目的 探讨18F-氟代脱氧葡萄糖正电子发射计算机断层显像/电子计算机断层扫描(18F-fluorodeoxyglu-cose positron emission tomography/computed tomography,18F-FDG PET/CT)在多发性骨髓瘤(multiple myeloma,MM)中的诊断价值及其影像学表现.方法 回顾性分析2015-01/2020-12月在作者医院经病理活检确诊为MM患者的18F-FDG PET/CT检查资料,统计分析18F-FDG PET/CT对MM病例的检出率,通过骨病变、髓外浸润性病变在显像中的形态、分布特点及病变的代谢特点,对MM的18F-FDG PET/CT表现进行分型.结果 18 F-FDG PET/CT显像对MM病变的检出率为95.24％,57.50％的病例累及20个以上局灶性病变或呈弥漫性病变,常见累及部位依次为脊椎35例(87.50％),骨盆31例(77.50％),肋骨30例(75.00％),其影像学分型包括:①骨质破坏代谢活跃型31例(73.81％),形态上以穿凿样或虫蚀样溶骨性改变(90.32％)和膨胀性骨质破坏(48.39％)多见,最大标准化摄取值(maximal standardized uptake value,SUVmax)范围 2.9～11.7(5.1±3.26);②骨质破坏代谢正常型 5 例(11.90％);③骨髓弥漫代谢活跃型4例(9.52％),SUVmax范围6.1～10.2.本组经18F-FDG PET/CT检出髓外病变7例(16.67％),累及部位包括淋巴结(5例)、脾脏(1例)、肝脏(1例)、肌肉(1例).结论 18F-FDGPET/CT显像对MM有较高的检出率,不仅能显示包括骨质破坏型和骨髓弥漫型在内的骨病变,同时也能显示髓外病变,为临床后续治疗提供依据.

目的 探讨99Tcm-亚甲基二膦酸盐(99Tcm-methylene diphosphonate,99Tcm-MDP)全身骨显像中肾脏影像特征变化及其临床意义.方法 回顾性分析2020-01/2021-07月在作者医院行全身骨显像的1090例住院患者影像及相关临床资料,根据全身骨显像中肾脏的大小、形态、位置及示踪剂分布情况将异常肾脏影像进行分型.结果 253例(23.21％)患者全身骨显像中出现了肾脏影像异常.15例(1.38％)弥漫性放射性分布增浓型者,均在近期分别接受了化疗、靶向治疗、输血或降钙素治疗.151例(13.85％)局灶性放射性浓聚型者,多为肾结石、局限性积液、钙化灶以及体位性示踪剂滞留.17例(1.56％)弥漫性放射性分布减低型者,其中16例为广泛骨转移,1例为患肾功能受损.34例(3.12％)局灶性放射性分布减低型者,与肾囊肿、肿瘤、肾脏局部切除术后有关.另外肾脏大小、形态、位置异常在全身骨显像中也有相应显示.结论 关注全身骨显像中肾脏影像变化,有助于发现可能存在的肾脏异常.

病例男,77岁,主因思睡、乏力2月就诊.患者2月前出现思睡和乏力症状,伴记忆衰减、反应迟缓.血常规化验单显示红细胞计数、血红蛋白减低,遂以贫血收入院.近期患者食欲、精神不良,多感疲乏无力,体质量指数无减低,二便无异常.1999年于外院经骨髓穿刺等检查诊断过原发性血小板增多症,遵医嘱行隆化诺(干扰素α-1b)、羟基脲等药物治疗,后因白细胞偏低等副反应停药,自服盐酸阿拉格雷,目前已停用;既往有高血压、高血压心脏病、房颤、慢性支气管炎、上消化道大出血、肺结核、肾结核病史;早年曾行扁桃体切除术、右侧斜疝手术、混合痔手术及左侧乳腺瘤切除术,无外伤史.

Objective The purpose of the current study was to evaluate the 18 F-FDG PET/CT features in detection of multiple myeloma ( MM) lesions, and to elevate its recognition and diagnostic accuracy. Methods 18 F-FDG PET/CT imaging findings were retrospectively analyzed in patients with MM proved by bone marrow biopsy from January 2010 to January 2016. The imaging features of both bone lesions and extramedullary lesions were analyzed, and the metabolic situation was described by semiquantita-tive method (SUVmax). Results 1)The distribution of bone lesions: The following sites were most commonly affected: verte-brae in 29 cases (87. 9%), pelvis in 27 cases (81. 8%) and ribs in 26 cases (78. 8%);2)18F-FDG PET/CT imaging findings in bone lesions:dissovent bone destructions were most commonly and were detected in 30 cases (90. 9%), the SUVmax was 2. 3~12. 7 (mean value 6. 75 ± 4. 21). Medullary or parosteal soft tissue masses were found in 17 cases (51. 5%), the SUVmax was 3. 2~11. 6 (mean value 7. 12 ± 4. 84);3) Imaging findings in extramedullary lesions:extramedullary lesions were detected in 5 cases (15. 1%), 3 of which affected retroperitoneal or lesser omentum sac lymph nodes, the SUVmax was 4. 6~9. 7 (mean value 7. 1 ± 3. 14). Conclusion 18 F-FDG PET/CT has high application value in diagnosis of MM, which can detect, theseby providing the distribution and the metabolic situation of bone lesions, as well as find what of extramedullary lesions by one exami-nation, theseby providing the basis for clinical follow-up treatment.

Objective To investigate the imaging features of 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) in autoimmune pancreatitis (AIP).Methods A total of 14 AIP patients' 18F-FDG PET/CT data in authors' hospital were retrospectively analyzed,the metabolic activity characteristics of the local pancreatic and extrapancreatic organs were analyzed,and average retention index (RI) of pancreatic lesions,early maximum standardized uptake value (SUVmax),delayed SUVmax were calculated and compared.Results Among 14 patients (5 males and 9 females),the average age was 49 years (ranged,31-67 years),11 patients with diffuse enlargement of pancreas,3 patients with local enlargement of the head of pancreas,the metabolic activity of the lesion site were increased.The main pancreatic duct in 10 patients showed diffuse stenosis,3 patients were localized and multifocal stenosis,1 patients was localized pancreatic duct stricture with proximal pancreatic obiliary dilatation,5 patients with peripancreatic sheath syndrome,3 patients with pancreatic leakage around.There were statistically significant difference in early SUVmax and the delayed SUVmax of 14 AIP patients(t=-6.63,P<0.05),and had no statistical difference between early SUVmax and delay SUVmax of 3 local pancreatic growth patients (t=-4.5,P=0.05).The difference among the early SUVmax,delayed SUVmax and RI were not statistically significant of patients with diffuse enlargement in pancreas (P>0.05).In 14 AIP patients,the changes of pancreatic external organs were found.The diagnostic accuracy of PET/CT was 71.40% (10/14),among which 3 patients was misdiagnosed as pancreatic head carcinoma,and 1 patient were misdiagnosed as acute pancreatitis.Conclusion 18F-FDG PET/CT AIP imaging has certain characteristics,and it is helpful to improve the correct rate and the accuracy of the disease.

Objective To discuss the values of 99mTc-diethylenetriaminepentaacetic acid(DTPA)dynamic radionuclide renal imaging measured glomerular filtration rate(GFR)in early diagnosis of renal impairment in type 2 diabetic nephropathy.Methods According to the urinary albumin excretion rate(UAER),patients were divided into normoalbuminuria,microalbuminuria and macroalbuminuria groups.The differences of GFR,blood biochemical indexes among three groups were compared,reduction rates of GFR were analyzed and influence factors of lower GFR were discussed.Results①The proportion of type 2 diabetes mellitus patients with albuminuria was 50.47％.Compared with normoalbuminuria group,the level of fasting blood glucose(FBG)in microalbuminuria group was much higher(P<0.05),meanwhile there were no significant differences in other biochemical indexes and GFR(P>0.05).The GFR was obviously lower,and levels of blood urea nitrogen(BUN),serum creatinine(SCr),cholesterol(CH),low-density lipoprotein(LDL)in the macroalbuminuria group were significantly higher.②The rates of decrease in GFR in normoalbuminura,microalbuminura and macroalbuminuria group were 49.06％,63.64％and 75.00％,respectively.The rate of decrease in GFR in the macroalbuminuria group was significantly higer than that in the normoalbuminura group.The GFR of 24.53％patients(13/53)in the normoalbuminuria group were less than or equal to 60ml/min,meanwhile,33.33％patients(13/39)with GFR under 60 ml/min kept normoalbuminuria.③The influence factors of decreased GFR were age,systolic blood pressure(SBP)and UAER.Conclusion Combining detection of UAER and GFR can offer a valuable reference to envaluate the renal impairment in type 2 diabetics mellitus.

目的 探讨本地区体检人群幽门螺杆菌(helicobacter pylori,Hp)感染状况与脂代谢异常的关系.方法 2366例健康体检者以14C尿素呼气试验(14C urea breath test,14 C-UBT)检测了Hp感染的情况,分析体检人群Hp感染的性别、年龄分布特点.14 C-UBT值≥100dpm/mmol CO2为Hp阳性的判断标准,分为Hp阳性组(n=691)和Hp阴性组(n=1675),比较2组血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)及高密度脂蛋白(high-density lipoprotein,HDL)水平以及血脂异常的发生率.结果 体检人群总体Hp感染率为29.21％,男性28.46％,女性30.14％,性别间差异无统计学意义(P＞0.05).各年龄段Hp感染率不同,差异具有统计学意义(P＜0.05);40～49岁组感染率为35.18％,明显高于总体水平.20～29岁组Hp感染率为22.16％,明显低于总体水平.Hp阳性组血脂异常发生率与Hp阴性组比较差异无统计学意义(P＞0.05).结论 Hp感染与血脂异常的关系尚不明确,有待深入研究.

Objective To explore the value of elevated urinary microalbumin in patients with type 2 diabetes mellitus(T2DM)and the influential factors.Methods Urinary microalbumin of 79 T2DM patients were detected.The association of urinary microalbumin with serum creatinine(Scr),hyperuricemia and clinical signs were analysed.Results Elevated urinary microalbumin occurred before the increasing of Scr,and its increase was companied with the deterioration of the kidney function.Hyperuricemia,hypertension and uncontrolled blood glucose could worsen the kidney function.Conclusion Urinary microalbumin is a sensitive markers for early renal function damage in T2DM patients whose occurrence and development is affected by multiple factors.

Objective To investigate variation of serum homocysteine in middle-aged and elderly population.Methods The serum Hcy were detected in 446 middle-aged and elderly persons and analyzed by gender and ages. The changes of serum Hcy in persons with hypertension,coronary heart disease( CHD) and cerebral apoplexy were studied. Results The mean value of serum homocysteine was 16. 60 ± 7. 58μmol /L. A higher homocysteine in male and persons more than 80 years were observed. The serum homocysteine in persons with cardio-cerebral vascular disease were higher than that of normal control. Conclusion There are gender and age difference in serum homocysteine. The hyperhomocysteinemia( HHcy) is a risk factor for cardiac-cerebral vascular disease.

Objective To investigate the clinical value of 18F-FDG PET/CT imaging in the diagnosis and treatment of nasopharygeal carcinoma(NPC).Methods Sixty-two patients with nasopharygeal carcinoma underwent 18F-FDG PET/CT examination.Sixteen of them received their first time examination and 46 had previous treatment.Another 14 patients with nasopharygeal inflammation were taken as control group.The examination was conducted before treatment or 6 weeks after treatment.The final diagnosis was determined by the results of pathological tests and the random follow-up.The follow-up was longer than 6 months.Results ① When nodular or massive hypermetabolism area in nasopharynx was detected in PET,the soft tissue mass or thickening was also detected in the same region in CT.The diagnostic sensitivity, specificity and accuracy of PET/CT in NPC were 93.8%,92.9.% and 93.3%.② For treated patients,13 of 24 cases that were positive in CT showed hypermetabolism in PET.Among them,8 cases were finally diagnosed as neoplasm residue/recurrence.Two of 22 patients without changing in CT show positive in PET,1 was diagnosed as neoplasm residue.③ Regional nodal involvement were detected in 43.8% and distant metastases to bone,lungs,liver and brain in 19.4%.Conclusion 18F-FDG PET/CT is a useful modality for diagnosis and staging of NPC and has the potential to detect the neoplasm residual/recurrent.

颈部是全身淋巴结转移癌的最常见部位.头颈部恶性肿瘤、胸部肿瘤、淋巴瘤等常转移或侵及颈部淋巴结,头颈部炎症、结核也可引起颈部淋巴结肿大,其病因不同,治疗方案和预后也截然不同.

随着CT、MRI等医学影像技术的不断进步,尤其是正电子发射计算机断层显像(positron emission tomography,PET)的出现,现代医学影像已经由以提供解剖和病理形态学信息为主的形态学影像诊断逐渐向提供生理信息和分子信息为主的功能性影像诊断发展.

Objective:To investigate the clinical effects of deanxit in the treatment of post-stroke depression and anxiety.Method:65 stroke patients with depressive and anxious disorder were randomly divided into two groups which were treated with deanxit(as deanxit group) and without deanxit(as controlled group) respectively.SDS and SAS scales were used to evaluate the changes of clinical symptoms.Result:The scores of SDS and SAS scales in the deanxit group after 2 weeks'treatment were 36.37±7.07 and 32.91±5.28,which were significantly lower than those of the controlled group (P<0.01).The scores of SDS and SAS scales significantly decreased after the treatment(P<0.01).The effective rates of SDS and SAS in the deanxit group were 85.7%and 91.4%,which were significantly lower than those of the controlled group(P<0.01).Conclusion:Deanxit has its good effect on the post-stroke depression and anxiety.

Objective To investigate the change and significance of serum level of homocysteine (Hcy) in patients with chronic cerebral circulation insufficiency (CCCI). Methods Serum level of Hcy were detected by chemiluminescence in 53 patients with CCCI (CCCI group), 55 patients with cerebral infarction (infarction group), and 51 healthy controls (control group). Results Serum level of Hcy was significantly higher in CCCI group than that in control group, that in CCCI patients with carotid atherosclerosis was higher than those in CCCI patients without carotid atherosclerosis and in control group. Conclusion Serum level of Hcy is correlated with carotid atherosclerosis, and hyperhomocysteinaemia plays an important role in the development of ischemic cerebrovascular disease.

Objective To investigate the possible apoptotic pathway in breast cancer daunorubicin-resistant subline,MCF-7/Adr cell line.Methods Drug-resistance cell line MCF-7/Adr expressing functional P-gp and its wild type MCF-7/wt cell line were used for comparison.The concentration of hydrogen peroxide(H2O2)that may lead to loss of mitochondrial function was determined using MTT assay.The cell morphology and the mitochondrial ultrasructure were observed by invert and transmission electron microscopy,respectively.The apoptosis of the two cell lines was determined with DNA gel electrophoresis and Annexin V and PI double-stained flow cytometry.Mitochondrial membrane potential(MMP)and the function of P-gp were assessed with rhodamine 123(Rh123)staining intensity by confocal microscopy.The release of cytochrome C from mitochondria was observed by Western blotting.Results The mitochondrial function of MCF-7/Adr was irreversibly damaged at the concentration of 4 mmol/L H2O2.The mitochondria were vacuolated and their cristae were swollen.The percentage of MCF-7/Adr cell apoptosis was significantly higher than that of MCF-7/wt,96.52% and 18.57%,respectively(P0.01).Only 800 and 1 600 Da DNA fragmentation was seen.The number of mitochondria and membrane potential of MCF-7/Adr mitochondria decreased as compared with those of MCF-7/wt.H2O2 at the concentration of 4 mmol/L induced release of cytochrome C from MCF-7/Adr mitochondria to cytoplasma,but little was detected in MCF-7/wt.Conclusion MCF-7/Adr cells expressing functional P-gp are more sensitive to H2O2-mediated mitochondrial apoptosis.It may attribute to the changes of mitochondrial structure and function in MCF-7/Adr cells.These may suggest that some way which may modify mitochondrial characteristics may be benificial to overcome the multidrug resistance related to P-gp.

目的 比较亲肿瘤显像剂99mTc-MIBI和99mTc-TF在鼻咽癌细胞系中的细胞摄取动力学, 探讨鼻咽癌肿瘤显像的理论依据. 方法 鼻咽癌细胞接种于24孔培养板, 分别以含有99mTc-MIBI和99mTc-TF的培养液培养至0、 15、 30、 45、 60、 90、 120、 150、180min时取样,测定细胞内放射性计数, 计算各时间点细胞对示踪剂的摄取百分率. 结果99mTc-MIBI和99mTc-TF在CNE细胞系的摄取动力学基本相似,在15 min即可见升高,在1h达到高峰进入平台期,3h内显像剂细胞内的蓄积维持于高水平,但99mTc-MIBI摄取峰值是99mTc-TF的1.63倍.结论 99mTc-MIBI和99mTc-TF在鼻咽癌显像中有一定的临床应用前景,99mTc-MIBI显像可能会有更高的灵敏度.

Objection Evaluating the clinical value of Hcy in 2 type diabetes patients with and without cerebral infarction.Methods serum Hcy were detected in 33 2 type diabetes patients with cerebral infarction and 34 patients without cerebral infarction.51 healthy were as control.Result the serum Hcy of 2 type diabetes patients with cerebral infarction was obviously higher than that of without cerebral infarction and controls,The patients with higher serum Hcy level in cerebral infarction patients were much more than that controls also.Conclusion Detecting the serum Hcy in 2 type diabetes patients would be helpful to anticipate the risk of occurrance of cerebral infarction complications.

Objective To evaluate thyroid function and thyroid autoantibody in type 2 diabetes patients.Methods Serum levels of FT3,FT4,TSH,aTPO and aTG were detected of 78 patients with type 2 diabetes and of 74 normal subjects(control).Results Thyroid dysfunction occurred in 19.23% of type 2 diabetes patients,of whom 15.38% were hypothyroidism and 3.85% were hyperthyroidism.The positive rates of aTPO and aTG were 52.56% and 16.67%.The positive rates of hypothyroidism and aTPO were significantly higher than those of normal control(P<0.05),while the positive rates of hyperthyroidism and aTG had no significant difference with those of normal control.Conclusion Patients with type 2 diabetes are prone to thyroid dysfunction,especially to hypothyroidism.Thyroid autoantibody aTPO was more sensitive than aTG.It is important to monitor thyroid function and thyroid autoantibody for the patients with type 2 diabetes.

Objective To predict the effect of neoadjuvant chemotherapy for breast cancer by 99mTc-MIBI scintimammography.Methods Forty-three patients with stageⅡ,Ⅲbreast cancer were enrolled in this study.Before operation,99mTc-MIBI scintigraphy was performed at 15 min and 90 min after injecting the tracer.The uptake of 99mTc-MIBI was evaluated as tumor over background ratio with region of interest technique.Such indexes as early uptake ratio(EUR),delay uptake ratio(DUR)and retention index(RI)were calculated respectively.Then two cycles of FAC [5-FU 500 mg/m2(1st day,8th day),ADM 30 mg/m2(1st day),CTX 500 mg/m2(1st day,8th day),every 3 weeks] were administrated.Results In the group RI ≥ 0,respone rate was 83.3 %(25/30).In the group RI 0,respone rate was 23.1 %(3/13).There was significant difference between the two groups(P 0.01).Conclusion It is suggested that 99mTc-MIBI scintimammography can be used as predictor of response to neoadjuvant chemotherapy in breast cancer and be beneficial to select individualized chemotherapy regimen.

<正> 许多技术因素会影响肾动态显像结果的准确性。本研究探讨了放射性核素剂量对肾动态显像结果的影响,现报道如下。一、资料与方法1.临床资料。临床检查肾功能无异常的受检者30例,男18例,女12例,年龄18～46岁。受检者随机分为普通剂量组和高剂量组,分别给予74～185 MBq 和>185～370 MBq显像剂,行肾动态显像,测定肾小球滤过率(GFR)。