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Objective:To compare the 99Tc m-dextran(DX) lymphoscitigraphy and direct lymphography (DLG), in order to investigate the imaging features and clinical significance of 99Tc m-DX lymphoscitigraphy in patients with thoracic duct exports (TDE)obstruction. Methods:A total of 304 patients (140 males, 164 females, median age: 32 years) with TDE obstruction confirmed by thoracic duct exploration between 2017-01-01 and 2019-01-01 in Beijing Shijitan Hospital were retrospectively analyzed. Based on the different imaging characteristics of TDE, the reluts of 99Tc m-DX lymphoscitigraphy were divided into five groups (Ⅰ: no TDE presenting; Ⅱ: TDE presenting temporarily; Ⅲ: TDE presenting constantly or extensively; Ⅳ: abnormal reflux of imaging agents; Ⅴ: bilateral venous angle presenting). Ⅰ/Ⅱ groups were regarded as negative and Ⅲ-Ⅴ groups as positive. The consistency of 99Tc m-DX lymphoscitigraphy with DLG was evaluated with Kappa test, and the positive rates of the two methods were compared by McNemar test. Results:In the detection of TDE, the positive rate of 99Tc m-DX lymphoscintigraphy was 70.1% (213/304), which was significantly lower than that of DLG (97.4%, 296/304; χ2=4.16, P<0.001). The group Ⅲ has the largest number of cases (54.9%, 167/304), and there was a low consistency with DLG ( Kappa=0.08, P=0.005). However, there was a higher consistency between 99Tc m-DX lymphoscintigraphy results and the corresponding DLG results in the groups Ⅳ/Ⅴ ( Kappa values: 0.48, 0.86, both P<0.001). Furthermore, the diagnostic accordance rates of lower extremity lymphedema and chylous effusion were 96.1%(98/102) and 83.6%(127/152), respectively, compared with the clinical diagnosis. Conclusions:TDE obstruction of 99Tc m-DX lymphoscitigraphy presents in the majority with Ⅲ type. 99Tc m-DX lymphoscitigraphy results in patients with type Ⅳ and Ⅴ have a better consistency with those of DLG. 99Tc m-DX lymphoscitigraphy can be used as a screening tool of TDE obstruction, and play a role in the diagnosis of lower limb lymphedema and chylous effusion caused by TDE obstruction.
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Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.
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Objective To evaluate the value of imaging examinations in the treatment of lymphangioleiomyomatosis (LAM) with chylothorax by thoracic duct extremity exploration.Methods Data of 34 LAM with chylothorax confirmed by pathology and clinical diagnosis were retrospectively analyzed.All patients underwent 99Tcm-DX lymphoscintigraphy and CT lymphangiography (CTL).Thoracic duct lesion types of 99Tcm-DX lymphoscintigraphy were type Ⅰ (abnormal concentration pattern),type Ⅱ (ectopic drainage pattern),and type Ⅲ (without image or transient image pattern).The type Ⅰ and type Ⅱ were diagnosed as thoracic duct abnormalities.Thoracic duct lesion types of CTL were type Ⅰ (dilatation pattern),type Ⅱ (distal obstruction pattern),type l (truck constriction pattern),type Ⅳ (ectopic drainage pattern),and type Ⅴ (no-display pattern).Type Ⅰ-Ⅳ were diagnosed as thoracic duct abnormalities.Consistency of displaying thoracic duct abnormalities between 99Tcm-DX lymphoscintigraphy and CTL was evaluated.Results The thoracic duct abnormalities in 99Tcm-DX lymphoscintigraphy were 58.82％ (20/34;type Ⅰ in 17,type Ⅱ in 3,type Ⅲ in 14),and in CTL were 73.53％ (25/34;type Ⅰ in 15,type Ⅱ in 3,type Ⅲ in 5,type Ⅳ in 2,type Ⅴ in 9).The consistency of CTL and 99Tcm-DX lymphoscintigraphy for detecting thoracic duct abnormalities was good (Kappa=0.679).In CTL thoracic duct types,type Ⅰ and Ⅱ were operated by thoracic duct-venous anastomosis or thoracic duct extremity release operation,type Ⅲ was operated by thoracic duct adhesion or compression band release operation,operative approach and method were chosen according to the abnormal thoracic duct flow path in type Ⅳ,type Ⅴ was took conservative treatment.Conclusion CTL is superior to 99Tcm-DX lymphoscintigraphy,which can clearly display the type of thoracic duct lesion and provide imaging informations to choose operation methods in thoracic duct exploration treatment for LAM with chylothorax.
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Objective To evaluate the value of 18F-fluorodeoxyglucose (FDG) PET/CT in evaluation of curative effect and progression-free survival (PFS) for lymphoma patients.Methods The data of 85 lymphoma patients were retrospectively analyzed.Before and after 4-8 cycles standardized chemotherapy,the patients were evaluated with 18F-FDG PET/CT.The two-year PFS rate was compared.The value of 18F-FDG PET/CT in evaluation of curative effect and PFS for lymphoma patients received chemoradiotherapy was analyzed.Results The non Hodgkin lymphoma (NHL) was the common type,and the common pathogenic sites were head and neck lymph nodes,mediastinum and retroperitoneum.The majority of patients were accompanied with spleen enlargement and local lesions with high metabolism.The complete remission (CR) rate of Hodgkin lymphoma (HL)patients in PET/CT negative group was significantly higher than that in positive group (86.4％ vs.42.9％,P =0.038).The two-year PFS rates in PET/CT positive group and negative group were 42.9％ and 81.8％,and the difference was statistically significant (x2 =7.70,P =0.006).Thirty-five NHL patients achieved CR,13 achieved partial remission (PR),and 8 achieved stable disease (SD) or disease progression (PD).The two-year PFS rates in the CR group,PR group,SD or PD group were 89.7％,65.3％ and 19.4％ respectively,and the difference was statistically significant (x2 =12.41,P =0.002).PET/CT imaging had a strong PFS predictive effect on T cell lymphoma (TCL) patients (x2 =13.85,P =0.001) and diffuse large B cell lymphoma (DLBCL)patients (x2=13.51,P =0.001),and had no predictive effect on follicular lymphoma (FL) patients (x2 =4.63,P =0.099).Conclusion 18 F-FDG PET/CT can evaluate the curative effect of lymphoma effectively and early predict prognosis,and has great guiding significance in choosing therapeutic schedule.
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<p><b>OBJECTIVE</b>To evaluate the efficiency of (99)Tc(m)-sestamibi (MIBI) in the diagnosis of parathyroid diseases with primary hyperparathyroidism.</p><p><b>METHODS</b>One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed. With MIBI, single adenoma was found in 91 cases, two adenomas in 5 cases, carcinoma and hyperplasia in 3 cases respectively. Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients, while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination. Parathroid hormone levels ranged from 98 to 2 800 ng/L, and serum calcium levels were between 2.56-4.23 mmol/L.</p><p><b>RESULTS</b>The sensitivity of MIBI for total diseased parntyroids was 84.0% (100/119), and that for parathyroid adenoma, parnthyroid carcinoma, atypical adenoma and primary parathyroid hyperplasia was 87.1% (88/101), 3/3, 2/2 and 7/13, respectively.</p><p><b>CONCLUSIONS</b>MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism. The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability, and thyroid nodule is additional source leading to false-positive results.</p>
Subject(s)
Humans , Adenoma , Carcinoma , Hyperparathyroidism, Primary , Diagnosis , Hyperplasia , Parathyroid Glands , Parathyroid Neoplasms , Parathyroidectomy , Radiopharmaceuticals , Reproducibility of Results , Technetium Tc 99m Sestamibi , Thyroid NoduleABSTRACT
Objective To evaluate the clinical features and efficiency of surgical treatment in elderly patients with parathyroid tumor.Methods Clinical data of 12 cases (aged 60-83 years) was retrospectively analyzed.Their main complaints varies individually,including bone and muscle trouble in 9 patients,abdominal problem in 7 ones,and kidney stone in 6 ones.PTH level ranged from 78 to 2850 μg/L,and calcium level 2.6-4.5 mmol/L.Parathyroidectomy was carried out in 8 patients,while extended excision of suspected tissues in 6 ones.Intraoperative PTH determination was routinely performed.Results A drop by at least 50％ in PTH level was achieved in all cases after 10 minutes of tumor-bearing tissues excision.A much improvement of main complaints was shown in all cases about 1 week postoperatively.During the follow-up period from 18 to 48 months,both PTH and calcium levels were still in normal range in 9 patients,relapse was noticed in two cases 1 or 2 years after operation respectively.One patient died even after successful excision of parathyroid tumor.Conclusions PTH and calcium level determination is advised in elderly patients with suspected parathyroid tumor,and surgical treatment is generally safe and effective.