SPECT-CT的临床应用进展

SPECT-CT能有效显示解剖与功能关系,更好帮助疾病诊断和病理生理的理解。SPECT通过与同机定位CT图像融合可有效地对病变进行定性定位,提高了传统SPECT定位、定性的准确性。SPECT-CT在肿瘤与非肿瘤疾病诊断、治疗方面发挥了重要的作用。     

甲状腺肿瘤SPECT-CT融合显像的应用近况

甲状腺肿瘤SPECT-CT融合显像将解剖成像与功能成像的优势相结合,克服了以往SPECT、CT单一成像的各自缺陷,可同时提供病变的解剖结构与功能代谢信息,能在术前对甲状腺肿瘤进行精确定位,在鉴别肿瘤良恶性、探测复发或转移、评价治疗效果等方面具有独特优势。与PET-CT相比,其价格低廉,具有较高的临床应用价值。     

SPECT-CT——核医学影像技术的新阶段

精确的解剖定位一直是具有功能特异性的SPECT所追求的目标.SPECT与CT融合系统为临床诊疗提供了丰富的信息,其良好的定位功能进一步巩固了SPECT的临床地位.在心脏病学中,SPECT-CT可提供准确的衰减图或心功能影像,有利于早期和更准确的诊断.在肿瘤病学中,可对神经内分泌瘤等原发或转移病灶的位置、性质等作出准确判断,有利于临床制定切实可行的诊疗措施.在常规核医学的应用中,能够较为准确地寻找感染灶以及为肺栓塞形态学-灌注缺损关系的评估提供精确的方法.SPECT-CT带来了清晰的解剖图像并加快了工作流程.     

99Tcm-MDP全身骨显像、99Tcm-MDP SPECT-CT和18F-FDG SPECT-CT探测脊柱转移瘤的比较

目的 比较99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨显像、99Fcm-MDPSPECT-CT与18F-FDG SPECT-CT诊断脊柱转移瘤的临床价值.方法 对行常规99Tcm-MDP全身骨显像的88例肿瘤患者同时行99Tcm-MDP SPECT-CT,同期(2周内)行18F-FDG SPECT-CT.回顾...     

比较SPECT-CT和PET-CT在小动物模型中的应用

在医学研究中,针对疾病的小动物模型进行动态生物学进程的监测已成为最重要的研究方法之一。传统核医学影像测得的重要生理学参数包括血流量、生化代谢和细胞受体等。而如今,核医学已发展至双元融合的影像模式,包括SPECT-CT和PET-CT,这意味着在同一次扫描中,通过硬件对图像的融合,可得到功能学和解剖学的双重影像。该文针对SPECT-CT和PET-CT在小动物模型中的应用进行了比较,结论:针对小动物模型的PET-CT在医学研究中的应用具有很大优势,但SPECT-CT仍有着非常重要的作用,而且研究成本低。     

18F-FDG SPECT-CT诊断胃癌术后复发及转移的价值

目的 探讨18F-FDG SPECT-CT在监测胃癌术后复发及转移中的临床价值.方法 回顾性分析122例胃癌术后患者的SPECT-CT显像资料,结合再次病理检查结果,其中79例与同期增强CT检查及二者联合检查两两比较其在残胃或吻合口复发的诊断效能;109例与同期胃肿瘤标志物结果及二者联合检查两两比较其在评价转移灶的诊断效能.应用SPSS13.0软件进行卡方检验或Fisher精确检验.结果 ①18F-FDG SPECT-CT诊断残胃或吻合口复发的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为84.0％、96.3％、91.3％、92.9％及92.4％;同期增强CT为58.3％、78.2％、53.8％、81.1％及72.2％,其中前者的灵敏度、特异度、阳性预测值及准确率均显著高于增强CT( x2=3.953～11.805,P均＜0.05),阴性预测值虽然高于增强CT,但差异无统计学意义(x2=3.344,P＞0.05);二者联合诊断的指标为:88.0％、98.1％、95.7％、94.6％及94.9％,显著高于增强CT( x2=4.732～10.341,P均＜0.05),二者联合诊断虽然也高于18F-FDG SPECT-CT,但差异均无统计学意义(x2均=0.000,P＞0.05).②18F-FDG SPECT-CT诊断胃癌术后转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为92.9％、87.5％、96.3％、80.8％及91.7％;胃肿瘤标志物检测为81.2％、75.0％、92.0％、52.9％及79.8％,其中前者灵敏度、阴性预测值及准确率显著高于胃肿瘤标志物检测(x2=4.026～6.355,P均＜0.05),特异度与阳性预测值虽然也高于胃肿瘤标志物检测,但差异无统计学意义(x2=0.574,x2=0.681,P＞0.05);二者联合诊断的指标分别为96.5％、83.3％、95.3％、87.0％及93.6％,与18F-FDG SPECT-CT大致相仿,且差异均无统计学意义(x2=4.026～6.355,P均＞0.05),但灵敏度、阴性预测值及准确率显著高于胃肿瘤标志物(x2=7.143～10.014,P均＜0.05).结论 18F-FDG SPECT-CT诊断胃癌术后复发及转移具有较大的临床价值.     

SPECT-DR图像融合在骨骼系统疾病诊断中的应用

目的 :对比SPECT-DR、SPECT-CT 2种图像融合技术在骨关节系统疾病诊断中的差异。方法:回顾性分析280例均行SPECT-DR、SPECT-CT检查的骨骼系统疾病患者的临床及影像资料,168例发生于四肢骨,112例发生于躯干骨;以临床随访诊断为金标准,由3名专家评价2种检查方法的图像,对评价结果进行统计学分析。结果:280例患者,SPECT-DR融合图像的诊断符合率为70.36%,SPECT-CT为90.36%,差异有统计学意义(P=0.00),两者一致性较差(K=0.38)。168例发生于四肢骨骼,SPECT-DR融合图像的诊断符合率88.69%,SPECT-CT为91.07%,差异无统计学意义(P=0.13),两者一致性较好(K=0.77)。112例病变发生于躯干骨骼,SPECT-DR融合图像的诊断符合率42.86%,SPECT-CT为88.39%,差异有统计学意义(P=0.00),两者一致性较差(K=0.18)。结论:对四肢骨关节系统疾病患者如有必要进行图像融合检查时,应首选SPECT-DR,其诊断效能同SPECT-CT相当,且可适当减少辐射剂量。     

SPECT-CT探测喉癌前哨淋巴结

目的 评价SPECT-CT淋巴显像探测喉癌患者前哨淋巴结(SLN)的价值。方法 30例临床N₀期喉癌患者,术前于喉镜引导下注射99Tcm-硫胶体(SC),使用SPECT-CT进行SLN显像;同时,术中用γ探测仪探测放射性"热点"。将手术切除的SLN及颈清扫标本行病理检查。结果 全组30例检出SLN28例,检出率为93.3%。术前平面显像、SPECT-CT分别检出61个和66个SLN。术中用手持式γ探测仪有27例患者探测到SLN,共计70个,检出率为90.0%(27/30)。γ探测仪探测SLN数目与SPECT-CT淋巴显像数目有4例不一致,24例符合,其符合率为85.7%(24/28)。病理结果显示,6例患者有淋巴结转移,占20.0%。SLN检测的灵敏度、特异度、准确率和假阴性率分别为83.3%、95.8%、93.3%和16.7%。结论 术前SPECT-CT淋巴显像能有效探测喉癌患者的SLN,准确预测颈部淋巴结转移情况。     

18F-FDG SPECT-CT在宫颈癌监测中的价值

目的 评价18F-FDG SPECT-CT在监测宫颈癌复发和(或)转移中的价值.方法 回顾性分析为评估宫颈癌是否复发和(或)转移而行18F-FDG SPECT-CT的62例患者的临床资料,以二次手术或局部活检病理或临床随访为最终结果,并与同期CT和鳞状细胞癌抗原(SCCA)检查结果对比.结果 经病理或临床随访证实,62例患者中有36例复发和(或)转移.18F-FDG SPECT-CT对宫颈癌复发和(或)转移监测的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为94.4%、92.3%、94.4%、92.3%、93.5%;CT分别为69.4%、80.8%、83.3%、65.6%、74.2%;SCCA检查分别为66.7%、46.2%、63.2%、50.0%、58.1%.结论 18F-FDG SPECT-CT监测宫颈癌复发和(或)转移有较大临床价值.     

骨样骨瘤的影像学表现及诊断价值分析

目的:分析骨样骨瘤的X线、CT、MRI及SPECT-CT融合图像的表现,总结其影像学特征。方法:对我院经手术或穿刺病理证实的28例骨样骨瘤的影像学表现进行回顾性分析。25例行X线检查,20例行CT检查,7例行MRI检查,9例行SPECT-CT图像融合。结果:28例均出现大小不一的圆形或椭圆形瘤巢,直径为2.3~19.5mm,瘤巢周围伴有不同程度的骨质硬化。X线对瘤巢显示率为48%(12/25),4例瘤巢中心出现钙化;CT对瘤巢显示率为95%(19/20),出现钙化者16例,2例显示"血管沟征";SPECT-CT融合图像,9例瘤巢均有显像剂团状异常浓聚,呈"太阳征";MRI对瘤巢显示率为57%(4/7),7例均显示不同程度骨髓水肿。结论:瘤巢是确诊骨样骨瘤的关键,CT是发现瘤巢的较好方法,SPECT有利于发现隐匿性病变,SPECT-CT融合图像可以明确病变及其累及的范围。     

The added value of SPECT-CT for the identification of sentinel lymph nodes in early stage oral cancer

Purpose

To assess the role of single-photon emission computed tomography with computed tomography (SPECT-CT) for the identification of sentinel lymph nodes (SLNs) in patients with early stage (T1–T2) oral cancer and a clinically negative neck (cN0).

Methods

In addition to planar lymphoscintigraphy, SPECT-CT was performed in 66 consecutive patients with early stage oral cancer and a clinically negative neck. The addition of SPECT-CT to planar images was retrospectively analyzed for the number of additional SLNs, more precise localization of SLNs, and importance of anatomical information by a team consisting of a nuclear physician, surgeon, and investigator.

Results

Identification rate for both imaging modalities combined was 98% (65/66). SPECT-CT identified 15 additional SLNs in 14 patients (22%). In 2/15 (13%) of these additional SLNs, the only metastasis was found, resulting in an upstaging rate of 3% (2/65). In 20% of the patients with at least one positive SLN, the only positive SLN was detected due to the addition of SPECT-CT. SPECT-CT was considered to add important anatomical information in two patients (3%). In 5/65 (8%) of the patients initially scored SLNs on planar lymphoscintigrams were scored as non-SLNs when SPECT-CT was added. There were four false-negative SLN biopsy procedures in this cohort.

Conclusions

The addition of SPECT-CT to planar lymphoscintigraphy is recommended for the identification of more (positive) SLNs and better topographical orientation for surgery in sentinel lymph node biopsy for early stage oral cancer.

     

Streamlining the Imaging of Clinically Suspected Pheochromocytoma: Using Urine Metanephrines to Decrease Imaging Costs

Purpose

To improve the cost efficiency of the imaging evaluation of clinically suspected pheochromocytoma by using 24-hour fractionated urine metanephrine (FUM) results.

Methods

A retrospective review of I-123 meta-iodo-benzyl-guanidine single photon emission tomography (SPECT) computed tomography (CT) studies performed at our institution between January 2007 and February 2011 for clinically suspected pheochromocytoma was performed. SPECT-CT results from 70 patients were compared with results from 24-hour FUM analysis (within 2 months of SPECT-CT) and with relevant CT or magnetic resonance imaging studies (within 6 months of SPECT-CT). An imaging algorithm was developed to maximize cost efficiency without altering the final imaging interpretation. Actual imaging costs for the studied cohort were compared with the expected costs if this algorithm had been applied.

Results

If the 24-hour FUMs were normal, then all the SPECT-CT studies were negative (16/70). Eighty-seven percent of patients with abnormal total metanephrine had a positive SPECT-CT. If the total metanephrine was normal but 1 or more of the metanephrine fractions were abnormal, then 39%-58% of the SPECT-CT studies were positive. Within this subgroup, none had a positive SPECT-CT if a CT or magnetic resonance image was negative or benign. The actual imaging costs averaged CAD$2833.19 per patient for this cohort. Applying a streamlined imaging algorithm guided by 24-hour FUM analysis would result in an average imaging cost of CAD$1225.97 per patient without an expected change in the final imaging impression.

Conclusion

By using 24-hour FUM results to streamline imaging, considerable cost savings per patient (56.7%) can be attained without a change in the final overall imaging interpretation.     

SPECT-CT of the foot

During the last years SPECT-CT combining the high resolution of CT with high sensitivity of bone SPECT has gained widespread clinical application. Especially in complex anatomic situations, SPECT-CT allows to exactly define the area of the skeleton which is responsible for pain. This holds true especially in patients with foot diseases. CONCLUSION: Bone SPECT-CT gives additional useful information in arthrodesis, infection, accessory bones (sesamoids) as well as tarsal coalition.