99Tcm-MIBI和99TcmO-4显像定位诊断甲状旁腺机能亢进

目的评价99TcmMIBI双时相显像及99TcmMIBI/99TcmO-4联合显像对探测功能亢进甲状旁腺组织的临床应用价值,并与其他影像学手段进行比较。方法68例诊断或疑诊甲旁亢患者行99TcmMIBI甲状旁腺双时相显像(其中9例在一周内行99TcmO-4甲状腺显像),患者均行全身显像,其中1例行SPECT/CT融合显像,35例行B超检查,6例行CT检查。54例行手术治疗获得病理结果(甲状旁腺增生18例,甲状旁腺腺瘤25例,甲状旁腺癌7例,结节性甲状腺肿2例,甲状腺癌1例,淋巴结慢性炎症1例),其余14例临床最终除外甲旁亢。结果99TcmMIBI双时相显像阳性47例,阴性21例;99TcmMIBI/99TcmO-4联合显像阳性8例,阴性1例。核素显像经病理及临床其他检查证实真阳性47例,真阴性15例,假阳性3例,假阴性3例。灵敏度94%,特异性83.3%,准确性91.2%,阳性预测值94%,阴性预测值83.3%。结论综合运用99TcmMIBI的双时相显像、全身显像、SPECT/CT融合显像及99TcmO-4显像能进一步提高核医学对功能亢进甲状旁腺组织定性及定位诊断的准确性。     

18F-FDG PET/CT在肾脏肿瘤诊疗中的应用

目的评价18F-FDG PET/CT在肾脏肿瘤诊断和治疗中的价值。方法对30例CT或MRI确诊或怀疑肾脏肿瘤的患者行18F-FDG PET/CT显像,22例患者行延迟显像。所有肾脏肿瘤均经手术或穿刺活检后病理确诊。评价18F-FDG PET/CT对患者治疗方案的影响。结果 30例中,肾细胞癌(RCC)24例,肾神经内分泌肿瘤1例,淋巴瘤3例,肺癌肾转移1例,肾脏炎性病变1例。PET/CT诊断肾脏肿瘤的灵敏度为89.66%(26/29),特异度为100%(1/1),准确率为90.00%(27/30),阳性预测值为100%(26/26),阴性预测值为25.00%(1/4)。PET/CT检出肾癌伴肾门淋巴结转移2例,远处转移5例。8例(RCC 4例、肾淋巴瘤3例及肾转移癌1例)接受PET/CT后治疗方案发生改变。显像阳性肾癌患者Fuhrman分级高于阴性患者(P<0.05),显像阳性肾癌平均直径大于阴性者(P<0.05)。22例肾癌早期最大标准摄取(SUVmax)值与延迟显像SUVmax值差异无统计学意义(P>0.05)。结论 18F-FDG PET/CT可准确显示肾肿瘤患者局部病变及远处转移。对可疑肾淋巴瘤及肾转移瘤患者应行18F-FDG PET/CT显像,以明确分期并寻找原发灶。     

99Tcm-HL91与99Tcm-MIBI肿瘤阳性显像在肺部肿块诊断中的对比研究

目的比较99Tcm-HL91和99Tcm-MIBI肿瘤阳性显像对肺部单发肿块的诊断效能和影像质量.方法 50例肺部结节或肿块患者,分为恶性组和良性组,术前分别行99Tcm-HL91和99Tcm-MIBI早、晚期平面及断层融合显像,对显像结果进行对照分析.结果①定性诊断HL91组的敏感性为97.30%(36/37例),特异性为69.23%(9/13例);MIBI组诊断的敏感性为83.78%(31/37例),特异性为76.92%(10/13例). 肺门及纵膈肿大淋巴结使用HL91检测的阳性率为91.30%(21/23个); MIBI法为73.91%(17/23个).② HL91法断层显像ROC曲线下的面积(0.953±0.034)较MIBI法(0.857±0.073)高约10%,以T/N值1.76为界点HL91诊断的敏感性为100%(37/37例),特异性为84.62%(11/13例);以1.66为界点MIBI组诊断的敏感性为86.49%(32/37例),特异性为76.92%(10/13例),以1.85为界点MIBI组诊断的敏感性为78.38%(29/37例),特异性为84.62%(11/13例).结论 99Tcm-HL91肺部病变亲肿瘤阳性显像在图像质量和诊断性能上均优于99Tcm-MIBI显像.     

99Tcm-Tetrofosmin 胸部显像诊断肺部肿瘤的临床研究

目的评价 99Tcm-Tetrofosmin(TF)胸部显像在诊断肺部肿瘤及纵隔淋巴结转移中的临床应用价值.方法对33例肺部肿块患者(肺癌23例,肺部良性疾病10例)行胸部 99Tcm-TF显像和CT扫描,并对SPECT图像进行半定量分析,比较各组间结果.结果 99Tcm-TF胸部显像区分肺部原发性肿瘤良、恶性及其诊断纵隔淋巴结转移的灵敏度均高于CT(P<0.05).肺癌组的靶/非靶(T/N)值明显高于相应的肺部良性病变组T/N值(P<0.001);且肺癌组断层显像的T/N值明显高于平面显像(P<0.01).肺鳞癌组和肺腺癌组的T/N值均高于小细胞肺癌组(P<0.05);而2 h滞留分数(RI)肺腺癌组要高于肺鳞癌组(P<0.05).结论 99Tcm-TF能准确、有效地探测肺癌的原发灶和纵隔淋巴结转移灶,利用半定量方法能提高其准确性,还可能为肺癌的组织类型提供更多的信息,在肺癌的诊断和分期中具有重要的临床实用价值.     

原发性鼻腔非霍奇金淋巴瘤99mTc-MIBI显像的临床初探

目的:探讨99mTc-MIBI亲肿瘤显像在原发性鼻腔非霍奇金淋巴瘤定性诊断中的应用价值。方法:经病理活检确诊的8例鼻腔非霍奇金淋巴瘤的患者进行了头颈部99mTc-MIBI早期和延迟断层显像,通过视觉判断和半定量分析,与鼻息肉及正常对照组进行比较。结果:8例非霍奇金淋巴瘤患者99mTc-MIBI早期显像均为阳性,灵敏度100%。延迟显像阳性7例,灵敏度87.5%。早期及延迟显像对鼻腔非霍奇金淋巴瘤定性诊断的特异性为70%。淋巴瘤组肿瘤/齿龈、肿瘤/腮腺、肿瘤/头皮的摄取比值与鼻息肉组及正常对照组比较差异均有显著性(P<0.05)。结论:99mTc-MIBI显像在鼻腔非霍奇金淋巴瘤的定性诊断中有较好的应用前景。     

67Ga-Citrate和99Tcm-MIBI核素显像与CT诊断头颈部肿瘤的评价

目的探讨67Ga-Citrate(Cit) 和99Tcm-MIBI显像与CT诊断头颈部肿瘤的价值.方法 48例头颈部肿瘤患者术前接受67Ga-Cit和99Tcm-MIBI显像及CT检查.结果 23例良性肿块,67Ga-Cit、99Tcm-MIBI显像和CT检查阴性者分别为18、19、20例;25例恶性肿瘤,67Ga-Cit、99Tcm-MIBI显像和CT检查阳性者分别为24、13、12例;67Ga-Cit、99Tcm-MIBI显像和CT的灵敏度分别为96.0%、52.0%、48.0%,特异度78.3%、82.6%、87.0 %,准确度 87.3%、66.7%及66.7%.结论 67Ga-Cit诊断头颈部肿瘤较99Tcm-MIBI、CT有较高的灵敏度和准确度.     

^67Ga、^210TL与^99mTC—MiBi肺肿瘤阳性显像的诊断分析

目的：对比分析^67Ga、^201TL与^99TC-甲氧基异丁基异腈（MiBi)肺肿瘤显像的诊断价值。方法：对184例使用^67Ga201,25例使用^201TL与48例使用^99TC-MiBi进行肺肿瘤显像,患均经穿刺活组织检查,手术切除或其他方法获得病理结果,其中肺癌174例,肺良性病变83例,结果：^67Ga对肺癌显像的灵敏度为79.5%,特异性79.9%,准确率79.3%.^201TL的灵敏度为66.7%,特异性85%,准确率72%,^99mTC-MiBi的显像灵敏度、行异性和准确率均为75%。结论:^67Ga、^201TL以及^99mTC用于肺肿瘤阳性显像对肺肿瘤的诊断及鉴别其良恶性肿瘤具有一定的实用价值。     

99Tcm-MIBI与99TcmO4-联合显像对甲状旁腺功能亢进病变的定位诊断

目的：探讨甲状旁腺功能亢进症（HPT）患者行99Tcm-MIBI与99TcmO4-联合显像对HPT病变的定位诊断价值。方法：原发性HPT患者36例,对照组10例为甲状腺疾病患者。99Tcm-MIBI注射后15min行早期相甲状旁腺显像,2h后行延迟显像。相隔24h后加做99TcmO4-甲状腺显像,对两种图像进行对比分析、视觉相减及图像判断。结果：36例HPT患者99Tcm-MIBI/99TcmO4-联合显像在甲旁腺部位或其邻近部位出现局限性核素明显增浓的阳性结果34例,假阴性结果2例,阳性率为94.44%;36例甲旁亢患者单行99Tcm-MIBI显像检出阳性结果12例,假阴性结果4例,可疑阳性结果20例,阳性率88.89%（其中55.56%为可疑阳性）。10例对照组单行99Tcm-MIBI显像出现假阳性结果3例,可疑假阳性结果1例,加做99TcmO4-显像后,对照组无假阳性结果。结论：99Tcm-MIBI/99TcmO4-联合显像可提高HPT病变诊断的阳性率,减少假阳性结果的发生,对单行99Tcm-MIBI显像出现可疑阳性结果者,联合显像有利于结果的准确判断,对甲状旁腺腺瘤的诊断与定位诊断有重要价值。     

符合线路18F-FDG显像诊断头颈部肿物

目的探讨18F-氟代脱氧葡萄糖(18F-FDG)符合探测显像在头颈部肿物诊断中的临床应用价值.方法回顾性分析38例经病理及临床随访证实头颈部肿物患者的符合线路显像结果,观察各种病变对于18F-FDG的摄取情况,并计算其T/N值.结果 38例患者,恶性淋巴瘤13例, 10例阳性;颈部淋巴结转移癌8例,全部显像阳性;10例原发肿瘤中 1例未显影;7例良性病变患者中6例呈阳性,即真阳性27例,真阴性4例,假阳性6例,假阴性1例.敏感性96.4%(27/28),特异性40.0%(4/10),准确性81.6%(31/38).结论 18F-FDG 符合显像诊断头颈部肿瘤具有较高的敏感性和准确性,多床位显像有助于肿瘤的分期.紧密结合临床,认真分析病灶的显像特征,有利于提高诊断的特异性.     

99Tcm-N-NOET与99Tcm-MIBI心肌显像的对比研究

目的评价 99Tcm-N-NOET{双[N-乙氧基,N-乙基(二硫代氨基甲酸脂)氮化锝](Ⅴ)}静息心肌血流灌注显像诊断冠心病(CAD)的临床价值.方法可疑冠心病的74例男性、12例女性(平均年龄 55.6±11.5岁)行门控静息心肌血流灌注显像和冠脉造影(将冠脉管腔狭窄≥50%定为病变血管),其中行 99Tcm-N-NOET静息心肌显像44例(平均年龄55.9±11.6岁),行 99Tcm-MIBI静息心肌显像42例(平均年龄55.4±11.5岁).前者于注药后1h显像,后者于注药后1～1.5h显像.结果 99Tcm-N-NOET和 99Tcm-MIBI诊断冠心病的灵敏度分别为71.4%和64.7%(P＞0.05),特异性分别为 88.9%和87.3%(P＞0.05),两组间灵敏度和特异性均无显著性差异.结论 99Tcm-N-NOET与 99Tcm-MIBI静息心肌血流灌注显像对诊断冠心病具有一致性.     

Localization of neuroendocrine tumours with [111In] DTPA-octreotide scintigraphy (Octreoscan): a comparative study with CT and MR imaging

A wide variety of neuroendocrine tumours express somatostatin receptors, and can be visualized by radiolabelled somatostatin analogue scintigraphy. To investigate the value of [111In]-octreotide scintigraphy (Octreoscan), 48 patients (37 with proven carcinoid, pancreatic endocrine and medullary carcinoma of thyroid tumours, 11 with neuroendocrine syndromes multiple endocrine neoplasia (MEN-I) and Zollinger-Ellison syndrome (ZES) were examined with 111In-DTPA-D-Phe1- octreotide. Scintigrams were obtained at 24 and 48 h, and the results were compared with CT and magnetic resonance imaging (MRI). Thirty-five of 48 patients had positive [111In]-octreotide scintigraphy (23/25 (92%) carcinoids, 8/9 (89%) PETs, 4/11 (36%) MEN-I & ZES). Of the 42 lesions located by conventional imaging techniques, 37 (88%) were also identified by Octreoscan. Unexpected lesions (40 sites), not detected by CT or MR imaging were found in 24/48 (50%) patients. [111In]- octreotide scintigraphy has a higher sensitivity for tumour detection, and is superior to MR imaging and CT scanning in the identification of previously unsuspected extraliver and lymph node metastases. It may also be helpful for the localization of clinically suspected tumours in patients with MEN-I and ZES.      

Evaluation of unusual neuroendocrine tumours by means of Ga-DOTA-NOC PET

¹⁸F-FDG PET value for the assessment of neuroendocrine tumours (NET) is limited. Preliminary studies indicate that somatostatin receptor PET using ⁶⁸Ga-DOTA-peptides is more accurate for disease assessment and provide additional data on receptor status, that are crucial for targeted radionuclide therapy. At present, however, few papers investigated the role of ⁶⁸Ga-DOTA-NOC PET in NET, especially in unusual situations. The purpose of the present study was to evaluate ⁶⁸Ga-DOTA-NOC for the evaluation of NET of uncommon presentation. Patients with biopsy-proven NET were scheduled for ⁶⁸Ga-DOTA-NOC PET; we excluded from further evaluation cases with most common NET tumours (gastro-entero-pancreatic and pulmonary localization of primary lesion, MEN syndromes, medullary thyroid carcinoma, pheochromocytomas). PET results were compared with findings of conventional imaging, including CT, ultrasonography, MR and somatostatin receptor scintigraphy; finally PET results were compared with follow-up data with respect to the impact on patient management. Fourteen patients were finally enrolled; primary tumours were located at uterine level (3 cases), prostate (3 cases), ovary (1 case), kidney (1 case), breast (1 case), ear (1 case); also 3 cases of paraganglioma (at neck, abdominal and mediastinum level) and 1 case of lymphoma were included. ⁶⁸Ga-DOTA-NOC PET was positive, showing at least 1 lesion, in 6/14 cases while 5 cases turned out negative and 2 inconclusive. On a clinical basis, ⁶⁸Ga-DOTA-NOC provided additional information in comparison to conventional imaging procedures in 7/14 cases, and was considered useful in 12/14 patients, with 8 patients in which ⁶⁸Ga-DOTA-NOC PET was determinant for patient's management. Although the number of patients studied is limited, our data show that ⁶⁸Ga-DOTA-NOC can be usefully applied for the evaluation of NET of uncommon presentation; in particular very promising results were obtained in paraganglioma. On the other hand, care has to be paid when studying lesions localized at sites of physiological concentration of the tracer, and in presence of inflammation.     

Clinical manifestations of neuroendocrine tumors

A complex clinico-functional morphologic examination was carried out on 125 patients with neuroendocrine tumors (NET): carcinoids, pheochromocytoma and multiple endocrine adenomatosis (an integral part of which is pheochromocytoma, gastrinoma and medullar C-cell carcinoma of thyroid gland). There was a clinical examination using laboratory and instrumental methods in pre- and postoperative periods, morphological research of removed tumors. According to the obtained indications, selective angiography and static scintigraphy with 111Tc was carried out. Isotopes 111-In were used in 3 patients for scintigraphic research of somatostatinpositive NET. The following versions were selected: serotonin and sympathoadrenal clinical variants of monoaminoforming NET, clinical versions of multiple endocrine neoplasias, a clinical version of adenocarcinomas having in their composition cells with neuroendocrine differentiation accompanied by neuroendocrine paraneoplastic syndrome. There were offered a term and definitions of hyperproduction syndrome of regulatory peptides in case of NET.     

Localization of Parathyroid Adenomas by Sonography and Technetium Tc 99m Sestamibi Single‐Photon Emission Computed Tomography Before Minimally Invasive Parathyroidectomy

Objective. The purpose of this study was to determine the utility of radiologist‐performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. Methods. Both sonography and technetium Tc 99m sestamibi single‐photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E.T.), and results were immediately reported. Findings of a subsequent Tc 99m sestamibi study were recorded blinded to the sonographic results. The sensitivity and specificity of sonography and Tc 99m sestamibi SPECT were assessed with the use of surgery and pathology reports as a reference standard. The 2007 global Medicare reimbursement rates were used to assess the costs of preoperative localization. Results. Parathyroidectomy was performed in 144 of 172 patients evaluated by both modalities. The sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74%, 96%, and 90%, respectively. Sonography correctly localized a single adenoma or suggested multiglandular disease in 112 of 144 patients (78%). The sensitivity, specificity, and positive predictive value of SPECT were 58%, 96%, and 89%. Technetium 99m sestamibi SPECT correctly predicted an adenoma or multiglandular disease in 88 of 144 patients (61%). Five patients with negative sonographic findings were shown to have uniglandular disease on Tc 99m sestamibi SPECT. Selective use of Tc 99m sestamibi SPECT (ie, when sonographic findings were negative or equivocal) would have decreased the cost of imaging by 53%. Conclusions. Radiologist‐performed sonography may potentially be used as a principal imaging modality for patients with HPTH. Selective use of Tc 99m sestamibi in cases with negative or equivocal sonographic findings can decrease the cost of imaging before parathyroid resection considerably.     

Mack Forster Award Lecture Receptor nuclear medicine: vasointestinal peptide and somatostatin receptor scintigraphy for diagnosis and treatment of tumour patients

The multiple aspects of radioligand–receptor interactions do not only show a major impact of certain cell surface-bound receptors in the pathophysiology of human disease: the concept of radioligand–receptor interactions has also been extended to the clinic. In particular, naturally occurring peptides, when radiolabelled, are clinically useful for the imaging diagnosis of human disease and have future implications for the treatment of tumour expressing certain target receptors using radiolabelled peptide tracers. The finding that receptors for VIP (vasoactive intestinal peptide) and SST (somatostatin) are overexpressed on tumour cells presents a breakthrough into this direction. Recent data indicate that [¹²³I]-VIP receptor scintigraphy is clinically useful for the in vivo localization of small primary adenocarcinomas, liver metastases and certain endocrine tumours of the gastrointestinal tract. After the successful clinical introduction of the SST analogues [¹²³I]-Tyr³-octreotide and [¹¹¹In]-DTPA- d -Phe¹-octreotide for localization diagnosis of neuroendocrine tumours in 1989, P829, labelled with the more cost-effective radionuclide ^99mTc, nowadays promises to be a potential novel diagnostic imaging agent for tumours expressing SST/VIP receptors. Furthermore, the novel SST analogue [⁹⁰Y]-MAURITIUS is entering the clinic for treatment of VIP/SST receptor-expressing tumours.     

~(99m)Tc-C50卵巢肿瘤放射免疫显像的应用研究

目的：采用９９ｍＴｃ－Ｃ５０进行放射免疫显像，以探讨诊断和鉴别诊断卵巢肿瘤的临床应用价值。资料与方法：６２例临床诊断为卵巢肿瘤的病人接受了检查，全部病例均经手术治疗，获得病理结果，分为恶性肿瘤１２例，良性肿瘤５０例。结果：９９ｍＴｃ－Ｃ５０ＲＩ检测卵巢恶性肿瘤的敏感性１００％，特异性８２％，准确性８５５％，假阳性率１８％，转移灶检出率８８６％。结论：该方法对卵巢肿瘤的定性诊断有一定临床意义，对转移灶的检出价值较大。     

Time to give up traditional methods for the management of gastrointestinal neuroendocrine tumours

Neuroendocrine tumors (NETs) are a rare and heterogeneous disease group and constitute 0.5% of all malignancies. The annual incidence of NETs is increasing worldwide. The reason for the increase in the incidence of NETs is the detection of benign lesions, incidental detection due to the highest use of endoscopic and imaging procedures, and higher recognition rates of pathologists. There have been exciting developments regarding NET biology in recent years. Among these, first of all, somatostatin receptors and downstream pathways in neuroendocrine cells have been found to be important regulatory mechanisms for protein synthesis, hormone secretion, and proliferation. Subsequently, activation of the mammalian target of rapamycin pathway was found to be an important mechanism in angiogenesis and tumor survival and cell metabolism. Finally, the importance of proangiogenic factors (platelet-derived growth factor, vascular endothelial growth factor, fibroblastic growth factor, angiopoietin, and semaphorins) in the progression of NET has been determined. Using the combination of biomarkers and imaging methods allows early evaluation of the appropriateness of treatment and response to treatment.     

18F-FDG SPECT/CT与99Tcm-MDP骨显像对肺癌骨转移诊断价值的对比研究

目的　比较18F FDGSPECT/CT显像与99Tcm MDP骨显像在肺癌骨转移诊断中的临床价值。方法　 19例经病理证实的肺癌患者同期进行18F FDGSPECT/CT显像和常规99Tcm MDP骨显像。结果　 19例患者 8例有骨转移 ,共发现 47个转移灶。18F FDGSPECT/CT发现 8例骨转移 ,99Tcm MDP骨显像发现 7例骨转移 (P >0 .0 5 ) ;18F FDGSPECT/CT发现 45个转移灶 ,99Tcm MDP骨显像发现 2 6个转移灶 (P <0 .0 1)。18F FDGSPECT/CT探测骨转移的灵敏度 95 .74% ,特异度 89.47% ,准确度93 .94% ;99Tcm MDP探测骨转移灵敏度 5 5 .3 2 % (P <0 .0 1) ,特异度为 94.74% (P >0 .0 5 ) ,准确度 66.67% (P <0 .0 1)。结论　在探测肺癌骨转移方面 ,18F FDGSPECT/CT显像较常规99Tcm MDP骨显像具有更高的灵敏度和准确度。对99Tcm MDP骨显像阴性、单一病灶及可疑脊椎转移患者 ,应进一步行18F FDGSPECT/CT显像 ,可起到信息互补、明确诊断的作用。     

Safety review: Dose optimization of somatostatin analogs in patients with acromegaly and neuroendocrine tumors

Introduction  

Patients with either acromegaly or neuroendocrine tumors (NET) can be treated with somatostatin analogs to relieve symptoms and improve disease control. However, there is an absence of large clinical trials specifically designed to document the safety when increases in somatostatin analog dosing are needed in patients who do not achieve their treatment goals. To fully explore and communicate any potential risks, we conducted a literature review and present a summary of the studies documenting the safety and tolerability of dose optimization with somatostatin analogs in patients with acromegaly and NET.