99Tcm-MIBI双嘧达莫负荷/静息门控心肌灌注显像TID比值正常值及其临床应用

目的探讨99^Tc^m-MIBI双嘧达莫负荷／静息门控心肌灌注显像心腔一过性缺血扩大（TID）比值的正常值及其对冠状动脉三支病变的诊断价值。方法TID比值正常上限是健康人群TID比值平均数加2倍标准差（x^-＋2s）。健康组由67名患冠心病概率〈5％的人群组成，患者组由112例可疑冠心病患者组成。所有受试者进行99^Tc^m-MIBI双嘧达莫负荷／静息门控心肌灌注显像，患者组在显像后14d内接受冠状动脉血管造影。对心肌灌注图像进行定量分析，计算TID比值。结果TID的上限值为1．31。患者组中冠状动脉无明显狭窄者12例，其TID比值为1．07±0．21；冠状动脉单支狭窄者30例，其TID值为1．15±0．23；冠状动脉双支病变者28例，其TID比值为1．18±0．24；冠状动脉三支病变者42例，其TID比值为1．31±0．22。以1．31为TID比值的正常上限值，其发现冠状动脉三支病变冠心病的灵敏度和特异性分别为66．7％和98．4％。结论以1．31为TID比值的正常上限值，是发现同时具有三支冠状动脉病变冠心病的有效方法，是对心肌灌注显像目测分析法的有效补充。     

硝酸甘油介入99Tcm-tetrofosmin SPECT与18F-FDG PET显像评估心肌活力比较

目的 比较硝酸甘油介入^99Tc^m-tetrofosmin SPECT心肌血流灌注显像与^18F-FDG PET心肌代谢显像评估心肌活力的价值。方法 既往有心肌梗死史伴左心功能不全经冠状动脉造影确诊为冠心病的患者36例，行二日法静息和硝酸甘油介入^99Tc^m-tetrofosmin SPECT显像，并在1周内再行^18F-FDG PET心肌代谢显像及静息超声心动图检查。将左心室分成13个节段，分析超声心动图室壁运动，并分析相同节段^99Tc^m-tetrofosmin与^18F-FDG的相对摄取比值，以^18Tc^m-tetrofosmin摄取比值55％，^18F—FDG摄取比值50％为判断心肌活力有无的阈值。以k统计比较3种方法的一致性。结果 超声心动图示131个节段呈无运动或反向运动。^99Tc^m-tetrofosmin静息显像示其中78个节段（60％）心肌有活力，53个节段（40％）无活力。该53个节段中14个（26％）在硝酸甘油介入后可见再填充，余39个节段无改变。在^18F—FDGPET显像中，硝酸甘油介入显像再填充节段的心肌放射性摄取明显增高。再填充节段与无填充节段比较，心肌FDG摄取分别为（76±15）％和（58±17）％，差异有统计学意义（P〈0．01）。硝酸甘油介入显像中，92个心肌节段（70％）有活力，39个无活力。tetrofosmin静息显像评估心肌活力与FDG PET显像比较，k值为0．35，而硝酸甘油介入^99Tc^m-tetrofosmin SPECT与^18F—FDGPET显像结果比较，k值为0．53。结论 硝酸甘油介入^99Tc^m-tetrofosmin SPECT显像可提高对心肌活力的检测能力，与^18F—FDG PET心肌代谢显像有很好的一致性。     

异舒吉^99Tc—MIBI心肌断层显像评价直接PTCA术与溶栓治疗心肌梗死的效果

目的：异舒吉^99mTc－MIBI心肌断层比较直接经皮冠状动脉内成形术（PTCA）与溶栓治疗急性心肌梗死的效果。材料与方法：对47例经直接PTCA治疗（A组）、溶栓再灌注成功（B组）和失败（C组）的急性心肌梗死患者异舒吉和静态^9mmTc－MIBI心肌显像。20例经介入性治疗患者,术后3个月复查静态心肌显像。结果：不论是静态,还是异舒吉^99mTc-MIBI心肌显像,A组心肌缺损面积小于B组,B组小于C组,三组之间差异有显著性。与静态心肌显像比较,A组和B组异舒吉心肌显像提示心肌灌注明显改善,在C组改善不明显,其中A组异舒吉心肌显像灌注改善大于B组＋C组。15例介入治疗异舒吉显像有心肌存活者,术后心肌缺损面积缩小,由术前36．3％±22．6％降至22．0％±19．3％。5例无心肌存活者,术后心肌缺损面积与术前比较无差异。结论：异舒吉^99mmTc－MIBI心肌断层显像定量分析显示直接PTCA术可减少心肌缺损面积,挽救更多的濒死心肌,同时可准确识别心肌梗死后存活心肌。     

125I粒子泪道探针治疗泪道狭窄的实验研究

目的 探讨^131I粒子泪道探针治疗兔泪道狭窄的作用。方法 制备兔双侧泪道狭窄模型，随机分成狭窄对照组、探通术治疗组和放射性探针（^131I粒子）治疗组，每组10只。不作任何处理的5只新西兰纯种白兔作为空白对照组。探通术治疗组与放射性探针治疗组分别于治疗后10min、30d及处死前60min行泪道数字减影（DSA）检查，所有动物处死后立刻进行泪道标本取材，HE染色并用计算机图像分析仪测量泪道管腔面积。结果 探通术治疗组与放射性探针治疗组治疗后10min，狭窄治愈率均为100％；2组治疗后10min与30d对比，再狭窄率分别为40％，10％。空白对照组、狭窄对照组、探通术治疗组、放射性探针治疗组泪道管腔面积分别为（0．84±0．28），（0．26±0．13），（0．55±0．31）和（0．80±0．36）mm。结论^131I粒子泪道探针具有治疗泪道狭窄兼预防其发生再狭窄的作用。     

负荷-静息心肌灌注显像对老年人冠心病的诊断价值

目的探讨负荷-静息心肌灌注显像对老年人冠心病的诊断价值。方法205例疑诊冠心病的老年患者[≥60（67±5）岁],行^99Tc^m-甲氧基异丁基异腈（MIBI）负荷-静息心肌灌注显像（运动负荷185例,药物负荷20例）和冠状动脉造影检查,排除曾行经皮冠状动脉介入治疗（PCI）及冠状动脉旁路移植术（CABG）者。以冠状动脉造影为“金标准”,评价负荷-静息心肌灌注显像诊断老年冠心病的灵敏度、特异性和准确性。采用SPSS 15．0软件对数据行χ^2检验。结果以冠状动脉管腔狭窄〉50％作为诊断标准,205例患者中冠状动脉造影阳性57例（28％）,其中单支病变30例,双支病变19例,三支病变8例。冠状动脉造影结果阳性的患者中核素负荷-静息心肌灌注显像异常者36例;冠状动脉造影阴性148例（72％）患者中,负荷-静息心肌灌注显像正常者135例。对照冠状动脉造影结果,负荷-静息心肌灌注显像对老年人冠心病总的诊断灵敏度63％（36／57）,特异性91％（135／148）,准确性83％（171／205）;对单支、双支以及三支病变的诊断灵敏度分别为57％（17／30）、58％（11／19）和8／8。行运动负荷显像患者185例,按照运动试验是否达到目标心率分为2组：组1运动试验高峰心率达到目标心率,共53例（29％）;组2运动试验高峰心率未达到目标心率,共132例（71％）。2组心肌灌注显像诊断冠心病的灵敏度分别为81％（13／16）和58％（22／38）。组1诊断灵敏度高于组2,但经χ^2检验,两者之间差异无统计学意义（χ^2=2．69,P=0．1）。结论负荷-静息心肌灌注显像是诊断老年人冠心病的可靠方法;当运动负荷达到目标心率时,核素心肌灌注显像诊断冠心病的灵敏度较高。     

蒽环类抗肿瘤药化疗患者心肌99Tcm-MIBI清除率变化

目的探讨用蒽环类抗肿瘤药（ATC）化疗患者心99^Tc^m-MIBI清除率变化及其在ATC心脏毒性监测中的价值。方法14例接受ATC化疗的患者化疗前和化疗第6周期后1周行99^Tc^m-MIBI静态平面及门控SPECT显像。比较化疗前后99^Tc^m-MIBI早期与晚期清除率及左心室射血分数（LVEF）的差异。结果ATC治疗患者化疗前早期及晚期心肌99^Tc^m-MIBI清除率分别为（17．92±5．86）％和（17．05±5．17）％，化疗后为（21．27±7．14）％和（19．67±6．41）％，化疗前后相比差异均有统计学意义（t值分别为-2．611，-2．824，P均〈0．05）。化疗前后LVEF变化差异无统计学意义（t=1．719，P〉0．05）。结论ATC化疗患者心肌99^Tc^m-MIBI清除率的变化有助于监测ATC所致的心肌损害，且其早于LVEF的改变。     

^99Tc^m-MIBI运动负荷-静息心肌灌注显像对冠心病患者经皮腔内冠状动脉血管成形术的疗效评价

目的 用^99Tc^m-甲氧基异丁基异腈（^99Tc^m-MIBI）运动-静息心肌灌注显像评价经皮腔内冠状动脉成形术（PTCA）的疗效。方法20例冠心病患者在PTCA术前和术后应用^99Tc^m-MIBI行运动负荷．静息心肌灌注显像,并对图像进行半定量分析。其中8例患者于术后6个月再次心肌灌注显像。结果对20例患者的27支冠状动脉呈狭窄病变进行PTCA,术前血管的平均狭窄为（84．3±9．2）％,术后平均残留狭窄减为（31．2±9．1）％。运动负荷-静息显像显示可逆性缺损（心肌缺血）的心肌节段数由术前的55个（30．6％）减为术后的10个（5．6％）,差异有显著性（x^2=38．02,P〈0．005）。术后心肌灌注的改善率为81．8％,8例患者术后6个月心肌显像显示3例出现缺血节段,冠状血管造影证实为再狭窄。结论^99Tc^m-MIBI运动负荷-静息心肌灌注显像是一种有效的无创性的判断PTCA术后疗效及再狭窄的方法。     

图像法获取犬18F-FDG PET/CT显像的输入函数

目的 比较^18F-FDG PET图像法和动脉采血法获取输入函数的差别，寻求图像法获取输入函数的最佳部位。方法 5条犬均进行股动脉连续采血和心腔及大血管^18F-FDG PET动态显像，获得动脉血浆输入函数和心腔及大血管区域显像的输入函数，比较不同输入函数计算的曲线下面积（AUC）及通过Patlak方法计算犬心肌的抑制指数（Ki）。结果 心腔和大血管^18F-FDG PET图像获得的输入函数与动脉采血法计算的AUC有很好的相关性（r≥0．97），其中采用主动脉弓（AC）和降主动脉（DA）区域的输入函数获得的心肌FDG代谢Ki与动脉采血法获得的值一致（两者比值分别为1．0±0．1和1．1±0．1）。结论 采用AC和DA区域获得输入函数较适合进行无创的定量分析。     

99Tcm-Annexin Ⅴ衍生物的制备及其生物分布和凋亡显像

目的 探讨^99Tc^m直接标记带有10个连续组氨酸的膜联蛋白V（Annexin V）衍生物的可行性，研究其在健康小鼠体内的分布和肺癌裸鼠模型凋亡显像。方法 直接标记法制备^99Tc^m-Annexin V衍生物，并测产物放化纯、胶体含量及健康小鼠体内不同时间点（5，30min和1，2,4，6，12，24h）的生物分布，DAS2．0软件拟合计算药代动力学参数。建立荷H460非小细胞肺癌裸鼠模型，分为紫杉醇诱导化疗组（5只）和未治疗对照组（5只）。紫杉醇诱导化疗后48h，于裸鼠尾静脉注射^99Tc^mAnnexinV衍生物18．5MBq，2和4h时进行凋亡显像，勾画ROI并计算肿瘤与对侧正常组织（T／NT）放射性比值。结果放化纯达（98．01±1．67）％，3h后放化纯仍可达（95．45±1．34）％，胶体含量为（3．31±1．37）％。健康小鼠体内分布实验表明肾脏对该示踪剂摄取最高，肝、脾摄取较少。DAS2．0软件拟合得到时间-放射性曲线符合二室模型特征，分布相半衰期（T1/2α）为（21．18±5．95）min，清除相半衰期（T1/2β）为（69．32±0．10）min。荷瘤鼠显像示，给药后2h即可获得清晰的图像，紫杉醇诱导化疗组2和4h的T／NT比值为3．85±1．10和4．63±0．97，明显高于对照组（1．60±0．29和1．71±0．43，P〈0．01）。结论 该AnnexinV衍生物易于^99Tc^m直接标记，方法简便，标记物在血液中清除迅速，肝、脾摄取少，易得到高清晰图像。     

乳腺癌辅助化疗前后18F-FDG、99Tcm-HL91显像的临床研究

目的观察乳腺癌辅助化疗前后18^F-FDG、99^Tc^m-4，9-二氮-3，3，10，10-四甲基十二烷-2，11-二酮肟（HL91）显像的变化，探讨其在乳腺癌辅助化疗疗效评价中的价值。方法28例经细针穿刺检查确诊为原发性乳腺癌的患者在化疗前、后分别行18^F-FDG、99^Tc^m-HL91显像，根据显像结果计算病灶ROI／对侧正常乳腺组织ROI（T／N）放射性计数比值。化疗结束以WHO制定的评价标准分为有效组和无效组，并观察化疗前后病理学改变。结果辅助化疗总有效率（RR）为71．4％（20／28），有效组20例，无效组8例；病理改变可见退化变性期（Ⅰ期）、肉芽肿期（Ⅱ期）、纤维化期（Ⅲ期）。治疗前病灶摄取18^F-FDG、99^Tc^m-HL91 T／N值分别为2．98±1．09，2．55±0．80（t=2．312，P=0.026），有效和无效组分别为3．03±1．23，3．09±1．39（t=1．314，P=0．108）和253±0．76，2．63±0．97（t=1．597，P=0．875）；T／N值分布18^F-FDG为1．68～6．49（中位值2．73），99^Tc^m-HL91为1．46—5．01（中位值2．39），两者间呈直线相关（r=0．743，P=0．024）。治疗后28例18^F-FDG T／N值有所下降，为2．40±0．79（t=1．932，P=0．031）；有效和无效组分别为2．28±0．81，2．93±0．76（t=2．462，P=0．015），与治疗前比较有效组差异有统计学意义（t=2．482，P=0．012），且与治疗前呈直线相关（r=0．673，P=0．035），而无效组差异无统计学意义（t=1．562，P=0．324）。99^Tc^m-HL91 T／N值下降的病例中4例为无效，5例为有效，其余为升高；有效和无效组分别为2．59±0．71，2．61±0．99（t=1．472，P=0．096），与治疗前比较2组差异均无统计学意义（t=1．368和1．341，P值为0．127和0．878）。结论18^F-FDG显像对乳腺癌辅助化疗疗效评价具有一定的临床价值。     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Sexual homicide: Brief review of the literature and case report involving rape,genital mutilation and human arson

The objective of the current paper is to report a new case of sexual murder involving human arson and summarize the literature on the phenomenon of sexual homicide. The present case study is unprecedented in Greece and a rarity in international literature due to the fact that the victim suffered genital mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed by the authors. The results revealed sparse, but significant, research findings. The authors discuss the limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender characteristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology, modus operandi), and victim selection. The incidence of the phenomenon is unclear (1–4%) due to non-standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early 30s and belong to Caucasian populations. Personal weapons were commonly used against women, strangulation is the prevalent killing method against children, and firearms against men. Most of the sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal with social isolation.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Extension du modèle puissance–temps limite pour estimer la production d’énergie aérobie et anaérobie lors de l’exercice intense

Aim

Examine how the modelling of the relation between power and time to exhaustion can provide an estimation of the production of aerobic and anaerobic energy during intense exercise.

Current knowledge

The hyperbolic model made it possible to define the critical power corresponding to the maximal rate of energy renewed by aerobic metabolism. A new model distinguishing the critical power from the maximal aerobic power has been built to estimate more precisely the anaerobic contribution. Data from middle distance runners and subjects tested on cycle ergometer showed a relative contribution of anaerobic metabolism arising from critical power and increasing until around 10 % of total power when aerobic energy production reaches its maximum.

Prospects

Considering the slow component of oxygen uptake would provide a more precise analysis of energy production and transformation during exercise at high intensity.     

Beziehungen zwischen Aufprallgeschwindigkeit,Fahrzeugbeschädigungen,Frakturen und „Wurfweite” bei 50 tödlichen Fußgänger-PKW-Unfällen

Zusammenfassung Aus 160 Obduktionen von Fußgängern, die durch PKW getötet worden waren, sind 50 nach folgenden Gesichtspunkten ausgewählt worden:Auffahrunfälle Erwachsener mit gesicherten Angaben in den Gerichtsakten über Fahrzeugbeschädigungen, Zusammenstoßstellen, Endlage der Fußgänger und Bremsspuren. Aus diesen Daten wurden Ausgangs- und Aufprallgeschwindigkeiten berechnet sowie die Wurfweite der Fußgänger gemessen.Die Ausgangsgeschwindigkeiten, nach der Berechnung zwischen 32 und 95 km/h, lagen meistens etwas höher als die angegebenen Geschwindigkeiten. Zwischen Ausgangs- und Aufprallgeschwindigkeiten waren die Differenzen größer. Ab 12 km/h Aufprallgeschwindigkeit kam es bereits zu tödlichen Verletzungen. Auffallend ist die zweigipfelige Verteilung der Häufigkeit sowohl bei der Einteilung nach den Aufprallgeschwindigkeiten als auch nach den Deformationsarbeiten (Aufprallgeschwindigkeit: 26% bei 51–60 km/h und 22% bei 21 bis 30 km/h; Deformationsarbeit: 34% bei 39–200 kpm und 30% bei 701–1000 kpm).Bei Aufprallgeschwindigkeiten über 50 km/h wurden doppelt so viel Knochenbrüche an der Wirbelsäule und am Becken als bei Aufprallgeschwindigkeiten unter 50 km/h festgestellt.Bei 44 Fußgängerunfällen lag ein Drittel innerhalb der Erwartungsgrenze der Wurfweite nach Fiala, je ein Drittel aber darüber bzw, darunter.Das Beschädigungsbild und die Anstoßverletzungen geben Hinweise zur Ermittlung der Aufprallgeschwindigkeit, vor allem wenn weitere Berechnungsgrundlagen fehlen.

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Summary Fifty cases were selected from 160 autopsies performed on pedestrians who were accidentally killed by private motorcars; the cases were selected according to the following criteria:The cases were confined to impact accidents involving adults in which reliable evidence could be gathered from the Court records in relation to damage to the car, the place of collision, the final position of the injured pedestrian and the extent of skidmarks. The initial and collision speeds of the cars were calculated from these facts and the distance of projection of the pedestrians were measured.The initial speeds, calculated between 32 and 95 km/h, were, in most cases, higher than the declared speeds. The differences between initial and collision speeds were larger. Fatal injuries could arise from a collision velocity of only 12 km/h. A striking feature of the analysis was the distribution of two peaks of frequency whether these were classified according to the collision speeds or according to the deformation of the vehicle (collision speed: 26% at the speed of 51 to 60 km/h and 22% at the speed of 21 to 30 km/h; deformation work: 34% at the deformation work of 39 to 200 kpm and 30% at the deformation work of 701 to 1,000 kpm).Twice as many fractures of the vertebral column and pelvis were sustained at collision speeds over 50 km/h as were sustained under 50 km/h.In one third of 44 pedestrian accidents, the distance of projection was within the expected range described by Fiala; in one third the distance was above and in one third below the expected range.If additional data for calculation were lacking, the patterns in injury arising from the impacts gave indications from which it was possible to estimate the collision speed.

Stipendiat der Alexander v. Humboldt-Stiftung, Dozent Dr. med. S. Kamiyama, Dept. of Legal Medicine, School of Medicine, Chiba University, 313 Inohanacho, Chiba, Japan.     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Hip and pelvic injuries in the elderly

Fractures of the hip and pelvis are frequent and serious injuries in elderly patients. Due to the aging population, their incidence should double by 2050. Therefore, the social and economical implications of these fractures are significant. Delay in diagnosis increases the associated morbidity and mortality. The purpose is to review the imaging features of these fractures, the imaging techniques (projections, CT) to depict them and their classification based on severity.