Technetium-99m-methylene diphosphonate single photon emission computed tomography/computed tomography combined with prostate-specific antigen/free prostate-specific antigen ratio for bone metastasis of prostate cancer

BACKGROUND Prostate cancer(PC)is one of the most common malignant tumors in men,and bone metastasis is one of its common complications,which seriously affects the quality of life and prognosis of patients.AIM To investigate the diagnostic value of technetium-99m-methylene diphosphonate(99mTc-MDP)single photon emission computed tomography(SPECT)/CT imaging combined with the serum prostate-specific antigen(PSA)/free PSA ratio for PC bone metastasis(PCBM).METHODS One hundred patients with PC who visited the Hospital of Chengdu University of Traditional Chinese Medicine from January 2020 to January 2022 were recruited as the experimental(Exp)group,while 30 patients with benign prostatic lesions(BPLs)were recruited as the control(Ctrl)group.All patients underwent 99mTc-MDP SPECT/CT imaging and serum PSA/fPSA testing.The SPECT/CT imaging results and serum PSA/fPSA ratios of patients were analyzed to evaluate their diagnostic values for PCBM.RESULTS The difference in general information of the patients was not obvious,showing comparability.The two methods showed no visible differences in negative predictive value and sensitivity for patients with PCBM,but had great differences in positive predictive value and specificity(P<0.05).The PSA/fPSA ratio of patients with PC in the Exp group was lower than those with BPLs,and patients with PCBM had a much lower PSA/fPSA ratio than those without PC(P<0.05).The results confirmed that the combined use of 99mTc-MDP SPECT/CT imaging and serum PSA/fPSA ratio achieved a detection rate of 95%for PCBM.CONCLUSION The combination of 99mTc-MDP SPECT/CT and PSA/fPSA ratio is accurate and reliable for the diagnosis of PCBM,which provides an important reference for clinical practice.

Pancreatic neuroendocrine tumor detected by technetium-99m methoxy-2-isobutylisonitrile single photon emission computed tomography/computed tomography:A case report

BACKGROUND Pancreatic neuroendocrine tumors(NETs)account for about 1%–2%of pancreatic tumors and about 8%of all NETs.Computed tomography(CT),magnetic resonance imaging,and endoscopic ultrasound are common imaging modalities for the diagnosis of pancreatic NETs.Furthermore,somatostatin receptor imaging is of great value for diagnosing pancreatic NETs.Herein,we report the efficacy of technetium-99m methoxy-2-isobutylisonitrile(99mTc-MIBI)single photon emission CT(SPECT)/CT for detecting pancreatic NETs.CASE SUMMARY A 57-year-old woman presented to our hospital with a 1-d history of persistent upper abdominal distending pain.The distending pain in the upper abdomen was aggravated after eating,with nausea and retching.Routine blood test results showed a high neutrophil percentage,low leukomonocyte and monocyte percentages,and low leukomonocyte and eosinophil counts.Amylase,liver and kidney function,and tumor markers alpha-fetoprotein,carcinoembryonic antigen,and cancer antigen(CA)125,CA72-4,CA19-9,and CA153 were normal.Abdominal CT showed a mass,with multiple calcifications between the pancreas and the spleen.The boundary between the mass and the pancreas and spleen was poorly defined.Contrast-enhanced CT revealed that the upper abdominal mass was unevenly and gradually enhanced.99mTc-MIBI SPECT/CT revealed that a focal radioactive concentration,with mild radioactive concentration extending into the upper abdominal mass,was present at the pancreatic body and tail.The 99mTc-MIBI SPECT/CT manifestations were consistent with the final pathological diagnosis of pancreatic NET.CONCLUSION 99mTc-MIBI SPECT/CT appears to be a valuable tool for detecting pancreatic NETs.

Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography

AIM: To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT) hybrid imaging for diagnosis of various endocrine disorders.METHODS: We performed MEDLINE and Pub Med searches using the terms: "SPECT/CT"; "functional anatomic mapping"; "transmission emission tomography"; "parathyroid adenoma"; "thyroid cancer"; "neuroendocrine tumor"; "adrenal"; "pheochromocytoma"; "paraganglioma"; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts(case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for ^(99m)Tc-sestamibi parathyroid scintigraphy and ^(99m)Tc-pertechnetate thyroid scintigraphy, ^(123)I- or ^(131)I-radioiodine for staging of differentiated thyroid carcinoma, ^(111)In- and ^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors, ^(131)I-norcholesterol(NP-59) scans for assessment of adrenal cortical hyperfunction, and ^(123)I- or ^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.

Quantification of Tc-99m-ethyl cysteinate dimer brain single photon emission computed tomography images using statistical probabilistic brain atlas in depressive end-stage renal disease patients:Correlation with disease severity and symptom factors

This study adapted a statistical probabilistic anatomical map of the brain for single photon emission computed tomography images of depressive end-stage renal disease patients. This research aimed to investigate the relationship between symptom clusters, disease severity, and cerebral blood flow. Twenty-seven patients （16 males, 11 females） with stages 4 and 5 end-stage renal disease were enrolled, along with 25 healthy controls. All patients underwent depressive mood assessment and brain single photon emission computed tomography. The statistical probabilistic anatomical map images were used to calculate the brain single photon emission computed tomography counts. Asymmetric index was acquired and Pearson correlation analysis was performed to analyze the correlation between symptom factors, severity, and regional cerebral blood flow. The depression factors of the Hamilton Depression Rating Scale showed a negative correlation with cerebral blood flow in the left amygdale. The insomnia factor showed negative correlations with cerebral blood flow in the left amygdala, right superior frontal gyrus, right middle frontal gyrus, and left middle frontal gyrus. The anxiety factor showed a positive correlation with cerebral glucose metabolism in the cerebellar vermis and a negative correlation with cerebral glucose metabolism in the left globus pailidus, right inferior frontal gyrus, both temporal poles, and left parahippocampus. The overall depression severity （total scores of Hamilton Depression Rating Scale） was negatively correlated with the statistical probabilistic anatomical map results in the left amygdala and right inferior frontal gyrus. In conclusion, our results demonstrated that the disease severity and extent of cerebral blood flow quantified by a probabilistic brain atlas was related to various brain areas in terms of the overall severity and symptom factors in end-stage renal disease patients.

Three-dimensional stereotactic surface projection in the statistical analysis of single photon emission computed tomography data for distinguishing between Alzheimer's disease and depression

AIM To evaluate usefulness of single photon emission computed tomography(SPECT) with three-dimensional stereotactic surface projection(3D-SSP) in distinguishing between Alzheimer's disease(AD) and depression.METHODS We studied 43 patients who presented with both depressive symptoms and memory disturbance. Each subject was evaluated using the following:(1) the Minimal Mental State Examination;(2) the Hamilton Rating Scale for Depression;(3) Clinical Global Impression-Severity scale(CGI-S); and(4) SPECT imaging with 3D-SSP.RESULTS The MMSE scores correlated significantly with the maximum Z-scores of AD-associated regions. CGI-S scores correlated significantly with the maximum Z-scores of depression-associated regions. Factor analysis identified three significant factors. Of these, Factor 1 could be interpreted as favouring a tendency for AD, Factor 2 as favouring a tendency for pseudo-dementia, and Factor 3 as favouring a depressive tendency.CONCLUSION We investigated whether these patients could be categorized as types: Type A(true AD), Type B(pseudodementia), Type C(occult AD), and Type D(true depression). The factor scores in factor analysis supported the validity of this classification. Our results suggest that SPECT with 3D-SSP is highly useful for distinguishing between depression and depressed mood in the early stage of AD.

Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has made it more challenging for patients to undergo yttrium-90(Y-90)radioembolization(RE).Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19,thus improving patient access.AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography(SPECT/CT)in order to optimize therapy.METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board,and were screened and tested for COVID-19 infection per institutional protocol.A same day procedure was developed,consisting of angiography,imaging,and Y-90 resin particle delivery.Routine SPECT/CT after technetium-99m macroaggregated albumin(Tc-99m MAA)administration was performed for assessment of arterial supply,personalized dosimetry,and extrahepatic activity.Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery,by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020.Mean lung shunt fraction was 6.13%(range 3.5%-13.1%).Y-90 RE was performed for a single lesion in 7 patients,while the remaining 7 patients had treatment of multifocal lesions.The largest lesion measured 8.3 cm.All patients tolerated the procedure well and were discharged the same day.CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible,and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond.We recommend consideration of SPECT/CT,especially among patients with complex malignancies,for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.

Cerebral functional imaging of Waiguan (SJ 5) acupoint specificity using single-photon emission computed tomography

The action of needling in acupoint therapy has to first be regulated and integrated by the brain, and then it affects the target organ and manifests its therapeutic effects, which is dependent on the specificity of the acupoints. The authors put forward the hypothesis of the ＂acupoint-related brain＂. Single-photon emission computed tomography was used to explore the activation of brain regions following true needling in true acupoint Waiguan （SJ 5）, sham needling in true acupoint Waiguan, true needling in a sham point, and sham needling in a sham point. The relative specificity of Waiguan in normal persons was analyzed by observing changes in regional cerebral blood flow. Compared with the sham needling in true acupoint group and sham needling in the sham point group, acupuncture at Waiguan can activate brain regions controlling movement. Compared with true needling in the sham point group, acupuncture at Waiguan can also activate brain regions controlling movement. The results suggest that the specificity of needling at an acupoint is related to certain activated cerebral functional regions, which are associated with the clinical application of the acupoint.

Deep brain stimulation of the subthalamic nucleus treats Parkinson's disease through enhancing metabolic activity of the corpus striatum Verification by single photon emission computed tomography and positron emission tomography

BACKGROUND： Subthalamic nucleus deep brain stimulation （STN DBS） for Parkinson＇s disease （PD） has achieved good effects, but to date the mechanism of STN DBS remains poorly understood STN DBS may increase dopamine levels or metabolic activity of the corpus striatum. OBJECTIVE： To validate the effects of STN DBS on dopamine metabolism and glucose metabolism in the corpus striatum of hemiparkinsonian monkeys using single photon emission computed tomography （SPECT） and position emission tomography （PET）. DESIGN, TIME AND SET＇rING： A controlled animal study was performed at the Neurosurgery Laboratory, Changhai Hospital of the Second Military Medical University of Chinese PLA between January 2004 and December 2007. METHODS： Hemiparkinsonism was induced in adult Rhesus Macaque monkeys, which exhibit similar characteristics of PD in humans, through unilateral internal carotid artery infusion of 1-methy-4-phenyl-1, 2, 3, 6-tetrahydropyrindine. Following model establishment, stimulation electrodes were implanted in the right STN, and chronic high-frequency stimulation （60 μs pulse width, 130 Hz frequency, and 1.5-2.0 V pressure） was performed. MAIN OUTCOME MEASURES： The changes in dopamine transporter （DAT）, D2 receptor （D2R）, and glucose metabolism in the corpus striatum following STN DBS were observed using SPECT and PET. RESULTS： SPECT examination showed that DAT specific binding in the right corpus striatum was increased at 3 months after DBS compared with prior to stimulation, and D2R specific binding in the right corpus striatum gradually decreased near levels on the left （non-electrode-implanted） side within 3 months after DBS. PET examination showed that the glucose metabolism in the right corpus striatum was markedly increased at 3 months after effective DBS. Hemiparkinsonism monkeys showed improved left limb rigidity, increased activities, and stable gait under chronic high-frequency stimulation. CONCLUSION： STN DBS increased striatal DAT, decreased D2R, and enhanced glucose metabolism, suggesting that chronic, high-frequency STN stimulation enhanced the metabolic activity of the corpus striatum, a mechanism for improving the PD symptoms of hemiparkinsonian monkeys.

Dopamine transporter distribution in patients with Parkinson disease of different stages detected using single-photon emission computed tomography brain imaging

BACKGROUND： Literatures have reported that the density changes of dopamine transporter is negatively correlated with the severity degree and grading of disease condition of Parkinson disease （PD）. However, the distribution ofdopamine transporter in each nucleus of corpora striatum at each period is still unclear. OBJECTIVE： To observe the radioactive uptake distribution of dopamine transporter in bilateral corpora striata of patients with different stages of PD using single photon emission computed tomography （SPECT）, and make a comparison with healthy controls. DESIGN： Case-control analysis. SETTING： Department of Imageology, Second Hospital Affiliated to Guangzhou University of Chinese Medicine. PARTICIPANTS： Thirty patients with PD admitted to Second Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine between January and December 2005 were recruited. The involved patients, 19 male and 11 female, were aged from 36 to 80 years and with disease course of 2.5 months to 10 years. They all met the clinical diagnosis criteria of Britain Parkinson＇s disease Association Think Tank; Following Hoehn-Yahr grading： grade Ⅰ ： unilateral morbidity; grade Ⅱ： bilateral morbidity, but without balance disorder; grade Ⅲ： bilateral morbidity, accompanied with early posture balance disorder; grade Ⅳ： severe morbidity, needs more help; grade V ： without help, only in bed or wheelchair. There were 11 patients with mild PD （grade Ⅰ - Ⅱ ）, 9 patients with moderate PD （grade Ⅲ） and 10 patients with advanced PD （grade Ⅳ - Ⅴ ）. Meanwhile, 6 healthy persons were selected as normal controls. Informed consents were obtained from all the subjects. METHODS： Twenty-four hours after withdrawal of PD drugs, 30 patients with PD and 6 healthy controls took kalium perchloricum 400 mg orally. After lying down for 30 minutes, all the subjects were intravenously injected with 740 MBq 99Tc m-TRODAT-1 （Jiangsu Institute of Atomic Medicine, Batch No. 20040310） at elbow part. Following injection, image was collected using scanner for single photon emission computed tomography （ADAC Company, USA）. Matrix was 64 × 64, each detecting head revolved 180 ° , 1 frame/60 s. Sixty-four frames were collected with double detecting heads, 50 K/frame. Faultages with clearest image of corpora striatum were selected. Regions of interest （ROI） of caudate nucleus, anterior and posterior putamen and thalamic region in bilateral corpora striata were radioactively counted, and mean value of radioactive counting of ROI was used as the mean value ofpixel in each region of bilateral corpora striata. MAIN OUTCOME MEASURES： Comparison of radioactive uptake in each region of brain between healthy persons and patients with PD. RESULTS： Thirty patients with PD and six healthy persons who received body examination participated in the final result. Comparison of radioactive uptake in each region between healthy persons and patients with PD： ①In the healthy persons, high-density radioactive uptake was found in bilateral corpora striata; Structures of caudate nucleus, anterior and posterior putamen, and thalamus were clear with eudipleural radioactive distribution, and the background of peripheral brain tissue was very low. ②Radioactive intakes in opposite anterior and posterior putamen of patients with mild PD were significantly inferior to those in homolateral ones（70.45±3.35, 87.64±2.65, t =15.82, P 〈 0.05）. Structures of bilateral caudate nucleus and thalamus were clear with eudipleural radioactive distribution （P 〉 0.05）. ③Radioactive intakes in anterior and posterior putamen and thalamus of patients with moderate PD were significantly reduced as compared with healthy persons. There were significant differences in mean radioactive counting of ROI between patients with PD and healthy persons （t =5.20, P 〈 0.05： t =3.95, P 〈 0.05）; The structure of opposite caudate nucleus was not very clear, radioactive distribution of opposite caudate nucleus was significantly reduced as compared with homolateral one （81.11±4.25, 104.56±3.64, t = 14.65, P 〈 0.05）. ④As for patients with advanced PD, the structure of bilateral corpora striata was not clear, radioactive intake was significantly reduced and peripheral background was heightened, even higher than the distribution of the whole corpora striatum. CONCLUSION： SPECT DAT imaging of brain can show the distribution of radioactive uptake in each region of bilateral corpora striata of patients with different stages of PD, which is helpful to diagnose and evaluate the severity of PD.

Rest Thallium-201/Stress Technetium-99m Sestamibi Dual-Isotope Myocardial Perfusion Single-Photon Emission Computed Tomography in Detecting of Chronic Coronary Artery Disease

To investigate diagnostic accuracy of 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in chronic coronary artery disease. Sixty-seven patients with suspected CAD were enrolled in the prospective study. All patients underwent myocardial perfusion scintigraphy in SPECT with dual isotopes of T1-201 and dipyridamole stress Tc-99m sestamibi. Rest and stress imaging protocol were performed in 2 hours by dose of 3 mCi TI-201 and 25 mCi Tc-99m sestamibi. The acquisition parameters includes LEHR collimator, energy peak of 72 and 167 keV for T1-201 and 140 keV for Tc-99m, 180-degree rotation from RAO to LPO, matrix size 64x64, and 25second/frame/64 frames. The 20-segment model of left ventricle was used in automatic quantitation software. Coronary angiography was used as gold standard. CAD was defined as 50% of lumen stenosis on coronary angiography. Rest TI-201/stress tc-99m sestamibi dual-isotope SPECT demonstrated a sensitivity of 94.59% and specificity of 70%, positive predictive value of 79.54% and negative predictive value of 91.3% in detection of coronary artery disease. Sensitivity and specificity for detecting multi-vessel coronary artery disease were 82.75% and 81.57% for the left anterior descending, 77.77% and 91.83% for left circumflex and 94.11% and 82% for right coronary artery. 2-hour protocol of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT has high sensitivity, specificity, positive predictive value and negative predictive value in detecting chronic coronary artery disease with greater than 50% stenosis assessed by coronary angiography Moreover, this imaging protocol gives high imaging quality, time-saving and convenience.

应用瑞加诺生负荷D-SPECT评价定量血流分数在经皮冠状动脉介入治疗中的作用

目的应用瑞加诺生负荷动态单光子发射计算机断层扫描(dynamic single-photon emission computed tomography,D-SPECT)评价定量血流分数(quantitative flow ratio,QFR)在经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的作用。方法选择2021年6月31日至2023年6月31日在河北医科大学第一医院心内科住院行择期PCI术的200例不稳定型心绞痛患者,年龄(57.56±8.23)岁,按照随机数字表法分为常规组(n=100)和QFR组(n=100),试验采用双盲法进行。常规组根据医师经验行PCI术治疗,QFR组根据QFR测定结果行PCI治疗。所有入选患者术前及PCI术后7 d,应用瑞加诺生负荷D-SPECT,分别采集短轴、垂直长轴、水平长轴的图像,计算心肌17节段分布下心肌灌注总积分、心肌缺血总节段数情况。结果PCI术前两组患者心肌缺血节段数(7.59±3.14 vs.7.48±3.36,P=0.811)、心肌灌注总积分(15.87±7.61 vs.15.63±5.97,P=0.860)差异无统计学意义,QFR组PCI术后7 d的心肌缺血节段数(5.58±3.36 vs.6.51±2.14,P=0.020)和心肌灌注总积分(10.55±4.41 vs.12.96±6.50,P=0.002)显著优于常规组(P<0.05)。结论应用QFR指导PCI可以更好改善患者心肌缺血程度。

疑诊原发性甲状旁腺功能亢进症的患者术前^(99m)Tc-MIBI SPECT/CT显像结果的影响因素分析

目的探讨疑诊原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的患者术前^(99m)Tc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)单光子发射计算机断层扫描/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)(以下简称MIBI SPECT/CT)显像结果的影响因素。方法将2019年1月至2023年8月于首都医科大学附属北京朝阳医院疑诊PHPT并在术前完善甲状旁腺MIBI SPECT/CT显像的257例患者作为研究对象。比较MIBI SPECT/CT显像阳性组和阴性组的实验室检查、病理特征及影像特征。采用多因素Logistic回归分析MIBI SPECT/CT显像结果的影响因素。结果单因素分析显示,与阴性组相比,血清总钙、血清甲状旁腺激素(parathyroid hormone,PTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平在阳性组显著升高(P<0.05);病灶的病理类型、最大径、体积及位置在两组间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术前血清PTH水平、病灶病理类型、位置及最大径与MIBI SPECT/CT显像结果阳性显著相关(P<0.05)。结论疑诊PHPT患者术前MIBI SPECT/CT显像结果受多重因素影响,术前血清PTH水平、病灶病理类型、位置及最大径是MIBI SPECT/CT显像结果的独立影响因素。

SAPHO综合征累及骨及关节^(99)Tc^(m)-MDP SPECT/CT显像表现

目的观察^(99)Tc^(m)-MDP SPECT/CT显像所示滑膜炎、痤疮、脓疱病、骨肥厚及骨炎(SAPHO)综合征累及骨与关节表现。方法回顾性分析69例SAPHO综合征患者^(99)Tc^(m)-MDP SPECT/CT资料,以聚类分析法评估SAPHO综合征累及骨、关节模式。结果根据聚类分析,SAPHO所致骨与关节病变可分为肋骨型(n=19)、脊柱型(n=32)和胸锁关节型(n=18)。共于19例肋骨型检出145处病灶,包括60处肋骨病灶及95处其他病灶,半数以上呈低、中度摄取;半数呈溶骨性骨质破坏、边缘呈低度摄取;少数肋骨密度无明显改变。脊柱型多累及中轴骨(27/32,84.38%);椎体病变多累及一侧肋椎关节、呈连续性分布及低、中度摄取。胸锁关节型均累及胸锁关节,半数以上病灶位于胸锁关节并呈高度摄取,以“牛头征”和“半牛头征”为典型表现,多见骨质增生硬化、骨皮质肥厚。结论SAPHO综合征累及骨关节可分为肋骨型、脊柱型及胸锁关节型。全身骨显像缺乏“牛头征”或“半牛头征”等典型表现时,结合临床表现及SPECT/CT融合显像有助于诊断。

R-I subtype single right coronary artery with congenital absence of left coronary system: A case report

BACKGROUND Isolated single coronary artery is a rare congenital anomaly.R-I subtype single coronary artery is even rarer.In this subtype,a very large right coronary artery extends in the coronary sulcus to the anterior base of the heart where it produces the left anterior descending coronary artery.Currently,only a few case reports are available in the literature for this anomaly.CASE SUMMARY Here,we report the case of a 62-year-old woman who presented to the cardiology clinic with decreased exercise tolerance and poor blood pressure control.The patient underwent coronary angiography(CAG)and emission computed tomography(ECT).CAG images revealed a single gigantic right coronary artery(R-I type)arising from the right coronary sinus with branches supplying the left coronary territory.The ECT results confirmed myocardial ischemia at the location of the absent left coronary artery.The ECT findings confirmed that ischemia was consistent with the vascular loss location in CAG images.In such anomalies,there is a compensatory widening of the coronary artery lumen.Medical treatment was administered,and the patient was discharged.CONCLUSION Isolated single coronary arteries are associated with ischemia and potentially fatal acute coronary events.Hence,controlling risk factors is critical.

螺旋采集改善SPECT定量准确性及图像质量:体模研究

目的观察螺旋采集用于改善SPECT定量准确性及图像质量的价值。方法针对1个包含6个球体(直径分别为37、28、22、17、13和10 mm)的体模模型,分别向球体及体模腔内灌注640 kBq/ml及20 kBq/ml^(99)Tc^(m)O_(4)^(-)溶液,并以5、10及15秒/帧行螺旋采集与常规步进采集;比较2种采集方式所获图像质量主观评分及客观参数,包括本底变异系数(CV)、对比度噪声比(CNR)、平均放射性计数(C_(sphere))和测量定量误差百分比(Error%)的差异。结果各采集时间下,螺旋采集图像质量评分均高于常规步进采集,以5秒/帧时二者差值最大;螺旋采集的CV、CNR、C_(sphere)均优于常规步进采集(P均<0.05)。排除直径10、13 mm球体后,5、10秒/帧下,螺旋采集Error%均优于常规步进采集(P均<0.05),而15秒/帧下二者差异无统计学意义(P均>0.05)。结论相同采集时间、尤其较短采集时间下,以螺旋采集所获SPECT的定量准确性及图像质量优于常规步进采集。

优化钇-90轫致辐射SPECT显像能窗:体外实验研究

目的观察中能通用(MEGP)准直器不同能窗对钇90(^(90)Y)轫致辐射SPECT图像质量的影响,遴选最佳显像能窗。方法获取^(90)Y轫致辐射能谱,比较MEGP准直器不同能窗下图像灵敏度、源感兴趣区计数/视野内总计数百分比(S/FOV%)及信号/背景比(S/B)。结果所获^(90)Y轫致辐射能谱呈连续曲线,MEGP准直器下能峰为76.2 keV。MEGP准直器显像清晰。以10%、20%窗宽显示图像的S/FOV%与S/B差异均无统计学意义(P均>0.05),而后者灵敏度更高(P<0.05)。70~90 keV图像灵敏度较高而S/FOV%及S/B有所下降;40~60 keV图像S/FOV%、S/B均较高而灵敏度较低;100 keV±20%能窗图像灵敏度、S/FOV%及S/B均较高,分别为69.73%、0.62和1.64。结论以MEGP准直器行^(90)Y轫致辐射显像时,20%窗宽图像质量优于10%窗宽;100 keV±20%图像灵敏度较高且S/FOV%及S/B无明显降低。

1例Parkin基因突变早发型帕金森病^(123)I-MIBG SPECT/CT表现

患者女,39岁,右下肢运动障碍10年,手抖3年、逐渐加重伴日常活动部分受限1年,外院疑诊“帕金森综合征”;既往健康,否认家族病史。查体:双上肢及右下肢静止性震颤,四肢肌力5级,无明显运动迟缓、小碎步及手足徐动或舞蹈样动作等姿态异常。实验室检查未见明显异常。头颈及胸部^(123)I-间碘苄胍(3-iodobenzylguanidine,MIBG)SPECT/CT显像:嘱患者服用复方碘溶液1 h后经静脉注射^(123)I-MIBG,注射后15 min(图1A)及4 h(图1B)见心脏显影清晰,心脏/纵隔计数分别为1.8和2.1;断层显像中,左心室各壁均见显像剂摄取(图1C)。影像学诊断:心脏交感神经功能未见减低。全外显子组测序:于PRKN(Parkin)基因中检出与本例表型相关的2个致病变异(chr6:162683558-162683797缺失及chr6:162206825突变)。临床诊断:Parkin基因突变早发型帕金森病(early-onset Parkinson disease,EOPD)。本例报道通过医院伦理委员会批准(2020-P2-164-02)。

Positron emission computed tomography/single photon emission computed tomography in Parkinson disease

Parkinson disease(PD)is the second-most common neurodegenerative disorder.Its main pathological mechanism is the selective degeneration and deletion of dopaminergic neurons in the dense part of the substantia nigra and the damage of dopaminergic neurons caused by the abnormal deposition of a Lewy body,leading to a decreased dopamine level.Positron emission computed tomography(PET)/single photon emission computed tomography(SPECT)is a molecular imaging technology that can directly or indirectly reflect changes in molecular levels by using a specific tracer.With the research and development on the tracers of related enzymes for labeling dopamine transporter and dopamine receptor and for being involved in dopamine formation,this imaging technology has been applied to all aspects of PD research.It not only contributes to clinical work but also provides an important theoretical basis for exploring the pathological mechanism of PD at a molecular level.Therefore,this review discusses the application value of PET/SPECT in PD in terms of early diagnosis,disease severity evaluation,clinical manifestations,differential diagnosis,and pathological mechanism.

^(99)mTc-c(RGD)_(2) SPECT/CT与^(18)F-FDG PET/CT 显像对肝泡型包虫病浸润带新生血管表达的相关性

目的探讨^(99)mTc肼基烟酰胺聚乙二醇双环RGD肽[^(99)mTc-c(RGD)2]SPECT/CT与^(18)氟-氟代脱氧葡萄糖(^(18)F-FDG)PET/CT显像对肝泡型包虫病(HAE)增殖浸润带新生血管表达的相关性。方法采用前瞻性研究方法,收集2023年1月~2024年1月在新疆医科大学第一附属医院收治的34例HAE患者资料,所有患者均行全身18F-FDGPET/CT、腹部^(99)mTc-c(RGD)2 SPECT/CT显像及手术治疗,对34例患者的41个HAE病灶组织行常规HE染色及CD34免疫组织化学染色,检测边缘带微血管密度(MVD)计数。分析HAE浸润带18F-FDGPET/CT显像的最大标准摄取值(SUVmax)及摄取比值(TBR)、^(99)mTc-c(RGD)2 SPECT/CT显像靶非靶比值(T/NT)分别与MVD计数的相关性;比较HAE浸润带^(99)mTc-c(RGD)2 SPECT/CT显像阳性(T/NT>1)及阴性(T/NT<1)两组间MVD计数的差异。结果41个HAE病灶浸润带^(99)mTc-c(RGD)2 SPECT/CT显像T/NT值与MVD计数两组间呈高度正相关性(r=0.823,P<0.01);^(18)F-FDGPET/CT显像SUVmax值、TBR与MVD计数均无相关性(P>0.05)。HAE浸润带^(99)mTc-c(RGD)2 SPECT/CT显像阳性组17个与阴性组24个病灶MVD计数分别为89.00±9.87、43.08±18.36个/高倍视野,组间差异有统计学意义(P<0.05)。结论HAE^(99)mTc-c(RGD)2 SPECT/CT显像RGD的摄取程度与HAE浸润带新生血管表达呈高度正相关,^(99)mTc-c(RGD)2 SPECT/CT显像可间接反应HAE的侵袭性,可作为评价病灶侵袭性经济、无创的检查手段之一,并且可与18F-FDGPET/CT联合从HAE浸润带的新生血管表达及炎性活性两方面共同评价其生物学活性。

^(99)Tc^(m)-PYP SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变与肥厚型心肌病

目的探讨^(99)Tc^(m)-焦膦酸盐(PYP)SPECT显像鉴别诊断转甲状腺素蛋白型心脏淀粉样变(ATTR-CA)与肥厚型心肌病(HCM)的效能。方法回顾性分析2020年6月至2023年3月于中南大学湘雅二医院经心外活组织检查和心脏超声明确诊断为ATTR-CA[35例(男28例,女7例);年龄62.5(58.6,64.3)岁]或HCM[14例(男13例,女1例);年龄60.5(57.3,68.7)岁]的患者资料。所有患者在注射370~720 MBq^(99)Tc^(m)-PYP后1 h行平面显像和SPECT断层显像;对显像图进行视觉评分(0~1分为阴性,2~3分为阳性),计算心脏与对侧肺摄取比值(H/CL);采用χ^(2)检验比较ATTR-CA和HCM组间视觉评分差异,计算视觉评分法的诊断效能;行Mann-Whitney U检验比较组间H/CL差异;采用ROC曲线分析H/CL鉴别诊断ATTR-CA和HCM的效能。结果ATTR-CA组34例视觉评分≥2分,1例视觉评分<2分;HCM组6例视觉评分为2分,8例视觉评分<2分;视觉评分诊断ATTR-CA的灵敏度为97.1%(34/35),特异性为8/14;ATTR-CA与HCM组间视觉评分差异有统计学意义(χ^(2)=16.20,P<0.001)。ATTR-CA组H/CL明显高于HCM组[2.08(1.97,2.20)与1.26(1.17,1.35);z=-5.09,P<0.001];ROC曲线分析示H/CL最佳截断值为1.45[AUC:0.980(95%CI:0.946~1.000),P<0.001],H/CL鉴别诊断HCM和ATTR-CA的灵敏度为97.1%(34/35),特异性为14/14。结论^(99)Tc^(m)-PYP SPECT显像有助于鉴别诊断ATTR-CA和HCM,H/CL鉴别诊断这2种疾病的最佳截断值为1.45。