精神分裂症和抑郁症局部脑血流的变化

目的　探讨单光子发射电子计算机断层显像扫描 (SPECT)在精神分裂症 (SC)与抑郁症 (DE)的临床诊断及脑部功能异常定位研究的价值。方法　采用SPECT技术 ,对首发、未服药的 2 7例精神分裂症及 12例抑郁症患者与 10例正常人于静息状态下行脑血流 (rCBF)显像研究。结果　以阳性症状为主SC、以阴性症状为主SC及DE患者rCBF异常的阳性率分别为 5 4.5 4%、75 .0 0 %、83.33%。rCBF异常均表现皮层内局限性放射性分布稀疏、缺损区。SC患者rCBF异常脑叶涉及范围较大 ,以颞叶、额叶、顶叶、枕叶为主 ,且额叶rCBF减低与阴性症状明显有关。DE患者rCBF减低仅局限在颞叶或额叶 ,且以左侧颞叶或额叶为主。结论　精神分裂症不同亚型和抑郁症患者的脑叶rCBF的异常各有其特点。SPECT脑显像对两种疾病的诊断及脑功能异常的定位研究均有重要的价值。     

运用单光子发射计算机断层扫描显像诊断帕金森病和血管性帕金森综合征

目的探讨99Tcm-TRODAT-1{99Tcm-2β-[N,N′-双(2-巯乙基)乙撑二胺基]甲基,3β-(4-氯苯基)托烷}脑显像在早期帕金森病(PD)和血管性帕金森综合征(VP)鉴别诊断中的意义。方法对确诊的47例早期PD患者、26例VP患者和30例年龄匹配的正常对照者分别进行99Tcm-TRODAT-1SPECT脑显像,应用计算机感兴趣区(regions ofinterest,ROI)技术分别计算各组双侧纹状体/小脑的放射性计数比值,并对结果进行比较分析。结果早期PD患者患肢对侧纹状体对99Tcm-TRODAT-1的摄取减少,患肢同侧和对侧纹状体/小脑的放射性计数比值均较正常对照者均值明显降低(P<0.05)。VP患者双侧纹状体区对99Tcm-TRODAT-1的摄取接近正常,患肢同侧和对侧纹状体/小脑的放射性计数比值与正常对照者双侧均值无显著差异(P>0.05)。结论99Tcm-TRODAT-1显像及半定量分析有助于PD的早期诊断及与VP的鉴别诊断。     

~(99m)TC-MIBI心肌显像对扩张型心肌病的诊断价值

为探讨心肌显像对扩张型心肌病（DCM）的诊断价值，对34例DCM患者和14例以心衰为突出表现的其它心脏增大患者进行99mTc－MIBI心肌灌注断层显像。34例DCM患者表现左室重度扩大者32例（占94％），其中72％（23／32）同时伴有不同程度的右室扩大，心肌出现多节段花斑样改变者占85％；6例缺血性，C肌病（ICM）患者主要表现为轻度和中度的左室扩大；以二尖瓣狭窄为主的风湿性心脏病（RHD）患者主要表现为右室扩大。提示该显像技术可用于DCM的诊断及鉴别诊断。     

~(99)Tc~m-ECD SPECT显像定量测定癫痫局部脑血流量

目的　应用SPECT脑显像定量测定癫痫局部脑血流量的变化 ,旨在评价其在致痫灶定位诊断中的意义。方法　对 3 5例癫痫患者发作间期进行SPECT脑显像 ,用自编软件定量测定其局部脑血流量。结果　SPECT阳性检出率为 80 % ,其中以颞叶最多 ,额叶及基底节次之。癫痫患者致痫灶脑血流量明显降低 ,平均降低约 3 4 .3 %。结论　SPECT脑显像定量测定发作间期癫痫患者局部脑血流量对癫痫灶定位诊断具有较高的临床价值     

~(99m)Tc-MIBI甲状腺癌阳性显像

目的　研究99mTc -MIBI三相显像对甲状腺癌的定性诊断价值。方法　将 1 5 0例受检者分甲状腺癌 ( 5 8例 )和甲状腺良性结节 ( 92例 )两组 ,以患侧 /健侧摄取比值 (UR)为定量指标 ,观察其 5min和 60min摄取比值变化。结果　甲状腺癌组动脉血流灌注异常增高占 74 1 3% ,而良性结节组仅为 31 .5 2 % ;甲状腺癌组 5min和 60minUR值分别为 1 86± 0 65和 1 63±0 49,而良性结节组分别为 0 81 3± 0 1 8和 0 82 7± 0 1 6,两组两时相UR值比较均有显著性差异 (P <0 0 1 )。结论　99mTc MIBI三相显像对甲状癌的定性诊断具有较高价值。     

SPECT颌骨静态显像对良恶性病变的鉴别诊断价值

应用SPECT(单光子发射计算机断层仪)对正常领骨30例和病人53例行SPECT颌骨静态显像,结果表明领骨良恶性肿瘤病变其SPECT静态像的核素浓集程度和方式、病变侧放射性计数(A)与健侧放射性计数(N)的比值(A/N)差异有高度显著性(P<0.005),病变范围大小同X线对照表明;当领骨肿瘤其SPECT静态图的病变范围明显大于X线显示的病变,则肿瘤的恶性可能性大。以上的结果为临床上对良恶性颌骨病变的鉴别提供了较重要的根据和定量筛选恶性病变的指标。     

小儿脑积水~(99m)Tc-ECD SPECT脑显像的影像特征及临床价值

以往对脑积水患者多采用放射性核素脑脊液循环显像 ,本文采用脑血流灌注显像研究脑积水的影像特征 ,着重于观察脑积水形成后对脑血流灌注和脑功能活动的影响。目前国内少见对小儿脑积水的99ｍＴｃ 双胱乙酯 (99ｍ Ｔｃ ｅｔｈｙｌ ｃｙｓｔｅｉｎａｔｅｄｉｍｅｒ ,99ｍＴｃ ＥＣＤ)显像诊断报告 ,本文对 2 0例临床确认的脑积水患儿进行99ｍＴｃ ＥＣＤＳＰＥＣＴ脑灌注显像 ,并与Ｘ ＣＴ进行对比分析 ,现将结果报道如下。1　对象和方法1.1　研究对象　正常对照组 10例 ,男 6例 ,女 4例 ,年龄 3～ 11岁 (平均 5岁 ) ,均经临床和ＣＴ检查排除…     

35例原发肥厚性心肌病临床特征分析

对35例原发肥厚性心肌病的临床表现、超声心动图及核素心肌显像资料进行分析，认为诊断主要依靠超声心动图及核素检查。超声心动图室间隔绝对厚度≥13mm为诊断可靠标准，IVS／LVPW≥1．8＋SAM多见于肥厚梗阻性心肌病。核素心肌显像对超声心动图不能诊断者可以补充其不足。     

短暂性脑缺血发作患者认知能力与单光子发射断层扫描脑血流显像的关系

目的探讨脑单光子发射断层扫描(SPECT)血流检测对短暂性脑缺血发作(TIA)患者认知障碍判断的价值。方法根据简易智力状态量表(MMSE)评估65例最后一次发作在72 h内的TIA患者的认知能力状况,同时用SPECT观察患者TIA发作间歇期的脑血流灌注显像。根据脑SPECT显像特点,比较不同程度低灌注组的TIA发作次数、认知能力及发作时的临床神经功能缺失评分;分析TIA患者脑SPECT、TIA发作次数与患者认知能力的关系。结果①所有患者的脑SPECT灌注显像均有不同程度的低灌注区域,其中轻度、中度、重度低灌注各为21、26、18例,且脑SPECT灌注显像低灌注区范围越大,TIA发作次数越多(rs=0.751,P<0.01),患者的临床神经功能缺损程度越重(rs=0.470,P<0.01);②TIA患者的MMSE评分明显低于对照组,且与脑SPECT灌注显像呈负相关(rs=-0.308,P<0.05)。结论TIA患者存在认知障碍,其程度与TIA发作次数及患者脑血流状况相关;SPECT可作为评价TIA患者认知能力的良好手段。     

~(99)Tc~m-HL91在肺部肿瘤诊断中的临床价值

目的　应用99Tcm HL91进行肺部肿瘤阳性显像 ,探讨其在肿瘤良恶性诊断中的临床应用价值。方法　对 42例高度怀疑肺部肿瘤的患者注射99Tcm HL91后行 2h、4h平面显像及 4hSPECT/CT断层融合显像 ,使用ROI技术计算肿块与对侧正常肺组织的比值 (T/N)。结果　恶性组在 2h、4h平面及 4h断层图像上T/N值分别为 1.50±0 .17、1.71± 0 .2 2、2 .72± 0 .75,良性病变组分别为 1.2 1± 0 .10、1.2 5± 0 .2 2、1.49± 0 .3 6,各组间均有显著性差异 (P均 <0 .0 1) ;恶性组 4h延迟平面像组较 2h组T/N比值明显增高 (P <0 .0 1) ,而良性组无明显增高 (P >0 .0 5) ;各病理类型各时相之间无显著性差异 (P <0 .0 5) ;以恶性组横断层T/N值 x -1s为诊断阈值 ,其诊断灵敏度、特异度、准确性分别为 84.85%、88.89%和 85.71% ;以良性组 x + 1s为诊断阈值 ,灵敏度、特异度及准确性分别为 90 .91%、88.89%和 95.2 4%。结论　99Tcm HL91作为一种肿瘤阳性显像剂 ,对肺部肿瘤的定性诊断具有较高价值     

脑肿瘤患者手术前后免疫功能的观察

对２７例脑肿瘤患者手术前后免疫功能进行了检测。结果血清ＩｇＧ、ＩｇＡ和ＩｇＭ的改变与正常组相比，手术前后均无明显差异（Ｐ＞０．０５）；淋巴细胞亚群较正常组降低极为明显（Ｐ＜０．００１），肿瘤切除术后细胞免疫功能有所恢复，但与术前比较无明显差异（Ｐ＞０．０５），且仍显著低于正常状态（Ｐ＜０．０１）。说明脑肿瘤病人体液免疫无变化，细胞免疫功能则明显低下，且肿瘤切除术后其细胞免疫功能尚难很快恢复到正常状态。     

Classification decision tree algorithm assisting in diagnosing solitary pulmonary nodule by SPECT/CT fusion imaging

Objective To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78. 57e, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P=0.204), but greater than that of residents (P<0.001). Conclusion Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.     

人脑胶质瘤组织中PCNA表达与病理分级、患者预后的相关性研究

用免疫组化法对 50例人脑星形胶质细胞瘤组织中的 PCNA表达 ,及其与肿瘤临床病理学特征和患者预后的关系作了分析 ,取 10例正常脑组织作对照。结果显示 ,人脑星形胶质细胞瘤组织中PCNA阳性表达显著高于对照组 ,染色强弱与肿瘤的病理分级呈正相关 ,而与预后呈负相关。提示检测肿瘤组织中 PCNA表达能快速、准确地反映肿瘤细胞的增殖状态及评估患者预后 ,有望成为临床判定胶质瘤恶性程度及患者预后的重要指标。     

PRELIMINARY STUDY OF OMENTUM TRANSPOSITION TO BRAIN FOR TREATMENT OF ALZHEIMER'S DISEASE

Objective To learn the effect of omemtum transposition to the brain of patients with Alzheimer's disease. Methods Ten consecutive patients, aged 58 - 81 years old, underwent graft of their elongated pedicled omentum onto their left frontal-temperal-parietal cerebral cortex. Those patients, who had more than five years of dementia with low mini mental-state examination (MMSE) scores of 2 -15, were diagnosed by a neurologist. All subjects underwent single photon evoked computer tomography (SPECT) pre- and post-operatively.SPECT results were analyzed semi-quantitatively by calculation of the left/right radioactivity counts symmetry index (Si). The patients were followed up to one year. The outcome was evaluated by the neurologist with a modified scale of activities of daily living (mADL) as well as the MMSE. Results Three months following the surgery,the Si of SPECT increased from ( 98. 7 ± 1.9) % to ( 103. 9 ± 2.3 ) % ( P = 0. 0307). The neurological and neuropsychological testing scores increased insignificantly during the follow-up period. By the one year, the MMSE score rose from 8. 7 ± 1.4 to 10. 7 ± 1.8 ( P ＞ 0. 05 ), while the mADL from 13.3 ± 1.8 to 16. 9 ± 2. 0 ( P ＞ 0. 05 ). One of the patients suffered a heart attack, two had epileptic episodes postoperatively. Conclusion We believe that omental transposition to the brain augments cerebral blood flow, which might be helpful to decelerate the processing of Alzheimer's disease. However, it is still a potentially risky procedure for the elderly.     

P~（53）蛋白在人脑星形胶质细胞瘤中的表达及意义

采用免疫组化法对５０例人脑星形胶质细胞瘤组织中Ｐ５３蛋白的表达，及其与肿瘤临床病理学特征和预后的关系作了分析，结果显示：本组５０例中２２例表达阳性，阳性率占４４％，Ｐ５３蛋白主要分布在细胞核内，正常脑组织Ｐ５３蛋白表达均为阴性，且肿瘤分化程度越差，预后不良者其阳性染色愈强烈，提示Ｐ５３基因及其蛋白与人脑星形胶质细胞瘤的发生、发展密切相关，可做为判定脑肿瘤恶性程度和预后的重要指标。