目的:对比研究131I-MIBG显像、18F-FDG PET/CT显像与99Tcm-MDP-WBS多模态显像在嗜铬细胞瘤/副神经节瘤(PCC/PGL)骨转移病灶中的诊断价值.方法:回顾性分析本院收治的PCC/PGL患者共30例,所有患者均伴骨转移且已行以上三种检查(检查的时间间隔为3个月内).以病理、影像学检查及临床随访结果作为骨转移的诊断依据.比较三种检查方法检测PCC/PGL骨转移病灶的灵敏度、特异性、阳性及阴性预测值和准确性.使用SPSS 25.0软件分析,采用McNemar检验比较三种检查方法诊断骨转移的价值.结果:30例PCC/PGL患者共检查出骨异常病灶302处,确诊为骨转移病灶271处.131 I-MIBG显像、18 F-FDG PET/CT显像与99 Tcm-MDP-WBS在诊断PCC/PGL骨转移病灶时的灵敏度、特异性、阳性和阴性预测值及准确性分别是92.00％、96.30％、99.60％、54.17％、92.38％;96.00％、92.59％、99.25％、69.44％、95.70％和88.39％、62.86％、94.78％、41.51％、85.43％.三种检查方法在诊断PCC/PGL骨转移病灶时18 F-FDG PET/CT显像灵敏度最高,131 I-MIBG显像特异性最好.三种检查方法的诊断效能经McNemar检验,差异有统计学意义(P<0.05).结论:131I-MIBG显像可作为PCC/PGL骨转移的首选检查方法并指导后续131I-MIBG治疗,18 F-FDG PET/CT显像和99 Tcm-MDP-WBS可作为可疑病灶131 I-MIBG显像阴性时的有效补充.

目的 研究胸部CT联合BRAFV600E对放射性碘难治性分化型甲状腺癌(RAIR-DTC)伴肺转移患者的诊断,和肺转移瘤预后因子.方法 118例RAIR-DTC伴有肺结节患者,其中明确诊断为甲状腺癌肺转移55例,甲状腺癌伴良性结节的63例.观察比较联合诊断与单独检测胸部CT、BRAFV600E对RAIR-DTC伴肺转移的诊断价值;观察RAIR-DTC伴肺转移的发病和生存情况;分析影响RAIR-DTC伴肺转移预后的相关因素.结果 联合诊断敏感度为94.5％明显高于其他两种诊断的81.8％和69.1％,差异具有统计学意义(P<0.05).肺转移瘤<1 cm组的4年和8年生存率分别为76.3％、50.8％均高于肺转移瘤≥1 cm组的54.2％、25.4％,差异均具有统计学意义(P<0.05);转移瘤<1 cm组的中位生存期(mOS)为(116±9.8)个月长于转移瘤≥1 cm组的(80.6±6.5)个月,差异具有统计学意义(P<0.05).BRAFV600E、肺结节大小是影响RAIR-DTC伴肺转移患者临床独立预后因素.结论 胸部CT联合BRAFV600E,应用于RAIR-DTC伴肺转移患者,有助于增加诊断效能,为早期肺转移癌提供诊断依据.

The aim of this study was to evaluate the utility of thyroid static imaging with 99mTcO4- for detecting metastatic lesions following surgery in patients with Differentiated Thyroid Cancer (DTC). A total of 420 consecutive post-total thyroidectomy patients with pathologically diagnosed differentiated thyroid cancer underwent thyroid static imaging with 99mTcO4- before 131I treatment to evaluate the size, location, and function of the residual thyroid. They also underwent 131I whole-body scanning (131IWBS), as well as single-photon emission computed tomography/computed tomography fusion imaging (when necessary), for evaluation of the lesions. The detection rates of thyroid static imaging with 99mTcO4- and 131I-WBS (therapeutic dose) were 83.81% and 98.33%, respectively. The sensitivity of 99mTcO4- thyroid static imaging was 85.2%, and the rate of detection with both 99mTcO4- static imaging and 131I-WBS was 85.48%. The use of 99mTcO4- thyroid static imaging identified metastatic lesions in 10 patients; thus, the original planned treatment dose and protocol were adjusted in these patients. Based on our findings, we conclude that thyroid static imaging with 99mTcO4- can be used to evaluate the residual thyroid tissue after thyroid carcinoma resection and can identify metastatic lesions, thereby helping to guide the selection of the 131I treatment dose.

Objective :To observe and analyze the clinical effect of Shenqi Shiyiwei Granules in preventing bone marrow suppression in-duced by 131I in differentiated thyroid cancer. Methods 300 patients with differentiated thyroid cancer who underwent surgical treatment from June 2014 to June 2016 in the hospital were selected and divided into the control group and the study group in accordance with the random number table method, 150 cases in each group. The control group was given 131I treatment, and on this basis, the study group based was given Shenqi Shiyiwei Granules. The neutrophils and white blood cell levels in the two groups were observed and com-pared. Results There was no significant difference in neutrophils and white blood cell count between the two groups before treatment ( P > 0. 05 ) . After 4 and 8 weeks of treatment, the neutrophils and white blood cell count of the study group were significantly higher than those of the control group ( P < 0. 05 ) . The incidence of adverse reactions was 16. 67% in the study group and 13. 33% in the control group, the difference was not statistically significant ( P > 0. 05 ) . Conclusion Shenqi Shiyiwei Granules in preventing bone mar-row suppression induced by 131I in differentiated thyroid cancer has clear effect, it is better to prevent white blood cells and granulo-cytes, which is worthy of clinical promotion.

目的：分析嗜铬细胞瘤的临床特点，提高嗜铬细胞瘤的诊治水平。方法回顾性分析70例嗜铬细胞瘤或副神经节瘤患者的临床资料，包括临床表现、诊断、病理分型、复发转移、手术治疗等。结果70例患者中肾上腺嗜铬细胞瘤46例（65.7%），副神经节瘤24例（34.3%），其中膀胱副神经节瘤4例（5.7%），腹膜后副神经节瘤9例（12.9%），其他副神经节瘤11例（15.7%）。57例患者接受过手术治疗，术后出现复发23例，出现远处器官及淋巴结转移58例。血压升高67例，心悸37例，头痛42例，大汗39例。结论嗜铬细胞瘤常表现以高血压为代表的临床综合征，症状复杂多样，缺乏特异性，恶性嗜铬细胞瘤易出现术后复发及多器官转移。

Objective:To summarize the treatment method,clinical effect and side effect of Iodine 131I Metuximab injection for treating moderate and advanced primary hepatocellular carcinoma(HCC)patients with different liver function.Methods:All 79 HCC patients received treatment of infusing Iodine 131I Metuximab injection via hepatic artery.Patients were followed-up monthly for general information,tumor size,imaging changes,alpha-fetoprotein,liver function,peripheral white blood cell value and platelet value.The efficacy and side effects of patients with different liver function classification were evaluated.After the treatment,71 patients were followed-up.1 months,3 months and 6 months without recurrence rates were 100%,76.1% and 28.2% respectively.Of all patients 14 cases died(19.2%),median survival time was 8 months.There was no severe complication associated with therapeutic drug.Conclusion: Iodine 131I Metuximab injection used for the treatment of inoperable HCC patients,especially the patients with better liver function,can obtain good effect and it is an newly effective comprehensive treatment method for HCC.

[Objective] To retrospectively evaluate clinical efficacy and safety of partial splenic embolization(PSE) in treating primary hepatocellular carcinoma with hypersplenism.[Methods] Fifty-five primary hepatic carcinoma patients with liver cirrhosis,portal hypertension and hypersplenism were treated with PSE,the area of embolization was 50%～70%.After one week,2 weeks and a month to re-examination the blood routine,liver function,one month postoperatively for CT scan.Postoperative complications were recorded.[Results] After embolization 1 week,2 weeks and a month as peripheral blood tests,white blood cells,platelets embolization was significantly higher than the former,the red blood cells,hemoglobin had no significant difference.After embolization a month the white blood cells(5.32±1.48)×109 /L,and platelets(105.68±18.18)×109 /L.After one week,liver functions on AST,ALT and TBIL were significantly increased,after two weeks and after a month,they had no significant difference compared with before PSE.No patient suffered from severe complication such as splenic abscess.[Conclusion] PSE is a safe and effective method to treat primary hepatocellular carcinoma with hypersplenism.