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(SPEC...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.展开更多
AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-galactosyl-human serum albumin (GSA) single-photon emission com...AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-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 <sup>99m</sup>Tc-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/<sup>99m</sup>Tc-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 cong展开更多
目的比较硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 心肌血流灌注显像与^(18)F-FDG PET 心肌代谢显像评估心肌活力的价值。方法既往有心肌梗死史伴左心功能不全经冠状动脉造影确诊为冠心病的患者36例,行二日法静息和硝酸甘油介入^(99)Tc...目的比较硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 心肌血流灌注显像与^(18)F-FDG PET 心肌代谢显像评估心肌活力的价值。方法既往有心肌梗死史伴左心功能不全经冠状动脉造影确诊为冠心病的患者36例,行二日法静息和硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 显像,并在1周内再行^(18)F-FDG PET 心肌代谢显像及静息超声心动图检查。将左心室分成13个节段,分析超声心动图室壁运动,并分析相同节段^(99)Tc^m-tetrofosmin 与^(18)F-FDG 的相对摄取比值,以^(99)Tc^m-tetrofosmin 摄取比值55%,^(18)F-FDG 摄取比值50%为判断心肌活力有无的阈值。以 k 统计比较3种方法的一致性。结果超声心动图示131个节段呈无运动或反向运动。^(99)Tc^m-tetrofosmin 静息显像示其中78个节段(60%)心肌有活力,53个节段(40%)无活力。该53个节段中14个(26%)在硝酸甘油介入后可见再填充,余39个节段无改变。在^(18)F-FDG PET 显像中,硝酸甘油介入显像再填充节段的心肌放射性摄取明显增高。再填充节段与无填充节段比较,心肌 FDG 摄取分别为(76±15)%和(58±17)%,差异有统计学意义(P<0.01)。硝酸甘油介入显像中,92个心肌节段(70%)有活力,39个无活力。tetrofosmin静息显像评估心肌活力与 FDG PET 显像比较,k 值为0.35,而硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT与^(18)F-FDG PET 显像结果比较,k 值为0.53。结论硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 显像可提高对心肌活力的检测能力,与^(18)F-FDG PET 心肌代谢显像有很好的一致性。展开更多
BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,ch...BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.展开更多
文摘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.
文摘AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/<sup>99m</sup>Tc-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 <sup>99m</sup>Tc-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/<sup>99m</sup>Tc-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 cong
文摘目的比较硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 心肌血流灌注显像与^(18)F-FDG PET 心肌代谢显像评估心肌活力的价值。方法既往有心肌梗死史伴左心功能不全经冠状动脉造影确诊为冠心病的患者36例,行二日法静息和硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 显像,并在1周内再行^(18)F-FDG PET 心肌代谢显像及静息超声心动图检查。将左心室分成13个节段,分析超声心动图室壁运动,并分析相同节段^(99)Tc^m-tetrofosmin 与^(18)F-FDG 的相对摄取比值,以^(99)Tc^m-tetrofosmin 摄取比值55%,^(18)F-FDG 摄取比值50%为判断心肌活力有无的阈值。以 k 统计比较3种方法的一致性。结果超声心动图示131个节段呈无运动或反向运动。^(99)Tc^m-tetrofosmin 静息显像示其中78个节段(60%)心肌有活力,53个节段(40%)无活力。该53个节段中14个(26%)在硝酸甘油介入后可见再填充,余39个节段无改变。在^(18)F-FDG PET 显像中,硝酸甘油介入显像再填充节段的心肌放射性摄取明显增高。再填充节段与无填充节段比较,心肌 FDG 摄取分别为(76±15)%和(58±17)%,差异有统计学意义(P<0.01)。硝酸甘油介入显像中,92个心肌节段(70%)有活力,39个无活力。tetrofosmin静息显像评估心肌活力与 FDG PET 显像比较,k 值为0.35,而硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT与^(18)F-FDG PET 显像结果比较,k 值为0.53。结论硝酸甘油介入^(99)Tc^m-tetrofosmin SPECT 显像可提高对心肌活力的检测能力,与^(18)F-FDG PET 心肌代谢显像有很好的一致性。
文摘BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.
