Objective To evaluate the effectiveness and safety of higenamine (HG),a pharmaco logical stress agent,for the detection of myocardial ischemia using SPECT.Methods This study was an open,multi-center,randomized and positively controlled trial with crossover references.It consisted of 120patients clinically confirmed or suspected of myocardial ischemia.Each patient underwent a resting MPI and two separate stress MPI in a randomized crossover manner with intravenous administration of HG or adenosine (Ad) on different days.The severity and extent of myocardial ischemia were diagnosed on stress MPI.The degree of vascular stenosis in terms of percentage narrowing was measured by CAG (＞50％ was defined as coronary disease),thus defined as gold standard.The diagnostic efficacy of HG and Ad was compared.Vital signs,routine blood and urine tests,blood biochemical items and side effects were documented for evaluation of procedure safety.Two-sample t test,x2 or Fisher's exact test,and Kappa test were used.Results A total of 109 patients completed the trim and CAG.The diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value of HG MPI were 56.1％ (32/57),78.8％ (41/52),67.0％(73/109),74.4％ (32/43) and 62.1％ (41/66),respectively,which were not significantly different from those ofAd MPI (52.6％ (30/57),82.7％ (43/52),67.0％ (73/109),76.9％ (30/39) and 61.4％(43/70) ;x2 =0-0.2476,all P＞0.05).The sensitivity of HG vs Ad MPI in the diagnosis of single-,double-and triple-vessel ischemia was 29.6％ (8/27) vs 22.2％ (6/27),64.7％ (11/17) vs 64.7％ (11/17)and 100％ (13/13) vs 100％ (13/13),respectively.The concordance between HG and Ad for the detection of LAD,LCX and RCA ischemia was 95.41％ (104/109),97.25％ (106/109) and 97.25％ (106/109) (Kappa=0.8905,0.8420 and 0.8874).HG did not induce significant systolic blood pressure change during or after administration.Both HG and Ad could induce temporary decrease of diastolic blood pressure.Either HG or Ad induced significantly increased HR during administration and 5 min after administration.The clinical laboratory profile (hematology,serum chemistry,and urinalysis) was either normal or with no significant change.A total of 176 side effects (e.g,dyspnea,short breath,palpitation,dizziness,headache) were found related to HG (69.2％,83/120) and Ad (77.5％,93/120) administration (x2=2.1307,P＞0.05),which were mostly mild and transient.Conclusion HG is a safe and effective pharmacological stress test agent as compared to adenosine for the detection of CAD with SPECT perfusion imaging.

Objective To evaluate the effectiveness and safety of higenamine （HG）, a pharmacological stress agent, for the detection of myocardial ischemia using SPECT. Methods This study was an open, multi-center, randomized and positively controlled trial with crossover references. It consisted of 120 patients clinically confirmed or suspected of myocardial ischemia. Each patient underwent a resting MPI and two separate stress MPI in a randomized crossover manner with intravenous administration of HG or adenosine （Ad） on different days. The severity and extent of myocardial ischemia were diagnosed on stress MPI. The degree of vascular stenosis in terms of percentage narrowing was measured by CAG （ 〉50% was defined as coronary disease）, thus defined as gold standard. The diagnostic efficacy of HG and Ad was compared. Vital signs, routine blood and urine tests, blood biochemical items and side effects were documented for evaluation of procedure safety. Two-sample t test, X2 or Fisher＇s exact test, and Kappa test were used. Results A total of 109 patients completed the trial and CAG. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value of HG MPI were 56.1% （32/57）, 78.8% （41/52）, 67.0% （73/109）, 74.4% （32/43） and 62.1% （41/66）, respectively, which were not significantly different from those of Ad MPI （52.6% （30/57）, 82.7% （43/52）, 67.0% （73/109）, 76.9% （30/39） and 61.4% （43/70） ;X2 =0-0.2476, all P〉0.05）. The sensitivity of HG vs Ad MPI in the diagnosis of single-, doub- le- and triple-vessel ischemia was 29.6% （8/27） vs 22.2% （6/27）, 64.7% （11/17） vs 64.7% （11/17） and 100% （13/13） vs 100% （ 13/13）, respectively. The concordance between HG and Ad for the detec- tion of LAD, LCX and RCA ischemia was 95.41% （ 104/109）, 97.25% （106/109） and 97.25% （ 106/ 109） （Kappa = 0.8905, 0.8420 and 0.8874）. HG did not induce significant systolic blood pressure change during or after administration. Both HG and Ad could induce temporary decrease of diastolic blood pressure. Either HG or Ad induced significantly increased HR during administration and 5 min after administration. The clinical laboratory profile （hematology, serum chemistry, and urinalysis） was either normal or with no significant change. A total of 176 side effects （e.g, dyspnea, short breath, palpitation, dizziness, headache） were found related to HG （69.2%, 83/120） and Ad （77.5%, 93/120） administration （X2 = 2. 1307, P〉0.05）, which were mostly mild and transient. Conclusion HG is a safe and effective pharma- cological stress test agent as compared to adenosine for the detection of CAD with SPECT perfusion imaging. Key words: Coronary disease ; Higenamine hydrochloride ; Adenosine ; Tomography, emission-computed, single-photon ; MIBI

目的 评价99mTc-HYNIC-TOC生长抑素受体显像诊断和鉴别诊断胰岛素瘤的临床价值.方法 回顾性分析近11年来65例胰岛素瘤患者的99mTc-HYNIC-TOC显像结果,并与胰腺灌注CT、B超或内镜超声结果比较.结果 65例患者均进行99mTc-HYNIC-TOC显像,阳性28例,检出率43.1％.部分患者进行胰腺灌注CT、B超或内镜超声检查,检出率分别为92.5％、25.6％和76.9％.结论 单独应用99mTc-HYNIC-TOC显像对胰岛素瘤的定性诊断和鉴别诊断临床价值有限,需联合应用多项分子影像诊断技术.

Primary Intestinal lymphangiectasia (PIL) is a common cause of protein losing enteropathy (PLE). It will affect enter-hepatic circulation of lipid-soluble vitamin, and absorption of electrolytes, cause malnutrition related osteomalacia or osteoporosis. While seldom health care workers noted to assess and treat osteomalacia or osteoporosis in PIL. Here we report a related case. We found increased parathyroid hormone, decreased 25(OH)D3, low bone mineral density, which indicated that the PIL patient had osteomalacia and/or osteoporosis. Adequate calcium and vitamin D supply can relieve the condition efficaciously. We should pay attention to osteomalacia and osteoporosis in PIL patients.

小肠淋巴管扩张症( ILE)是各种原因引起小肠淋巴回流障碍造成小肠黏膜渗漏或淋巴瘘产生的水肿、腹泻、低蛋白血症以及外周淋巴细胞减少等的一组症候群.有学者提出其诊断标准为:(1)典型的临床表现;(2)血浆白蛋白和IgG同时降低;(3)外周血淋巴细胞绝对数减少;(4)内镜活检或手术病理证实存在小肠淋巴管扩张;(5)实验室检查证明肠道蛋白质丢失增多.具备前3条应疑诊,具备后2条即可确诊[1].证明肠道蛋白丢失的方法有3种,但由于ILE较少见,国内多数大型综合医院均未开展相关的功能性影像检查,故多数医院均无有效的明确诊断方法,尤其是在内镜活检阴性时.本研究在国内初次报道1例经99Tcm-亚甲基二膦酸盐(MDP)显像证实存在肠道蛋白丢失的ILE患者.

OBJECTIVE: To evaluate the clinical utility of 99Tcm-MIBI scintigraphy in the postsurgical patients with differentiated thyroid cancer(DTC).METHODS: A prospective study of 69 patients randomized picked out from 300 DTC patients underwent 99Tcm-MIBI scan after thyroidectomy.Visual analysis of the scintigraphic images was performed by two experienced physicians without clinical findings and results of the other imaging.The result compared with posttherapy 131I scan.In addition,99Tcm-MIBI uptake in lung was semi-quantitatively evaluated by calculating the target-to-background(T/B) ratio.RESULTS: One patient who died of angiosarcoma was excluded.According to radioiodine therapy and surgery style,the patients were categorized into 3 groups for analysis.Group A(n=44): prepare for initial 131I treatment after thyroidectomy.Group B(n=22): need further 131I treatment.Group C(n=2): underwent partial thyroidectomy alone.In group A,99Tcm-MIBI scans detected thyroid remnants in 15 of 44 patients(34.1%) and metastatic foci in 6 of 20(30.0%) patients.In group B,99Tcm-MIBI scans detected recurrent and metastatic foci in 7 of 11(63.6%).In group C,99Tcm-MIBI scan detected all the remnants(2/2,100.0%),and to be the only examination detecting a cervical lymph node metastasis in one patient.Five patients had three type metastases: MIBI+I-,MIBI-I+ and MIBI+I+ metastases.T/B ratio showed no significant difference between non-metastatic and metastatic groups in lung which confirmed by high-resolution CT or posttherapy 131I scan.CONCLUSIONS: 99Tcm-MIBI can reveal both functioning and non-functioning metastases,so 99Tcm-MIBI scan may be useful for choosing the best therapeutic approach.The combination of 99Tcm-MIBI with 131I offers the highest diagnostic yield.

病例摘要 病例1:患者,女,29岁,因间断心悸、多汗7年,右下颌骨膨出15年来诊.患者14岁出现右下颌骨肿胀、膨出,伴疼痛,无其他部位骨痛及骨折史,外院疑诊为"骨髓炎",行两次下颌骨髓腔清理术及1次活检术,术后下颌骨病变无改善.

Objective To assess the clinical value of 131I-metaiodobenzylguanidine(MIBG)scintigraphy in pheochromocytoma.Methods A total of 430 patients with clinically suspected pheochromocytoma underwent 131I-MIBG whole body scintigraphy,326 among them underwent B-ultrasound,400 for CT and 77 for MR examination respectively.While 178 among them were diagnosed with pathology and the others were diagnosed clinically.Results Of all the patients,108 were diagnosed pheochromocytoma,including 89 131I-MIBG scan positive and 19 negative.The sensitivity,specificity and accuracy of 131I-MIBG were 82.41%,100% and 95.70%,respectively.131I-MIBG scan detected 90.00% of unilateral adrenal,45.45% of bilateral adrenal,85.71% of ectopic and 66.67% of malignant lesions,respectively.The proportion of patients with positive 131I-MIBG scan increased from 20.69% in all patients to 35.15% in patients with clinical symptoms and positive conventional imaging(at least one of B-ultrasonography,CT or MR was positive)and 64.58% in those with clinical symptoms,positive conventional imaging,and elevated 24 h urinary catacholamines.In 59 patients with adrenal incidentaloma,8 were scan-positive and all had confirmed pheochromocytoma,while 2 of scan-negative patients also had confirmed pheochromocytoma.Conclusion 131I-MIBG scintigraphy is the first choice for the diagnosis of both adrenal and extra-adrenal pheochromocytoma.However,it is inappropriate to take this method as the initial screening approach.

患者男,42岁,无诱因发热、咳白色黏痰、胸闷、鼻塞、乏力、视物不清、听力下降20个月,发热时胸骨疼痛、右肘关节及右手关节疼痛.

背景：传统的影像学检查方法（如CT、MRI）在胰腺神经内分泌肿瘤定位和分期中的价值有限。神经内分泌肿瘤表达生长抑素受体，因此应用放射性核素标记的生长抑素类似物能进行肿瘤显像。目的：评价^99mTc-HYNIC-TOC生长抑素受体显像诊断和定位胰腺神经内分泌肿瘤的临床价值。方法：37例临床确诊或怀疑胰腺神经内分泌肿瘤患者行^99mTc-HYNIC-TOC生长抑素受体显像，其中胰岛素瘤18例，胃泌素瘤4例，胰高血糖素瘤4例，未分类的胰腺神经内分泌肿瘤11例。静脉注射^99mTc-HYNIC-TOC 350～400MBq后1、4h行全身显像，部分阳性区域行局部显像或单光子发射计算体层摄影（SPECT）／CT。结果：37例患者中^99mTc-HYNIC-TOC显像阳性27例．其中胰岛素瘤9例．胃泌素瘤4例，胰高血糖素瘤3例，未分类的胰腺神经内分泌肿瘤11例。^99mTc-HYNIC-TOC显像诊断胰腺神经内分泌肿瘤的检出率为73，O％。^99mTc-HYNIC-TOC显像改变了6例患者的肿瘤分期，并证实了7例患者的治疗效果。结论：^99mTc-HYNIC-TOC显像可有效帮助诊断，定位胰腺神经内分泌肿瘤，指导分期，并辅助临床评价各种治疗方法的疗效。

患者男,35岁,因反复口腔、外阴溃疡,间断发热,多部位深静脉血栓1年入院。临床诊断白塞病可能性大。体格检查:颈部增粗,颈静脉怒张,胸壁及背部静脉显露,阴囊表面溃疡,针刺反应阳性。胸部正侧位 X 线检查示双下肺纹理增粗,右侧少量胸腔积液。CT 检查示下腔静脉内血栓形成,平肝门至髂静脉部分闭塞,腰、腹腔及腹壁静脉代偿性扩张。CT 血管造影（CTA）:上腔静脉内造影剂不均匀,近心端纤

患者男，35岁，因反复口腔、外阴溃疡，间断发热，多部位深静脉血栓1年入院。临床诊断白塞病可能性大。体格检查：颈部增粗，颈静脉怒张，胸壁及背部静脉显露，阴囊表面溃疡，针刺反应阳性。胸部正侧位X线检查示双下肺纹理增粗，右侧少量胸腔积液。CT检查示下腔静脉内血栓形成，平肝门至髂静脉部分闭塞，腰、腹腔及腹壁静脉代偿性扩张。CT血管造影（CTA）：上腔静脉内造影剂不均匀，近心端纤细；前后胸壁及腋窝内大量迂曲血管影。D-二聚体：1．33（正常0～0．2）mg／L，多次血气分析示低氧血症。为除外肺栓塞，至本科行肺灌注显像。采用GEHawkeye型SPECT仪，

OBJECTIVE:To study the safety, biodistribution, and dosimetry of myocardial perfusion imaging agent 99Tc(m)N-NOET in 10 healthy volunteers.METHODS:744-792 MBq of 99Tc(m)N-NOET was injected to each volunteer. Safety parameters and adverse event was measured in 24 hours of injection. Biodistribution was studied by whole-body imaging 1, 30 minutes, 1, 2, 4, 8, and 24 hours after the injection of 99Tc(m)N-NOET. The estimation of dosimetry was based on the standard medical internal radiation dose method using MIRDOSE 3.0 analysis program. Myocardial single photon emission computed tomography (SPECT) imaging was performed at 1 and 4 hours after injection.RESULTS:No undesirable effects were reported by the subject during 24 hours after injection of 99Tc(m)N-NOET. No clinically significant changes were found in vital signs (heart rate, blood pressure, and electrocardiogram). No biochemical aspects and serology changes were measured. The myocardial SPECT imaging was clear. Cardiac uptake of 99Tc(m)N-NOET was as high as 2.68% at 2 hours after injection. The heart to lung ratio was more than 1 from 30 minutes after injection, reaching a maximum of 1.91 +/- 0.53 at 2 hours after injection. Radiation dosimetry calculations indicated an effective absorbed dose of 1.28 x 10(-5) Sv/MBq. The dosimetry in each main organ is lower then 50 mGy given 740 MBq of 99Tc(m)N-NOET in once imaging.CONCLUSIONS:99Tc(m)N-NOET exhibits high cardiac uptake and low estimated effective absorbed dose. It's a safe myocardial perfusion imaging agent.

OBJECTIVETo evaluate the sensitivity and specificity of (99)Tc(m)-N-NOET myocardial perfusion tomographic imaging (MPI) for the diagnosis of coronary artery disease (CAD).METHODSCoronary angiography and (99)Tc(m)-N-NOET myocardial perfusion tomographic imaging were performed in the patients hospitalized in the Department of Cardiology, Peking Union Medical College Hospital, from June to December 2005 with known or suspected diagnosis of CAD. Adenosine was infused intravenously at a rate of 140 microg x kg(-1)min(-1) for 6 minutes. At the third minute of adenosine infusion, 740 MBq (20 mCi) (99)Tc(m)-N-NOET was injected intravenously. MPI was obtained 15 minutes after the (99)Tc(m)-N-NOET infusion. If the result was abnormal, rest myocardial perfusion imaging would be performed 2 hours later. Coronary angiography was performed in all patients within one week after the myocardial perfusion imaging.RESULTSMyocardial perfusion imaging was performed in 53 cases, 36 males and 17 females, aged 56 +/- 10, who underwent coronary angiography, among which 31 had > or = 50% stenosis of coronary artery and 23 had normal coronary artery. All of the patients with stenosis of coronary artery had positive (99)Tc(m)-N-NOET adenosine stress myocardial perfusion imaging. Nineteen out of the 29 cases without stenosis of coronary artery had negative adenosine myocardial perfusion imaging. The sensitivity and specificity of (99)Tc(m)-N-NOET adenosine myocardial perfusion imaging were 100% and 73% respectively in the detection of stenosis of coronary arteries. Seven cases got percutaneous coronary intervention and 2 got coronary artery bypass graft. Six of the 9 patients undergoing revascularization had stenosis of stents or grafts, 5 of which had positive myocardial perfusion imaging. 3 cases hadn't restenosis and their results of myocardial perfusion imaging were negative.CONCLUSION(99)Tc(m)-N-NOET myocardial perfusion imaging is a useful non-interventional method for detecting coronary artery stenosis.

Objective To study the in vivo stability of and absorbed radiation dose from 99mTc-RBC, prepared using RBC kit made in our laboratory. Methods Four healthy volunteers were studied with 99mTc-RBC prepared by kit method. Whole body images were acquired at 5 min, 1, 2.5, 4, 8 and 24 hours after intravenous injection of 481-555 MBq 99mTc-RBC. Biodistribution analysis was performed in regions of interest (ROI). The absorbed radiation doses were calculated using the MIRDOSE3.0 analysis program and the time-related activity curves for different organs were used for the residence time calculations. Results 99mTc-RBC prepared by kit method was stable in vivo. The quality of blood pool imaging from 5 min to 8 h in healthy volunteers was satisfactory. The absorbed radiation dose was lower than the permissible value. Conclusion 99mTc-RBC prepared by kit method is very suitable for clinical application.

A kit for preparing ~(99)Tc~m-SAA(small albumin aggregates) is obtained by heating the HSA solution and freeze-drying the product. The particle size detected by electron microscope is smaller than 80 nm which is suitable for bone marrow, inflammation and lymph imaging. The labeling yield with Na~(99)Tc~mO_4 is more than 99% and the labeling is stable within 4 hours. The biodistribution in mice shows that the ~(99)Tc~m-SAA excretes mostly from the urinary tract. High concentration of radioactivity in liver, spleen and marrow are observed and the bone marrow can be seen clearly from 30 to 60 minute after injection in rabbit imaging. The labeling method is simple,~(99)Tc~m-SAA has desirable stability, higher uptake in marrow and may serve promising as a new colloid imaging agent.

Objective To explore the diagnostic value of 18 F-fluorodeoxyglucose (FDG) dual-head coincidence (DHC) imaging for detecting breast cancer and axillary lymph node metastases. Methods Thirty-one female patients were studied by 18 F-FDG DHC imaging, and 21 of them received fine needle aspiration biopsy after 18 F-FDG DHC imaging. The results of 18 F-FDG DHC imaging and fine needle aspiration biopsy were compared with those of histopathology. Results ①Among the 26 cases of breast carcinoma by 18 F-FDG DHC imaging, the FDG uptake of 21 cases showed positive. The lesion diameters ranged from 1.7～8 (mean 3.2±1.6) cm, the lesion/background (L/B) ratio range was 1.4～7.3 (mean 2.4±1.3). The other 5 malignancies were negative, their diameter range was 0.8～3.3 (mean 1.9) cm. ②Ten cases of the malignancies were confirmed with axillary lymph node metastases. Three cases by 18 F-FDG DHC imaging were positive. Those lymph node diameters were 1.4, 1.8 and 5.2 cm, respectively. The L/B ratios were 1.3, 1.5 and 6.2, respectively. The other 7 cases were negative. The lymph node diameter range was 0.2～1.8 cm. ③Twenty-one cases received fine needle aspiration biopsy . Tumor cells were found in 13 cases. ④The sensitivity, specificity and accuracy of 18 F-FDG DHC imaging for diagnosing primary breast carcinoma were 80.8%, 5/5 and 83.9%, respectively. The sensitivity, specificity and accuracy of 18 F-FDG DHC imaging for diagnosing lymph node metastases were 30.0%, 100% and 77.4%, respectively. The sensitivity, specificity and accuracy of fine needle aspiration biopsy for diagnosing primary breast carcinoma were 72.2%, 3/3 and 76.2%, respectively. ⑤There was no significant difference between the sensitivity of 18 F-FDG DHC imaging and fine needle aspiration biopsy (P0.05). Conclusion 18 F-FDG DHC imaging possesses higher sensitivity and specificity in the diagnosis of breast cancer. It can be used as a noninvasive modality for evaluating breast cancer.