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In order to help the standardized residency training of nuclear medicine residents, the standardized residency training base of nuclear medicine residents in Peking University People's Hospital, combined with forty-five nuclear medicine departments of teaching hospital, established the WeChat official account of "Standardized Residency Training of Nuclear Medicine" and submitted one teaching case per week. The appearance of the WeChat official account of "Standardized Residency Training of Nuclear Medicine" has made up for the shortcomings of insufficient teaching cases in a single training base, strengthened the training of residents' imaging diagnostic thinking, and promoted mutual learning among the bases. By writing teaching cases, instructors and residents have opened up ideas, increased knowledge, improved self-learning ability, and cultivated imaging diagnostic thinking. With the flexible and practical features of the WeChat official account, the consciousness and sustainability of residents' learning have been enhanced.
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Objective:To evaluate the clinical value of the superior thyroid artery peak systolic velocity (STA-PSV) for the differential diagnosis of autoimmune thyrotoxicosis.Methods:A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism, Peking University People′s Hospital from Jan. 2015 to Oct. 2018. Among them, 241 patients were with Graves′ disease (GD) and 60 patients were with autoimmune thyroiditis (AIT). STA-PSV, thyroid function and thyrotropin receptor antibody (TRAb) were determined. A multiple linear regression was used to identify factors associated with STA-PSV. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the discriminating ability of STA-PSV to GD.Results:STA-PSV leves in GD group were significantly higher than those in AIT group [61.00 (41.00, 86.50) cm/s vs. 34.50 (25.25, 46.00) cm/s, P<0.001]. The ROC curve analysis showed that the AUC was 0.790 (95 %CI 0.734-0.845), and 49.5cm/s was the optimal cutoff point for the diagnosis of GD, in which the sensitivity was 64.3% and the specificity was 83.3%. In all patients with thyrotoxicosis, multiple linear regression analyses showed free thyroxine (FT 4) (β=0.371, 95 %CI 0.005-0.010, P<0.001) and TRAb (β=0.138, 95 %CI 0.001-0.014, P=0.035) were positively associated with STA-PSV. Conclusions:The STA-PSV is positively associated with FT 4 and TRAb levels, and it is a helpful marker in differential diagnosis between GD and AIT.
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Objective:To further understand the etiological distribution of fever of unknown origin (FUO) in patients underwent 18F-fluorodeoxyglucose (FDG) PET/CT imaging, and to explore the significance of 18F-FDG PET/CT in the diagnosis of different types of diseases in FUO patients. Methods:From January 2013 to August 2019, the clinical and PET/CT image data of 466 FUO patients (194 males, 272 females, age: 3-91(52.7±20.9) years) in Peking University People′s Hospital were retrospectively analyzed. The etiological distribution of FUO patients was analyzed according to the final clinical diagnosis. PET/CT imaging manifestations were analyzed for different types of diseases in FUO patients. The role of 18F-FDG PET/CT in differential diagnosis for FUO was evaluated through clinical questionnaire. Data were analyzed by using χ2 test. Results:The common disease types in FUO patients were rheumatic and immune disease (48.7%, 227/466), infection (28.5%, 133/466) and malignant tumor (11.2%, 52/466). For PET/CT imaging, 95.5% (445/466) of the patients were positive, of which 313 (70.3%, 313/445) were found to have focal lesions, and the other 132 (29.7%, 132/445) showed only nonspecific abnormal uptake. Lesions in different types of diseases were varied in the location, morphological changes as well as FDG uptake. The results of the questionnaire showed that PET/CT imaging could benefit 95.9% (447/466) of the patients in the FUO diagnosis and treatment. PET/CT reached direct etiological diagnosis of malignant tumors more frequently than other types of diseases ( χ2 values: 14.408-25.466, all P<0.001). PET/CT helped or directly reached the etiological diagnosis of rheumatologic diseases more frequently than infection and unknown cause group( χ2 values: 7.922, 9.647, both P<0.05). Conclusion:18F-FDG PET/CT imaging has high clinical value in the diagnosis of FUO etiology and can provide multilevel diagnostic information.
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Objective:To explore the clinical value of 18F-fluorodeoxyglucose (FDG) PET/CT in panniculitis presenting as fever of unknown origin (FUO). Methods:Patients with FUO ( n=503) who underwent 18F-FDG PET/CT examination in Peking University People′s Hospital between January 2013 and December 2019 were retrospectively analyzed, and those with final diagnosis of panniculitis were enrolled. The clinical and imaging data of patients with panniculitis were evaluated. Results:Five of the 503(0.99%) patients with FUO who underwent PET/CT imaging were diagnosed with panniculitis. Their age ranged from 41 to 76 years, and 3 of them were females. The main clinical manifestation was fever. Laboratory tests showed an increase in erythrocyte sedimentation rate and C-reactive protein. The 18F-FDG PET/CT imaging found localized FDG uptake foci in multiple adipose tissue, with maximum standardized uptake value (SUV max) ranging from 0.8 to 5.0. Those lesions located in subcutaneous adipose tissue ( n=3), mesenteric adipose tissue ( n=3) and other adipose tissue in abdominal cavity and retro peritoneum ( n=1). Diffusely increased FDG uptake of the spleen was found in 4 patients, diffusely increased FDG uptake of bone marrow was found in 3 patients, and multiple reactive hyperplasia lymph nodes was found in 2 patients. In addition, in 2 patients with the scanning field extended to the mid-thigh, high FDG uptake of the polyarticular synovium was also seen. Conclusions:Panniculitis has some characteristics on 18F-FDG PET/CT imaging. 18F-FDG PET/CT is helpful for etiological diagnosis of FUO caused by panniculitis.
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Objective@#To evaluate the clinical value of the superior thyroid artery peak systolic velocity (STA-PSV) for the differential diagnosis of autoimmune thyrotoxicosis.@*Methods@#A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism, Peking University People′s Hospital from Jan. 2015 to Oct. 2018. Among them, 241 patients were with Graves′ disease (GD) and 60 patients were with autoimmune thyroiditis (AIT). STA-PSV, thyroid function and thyrotropin receptor antibody (TRAb) were determined. A multiple linear regression was used to identify factors associated with STA-PSV. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the discriminating ability of STA-PSV to GD.@*Results@#STA-PSV leves in GD group were significantly higher than those in AIT group [61.00 (41.00, 86.50) cm/s vs. 34.50 (25.25, 46.00) cm/s, P<0.001]. The ROC curve analysis showed that the AUC was 0.790 (95%CI 0.734-0.845), and 49.5cm/s was the optimal cutoff point for the diagnosis of GD, in which the sensitivity was 64.3% and the specificity was 83.3%. In all patients with thyrotoxicosis, multiple linear regression analyses showed free thyroxine (FT4) (β=0.371, 95%CI 0.005-0.010, P<0.001) and TRAb (β=0.138, 95%CI 0.001-0.014, P=0.035) were positively associated with STA-PSV.@*Conclusions@#The STA-PSV is positively associated with FT4 and TRAb levels, and it is a helpful marker in differential diagnosis between GD and AIT.
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Objective To investigate the clinical and CT features of basal cell adenomas (BCA)of parotid gland,and to improve the understanding of the disease.Methods Clinical and CT data of 1 8 patients with BCA of parotid gland confirmed by surgery and pathology were collected.The characteristics of age,sex,clinical symptom,lesion site,number,size,shape,density and CT dualGphase enhancement of the lesions were retrospectively analyzed.Results (1)Age and sex of onset:1 2 cases(6 6.6 7%)of age stage from 30 to 5 9,5 cases (27.78%)of the elder over 60,1 case of the younger below 29,5 cases (27.78%)for males,1 3cases (72.22%)for females,the incidence ratio of male to female being 1 ︰ 2.5.(2)Clinical manifestations:there were sporadic masses in the parotid region,3 cases were accompanied by mild pain and all patients had no facial nerve symptoms.(3)Location site,number,size:23 lesions in 18 cases, of which 15 cases (83.3%)were single and 3 cases (16.7%)had multiple lesions on one side.17 lesions (73.9%)were located in superficial lobe, and 6 lesions (26.1%)were located in the deep lobe;(4)Shape and cross section diameter:the shape of the tumor was round or ellipse with wellG defined margin,13 cases (56.5%)of the round shape,10 cases (43.5%)of the ellipse;the maximum cross section diameter was (2.49±1.3 8)cm,the superficial lobe group was (2.05 ±1.02)cm,and the deep lobe group was (3.73 ±1.59)cm.The difference between the two groups on the maximum cross section diameter was significant (P＜ 0.05).(5)Density:the density of most lesions was heterogeneous.17 lesions were accompanied by central or peripheral cystic degeneration of varying degrees,of which 10 lesions with cystic regions ＞ 50% and 2 lesions with maximum transverse diameter ＜ 0.8 cm.(6)CT dualGphase enhancement:19 lesions showed obvious homogeneous or heterogeneous enhancement on the arterial phase,and persistent enhancement on the venous phase.4 lesions showed progressive heterogeneous enhancement,and the enhancement degree of venous phase was even higher than that of arterial phase.Conclusion The BCA of the parotid gland aremainly occuring in middleGaged and older women,displaying regular shape of lesions,developing to cystic degeneration easily and presenting＂fastGelevation and sustained enhancement＂or progressive enhancement patterns in the dualGphase enhanced scans.These characteristics are helpful to make a diagnosis preoperatively.
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Objective To explore the value of HRCT and contrast-enhanced MRI in diagosis of facial nerve injuries.Methods HRCT and contrast-enhanced MRI were performed in 18 cases of facial nerve injuries.CPR of the facial nerve and canal was performed on the Philips EBW workstation,and the temporal bone involved location,fracture type and involvement of facial nerve and canal and its course were observed.The involved location,size,signal variation of facial nerve were analyzed compared with contralateral side on the GE AW 4.5 workstation.Results Among 18 cases,8 cases of longitudinal fractures,5 cases of transverse fractures and 5 cases of mixed fractures were found.HRCT axial scan and CPR of facial canal revealed that 18 cases had temporal bone fractures,including 1 case of labyrinthine segment,2 cases of geniculate fossa,4 cases of tympanic segment,2 cases of geniculate fossa,tympanic segment and hematoma of middle ear cavity,3 cases of tympanic segment with adjacent hematoma of middle ear cavity and 6 cases without obvious fracture of facial canal.Contrast-enhanced MRI and CPR of facial nerve revealed facial nerve injuries in all 18 cases,including 12 cases of internal auditory meatus segment,14 cases of labyrinthine segment,18 cases of geniculate ganglion,16 cases of tympanic segment and 15 cases of mastoid segment.Signal intensity ratio of affected internal auditory meatus segment,labyrinthine segment,geniculate ganglion,tympanic segment and mastoid segment were higher than those of contralateral side (all P＜ 0.001).Conclusion HRCT and contrast-enhanced MRI can clearly reveal the involvement of different segment of traumatic facial nerve,HRCT CPR and MR CPR are helpful to visualiz the involvement of traumatic facial nerve and canal.
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Objective To explore 18F-FDG PET/CT characteristics of extramedullary relapse in patients with acute leukemia (AL).Methods Thirty AL patients with extramedullary relapse were retrospectively evaluated.The infiltrated organs or tissues and the maximum standardized uptake value (SUVmax) were recorded and compared between patients with acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML).FDG uptake pattern of bone marrow was also recorded.Results Forty-five extramedullary lesions were found in 16 ALL patients,while 29 were found in 14 AML patients.The average SUVmax was 7.38±4.46 in ALL patients and 4.87±2.66 in AML patients (t=3.022,P=0.003).Among ALL patients,lymph node and soft tissue involvement were detected each in 10,with SUVmax of 6.38 ± 3.55 and 10.12± 5.48,respectively.Among AML patients,lymph node and soft tissue involvement were detected in 6,with SUVmax of 4.82 ±1.43 and 6.60±4.58,respectively (P＞0.05).Multiple focal bone marrow uptakes of FDG were found in 5 of 5 intramedullary recurrence ALL patients and 2 of 5 intramedullary recurrence AML patients.The other 3 intramedullary recurrence AML patients showed diffuse bone marrow uptake.Conclusion There are certain imaging characteristics of 18 F-FDG PET/CT in extramedullary relapse of AL.The common relapse sites are lymph node and soft tissues in both ALL and AML.FDG uptakes of extramedullary relapse lesions in ALL are significantly higher than those of AML.Multiple focal bone marrow uptake of FDG is valuable in predicting intramedullary recurrence.
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Objective To explore the application value of contrast-enhanced MRI and curved planar reformation (CPR) in diagnosis of facial neuritis.Methods Contrast-enhanced MRI scans were performed on 30 patients with facial neuritis.The involvement of intracranial facial nerve was observed,and the signal intensity of facial nerve and adjacent temporal lobe was measured with GE AW 4.5 workstation.While the signal intensity ratio (SIR) between facial nerve and adjacent temporal lobe was calculated.CPR of facial nerve was done with Philips EBW workstation,in order to observe the whole course and involvement of facial nerve.Results Among the 30 patients,SIR of affected geniculate ganglion,tympanic segment,labyrinthine segment,internal auditory meatus segment and mastoid segment was 1.59±0.28,1.16±0.16,1.38±0.20,1.30 ±0.19 and 0.96±0.14,respectively.While SIR of the relevant segment in contralateral side was 1.08±±0.19,0.74±0.13,0.81±0.13,0.83±0.08 and 0.69±0.12,respectively.There were significant differences of SIR between the affected and the contralateral segments (all P＜0.001).CPR could display the involved location and facilitate visualizing the whole course of facial nerve clearly.Conclusion Contrast-enhanced MRI and CPR are helpful to facilitate visualizing the whole course of facial nerve and clearly reveal the involvement.
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Objective To explore the value of HRCT for the diagnosis of internal ear injuries caused by temporal bone trauma.Methods Totally 106 patients with temporal bone trauma were scanned by HRCT,and 12 patients with internal ear injuries were collected.MPR of temporal bone (cochlea,vestibule,horizontal semicircular canal,anterior semicircular canal and posterior semicircular canal) was performed on Philips workstation.The locations,types,and the involving structures were observed.Results Among the 106 cases of temporal bone trauma,12 cases were internal ear injuries,including 8 cases of fractures of inner ear,3 cases of pneumolabyrinth,and 1 case of foreign body in the cochlea,which 3 cases complicated with traumatic labyrinthine ossification.Conclusion HRCT and MPR can clearly reveal internal ear injuries,which are effective methods for diagnosis of internal ear injuries.
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Objective To explore the application value of 256-slice high resolution CT(HRCT)and reconstuction technique in the preoperative assessment of ossicular chain trauma.Methods 106 cases of temporal bone trauma were scanned using 256-slice HRCT,38 cases of ossicular chain trauma were collected.The multi-planar reformaition(MPR),curved plannar reformation(CPR) and three-dimensional volume rendering reformation (3D VR)of the ossicular chain were performed on Philips work station.The locations, types and the involving structures were analyzed,then these cases were followed up.The display rates of AX,MPR,CPR,3D VR were evaluated.Results Among 106 cases of temporal bone trauma,38 cases(76 ears)were found ossicular chain trauma,in which there were 43 ears of ossicular dislocation,22 ears incudomalleolar joint separation,6 ears incudomalleolar and incudostapedial joint separation,3 ears incudostapedial joint separation,11 ears translocation of the ossicles,1 ear stapediovestibular dislocation;4 ears ossicular fractures,2 ears fracture of the malleus,1 ear fracture of the incus,1 ear fracture of the stapes.Among 38 cases,11 cases underwent surgery,and the surgical results were consistent with CT findings.The display rates of AX,MPR,CPR,3D VR were 97.87％,100％, 97.87％,82.98％ respectively.Conclusion 256-slice HRCT and reconstuction technique can clearly reveal the whole structure of ossicular chain trauma,which are effective methods for diagonsis of ossicular chain trauma before surgery.
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Objective To explore the value of HRCT for the diagnosis of internal ear injuries caused by temporal bone trauma.Methods Totally 106 patients with temporal bone trauma were scanned by HRCT,and 12 patients with internal ear injuries were collected.MPR of temporal bone (cochlea,vestibule,horizontal semicircular canal,anterior semicircular canal and posterior semicircular canal) was performed on Philips workstation.The locations,types,and the involving structures were observed.Results Among the 106 cases of temporal bone trauma,12 cases were internal ear injuries,including 8 cases of fractures of inner ear,3 cases of pneumolabyrinth,and 1 case of foreign body in the cochlea,which 3 cases complicated with traumatic labyrinthine ossification.Conclusion HRCT and MPR can clearly reveal internal ear injuries,which are effective methods for diagnosis of internal ear injuries.
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Objective To explore the application value of 256-slice high resolution CT(HRCT)and reconstuction technique in the preoperative assessment of ossicular chain trauma.Methods 106 cases of temporal bone trauma were scanned using 256-slice HRCT,38 cases of ossicular chain trauma were collected.The multi-planar reformaition(MPR),curved plannar reformation(CPR) and three-dimensional volume rendering reformation (3D VR)of the ossicular chain were performed on Philips work station.The locations, types and the involving structures were analyzed,then these cases were followed up.The display rates of AX,MPR,CPR,3D VR were evaluated.Results Among 106 cases of temporal bone trauma,38 cases(76 ears)were found ossicular chain trauma,in which there were 43 ears of ossicular dislocation,22 ears incudomalleolar joint separation,6 ears incudomalleolar and incudostapedial joint separation,3 ears incudostapedial joint separation,11 ears translocation of the ossicles,1 ear stapediovestibular dislocation;4 ears ossicular fractures,2 ears fracture of the malleus,1 ear fracture of the incus,1 ear fracture of the stapes.Among 38 cases,11 cases underwent surgery,and the surgical results were consistent with CT findings.The display rates of AX,MPR,CPR,3D VR were 97.87％,100％, 97.87％,82.98％ respectively.Conclusion 256-slice HRCT and reconstuction technique can clearly reveal the whole structure of ossicular chain trauma,which are effective methods for diagonsis of ossicular chain trauma before surgery.
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Objective To investigate the safety and effectiveness of using covered stent in endovascular isolation treatment of spontaneous peripheral artery dissection.Methods A total of 9 patients with peripheral artery dissection were collected.The dissectionwas located at iliac artery in 6 patients and at subclavian artery in 3 patients.Preoperative CT angiography was performed in all patients to determine the site and degree of the dissection,based on which the corresponding covered stents were prepared.After puncturing the femoral artery with Seldinger technique,angiography was performed to confirm the lesions in all patients,then,according to the angiographic findings the implantation of covered stent was carried out.Results Among the 9 patients,the dissections were located at the right common iliac artery in 3,at the right external iliac artery in one,at the left common iliac artery in 2 and at the left subclavian artery in 3.The length of the dissection was 0.9-3.3 cm with a mean of 1.7 cm.The distance between the initial part of arterial dissection and the target vessel opening was 0.5-5.6 cm with an average of 2.3 cm.The covered stent was successfully implanted in all patients.In one patient,the implanted stent covered the non-dominant left vertebral artery.During the procedure no obvious complications occurred.The patients were followed up for 3-32 months (mean of 18 months).No procedure-related complications were observed in all patients.Color Doppler ultrasound examination showed that all the implanted stents were unobstructed.Conclusion For peripheral artery dissection,endovascular isolation therapy by using covered stent is safe and effective.
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We retrieve and analyze the articles on body surface temperature of acupoints in the recent 50 years. Surface temperatures have been compared between acupoints and nonacupoints, and among acupoints in different states. The impacts of interventions for acupoint temperature are explored, including acupuncture,moxibustion and cupping, etc. We summarize the features and the rules of acupoint skin temperature. It is considered that there exists distribution rule for healthy people's acupoint skin temperature. That means acupoints have higher surface temperature than nonacupoints. In the same meridian the nearer acupoints close to the head and trunk, the higher the temperature is. The difference in symmetrical acupoints temperatures between the left and right side is about 0.5℃. In the different meridians the skin temperatures of adjacent acpoints are similar. The changes of acupoint's skin temperature in illness can be used as the auxiliary diagnosis. Acupuncture, moxibustion and cupping can produce acupoints stimulating, metabolism improving,balance, acupoint temperature regulating. Thus,diseases are relieved. The specificity and regularity that acupoint's skin temperature presents may be one of the manifestations of the acupoint specificity, also it is an important starting point of the research on acupoint sensitization. The further studies should consider different diseases and modern biological engineering techniques, so that more rules of acupoints temperature can be found by more sensitive and objective temperature measurements as well as experimental and the mathematical models.
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Objective To investigate the dose,efficacy and safety of pantoprazole in the prevention of duodenal ulcer.Methods The patients from October 2014 to October 2016,105 cases of neurosurgery,thoracic surgery,neurosurgery and orthopedic surgery were divided into group A,group B and group C according to random number table method,35 cases in each group.The three groups were treated with intravenous pantoprazole,the dosage of group A was 40mg,1 time/d;the dosage of group B was 80mg,1 time/d;the dosage of group C was 40mg,1 time/12h,treatment cycle was 1 week.Before and after treatment,the gastric pH change and onset time,the incidence of adverse reactions were compared among the three groups.Results After treatment for 24h,the gastric pH of group B was (5.15 ± 0.87),which was significantly higher than (2.35 ± 0.45) in group A and (3.59 ± 0.65) in group C,which in group C was significantly higher than that in group A(t =10.809,24.407,13.598,all P ＜ 0.05).The onset time of group B [(48.6 ± 12.2)] was significantly shorter than (88.7 ± 23.4) of group A and (85.4 ± 26.5) of group C (t =10.987,10.083,all P ＜ 0.05).In group B,the time of gastric pH ＞ 3 [(954.5 ± 156.4) rin],pH ＞ 4 time [(865.4 ±135.2)rin]and pH ＞5 time[(714.2 ± 115.4)min]were significantly longer than those in group A and group C,which in group C were significantly longer than that in group A,the differences were statistically significant (t =8.852,30.177,21,325,3.864,40.879,44.713,all P ＜ 0.05).The incidence rates of adverse reactions in group A,group B and group C were 5.71％,14.3％ and 8.6％,respectively,there was no statistically significant difference (t =4.175,45.149,43.974,all P ＜ O.05).Conclusion 80mg qd pantoprazole can significantly improve gastric pH,effectively prevent and treat duodenal ulcer,with high safety.
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Traditional Chinese medicine considers that the final purpose of acupuncture treatment for disease is to harmonize yin and yang. Acupuncture redresses a balance between yin and yang by transmitting information to acupoints and then to corresponding visceral tissues and organs and the brain through the meridian system or the nervous system. In recent years, scholars at home thoroughly studied heart rate variability (HRV) analysis for acupuncture treatment of diseases and found that the regulating effect of acupuncture on visceral organs was closely related to autonomic nerves and acupuncture could restore a balance between sympathetic and parasympathetic nerves. Many scholars explored the effect of acupuncture on diseases related to autonomic nervous dysfunction by HRV frequency domain or time domain analysis and gained a certain achievements. This article summarizes recent years’ domestic studies on HRV-based analysis of acupuncture for diseases with autonomic nervous dysfunction and reviews the close relationship between autonomic nerves and diseases and the related mechanism of acupuncture action.
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Objective To evaluate the characteristics and clinical application value of Dual Source CT(DSCT),3.0T MR and DSA in the diagnosis of intracranial aneurysm.Methods The imaging characteristics of DSCT,3.0T MR and DSA in 102 patients of in-tracranial aneurysm were analyzed retrospectively.Results The cerebral DSA were performed in 102 patients,and the sensitivity and accuracy of DSA were 100%.60 patients were detected by DSCT/CTA,and the sensitivity and accuracy of DSCT/CTA were 93.1% and 97.2% respectively.52 patients were detected by 3.0T MR/MRA,and the sensitivity and accuracy of 3.0T MR/MRA were 89.1% and 92.7% respectively.10 patients were detected simultaneously by CT and MR.The diagnostic sensitivity and accu-racy of these three methods had no significant difference(P >0.05).Conclusion The sensitivity and accuracy of DSCT,3.0T MR and DSA in the diagnosis of intracranial aneurysm are high and had no significant difference,each had its characteristic.Reasonable application of the three methods produces higher clinical value.