小儿先天性甲状腺功能减退症99mTc甲状腺显像的临床意义

43例先天性甲状腺功能减退症(CH)患儿以左旋甲状腺素钠治疗至2-3周岁,暂停药4周行99mTcO-4甲状腺显像.结果 示甲状腺发育不良37例(86.05%),99mTcO-4甲状腺显像正常6例(13.95%).99mTcO-4甲状腺显像对CH的病因诊断、治疗方案选择有指导作用.     

小儿先天性甲状腺功能减退症99mTc甲状腺显像的临床意义

43例先天性甲状腺功能减退症(CH)患儿以左旋甲状腺素钠治疗至2-3周岁,暂停药4周行99mTcO-4甲状腺显像.结果 示甲状腺发育不良37例(86.05%),99mTcO-4甲状腺显像正常6例(13.95%).99mTcO-4甲状腺显像对CH的病因诊断、治疗方案选择有指导作用.

Abstract：

Forty-three children with congenital hypothyroidism(CH)underwent 99mTc thyroid scintigraphy, after being followed up by receiving levothyroxine till 2 to 3 years of age. The results showed that thyroid agenesia happened in 37 cases( 86.05% ) while entopic gland in 6 cases (13.95% ). Thyroid scintigraphy with 99mTc is an informative procedure in determining etiology and treatment schedules for children with CH.     

转染甲状腺钠/碘同向转运体的卵巢癌99m TcO-4显像及131Ⅰ治疗

目的 通过观察131Ⅰ对转染人甲状腺钠/碘同向转运体(hNIS)的卵巢癌的治疗作用,为最终实现131Ⅰ治疗非甲状腺肿瘤提供理论依据.方法 应用hNIS基因全长转染人卵巢癌细胞系,建立裸鼠卵巢癌荷瘤模型,在整体水平研究hNIS转染后介导的卵巢癌移植瘤99mTcO-4显像和131Ⅰ的治疗作用.结果 转染hNIS基因后,原本不摄碘的卵巢癌可以应用99mTcO-4显像,并且在131Ⅰ作用下,肿瘤体积有所缩小.结论 131Ⅰ对转染hNIS基因的卵巢癌移植瘤增殖具有较强的抑制作用.     

99mTc-TF显像在老年人甲状腺"冷结节"性质判定中的价值

目的 对99m锝-1,2双[双(2-乙氧乙基)膦基]乙烷(99mTc-tetrofosmin,99mTc-TF)显像与颈部彩色多普勒超声(color doppler ultrasonography,CDU)检查对甲状腺"冷结节"性质判定的结果进行对比分析,以明确99mTc-TF显像在判定甲状腺"冷结节"性质中的价值.方法 选择经99mTcO-4显像证实为甲状腺"冷结节"60岁以上的患者60例,以术后病理结果为标准,分别对99mTc-TF显像及颈部CDU检查在96处甲状腺"冷结节"、62处直径＞1 cm的甲状腺"冷结节"中的判定结果进行对比分析.结果 病理结果示96处甲状腺"冷结节"中良性52处,恶性44处.颈部CDU准确率为79.17%,99mTc-TF显像准确率为77.08%,两种手段间准确率比较无显著差异(P>0.05).病理结果示直径＞1 cm的62处甲状腺"冷结节"中良性34处、恶性28处.颈部CDU准确率为79.03%,较其在甲状腺"冷结节"中判定的准确率无显著性差异(P>0.05);99mTc-TF显像准确率为91.94%,较其在甲状腺"冷结节"中,判定的准确率增高(P<0.05).99mTc-TF显像判定准确率高于颈部CDU(P<0.05).结论 99mTc-TF显像在直径较大的甲状腺"冷结节"的性质判定准确率优于颈部CDU检查.     

99mTcO4-甲状腺显像对不同时期亚急性甲状腺炎的诊断价值

目的探讨放射性核素99mTcO4-甲状腺显像对不同时期亚急性甲状腺炎(SAT)的诊断价值。方法选择SAT患者155例,按甲状腺功能分为甲状腺功能亢进(甲亢)组77例、甲状腺功能正常组78例。分别行甲状腺99mTcO4-显像和细针穿刺细胞学检查(FNAB),以FNAB结果为参照,观察99mTcO4-甲状腺显像诊断不同时期SAT的灵敏度和特异度。结果 99mTcO4-甲状腺显像诊断甲亢组的灵敏度为91.7%、特异度为60.0%,与FNAB检查比较差异有统计学意义(χ2=12.8,P<0.05);诊断甲状腺功能正常组的灵敏度为76.1%、特异度为57.1%,与FNAB检查比较差异无统计学意义(χ2=2.0,P>0.05)。结论 99mTcO4-甲状腺显像诊断甲亢期SAT敏感性和特异性均高于甲状腺功能正常期,可考虑作为首选方法。     

甲状腺静态显像诊断双异位甲状腺的6年回顾性研究

目的 回顾性分析拟诊存在异位甲状腺的患者中,双异位甲状腺的发生率,并对比甲状腺不同异位情况患者临床指标的差异.方法 回顾2008年6月至2014年6月因拟诊存在异位甲状腺而就诊患者的临床资料.甲状腺静态显像在静脉注射99TcmO4-后30 min进行,根据显像结果判断异位甲状腺的位置和数目.所有患者均测定血清甲状腺激素水平并行颈部超声检查.其中,共有122例患者被筛检出,根据甲状腺静态显像结果分为3组,单异位甲状腺组、双异位甲状腺组、无甲状腺组.结果 在122例异位甲状腺患者中,3组所占比例分别为单异位甲状腺组(83/122,68.03％)、双异位甲状腺组(7/122,5.74％)、无甲状腺组(32/122,26.23％).随着异位甲状腺个数的增加,患者的年龄、游离T3、游离T4水平呈显著上升趋势(F =110.42,69.70,64.51,P均＜0.01),而促甲状腺激素水平呈显著下降趋势,其中以双异位甲状腺组为著,与其他两组间差异均有统计学意义(F=21.71,P＜0.01).双异位甲状腺组有女性4例、男性3例,其中6例异位部位均为舌下区和舌骨下区,1例为舌根部和舌骨下区.4例甲状腺功能减退症、2例甲状腺功能正常、1例亚临床甲状腺功能减退症.结论 在本研究中,双异位甲状腺在拟诊存在异位甲状腺患者中的发生率为5.74％.大多数患者甲状腺功能正常或轻度减退,异位部位常在舌根部、舌下区和舌骨下区.     

131Ⅰ治疗舌根部异位甲状腺

本文首次报道一例软骨发育不全合并舌根部异位甲状腺患者,用放射性131 Ⅰ治疗后,异位甲状腺体积缩小,症状缓解.患者女性,71岁,患有软骨发育不全,因亚临床甲减和舌根部异位甲状腺引起进食同体食物后吞咽困难、发音障碍和窒息感而转至本院就诊.实验审检查结果 符合业临床甲减:TSH 13.9 mu/L(正常范围0.4～5.0),FT4 17.4 pmol,/L(正常范围11.0-23.0).甲状腺过氧化物酶抗体和甲状腺球蛋白抗体均为阴性.B超证实正常位置无甲状腺组织.99mTcO-4颈部扫描显爪舌根部位有99mTcO-4浓集灶.而颈部止常甲状腺位置无示踪剂摄取.颈部增强CT显示舌根部有3.0 cm×2.0 cm×2.0 cm实质肿块.结合病史,诊断为舌根部异位甲状腺和亚临床甲状腺功能减退症.     

先天性甲状腺功能减退症患儿甲状腺形态学改变和治疗时机对智力发育的影响

目的 探讨先天性甲状腺功能减退症(CH)患儿甲状腺形态学改变、开始治疗时间及治疗前甲状腺功能(血FT4、TSH浓度)对患儿智力发育的影响.方法 对52例CH患儿确诊后即给予左旋甲状腺素口服,监测其智力、体格发育,并进行甲状腺核素扫描(99mTcO4)或(和)超声检查了解甲状腺形态学改变,10～30个月行Bayley婴儿发育测量法测试,得到智力发育指数(MDI)及运动发育指数(PDI)测试结果,根据治疗开始时间及形态学改变进行分组分析.结果 甲状腺形态学异常组MDI明显低于甲状腺形态正常组(91±20 vs 102±15,P＜0.05),患者越晚开始治疗对MDI影响越大,以61～90 d治疗者MDI(73±24)影响最为显著.结论 CH患儿智力发育与甲状腺形态学改变及开始治疗时间有关,提示对筛查检出的新生儿甲减早期诊断和治疗的重要性.     

99m TcO-4甲状腺显像定量分析在Graves病诊治中的应用

1996年 6月至 2 0 0 0年 3月 ,我们对 71 2例经临床检查确诊的 Graves病患者进行了99m Tc O-4 甲状腺显像定量分析 ,其中临床资料详实者 1 0 8例 ,现分析其检测结果 ,以探讨 99m Tc O-4 甲状腺显像定量分析对Graves病的诊断、疗效和预后判断价值。1　资料与方法1 .1临床资料　 1 0 8例患者中 ,男 7例 ,女 1 0 1例 :年龄 1 9～ 53岁 ,平均 32 .56± 9.35岁 ;病程 0 .5个月至 4年 ,甲状腺弥漫性肿大 ～ °患者均依靠病史、体检、实验室检查、甲状腺显像、超声检查、细胞学检查、诊断性治疗和随访观察而确诊。根据甲状腺显像时甲功状态分…     

放射性核素显像诊断儿童异位甲状腺及核素显像剂的选择

目的探讨放射性核素显像诊断儿童异位甲状腺（ETG）的价值及显像剂的合理应用。方法对83例疑诊ETG患儿进行甲状腺核素显像检查,其中采用131I显像55例99mTcO4显像30例（两者联用2例）。并与临床病理检查结果比较。结果病理检查诊断为ETG11例。核素显像对11例ETG全部检出,诊断ETG的敏感性、特异性131I均为100％,99mTcO4亦均为100％;但99mTcO4较131I图像明显清晰。结论放射性核素显像对儿童ETG的诊断具有独特价值,宜常规选择99mTcO4^-显像。     

Accuracy of ultrasonography to establish the diagnosis and aetiology of permanent primary congenital hypothyroidism

OBJECTIVE: To compare ultrasonography and 99mTc thyroid scintigraphy for the aetiologic diagnosis of permanent congenital hypothyroidism (CH). STUDY DESIGN: Eighty-eight consecutive patients with CH were recruited at an endocrinology outpatient clinic and submitted to high-frequency ultrasonography and to 99mTc scintigraphy. RESULTS: Seventy-six patients were diagnosed with permanent CH and 12 with transitory CH. The agreement between ultrasound and scintigraphy was very high (kappa coefficient = 0.866; P < 0.001) for the entire group. In permanent CH patients, ultrasonography identified 67 cases of dysgenesis (absence of thyroid gland in the usual anatomical location in 66 and hemiagenesis in one), and this diagnosis was confirmed by scintigraphy (absence of functional thyroid tissue in 43 and ectopia in 24). In the other nine permanent CH patients, the thyroid was in the usual anatomical location on ultrasonography but scintigraphy did not identify functional tissue in one patient. In the 12 transitory CH patients, a normally shaped thyroid was detected by ultrasound in the usual location, whereas scintigraphy showed absence of functional tissue in two identical twins and scarce concentration of isotope in a third patient. CONCLUSION: Ultrasonography is an accurate method to establish the presence of dysgenesis and might be used as the first imaging tool in patients with CH, whereas scintigraphy should be used mainly to distinguish agenesis from ectopia. Further examination is required to differentiate permanent CH with a normally located and shaped gland from transitory hypothyroidism.     

The usefulness of MIBI scintigraphy for postoperative monitoring of patients with thyroid cancer

Metoxyizobutyloizonitrile labelled with technetium 99mTc is a radio-pharmaceutical that was shown to accumulate in benign and cancerous thyroid tissue. As it can be applied without thyroid hormone withdrawal this gave a stimulus to the investigations on its usefulness in diagnostic and follow up procedures for thyroid cancer patients. The goal of this study is to evaluate the efficacy and benefit of 99mTc-MIBI whole body scintigrams in post surgery follow-up of patients with differentiated thyroid cancer. One hundred and twenty eight 99mTc MIBI scintigraphy were performed and evaluated. Sensitivity of MIBI scans was the highest for bone metastases--79%. Good results were also obtained for lymph node metastases (sensitivity--73%, specificity--90%). In case of lung metastases the sensitivity and specificity were 21% and 94% respectively. Sensitivity of detection of clinically apparent recurrent disease in thyroid bed was 70% and specificity of visualization 78%. Results of our study demonstrate that 99mTC-MIBI is valuable tool in follow up of thyroid cancer patients, but can not replace 131I scintygraphy.     

原发性甲状旁腺功能亢进的核素定位诊断

应了~（99m）Tc-MIBI进行了甲状旁腺显像,并对方法学进行了探讨。10例患者经临床、生化确诊为原发甲旁亢,但均未触及增大的甲状旁腺或甲状腺。其中7例在应用~（99m）Tc-MIBI和~（99m）Tc两种示踪剂分别进行甲状旁腺显像和甲状腺显像,3例仅用~（99m）Tc-MIBI,但在显像过程中给予了过氯酸盐。在静泳注射~（99m）Tc-MIBI后不同时间采集图象并选用产P/T值（甲状旁腺计数/甲状腺计数）做参数,以了解示踪剂的代谢及确定最佳显像时间。10例患者经手术共摘除12枚肿大的甲状旁腺,病理证实10枚为甲状旁腺腺瘤,2枝为甲状旁腺增生,B超检查9例中发现2枚腺瘤,CT检查8例共发现3枚腺瘤,核素显像10例患者各发现腺瘤一个,其阳性部位与手术所见完全吻合。尽管例数较少,但初步看,此方法简便、准确,对于原发甲旁亢的定位诊断确有临床价值。     

Diagnostic imaging of the thyroid]

Among various imaging modalities used for the diagnosis of thyroid diseases, ultrasonography is the most sensitive and economical method to visualize anatomic detail and structural relations. Scintigraphy using 123I or 99mTc gives critical information about thyroid cell function and makes it possible to differentiate the causes of thyrotoxicosis. Tumor scintigraphy using 201T1, 67Ga, 131I-metaiodobenzyl guanidine or 99mTc(V)-dimercaptosuccinic acid is useful for the characterization of nodules. Recently introduced magnetic resonance imaging appears promising in demonstrating pseudocapsules around tumors and capsular invasion.     

Late pulmonary scintigraphic defects after uneventful recovery from focal pneumonia in children: comparison with initial radiograph

Pulmonary radionuclide studies provide reliable information on regional lung perfusion and ventilation. In children of focal pneumonia with consolidation on the chest radiographs, we determined the association between the initial pneumonia sites and the late lung ventilation-perfusion (V-P) scan abnormalities six months to one year later. Totally fifteen children, 9 males and 6 females, aged 2 to 12 years, were enrolled. All cases had normal chest radiographs in follow up, and had unremarkable respiratory symptoms or signs. Both of 99mTc MAA perfusion scintigraphy and 99mTc DTPA radioaerosol ventilation scintigraphy were performed in 12 cases while the other 3 cases had only perfusion studies. As results of these findings, there were 10 abnormal lung scans, including 9 cases at comparable areas (66%) and one at incomparable area with the initial pneumonia sites. Among those 9 comparable cases, we found 6 ventilation/perfusion (V/Q) matched defects, 2 high V/Q mismatched defects and one decreased perfusion defect. We concluded that abnormal lung V-P scans were frequently after uncomplicated pneumonia in childhood, mostly being matched defects, which may be secondary to local bronchial obstruction and decreased perfusion. However, they seem not always to correlate with the initial pneumonia sites.     

Isotope imaging for metastatic thyroid cancer.

Many isotopes are available for imaging patients with suspected thyroid cancer recurrence and metastases. TSH-stimulated low-dose 131I whole-body scanning with serum thyroglobulin either by standard LT4 withdrawal or rhTSH stimulation is the preferred test for monitoring patients without palpable disease or elevated serum thyroglobulin on LT4 therapy (Fig. 5). This approach has the advantage of finding disease that may be amenable to 131I therapy, although low-dose 131I scans are less sensitive than are scans with other imaging agents. 123I has better imaging characteristics than 131I and has been shown to be equivalent or superior to low-dose 131I in recent studies. As the availability of 123I increases and the cost decreases, this agent may replace 131I in imaging for recurrent or metastatic thyroid cancer. Patients who have an elevated serum thyroglobulin on LT4 therapy or after TSH stimulation but have a negative low-dose 131I scan require other imaging procedures to find the suspected disease. The authors currently perform a sensitive neck ultrasound to look for surgically remediable disease and consider a noncontrast CT scan of the chest to look for small pulmonary metastases that poorly concentrate low doses of 131I (Fig. 5). Fluoro-18-deoxyglucose PET, 99mTc MIBI, 201Tl, and 99mTc tetrofosmin are primarily useful in the setting of a negative whole-body 131I scan and elevated serum thyroglobulin. 18FDG-PET seems to have the highest sensitivity in this setting and would be the preferred imaging agent, but availability and cost are major issues (Fig. 5). Although some researchers have advocated these radiopharmaceuticals as first-line agents replacing 131I, there is little support for this position. This approach to imaging is not cost-effective because positive scans in these patients would most likely require 131I scintigraphy to determine whether the lesions are amenable to radioiodine therapy. 99mTc pertechnetate, 99mTc furifosmin, and somatostatin receptor scintigraphy have a limited role in imaging for recurrent or metastatic differentiated thyroid carcinoma. In choosing among 99mTc MIBI, 201Tl, and 99mTc tetrofosmin, the technetium label of sestamibi and tetrofosmin results in better image quality and faster imaging than 201Tl. Although 99mTc sestamibi and 99mTc tetrofosmin have not been compared in a large series, the higher tumor-to-background ratio and consistently high sensitivities of 99mTc tetrofosmin suggest that it could potentially have additional value over 99mTc sestamibi, but there is still limited experience with 99mTc tetrofosmin.     

False-positive technetium 99m depreotide scintigraphy resulting from round atelectasis

The authors report two cases of round atelectasis that showed increased accumulation of technetium (Tc) 99m depreotide on planar and single photon emission computed tomographic scintigraphy. It should be considered that round atelectasis is a potential nonmalignant cause for positive 99mTc depreotide scintigraphy.     

Protein-Losing Gastroenteropathy Detected by Technetiuni-99m-Labeled Human Serum Albumin

Gastric and fecal clearance of alpha 1-antitrypsin were measured in three cases of protein-losing gastroenteropathy and in two control cases. Abdominal scintigraphy using 99mTc-labeled human serum albumin was performed in all five subjects. All three cases of protein-losing gastroenteropathy showed 99mTc activity in the gastrointestinal tract. In the patient with hypertrophic gastropathy, the activity was seen initially in the stomach and duodenum. In the patients with intestinal lymphangiectasia, the activities were initially in the small bowel. We conclude that 99mTc scintigraphy was useful, not only in diagnosing protein-losing enteropathy, but, also, in detecting the responsible region of the gastrointestinal tract.