甲状旁腺功能亢进症患者甲状旁腺激素测定与^99Tc^m-MIBI显像

目的评价原发性甲状旁腺功能亢进症（简称甲旁亢）诊断中^99Tc^m-MIBI显像与血清全段PTH测定结果间的关系。方法对70例临床疑诊甲旁亢患者行血清全段PTH测定和^99Tc^m-MIBI显像。血清PTH〉88ng／L为诊断甲旁亢依据;^99Tc^m-MIBI显像以早期相发现且延迟相显示相对清晰的异常放射性浓聚灶为病变腺体的检出依据。对照最终临床诊断结果,评价鲫Tcm_MIBI显像对病变甲状旁腺的检出效能及与血清PTH检测结果的关系;并以Pearson直线相关分析法分析血清PTH水平与病变腺体体积之间的相关性。结果70例患者中最终证实为甲旁亢者38例。^99Tc^m-MIBI显像对70例患者的诊断准确性为90．0％（63／70）;在PTH正常组为80．0％（12／15）,在PTH升高组为92．7％（51／55）;假阳性均见于PTH正常者。若^99Tc^m-MIBI显像诊断甲状旁腺病变以PTH升高为前提,则总体诊断准确性为94．3％（66／70）;Pearson直线相关分析显示,原发性甲旁亢患者血清PTH水平与病变腺体体积之间呈正相关（r=0．782,P〈0．001）。结论甲状旁腺病变腺体行^99Tc^m-MIBI显像时应先测定血清PTH,以提高^99Tc^m-MIBI显像的诊断准确性。     

^99Tc^m—MIBI双时相显像定位诊断继发性甲状旁腺功能亢进症的价值

目的探讨^99Tc^m-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症（SHPT）中的临床价值。方法回顾性分析2010年至2013年间20例（男8例,女12例,平均年龄49．6岁）行甲状旁腺切除术的肾性SHPT患者影像学资料,以术后病理结果为“金标准”,计算^99Tc^m-MIBI双时相SPECT／CT显像结果与彩色多普勒超声（CDUS）对SHPT的诊断效能,同时对延迟显像中甲状旁腺摄取的最高放射性比值（T／NT）与患者近期全段PTH（iPTH）水平及术中切除的相应甲状旁腺体积的关系作分析。采用x^2检验、Pearson相关或Spearson相关分析数据。结果^99Tc^m-MIBI双时相显像和CDUS诊断SHPT的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为66．67％（44／66）、100％（14／14）、100％（44／44）、38．89％（14／36）、72．50％（58／80）和78．19％（43／55）、52．38％（11／21）、81．13％（43／53）、47．83％（11／23）、71．05％（54／76）。二者诊断SHPT的特异性和阳性预测值差异有统计学意义（x^2=9．33和9．26,均P〈0．05）,其余3个指标差异均无统计学意义（x^2=1．97、0．04和0．46,均P〉0．05）。最高T／NT与患者iPTH水平及手术切除的相应甲状旁腺体积均呈正相关（r=0．638,rs=0．571,均P〈0．05）。结论^99Tc^m-MIBISPECT／CT显像诊断SHPT的特异性高于CDUS0^99Tc^m-MIBI双时相显像可准确定位功能亢进的甲状旁腺,为手术治疗提供依据。     

MRI及99Tcm-MIBI显像对甲状旁腺机能亢进症的诊断价值

目的：评价MRI及^99Tcm-甲氧基异丁基异腈（MIBI）显像在原发性甲状旁腺机能亢进症（PHT）中检出病理性腺体的临床价值。方法：25例经手术证实的PHT患者实行了术前定位MRI检查，若甲状旁腺部位发现可凝软组织肿物，其信号高于周围正常甲状腺，则认为是病理性甲状旁腺，其中23例同时进行了双时相99Tcm-MIBI显像，如早期相出现放射性浓聚区且延迟相持续存在则考虑为异常甲状旁腺，MRI和99Tcm-MIBI显像阅片结果与病理检查结果对照。结果：术中共发现39个异常甲状旁腺，包括19个腺瘤（18例），19个增生（6例）和1个上皮细胞癌（1例），MRI和99Tcm-MIBI显像对检出病理性腺体的准确性分别为84．1％和85．0％,但前者灵敏度（74．4％）高于后者（67．6％），而后者的特异性（97．8％）高于前者（91．8％），两种方法联合应用准确性提高到91．3％，灵敏度为91．2％，特异性为91．3％，结论：99Tcm-MIBI显像可作为继B超检查之后的首选术前定位检查法，但最理想的最联合应用MIR和99Tcm-MIBI显像。     

99Tcm-MDP骨显像诊断甲状旁腺瘤

目的 探讨^99Tc^m-亚甲基二膦酸盐(MDP)骨显像诊断甲状旁腺瘤的价值。方法 回顾性分析26例甲状旁腺瘤患者骨显像和^99Tc^m-甲氧基异丁基异腈(MIBI)甲状旁腺瘤显像的特点，并与其他相关疾病相鉴别。26例皆行B超检查，其中18例行^99Tc^m-MIBI颈部显像。结果 核素显像诊断的26例甲状旁腺瘤皆经手术治疗、病理检查证实，其中2例为异位甲状旁腺瘤，1例为甲状旁腺癌。26例^99Tc^m-MDP骨显像皆清晰，呈全身骨转换增加的代谢性骨病征，代谢指数≥5，典型表现特点为“黑颅”和骨显像清晰。18例^99Tc^m-MIBI显像皆可见甲状旁腺瘤，其中3例B超检查未见。结论 对骨痛和病理性骨折患者行全身骨显像有助于甲状旁腺功能亢进导致代谢性骨病的病因诊断，与甲状旁腺瘤显像联合应用，可准确诊断和定位甲状旁腺瘤。     

^99Tc^m—MIBISPECT结合定位CT显像诊断功能亢进异位甲状旁腺的价值

目的评价^99Tc^m-甲氧基异丁基异腈（MIBI）SPECT结合定位CT显像对功能亢进异位甲状旁腺的定位诊断价值。方法回顾性分析28例功能亢进异位甲状旁腺患者的手术、病理及影像资料。28例均行常规CT检查,其中25例先行双时相^99Tc^m-MIBI显像,对甲状腺外存在异常放射性浓聚灶患者,随即进行SPECT结合定位CT采集,经计算机处理得到二者融合图像,对放射性浓聚灶进行精确定位。以手术及病理检查结果为检查“金标准”,所有患者均按4个甲状旁腺计算,经手术及病理检查证实的为阳性,其余判为阴性。CT检查与核医学显像结果的比较采用四格表,检验。结果手术中28例患者共摘除28个异位病灶,均为单发。病理检查结果均为腺瘤。28例患者常规CT检查共发现22个阳性病灶,其中真阳性17个,假阳性5个,另假阴性11个,真阴性79个;25例^99Tc^m-MIBISPECT结合定位CT显像发现阳性病灶23个,无假阳性,另假阴性2个,真阴性75个。常规CT检查与核医学显像对检出病理性甲状旁腺的灵敏度分别为61％（17／28）、92％（23／25）,特异性为94％（79／84）、100％（75／75）,准确性为86％（96／112）、98％（98／100）,阳性预测值为77％（17／22）、100％（23／23）,阴性预测值为88％（79／90）、97％（75／77）;两者间比较差异有统计学意义,灵敏度：χ^2=6．98,P〈0．01,特异性：χ^2=4．61,P〈0．05,准确性：χ^2=10．30,P〈0．01,阳性预测值：χ^2=5．88,P〈0．05,阴性预测值：χ^2=5．36,P〈0．05。结论^99Tc^m—MIBI SPECT结合定位CT显像对功能亢进异位甲状旁腺的定位诊断优于常规CT,但存在一定的假阴性。     

甲状旁腺腺瘤伴甲状腺腺瘤99Tcm-MIBI显像一例

^99Tc^m-甲氧基异丁基异腈（MIBI）甲状旁腺平面显像诊断甲状旁腺腺瘤有2种阳性显像图，即甲状腺下缘型——单侧甲状腺下极外见浓聚灶和甲状腺腺体型——一侧甲状腺腺内见放射性浓聚灶，前者多见，后者少见。^99Tc^m-MIBI是一种亲肿瘤显像剂，可被甲状旁腺腺瘤和甲状腺腺瘤摄取。因此，鉴别甲状腺腺体型的甲状旁腺腺瘤与甲状腺腺瘤是避免误诊的关键。笔者报道一例罕见甲状旁腺腺瘤伴甲状腺腺瘤的^99Tc^m-MIBI显像结果，供读者参考。     

99 Tcm-MIBI显像定位诊断功能亢进性异位甲状旁腺

目的：探讨99Tc^m-甲氧基异丁基异腈（MIBI）显像对于异位甲状旁腺所致原发性甲状旁腺功能亢进（简称甲旁亢）的显像特点，提高甲状旁腺术前定位的准确性。方法：61例原发性甲旁患者采用99Tcm-MIBI显像（减影法6例，双时相法55例），其中52例有B超（US），15例有CT检查，全部病例均经手术和病理检查证实。结果：61例中发现异位甲状帝腺16例（26．2％），位置分别为：颈动脉鞘内3例，下颈部处伸至胸骨后6例，纵隔内7例，99Tcm-MIBI显像全部检出（100％），与手术部位一致，US检查15例，检出8例（53．3％），均位于颈部，纵隔内6例及颈动脉鞘内1例未检出。CT检查7例，纵隔内6例检出2例（28．6％），病理检查诊断：腺瘤14例，增生2例，病灶最小1g，最大＞60d,99Tcm-MIBI显像示病灶小者为放射性均匀浓聚，大者常有囊性变，甚至完全为囊肿样。位于甲状腺影像外者，双时相法的初始相即可显示，但位于纵隔深部病变的解剖关系不能精确表达，结论：99Tcm-MIBI显像是最有效的探测异位甲状旁腺的方法，缺点是对于纵隔深部病灶的解剖定位不够清楚，应加断显像或加做CT检查。     

甲旁亢患者99 TCm-MIBI显像异常二例

延迟法^99Tc^m-甲氧基异丁基异脯（MIBI）显像是诊断甲状旁腺功能亢进症（简称甲旁亢）常用的方法。现将2例腺瘤型甲旁亢患者的^99Tc^m-MIBI显像异常表现报道如下。     

多种影像学技术在甲状旁腺功能亢进症术前定位和诊断中的应用进展

甲状旁腺功能亢进症（HPT）的主要治疗方法为手术治疗,准确的术前影像学定位对手术至关重要。目前HPT手术的术前定位方法有很多种,包括超声、甲状旁腺核素平面显像、CT和MRI。超声、CT、MRI可显示颈部病灶的位置及解剖关系,甲状旁腺核素平面显像可以相对特异地定位病变的甲状旁腺,但均存在一定的局限性。甲状旁腺体积小,数量...     

术前甲状旁腺γ照像显示病变部位：不同读片方法的正确性研究

目的以组织学分析为参考标准．对原发性甲状旁腺亢进病人单发甲状旁腺病变（SGD）与多发甲状旁腺病变（MGD）的甲状旁腺叮照像进行回顾性对照研究，评价不同读片人诊断结果的正确性。方法此项研究符合HIPAA要求，并得到学院医学伦理委员会的批准。对462例原发性甲状旁腺机能亢进病人术前^99rc^m甲氧异腈与^99Tc^mO4^-扫描的影像结果进行了凰颐性复习。扫描包括^99Tc^cm甲氧异腈早期与晚期针孔影像、甲状腺针孔影像、减影与单光子发射计算机体层摄影术（SPECT）。     

Clinical comparison of 99mTc-HMDP and 99mTc-MDP

^99mTc-Hydroxymethylene diphosphonate (HMDP) was compared to ^99mTc-methylene diphosphonate (MDP) with respect to image quality, lesion detectability, and the uptake ratios of normal bone to soft tissue (B/S), metastatic bone to soft tissue (M/S) and bone metastases to normal bone (M/B) at 2 and 3 h after injection in the same subjects. Thirty-three patients with bone metastases were examined in six nuclear-medicine departments, with each center using its usual bone-scanning protocol which was identical for both compounds in the same patient. The uptake of ^99mTc-HMDP in normal bone (B/S) was significantly higher than that of MDP at 2 and 3 h, but there were no significant differences between the two compounds with regard to the M/S or M/B or M/B ratios. The M/B of HMDP at 2 h was not significantly different from that of MDP at 3 h, the latter showing a significantly higher B/S and M/S ratio. All lesions were detected with both compounds, even at 2 h. The image quality was rated as follows (in decreasing order): HMDP (3 h), MDP (3 h), HMDP (2 h), and MDP (2 h). HMDP was shown to be a useful bone-imaging agent, especially when shorter intervals between injection and recording are required.     

Clinical comparison of bone scintigraphy with 99Tcm-DPD, 99Tcm-HDP and 99Tcm-MDP

The bone-imaging agents MDP, DPD and HDP were compared radiochemically (only minor differences were found) in 12 patients with prostatic and 12 patients with breast carcinoma. Each patient received both MDP and either DPD or HDP. The scintigraphic examinations were compared visually and quantitatively. The uptake ratio normal bone/soft tissue was higher for DPD and HDP than for MDP. The ratio pathologic bone/normal bone was highest for MDP, particularly for prostatic carcinoma. The differences in this ratio for breast carcinoma were in general non-significant. The observed differences were minor and of little practical importance.     

Effect of milking efficiency on 99Tc content of 99mTc derived from 99mTc generators

Calculation was made of the effect of milking efficiency on the 99Tc content of 99mTc derived from 99mTc-generators. Reduced milking efficiency was shown to lead to an increase in the 99Tc/99mTc ratio. Levels of 99Tc were determined in samples from both column and solvent extraction generators using a HPLC procedure. It is recommended that producers of 99mTc from solvent extraction generators should ensure that complete generator milking is performed daily.     

Pharmacokinetic characteristics of 99mTc-Ethylene-l-dicysteine (99mTc-EC)

BACKGROUND: Ethylenedicysteine-99mTc (99mTc-EC) has been more and more commonly applied in dynamic studies as well as for clearance determinations. However, it was necessary to investigate in detail the pharmacokinetic characteristics of the radiopharmaceutical which may be important for its applicability in assessment of renal function. RESULTS: Kidney images obtained from renoscintigraphy are characterised by excellent quality without visualisation of the organs adjacent to kidneys (liver, spleen). Renoscintigraphic curves demonstrate typical shapes with TMAX and T1/2 values not differing from the corresponding values obtained for other radiopharmaceuticals (99mTc-MAG3, 131I-OIH). In plasma, 99mTc-EC binds with proteins to a considerably lesser degree (c. 1/3) than 131I-OIH (c. 2/3), or 99mTc-MAG3 (> 9/10). No binding of 99mTc-EC with erythrocytes has been demonstrated, whereas 131I-OIH attaches to or penetrates the red blood cells (10-12%). 99mTc-EC is quickly excreted from the organism: 40 min after i.v. injection up to 70% of the administered radiopharmaceutical is found in urine, and at 1 and 1.5 h after the administration 80% and 95%, respectively. The distribution of 99mTc-EC in the organism can be described in a fully satisfactory way by means of an open two-compartment model, which allows this model to be used for clearance determinations. Comparison of the values of renal plasma clearance without collection of urine with the values determined by means of measurement of activity excreted with urine and mean blood concentration over a finite time interval leads to the conclusion that extrarenal plasma clearance of this compound (via the liver?) is negligible and amounts to c. 17 ml/min (5-6% of the total). The obtained correlation between clearance values for 99mTc-EC and 131I-OIH supports the contention that extrarenal excretion rate of 99mTc-EC (through the liver and bile ducts) is lower than the corresponding rates of either 131I-OIH or 99mTc-MAG3. A very close correlation between clearance values for 99mTc-EC and ERPF (131I-OIH clearance) and between their extraction constants (r = 0.91 and 0.92, respectively), allows for the introduction of 99mTc-EC to the assessment of renal function instead of 131I-OIH. Effective dose to the patient from unit activity of 99mTc-EC is comparable with that resulting from administration of other radiopharmaceuticals labelled with 99mTc.     

Results of regular study on radionuclidic purity of 99mTc obtained from 99Mo-99mTc generators

A total of 39 ^99mTc eluates obtained from 9 ⁹⁹Mo-^99mTc generators delivered by The Radiochemical Centre Amersham during one year was studied with regard to their radionuclide purity. Using a Ge(Li) spectrometer the contaminants ⁶⁰Co, ¹⁰³Ru, ¹³¹I, ¹³⁴Cs, ¹⁴⁰Ba, ¹⁴⁰La and ¹⁸⁸Re were found in ^99mTc-eluates with average levels ranging from 2.9x10^-3 to 2.8x10^-1 per cent of ^99mTc activity. The additional total body absorbed dose caused by these contaminants, as calculated from their average content in ^99mTc eluates, was less than 1% of the dose due to ^99mTc pertechnetate.