中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2013年
6期
448-454
,共7页
汪建华%孙高峰%张建%邵成伟%潘桂霞%彭烨%茅娟莉%郑建明%左长京
汪建華%孫高峰%張建%邵成偉%潘桂霞%彭燁%茅娟莉%鄭建明%左長京
왕건화%손고봉%장건%소성위%반계하%팽엽%모연리%정건명%좌장경
胰腺炎%感染%放射性核素显像%环丙沙星%体层摄影术,发射型计算机,单光子%体层摄影术,发射型计算机%磁共振成像%猪
胰腺炎%感染%放射性覈素顯像%環丙沙星%體層攝影術,髮射型計算機,單光子%體層攝影術,髮射型計算機%磁共振成像%豬
이선염%감염%방사성핵소현상%배병사성%체층섭영술,발사형계산궤,단광자%체층섭영술,발사형계산궤%자공진성상%저
Pancreatitis%Infection%Radionuclide imaging%Ciprofloxacin%Tomography,emissioncomputed,single-photon%Tomography,emission-computed%Magnetic resonance imaging%Swine
目的 探讨和比较99Tcm-环丙沙星SPECT、18F-FDG PET和MRI弥散加权显像(DWI)3种功能影像技术诊断重症胰腺炎(SAP)继发感染灶的价值.方法 实验用2月龄幼猪28只,分为感染性SAP组(16只),非感染性SAP组(6只)和对照组(6只).感染性SAP和非感染性SAP猪模型建立后7d,3组均分别行99Tcm-环丙沙星SPECT、18F-FDG PET和MRI检查.图像视觉分析:在SPECT和PET图像上,胰腺及周围有局限性边缘清晰的放射性摄取高于周围胰腺组织的区域视为阳性;等于周围组织者或无明显放射性浓聚者为阴性.MRI DWI示胰腺坏死灶有气泡征或在梯度因子为1000 s/mm2时呈高信号为感染阳性.定量分析:利用ROI技术在3种图像上分别测量、计算病灶/本底放射性计数比值、SUVmax和表观弥散系数(ADC).以病理和细菌学检查结果为“金标准”,计算和比较3种功能影像技术诊断SAP继发感染灶的诊断效能.采用Bonferroni检验、最小显著差异t检验及x2检验分析数据.结果 (1)视觉分析结果:99Tcm-环丙沙星SPECT显像鉴别SAP继发感染的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为93.8％ (15/16)、5/6、90.9％(20/22)、93.8％(15/16)和5/6; 18 F-FDG PET的对应值分别为81.2％ (13/16)、2/6、68.2％ (15/22)、76.5％(13/17)和2/5;MRI DWI的对应值分别为15.4％ (2/13)、5/6、36.8％(7/19)、2/3和31.3％(5/16).感染性SAP组3只幼猪MRI图像质量差,未纳入分析.99Tcm-环丙沙星SPECT和18F-FDG PET显像鉴别诊断的灵敏度均高于MRI DWI(均P＜0.05),但前两者间差异无统计学意义(P＞0.05);而18F-FDG PET显像的特异性较低.(2)定量分析结果:感染性SAP组的病灶/本底放射性计数比值随时间变化趋势与非感染性SAP组和对照组比较,差异有统计学意义(F=95.66,P＜0.001).18F-FDG PET早期显像,感染性SAP组SUVmax(2.61±1.07)和非感染组SUVmax(1.87±0.76)差异无统计学意义(P＞0.05),而在延迟显像上,感染性SAP组SUVmax(2.27±0.75)则高于非感染性SAP组(1.40±0.64)(P＜0.05).MRIDWI上,SAP感染性坏死区的ADC[(2.70±0.90)×10-3 mm2/s]与非感染性SAP组坏死区ADC[(3.61±0.84)×10-3 mm2/s]差异无统计学意义(P＞0.05);但感染性SAP组环形壁出现率(76.9％,10/13)高于非感染性SAP组(1/6) (P＜0.05).结论 99Tcm-环丙沙星SPECT检测SAP继发感染灶的灵敏度、特异性和准确性较高.18F-FDG PET显像灵敏度高,但特异性低.ADC值难以鉴别SAP感染性坏死灶和非感染性的出血坏死灶,但MRI DWI在SAP继发感染的鉴别诊断中可能具有潜在的应用价值.
目的 探討和比較99Tcm-環丙沙星SPECT、18F-FDG PET和MRI瀰散加權顯像(DWI)3種功能影像技術診斷重癥胰腺炎(SAP)繼髮感染竈的價值.方法 實驗用2月齡幼豬28隻,分為感染性SAP組(16隻),非感染性SAP組(6隻)和對照組(6隻).感染性SAP和非感染性SAP豬模型建立後7d,3組均分彆行99Tcm-環丙沙星SPECT、18F-FDG PET和MRI檢查.圖像視覺分析:在SPECT和PET圖像上,胰腺及週圍有跼限性邊緣清晰的放射性攝取高于週圍胰腺組織的區域視為暘性;等于週圍組織者或無明顯放射性濃聚者為陰性.MRI DWI示胰腺壞死竈有氣泡徵或在梯度因子為1000 s/mm2時呈高信號為感染暘性.定量分析:利用ROI技術在3種圖像上分彆測量、計算病竈/本底放射性計數比值、SUVmax和錶觀瀰散繫數(ADC).以病理和細菌學檢查結果為“金標準”,計算和比較3種功能影像技術診斷SAP繼髮感染竈的診斷效能.採用Bonferroni檢驗、最小顯著差異t檢驗及x2檢驗分析數據.結果 (1)視覺分析結果:99Tcm-環丙沙星SPECT顯像鑒彆SAP繼髮感染的靈敏度、特異性、準確性、暘性預測值和陰性預測值分彆為93.8％ (15/16)、5/6、90.9％(20/22)、93.8％(15/16)和5/6; 18 F-FDG PET的對應值分彆為81.2％ (13/16)、2/6、68.2％ (15/22)、76.5％(13/17)和2/5;MRI DWI的對應值分彆為15.4％ (2/13)、5/6、36.8％(7/19)、2/3和31.3％(5/16).感染性SAP組3隻幼豬MRI圖像質量差,未納入分析.99Tcm-環丙沙星SPECT和18F-FDG PET顯像鑒彆診斷的靈敏度均高于MRI DWI(均P＜0.05),但前兩者間差異無統計學意義(P＞0.05);而18F-FDG PET顯像的特異性較低.(2)定量分析結果:感染性SAP組的病竈/本底放射性計數比值隨時間變化趨勢與非感染性SAP組和對照組比較,差異有統計學意義(F=95.66,P＜0.001).18F-FDG PET早期顯像,感染性SAP組SUVmax(2.61±1.07)和非感染組SUVmax(1.87±0.76)差異無統計學意義(P＞0.05),而在延遲顯像上,感染性SAP組SUVmax(2.27±0.75)則高于非感染性SAP組(1.40±0.64)(P＜0.05).MRIDWI上,SAP感染性壞死區的ADC[(2.70±0.90)×10-3 mm2/s]與非感染性SAP組壞死區ADC[(3.61±0.84)×10-3 mm2/s]差異無統計學意義(P＞0.05);但感染性SAP組環形壁齣現率(76.9％,10/13)高于非感染性SAP組(1/6) (P＜0.05).結論 99Tcm-環丙沙星SPECT檢測SAP繼髮感染竈的靈敏度、特異性和準確性較高.18F-FDG PET顯像靈敏度高,但特異性低.ADC值難以鑒彆SAP感染性壞死竈和非感染性的齣血壞死竈,但MRI DWI在SAP繼髮感染的鑒彆診斷中可能具有潛在的應用價值.
목적 탐토화비교99Tcm-배병사성SPECT、18F-FDG PET화MRI미산가권현상(DWI)3충공능영상기술진단중증이선염(SAP)계발감염조적개치.방법 실험용2월령유저28지,분위감염성SAP조(16지),비감염성SAP조(6지)화대조조(6지).감염성SAP화비감염성SAP저모형건립후7d,3조균분별행99Tcm-배병사성SPECT、18F-FDG PET화MRI검사.도상시각분석:재SPECT화PET도상상,이선급주위유국한성변연청석적방사성섭취고우주위이선조직적구역시위양성;등우주위조직자혹무명현방사성농취자위음성.MRI DWI시이선배사조유기포정혹재제도인자위1000 s/mm2시정고신호위감염양성.정량분석:이용ROI기술재3충도상상분별측량、계산병조/본저방사성계수비치、SUVmax화표관미산계수(ADC).이병리화세균학검사결과위“금표준”,계산화비교3충공능영상기술진단SAP계발감염조적진단효능.채용Bonferroni검험、최소현저차이t검험급x2검험분석수거.결과 (1)시각분석결과:99Tcm-배병사성SPECT현상감별SAP계발감염적령민도、특이성、준학성、양성예측치화음성예측치분별위93.8％ (15/16)、5/6、90.9％(20/22)、93.8％(15/16)화5/6; 18 F-FDG PET적대응치분별위81.2％ (13/16)、2/6、68.2％ (15/22)、76.5％(13/17)화2/5;MRI DWI적대응치분별위15.4％ (2/13)、5/6、36.8％(7/19)、2/3화31.3％(5/16).감염성SAP조3지유저MRI도상질량차,미납입분석.99Tcm-배병사성SPECT화18F-FDG PET현상감별진단적령민도균고우MRI DWI(균P＜0.05),단전량자간차이무통계학의의(P＞0.05);이18F-FDG PET현상적특이성교저.(2)정량분석결과:감염성SAP조적병조/본저방사성계수비치수시간변화추세여비감염성SAP조화대조조비교,차이유통계학의의(F=95.66,P＜0.001).18F-FDG PET조기현상,감염성SAP조SUVmax(2.61±1.07)화비감염조SUVmax(1.87±0.76)차이무통계학의의(P＞0.05),이재연지현상상,감염성SAP조SUVmax(2.27±0.75)칙고우비감염성SAP조(1.40±0.64)(P＜0.05).MRIDWI상,SAP감염성배사구적ADC[(2.70±0.90)×10-3 mm2/s]여비감염성SAP조배사구ADC[(3.61±0.84)×10-3 mm2/s]차이무통계학의의(P＞0.05);단감염성SAP조배형벽출현솔(76.9％,10/13)고우비감염성SAP조(1/6) (P＜0.05).결론 99Tcm-배병사성SPECT검측SAP계발감염조적령민도、특이성화준학성교고.18F-FDG PET현상령민도고,단특이성저.ADC치난이감별SAP감염성배사조화비감염성적출혈배사조,단MRI DWI재SAP계발감염적감별진단중가능구유잠재적응용개치.
Objective To compare the diagnostic values of 99Tcm-ciprofloxacin SPECT,18F-FDG PET and MR diffusion weighted imaging (DWI) for detecting secondary infection associated with severe acute pancreatitis (SAP) in swine.Methods Swine models were constructed and grouped,including control group (normal swine,n =6),non-infected SAP group (inoculated with inactivative Escherichia coli,n =6)and infected SAP group (inoculated with Escherichia coli,n=16).At 7 d after inoculation,a series of 99Tcmciprofloxacin SPECT,18 F-FDG PET and MR DWI scans were performed.The imaging findings were visually evaluated and semi-quantitative analyzed.Lesion-background radioactive counts ratio (L/B),SUVmax and the apparent diffusion coefficient (ADC) were calculated.The image results were compared with histopathological and bacteriological results,and the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were calculated.Bonferroni test,the least significant difference t test and x2 test were used for statistical data analysis.Results (1) The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 99Tcm-ciprofloxacin SPECT via visual analysis were 93.8％ (15/16),5/6,90.9％(20/22),93.8％(15/16) and 5/6,whereas 81.2％(13/16),2/6,68.2％(15/22),76.5％(13/17) and 2/5 for 18F-FDG PET,and 15.4％(2/13),5/6,36.8％(7/19),2/3 and 31.3％(5/16) for MRI DWI respectively.Both 99Tcm-ciprofloxacin SPECT and 18F-FDG PET had higher sensitivities (both P＞0.05),but the specificity of 18 F-FDG PET was lower.(2)99Tcm-ciprofloxacin imaging showed the changes of L/B for the infected SAP swine were significantly different from those of the non-infected and normal swine (F=95.66,P＜0.001).18F-FDG PET early-phase images showed SUVmax was not significantly different between infected SAP (2.61±1.07) and non-infected SAP (1.87±0.76) groups (P＞0.05),but the SUVmax of infected SAP group was higher than that of non-infected SAP group on delayed images (2.27±0.75 vs 1.40±0.64; P＜0.05).DWI image showed the difference of ADC values between infectious foci ((2.70±0.90) × 10-3 mm2/s) and non-infected necrosis ((3.61±0.84) × 10-3 mm2/s) was not significant (P＞0.05).However,the incidence of hyperintense ring in infected SAP group (76.9％,10/13) was higher than that in non-infected SAP group (1/6; P＜0.05).Conclmions 99Tcm-ciprofloxacin SPECT has potential to detect SAP secondary infection with higher sensitivity,specificity and accuracy.18F-FDG PET has high sensitivity but low specificity.ADC values are difficult to distinguish infectious foci from aseptic necrosis,but DWI may have value for diagnosing SAP secondary infection.
