Hepatic clearance measured with ^(99m)Tc-GSA single-photon emission computed tomography to estimate liver fibrosis

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.

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.

ASSESSMENT OF MYOCARDIAL VIABILITY WITH CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING AND COMPARISON WITH SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY

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.

Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver

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.

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.

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。

Perioperative Evaluation of Cerebral Blood Flow Using ^123I-labeled N-isopropyl-p-iodoamphetamine Single-Photon Emission Computed Tomography without Blood Sampling in Patients Who Underwent Carotid Artery Stenting

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）.

Significance of functional hepatic resection rate calculated using 3D CT/^(99m)Tc-galactosyl human serum albumin singlephoton emission computed tomography fusion imaging

AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-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 99mTc-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/99mTc-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.

硝酸甘油介入^(99m)Tc-MIBI SPECT心肌灌注显像评价存活心肌

目的探讨含服硝酸甘油(NTG)介入99mTc甲氧基异丁基异晴(99mTc-MIBI)单光子发射计算机断层(SPECT)心肌灌注显像在检测存活心肌中的价值。方法18例心肌梗死患者分别行99mTc-MIBI静息显像和24h后再次静脉注射99mTc-MI-BI,在注射前5min,患者给与硝酸甘油1.0mg舌下舍服,再次行静息心肌断层显像,并进行对比分析。结果18例患者共有97个心肌灌注异常节段,其中44个心肌节段在NTG后心肌血流灌注改善,呈现可逆性缺损,占45.36%;53个节段无变化。结论NTG介入99mTc-MIBISPECT心肌灌注显像可明显提高心肌梗死患者存活心肌细胞的检出率,可以真实地评价心肌梗死的面积和部位,并且操作安全、无创、方便。

~99Tc^m-Tetrofosmin SPECT半定量分析诊断肺部肿瘤

目的评价99Tcm-TetrofosminSPECT半定量分析在判断肺部肿瘤良恶性的临床价值。方法对33例肺部肿块患者,行胸部99Tcm-Tetrofosmin显像和CT扫描,并对SPECT图像进行半定量分析。以最终的病理结果为标准,比较各组间结果。结果肺癌组的T/N值明显高于相应时相肺部良性病变组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)。其区分肺部原发性肿瘤良、恶性的灵敏度和准确性均高于CT(P<0.05,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2hRI肺腺癌组要高于肺鳞癌组(P<0.05)。结论99Tcm-TetrofosminSPECT半定量分析能准确、有效地探测肺部肿块,还可能为肺癌的组织类型提供更多的信息,在肺癌的诊断中具有重要的临床实用价值。

Comparison of clinical value of dynamic contrast-enhanced MRI and SPECT renal dynamic imaging of GFR measurement in the evaluation of renal function in renal transplantation

Objective:To compare the clinical value of dynamic contrast-enhanced MRI(DCE-MRI)and single-photon emission computed tomography(SPECT)renal dynamic imaging in the measurement of glomerular filtration rate(GFR)in the evaluation of renal function in renal transplantation.Methods:A total of 70 recipients who underwent renal transplantation in Baogang Hospital of Inner Mongolia from April of 2015 to April of 2018 were selected as research objects.GFR was measured in renal transplant recipients by use of DCE-MRI and SPECT(GFR-MRI and GFR-SPECT respectively),and was compared with creatinine clearance rate(Ccr).The safety of contrast media was evaluated in DCE-MRI detection.Results:The bias of GFR-MRI against Ccr value was higher than that of GFR-SPECT against Ccr value,with 30%and 50%accuracy of GFR-MRI higher than that of GFR-SPECT,and the difference was statistically significant(p<.05).Pearson correlation analysis showed that GFR-MRI and GFR-SPECT values were positively correlated to Ccr(p<.05),and the correlation coefficient of GFR-MRI and Ccr was higher than that of GFR-SPECT and Ccr,with the difference statistically significant(p<.05).By Bland-Altman analysis,95%confidence interval of GFR-SPECT was 95.49 ml/(min·1.73 m^(2)),and 95%confidence interval of GFR-MRI was 62.35 ml/(min·1.73m^(2)),which was much narrower.Only 2 cases of patients developed mild rash among 70 cases of patients,and recovered spontaneously without any treatment.Conclusions:Compared with SPECT,the bias of GFR measured by DCE-MRI against Ccr is much greater.However,DCE-MRI has a higher accuracy,correlation and consistency in comparison with Ccr,and it has a narrower confidence interval.DCE-MRI can more accurately evaluate renal function in renal transplantation by measuring GFR,and it has a high safety.

飞利浦Precedence SPECT/CT故障维修案例分析

单光子发射型计算机断层显像/计算机断层扫描成像(SPECT/CT)检查是医院常用的影像检查方法,用于早期诊断恶性肿瘤、心肌缺血和癫痫等疾病,因其日常使用率高,维修保养工作尤为重要,故对常见故障及日常维修分析总结,为同类机型的维护提供参考。

^(99m)Tc-ECD SPECT脑显像NeuroGam^(TM)诊断早期认知障碍

目的前瞻性评价基于NeuroGam^(TM) Brodmann分区定量技术研究^(99m)Tc-ECD SPECT脑显像早期诊断早期认知障碍(mild cognitive impairment,MCI)的能力。方法纳入同济大学附属第十人民医院及上海交通大学附属第六人民医院经过筛选的24例受试者,包括MCI组患者18例及健康志愿者(NC组)6例,在复旦大学附属华山医院核医学科进行^(99m)Tc-ECD SPECT脑显像,并使用NeuroGam^(TM)技术对脑显像进行定量分析,研究Brodmann分区的4−11、17−25、28、31−32、36−40以及44−47等共29个大脑皮层区域的血流灌注情况。结果受试者平均年龄为(65.3±8.4)岁,其中MCI组男性受试者7例,女性受试者11例,平均年龄为(67.1±7.0)岁;NC组男性受试者2例,女性受试者4例,平均年龄为(59.8±10.4)岁;MCI组与NC组受试者的年龄差异无统计学意义。受试者蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评分平均值为22.6±5.1,简易精神状态评价量表(mini-mental state examination,MMSE)评分平均值为25.5±3.7,MCI组受试者MoCA评分平均值为20.8±4.5,NC组受试者MoCA评分平均值为28.2±0.8;MCI组受试者MMSE评分平均值为24.3±3.6,NC组受试者MMSE评分平均值为29.0±0.6,MCI组与NC组受试者的MoCA评分与MMSE评分差异有统计学意义(P=0.005,P=0.001)。MCI组与NC组受试者29个Brodmann分区的脑血流灌注值对比中17R、18R、19R、39L、39R 5个Brodmann区域的脑血流灌注值分别为68.0、59.3、54.2、50.0、54.0和72.7、64.8、60.6、59.7、58.51,差异有统计学意义(P<0.05),Brodmann 17R、18R、19R、39L、39R 5个区域的ROC曲线下面积(area under curve,AUC)分别为0.815、0.856、0.866、0.764、0.759,其中17R、18R、19R区域的P<0.05。结论17R、18R、19R 3个Brodmann区域脑血流灌注减低对诊断早期认知障碍有较高的诊断效能。

CT/^(99m)Tc-GSA SPECT fusion images demonstrate functional differences between the liver lobes

AIM: To evaluate the functional differences between the 2 liver lobes in non-cirrhotic patients by using computed tomography/99mTc-galactosyl human serum albumin (CT/99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODS: Between December 2008 and March 2012, 264 non-cirrhotic patients underwent preoperative liver function assessment using CT/99mTc-GSA SPECT fusion images. Of these, 30 patients, in whom the influence of a tumor on the liver parenchyma was estimated to be negligible, were selected. Specifically, the selected patients were required to meet either of the following criteria: (1) the presence of an extrahepatic tumor; or (2) presence of a single small intrahepatic tumor. These 30 patients were retrospectively analyzed to calculate the percentage volume (%Volume) and the percentage function (%Function) of each lobe. The ratio between the %Function and %Volume (function-to-volume ratio) of each lobe was also calculated, and the ratios were compared between the 2 lobes. Furthermore, the correlations between the function-to-volume ratio and each of 2 liver parameters [lobe volume and diameter ratio of the left portal vein to the right portal vein (LPV-to-RPV diameter ratio)] were investigated. RESULTS: The median values of %Volume and %Function were 62.6% and 67.1% in the right lobe, with %Function being significantly higher than %Volume (P < 0.01). The median values of %Volume and %Function were 31.0% and 28.7% in the left lobe, with %Function being significantly lower than %Volume (P < 0.01). The function-to-volume ratios of the right lobe (1.04-1.14) were significantly higher than those of the left lobe (0.74-0.99) (P < 0.01). The function-to-volume ratio showed no significant correlation between the lobe volume in either lobe. In contrast, the function-to-volume ratio showed significant correlations with the LPV-to-RPV diameter ratio in both lobes (right lobe: negative correlation, rs = -0.37, P = 0.048; left lobe: positive correlation, r s = 0.71, P < 0.001). The function-to-volume ratio in the left lobe tended to be higher, and that in the right lobe tended to be lower, in accordance with the increase in the LPV-to-RPV diameter ratio. CONCLUSION: CT/99mTc-GSA SPECT fusion images demonstrated that the function of the left lobe was significantly decreased compared with that of the right lobe in non-cirrhotic livers.

Investigating the role of^(99m)Tc-TRODAT-1 SPECT imaging in idiopathic Parkinson's disease

Objective:To investigate the role of ^(99m)Tc-TRODAT-1 SPECT in diagnosis and assessing severity of idiopathicParkinson's disease(PD).Methods:Thirty-eight patients with primary,tentative diagnosis of PD and eighteen age-matchednormal controls were studied with ^(99m)Tc-TRODAT-1 SPECT imaging.The regions of interests(ROIs)were drawn manually oncerebellum(CB),occipital cortex(OC)and three transverse plane slice-views of striatums,the semiquantitative BG(back-ground)/[(OC+CB)/2]were then calculated.Results:A lower uptake of ^(99m)Tc-TRODAT-1 in striatums were displayed inthirty-six out of thirty-eight PD patients by visual inspection,compared to controls.In twenty-four PD cases with HYS(Hoehn andYahr scale)stage Ⅰ,a greater loss of DAT uptake was found in striatum and its subregions contralateral striatum to the affectedlimbs than in the same regions of the controls,although the striatal uptake was bilaterally reduced.Using Spearman correlationanalysis showed that the reduction of the uptake ratios significantly correlated with the UPDRS in striatum and all its subregions inthe PD group(P<0.05),a similar change was also found in the putamen by using the rating scale of Hoehn and Yahr (P<0.05).However,analysis of variance(ANOVA)did not show any relationship between the decreasing uptake of ^(99m)Tc-TRODAT-1 andincreasing severity of PD patients,although the specific uptake of ^(99m)Tc-TRODAT-1 was continuously decreased in the striatumby visual inspection with the progress of PD from HYS stage Ⅰ to Ⅲ.Conclusion:^(99m)Tc-TRODAT-1 SPECT imaging may serve asa useful method for improving the correct diagnosis of PD.In assessing the role of ^(99m)Tc-TRODAT-1 SPECT in disease severity ofPD,UPDRS can offer a comprehensive index,although the Hoehn and Yahr assessment may be available in part.

Degree of dopaminergic degeneration measured by ^(99m)Tc-TRODAT-1 SPECT/CT imaging

To prevent and treat Parkinson＇s disease in its early stages,it is essential to be able to detect the degree of early dopaminergic neuron degeneration.Dopamine transporters（DAT） in the striatum regulate synaptic dopamine levels,and striatal ^99mTc-TRODAT-1 single-photon emission computed tomography（-SPECT） imaging is a marker for presynaptic neuronal degeneration.However,the association between the degree of dopaminergic degeneration and in vivo ^99mTc-TRODAT-1 SPECT imaging is unknown.Therefore,this study investigated the association between the degree of 6-hydroxydopamine（6-OHDA）-induced dopaminergic degeneration and DAT imaging using^99mTc-TRODAT-1 SPECT in rats.Different degrees of nigrostriatal dopamine depletion were generated by injecting different doses of 6-OHDA（2,4,and 8 μg） into the right medial forebrain bundle.The degree of nigrostriatal dopaminergic neuron degeneration was assessed by rotational behavior and immunohistochemical staining.The results showed that striatal ^99mTc-TRODAT-1 binding was significantly diminished both in the ipsilateral and the contralateral sides in the 4 and 8 μg 6-OHDA groups,and that DAT ^99mTc-TRODAT-1 binding in the ipsilateral striatum showed a high correlation to apomorphine-induced rotations at 8 weeks post-lesion（r = –0.887,P 〈 0.01）.There were significant correlations between DAT ^99mTc-TRODAT-1 binding in the ipsilateral striatum and the amount of tyrosine hydroxylase immunoreactive neurons in the ipsilateral substantia nigra in the 2,4,and 8 μg 6-OHDA groups at 8 weeks post-lesion（r = 0.899,P 〈 0.01）.These findings indicate that striatal DAT imaging using ^99mTc-TRODAT-1 is a useful technique for evaluating the severity of dopaminergic degeneration.

Differential Impact of Appropriate Use Criteria on the Association between Age and Abnormal Stress Myocardial Perfusion SPECT

Background:The diagnostic and prognostic value of appropriate use criteria(AUC)for coronary artery disease(CAD)is well established.Whether the diagnostic yield of AUC for predicting CAD is preserved among the elderly is not known.Methods:We analyzed a multisite prospective cohort of 1511 consecutive patients(age 59±13 years,57%males)who underwent outpatient,community-based single-photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI).Appropriateness of the studies was determined on the basis of the 2013 multimodality AUC for detection and risk assessment of stable ischemic heart disease.Abnormal SPECT MPI was defi ned by either a summed stress score of 4 or greater or a summed difference score of 2 or greater.Results:Abnormal SPECT MPI was present in 190 patients(12.5%),while ischemia on MPI alone was present in 122 patients(8%).In multivariate logistic regression analysis,age of 60 years or greater,male sex,hypertension,diabetes mellitus,and known CAD were independent predictors of abnormal SPET MPI,while appropriate indication for testing was not.Age of 60 years or greater was also an independent predictor of inducible myocardial ischemia,while appropriate indication for testing was not.Among the elderly(≥60 years),regardless of appropriateness of testing,there was no difference in the prevalence of abnormal SPECT(19 vs.14%,P=0.14)or prevalence of SPECT ischemia(11 vs.11%,P=1.00).Among younger patients,however,appropriate testing predicted a greater prevalence of abnormal SPECT(12 vs.7%,P=0.013).Conclusion:In this multisite cohort,testing based on AUC did not discriminate the risk of abnormal SPECT MPI among the elderly.Caution is advised when relying on AUC for referral of elderly patients for SPECT MPI.

Can regadenoson pharmacologic SPECT be performed effectively in patients with left bundle branch block or paced rhythm patients? A retrospective comparison to adenosine SPECT

Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.

^(99m)Tc-3PRGD_(2) SPECT/CT在晚期肺腺癌化疗后早期疗效中的评估应用

目的探讨^(99m)Tc标记的联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体(^(99m)Tc-3PRGD_(2))单光子发射计算机断层显像(SPECT/CT)在晚期肺腺癌化疗后早期疗效中的应用。方法选取2018年3月至2020年3月收入医院的晚期肺腺癌患者130例为研究对象。所有患者均在化疗前及治疗后2周行^(99m)Tc-3PRGD_(2) SPECT/CT显像,根据CT示临床疗效将所有患者分为进展组(67例)与无进展组(63例),观察两组患者临床疗效、治疗反应并分析其检测疗效能力。结果治疗后,两组患者T/N比值均降低,无进展组低于进展组,且无进展组△T/N比值高于进展组(P<0.05)。治疗开始后第2周,以△T/N比值25.01为最佳阈值,△T/N比值预测患者对反应的敏感性、特异度分别为84.6%及72.7%,阴性预测值为82.5%。接受者操作特性(ROC)分析表明,△T/N鉴别有进展组及无进展组患者的曲线下面积为0.829。结论 ~(99)mTc-3PRGD_(2) SPECT/CT在晚期肺腺癌化疗后早期疗效评估价值确切,可为肺腺癌的下一步治疗提供有效依据。

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。