^Tc^mO4^-异位胃黏膜显像，阴性者再行99^Tc^m-RBC胃肠道出血显像；成人患者直接行胃肠道出血显像．结果62例小儿患者异位胃黏膜显像阳性率72．58％（45／62）．阳性预测值100％；胃肠道出血显像定位诊断阳性率42．5％（17／40），准确定位诊断准确率为82.35％（14／17）。结论99^Tc^mO4^-异位胃黏膜显像对小儿异位胃黏膜症诊断具有很高诊断价值．99^Tc^m-RBC胃肠道出血显像也可作为消化道出血定位诊断的一种有效方法．     

先天性胆总管囊肿术后十二指肠胃返流的动态观察

目的：利用不同的二种动态检测方法研究不同术式的先天性胆总管囊肿术后病儿十二指肠胃返流的特点。方法：采用２４ｈ胃食管双ｐＨ动态检测结合持续性核素静脉注射肝胆闪烁显像技术,检测２０例不同术式的先天性胆总管囊肿术后病儿及１７名正常儿十二指肠胃返流（ｄｕｏｄｅｎｏｇａｓｔｒｉｃ ｒｅｆｌｕｘ,ＤＧＲ）出现情况。结果：二种术式中囊肿切除,肝总管十二指肠吻合组（Ｈ－Ｄ吻合组）ＤＧＲ发生率高于囊肿切除,肝总管空     

激光导管拔除心脏起搏除颤导线的临床应用研究

Objective The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction. Methods Consecutive lead extraction in 16 patients using the excimer laser sheath from Veterans Administration Medical Center, University of Minnesota between March 2008 and December 2009 were analyzed retrospectively. The clinical characteristics including basic disease, cardiac function, indication and reason for lead removal, lead characteristic, and complication were summarized. Results Thirty one leads ( laser sheaths were used in 25 leads) in 16 patients [mean age (67.4 ±9. 1 )years, range 54-82 years] were extracted. All leads were extracted successfully without complication.Most patients had severe heart diseases with left ventricular ejection fraction of 20% -60% (mean 36. 4% ±13.4% ). Mean implant time was (73.9 ±62. 9)months (range 3 -251 months). Nine patients had Class Ⅰ indications for lead extraction, 7 patients for Class Ⅱ indications. Atrial lead fractured in one patient during lead extraction, the remaining part of the lead was taken out from femoral vein by a snare-catheter apparatus. Another patient developed CS dissection and small pericardium perfusion during LV lead implantation (upgrade to BiV-ICD ) post successful lead extraction and patient discharged without complication. Conclusion Our single center experience suggests that Excimer Laser Sheath Lead Removal System is safe and effective in extracting pacemaker and ICD leads.     

冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像检测冬眠心肌的临床研究

目的 探讨PET/CT检测冬眠心肌数量预测伴有心功能不全的冠状动脉粥样硬化性心脏病（以下简称冠心病）患者冠状动脉旁路移植术（CABG）后左心室射血分数（LVEF）改善的价值并寻找与心脏主要不良事件（MACE）相关的影响因素。方法 收集46例LVEF严重减低（≤ 40%）且接受CABG的冠心病患者,术前均接受超声心动图检查,且行¹³N-NH₃/¹⁸F-FDG PET/CT心肌灌注-代谢显像评估冬眠心肌数量,于术后3~32个月复查超声心动图,评价LVEF情况,并追踪MACE发生情况。根据术后LVEF将患者分为LVEF改善组和LVEF未改善组,筛选两组有统计学差异的因素,并以二元Logistic回归分析术后LVEF改善的影响因素;采用ROC曲线确定预测CABG术后LVEF能否改善的冬眠心肌数量的界值;根据随访中发生MACE与否将患者分为两组,分析与MACE发生的相关因素。结果 与LVEF未改善组比较,术后LVEF改善组冬眠心肌数量较多,瘢痕心肌数量较少,患者术前左心室收缩末期容积（LVESV）较小,差异均有统计学意义（P均<0.05）;冬眠心肌数量及术前LVESV是CABG术后影响LVEF改善的独立因子;冬眠心肌预测LVEF改善的界值为21%;与MACE事件发生有关的因素为二尖瓣重度反流。结论 PET/CT检测冬眠心肌数量对预测伴心功能不全冠心病患者CABG后LVEF改善情况具有重要价值。     

探讨门控SPECT心肌灌注显像在慢性心衰患者心脏再同步化治疗中的临床应用价值

目的：探讨门控SPECT心肌灌注显像（GSMPI）在慢性心力衰竭（CHF）患者心脏再同步化治疗（CRT）及其预后评估中的临床应用价值。材料和方法：2012年1月—2014年6月行CRT植入且术前行GSMPI的CHF患者21例,经显像获得相位直方图带宽（PHB）、相位标准差（PSD）、左心室射血分数（LVEF）、左室舒张末容积（EDV）、静息灌注评分（SRS）及疤痕面积（SS）等功能参数。所有患者于CRT后半年复查心脏超声,以左室舒张末期内径缩小、LVEF增高（差值>5%）,且半年内无再住院记录为CRT有效,将入选患者分为有效组及无效组。比较两组患者各项参数间的差异、分析其对CRT疗效的预测价值。同时记录左室内最迟激动部位。结果：CRT有效组15例（71.4%）,无效组6例（28.6%）,两组患者各参数之间均有统计学差异（P均<0.05）,其中以PSD、PHB差异最显著（P<0.01）。左室内最迟激动部位位于心尖部、前壁、间壁者10例（47.6%）,下壁者6例（28.6%）,侧壁者5例（23.8%）。结论：GSMPI能够“一站式”提供多项功能参数,心脏收缩同步性定量参数及心肌梗死疤痕面积等可应用于预测术后疗效,其中PSD、PSW具有更高的预测价值;参考左室内最迟激动点及心梗疤痕部位,可应用于指导CRT电极植入。     

18F-FDG PET/CT显像在肝脏恶性肿瘤介入治疗后的临床应用价值

目的：探讨18F-FDG PET/CT显像在肝脏恶性肿瘤介入治疗后的临床应用价值。材料和方法：18例肝脏恶性肿瘤患者（男15例，女3例，年龄36～83岁，平均61.5岁）均在介入治疗后，临床症状或AFP检测怀疑残留或复发，但传统影像学检查未能明确病灶时行全身PET/CT检查，检查结果以最终病理结果或随访结局为参考。结果：最终共证实28处病灶，PET/CT检测出了93.7%（15/16例）的肝内病灶，100%（12/12例）的肝外病灶，总体检出率为96.4%。在15例中，PET/CT至少能检出1个病灶。结论：18F-FDG PET/CT显像有助于诊断肝脏恶性肿瘤介入治疗后传统影像学不能明确的肝内复发或新发病灶，并能同时有效地发现肝外病灶。     

18F-Flurpiridaz的制备及其在正常巴马小型猪PET/CT心肌灌注显像中的初步实验研究

目的 探讨合成18F-Flurpiridaz的优化方法,评估其在正常巴马小型猪PET/CT心肌灌注显像（MPI）中的分布情况。 方法 以18F取代2-叔丁基-4-氯-5-[4-（2-甲基磺酰基-乙氧基甲基）苯基甲氧基]哒嗪-3-哒嗪酮中的苯磺酸离去基团进行标记,通过高效液相色谱非梯度洗脱的方法纯化产物。5头正常巴马小型猪经耳缘静脉注射37 MBq 18F-Flurpiridaz后10 min行PET/CT MPI,并于注射后30和60 min进行PET/CT全身显像,观察显像剂在其体内主要脏器的摄取情况。 结果 18F-Flurpiridaz的制备时间约为50 min,非校正放射化学产率为40%,放射化学纯度>97%。MPI图像显示心肌细胞摄取明显,肝脏仅有少量摄取,肺基本无摄取,心肌图像质量好。全身显像中,显像剂注射后30 min,心肌和肾脏摄取明显,肌肉组织中有少量摄取,而其他组织器官均无明显摄取;显像剂注射后60 min,心脏内仍有较高摄取。 结论 实现并优化了18F-Flurpiridaz的自动化合成,为其临床应用奠定了基础。     

^(18)F-flurpiridaz PET/CT测量心肌血流量:实验研究北大核心CSCD

目的与^(13)N-NH_(3)·H_(2)O显像对比,观察^(18)F-2-(1,1-二甲基乙基)-4-氯-5[[4-[[2-氟(^(18)F)乙氧基]甲基]苯基]甲氧基]-3-哌啶酮(^(18)F-flurpiridaz)PET/CT测量巴马小型猪绝对定量心肌血流量(MBF)的准确性和可行性。方法将10只巴马小型猪随机分为实验组(n=5)与正常组(n=5);于实验组建立心肌梗死模型。对2组依次行^(18)F-flurpiridaz和^(13)N-NH_(3)·H_(2)O PET/CT静息显像;于次日对正常组行三磷酸腺苷(ATP)负荷显像。比较正常组^(18)F-flurpiridaz与^(13)N-NH_(3)·H_(2)O显像所示冠状动脉左前降支(LAD)、左旋支(LCX)、右冠状动脉(RCA)及左心室(LV)整体及其17个节段的静息MBF(rMBF)、负荷MBF(sMBF)及冠脉血流储备(CFR)差异,以及实验组心肌梗死区与正常区的rMBF差异。结果^(18)F-flurpiridaz显像与^(13)N-NH_(3)·H_(2)O显像所测正常组LAD、LCX、RCA、LV整体及其17个节段的rMBF、sMBF和CF差异均无统计学意义(P均>0.05)。^(18)F-flurpiridaz显像与^(13)N-NH_(3)·H_(2)O显像所测实验组梗死区及正常区的rMBF差异均无统计学意义(P均>0.05);不同显像方法所测实验组梗死区rMBF均明显低于正常区(P均<0.05)。结论^(18)F-flurpiridaz PET/CT可用于测量巴马小型猪绝对定量MBF,结果与^(13)N-NH_(3)·H_(2)O显像测值无显著差异。