AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPEC...AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.展开更多
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 th...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.展开更多
Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty pa...Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.展开更多
BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the prim...BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.展开更多
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 suspecte...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.展开更多
AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission com...AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.展开更多
The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and ca...The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and carotidendarterectomy （CEA）.展开更多
文摘AIM: To evaluate the clinical utility of hepatic clearance(HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin(99mTc-GSA) single-photon emission computed tomography(SPECT) to estimate the degree of liver fibrosis.METHODS:Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study.Indocyanine green clearance(ICG R15),quantitative indices estimated by 99mTc-GSA[the receptor index(LHL15 and HH15)and HC via SPECT analysis],and conventional liver function tests were performed before hepatectomy.Correlations among the quantitative indices for liver functional reserve,conventional liver function tests,andthe degree of liver fibrosis were evaluated.RESULTS:The degree of liver fibrosis was correlated with ICG R15,HH15,LHL15,and HC.HC showed the best correlation with conventional liver function tests.According to multivariate analysis,HC and LHL15 were significant independent predictors of severe fibrosis.HC was the most valuable index for predicting severe fibrosis.CONCLUSION:HC measured with 99mTc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.
基金supported by the National 973 Program of China,No.2006CB504505the National Natural Science Foundation of China,No.90709027
文摘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.
文摘Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.
文摘BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.
文摘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.
文摘AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and <sup>99m</sup>Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/<sup>99m</sup>Tc-GSA SPECT fusion images.RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.
文摘The evaluation of regional cerebral vascular reserve （rCVR） with single-photon emission computed tomography （SPECT） is useful for predicting cerebral hyperperfusion following carotid artery stenting （CAS） and carotidendarterectomy （CEA）.
