肝恶性肿瘤多模式影像技术PET／CT应用价值评估

目的探讨多模式影像技术PET／CT在原发和继发肝癌应用价值。方法^18F—FDG PET／CT检查肝内恶性肿瘤217例,原发肝癌120例;继发肝癌97例;其中38例原发肝细胞癌行同机肝脏CT三期增强扫描;15例小肝癌进行了随访生存曲线分析;比较不同大小及类型肝癌间SUVmax差异。PET／CT图像采用3级法进行分类,计算不同类型肝癌敏感性,将CT增强图像与PET／CT图像结合分析。结果75例未经任何治疗原发肝细胞癌显像1级24例占32％,2—3级51例占68％。未经任何治疗转移性肝癌93例,显像1级4例占4．3％,2～3级89例占95．7％。联合CT增强检查小于3cm肝癌敏感性为37．5％,大于3cm肝癌敏感性为73．7％。不同大小及不同类型肝癌间SUVmax比较有差异。生存曲线分析显示SUVmax大于2．5和小于2．5组比较无差异。结论^18F—FDG PET／CT对原发肝细胞癌敏感性较低,结合同机CT增强扫描可提高肝癌的敏感性;^18F—FDG PET／CT对转移性肝癌敏感性较高;转移性小肝癌SUVmax高于原发小肝癌。     

PET／CT检查在肺泡癌与其他非小细胞肺癌鉴别诊断中的应用

目的探讨^18F-脱氧葡萄糖（^18F-FDG）PET／CT在细支气管肺泡癌（BAC）诊断及鉴别诊断中的价值。方法回顾性分析经病理检查确诊的17例BAC（BAC组）及119例其他病理类型NSCLC（对照组）的^18F-FDG PET／CT显像资料。测量病灶^18F-FDG最大标准摄取值（SUVmax）和^18F-FDG摄取视觉评分,分析病灶大小和密度分布。评价与肿瘤分型有关的CT征象,比较单独PET、CT及PET和CT联合诊断的性能。结果CT图像示纯磨玻璃密度影BAC组9例（53．0％）,对照组5例（4．2％）,P〈0．01。BAC组SUVmax为1．72±0．57,对照组为7．13±3．26,P〈0．01。PET联合CT检查诊断BAC的灵敏度（76％）、特异性（84％）明显高于单独CT（53％、96％）和单独PET检查（65％、86％）,P均〈0．01。结论结合PET／CT显像中BAC的代谢和形态结构特征,有利于提高BAC诊断及鉴别诊断的准确度。     

18F-FDG PET/CT双时相显像在肝癌诊断中的应用价值探讨

目的 本研究的目的是探讨¹⁸F-FDG PET/CT双时相显像在不同类型肝细胞癌（HCC）诊断中的不同表现,以提高该方法诊断的灵敏度和特异度。方法 对经病理学检查确诊的小肝癌、结节型肝癌和巨块型肝癌各40例进行回顾性评价。使用德国Siemens Biograph Turepoint 40 PET/CT 成像仪和¹⁸氟-脱氧葡萄糖（¹⁸F-FDG）对所有病例进行PET/CT显像检查,依托半定量评估基础,计算最大标准摄入值（SUVmax）。结果 在40例小肝癌患者中,21例（52.5%）、在40例结节型肝癌中,24例（60.0%）和40例巨块型肝癌中,37例（92.5%）病灶延迟相SUVmax较早期相升高（F=16.714,P=0.000）;小肝癌患者早期相和延迟相SUVmax分别为3.99±1.40和4.17±1.99（t=-1.406,P=0.168）,结节型肝癌患者早期相和延迟相SUVmax分别为5.04±1.87和5.23±2.25（t=-1.364,P=0.180）,巨块型肝癌患者早期相和延迟相SUVmax分别为6.98±2.57和8.10±3.11（t=-4.119,P=0.000）,后者差异有统计学意义;三种类型肝癌之间早期相SUVmax值存在差异（F=22.765,P=0.000）,延迟相SUVmax值也存在差异（F=26.435,P=0.000）。结论 在HCC,随肿瘤直径的增大,双时相显像诊断的可能性增大。     

18F-FDG PET-CT显像在胰腺转移癌中的应用价值

目的 分析胰腺转移癌的PET-CT表现,提高对该病变的检出率.方法 回顾性分析31例经临床确诊的胰腺转移癌的PET-CT图像,并与26例胰腺原发癌进行比较.由两位经验丰富的专科医师在融合图像上确定病灶所在位置,经过帧对帧的图像分析,确认病灶放射性摄取明显高于周围正常胰腺者为阳性.沿PET所示病灶边缘勾画感兴趣区,由工作站自动算出最大标准摄取值（SUVmax）,SUVmax＞ 2.5为阳性病灶.结果 31例胰腺转移癌的原发灶为肺癌22例,胃癌及结肠癌各2例,上颌窦癌、甲状腺癌、黑色素瘤、胆囊癌及肾癌各1例.21例（67.7％）为单发,10例（32.3％）为多发或弥漫性病灶.单发病灶中7例（33.3％）位于胰头颈部,14例（66.7％）位于胰体尾部.26例原发胰腺癌18例（69.2％）位于胰头颈部,8例（30.8％）位于胰体尾部.胰腺转移癌与原发癌的发生部位差异具有统计学意义（x2 =6.102,P=0.014）.CT平扫仅发现17例胰腺有病灶,呈结节状,略低密度,大部分病灶边界欠清晰.31例转移性胰腺癌PET显像均显示病灶,平均SUVmax为7.42±3.48,显著高于胰腺原发癌的5.39±1.71 （F=4.87,P=0.032）.此外,PET-CT同时发现30例有其他脏器或淋巴结转移.结论 18F-FDG PET-CT在检出并诊断胰腺转移癌中有毋庸置疑的优势.     

18↑F-FDG PET/CT显像在软组织肿瘤诊断中的应用

目的探讨18氟脱氧葡萄糖（18↑F-FDG）PET/CT显像在软组织肿瘤诊断中的临床应用价值。方法软组织肿瘤患者65例,静脉注射18↑F-FDG后PET/CT显像。经衰减校正后行目测法和半定量分析法测定病灶的最大标准摄取值（SUVm ax）进行图像分析,并与病理检查结果对照。结果根据病理结果目测法发现局部软组织病灶47例,其中良性5例、恶性42例,淋巴结转移6例、骨转移10例、软组织转移7例、肺转移10例。目测法发现局部病灶的准确性、灵敏性均为100%,诊断转移病灶的准确性、灵敏性、特异性分别为96.9%、100%、95.1%。36.9%的病例根据PET/CT结果改变肿瘤分期。半定量分析对鉴别软组织恶性肿瘤的准确性、灵敏性、特异性分别为85.1%、92.9%和20%。结论在软组织肿瘤诊断中18↑F-FDG PET/CT显像是一种无创性、高灵敏性的检查,特别是对确定软组织肉瘤的分期。     

18F-FDG PET/CT显像在进展期前列腺癌诊断和分期中的应用

目的探讨^18F-FDG PET/CT显像在进展期前列腺癌诊断和分期中的临床价值.方法20例临床进展期前列腺癌患者行^18F-FDG PET/CT全身显像,同时行B超和骨扫描检查.结果①9例未经治疗者中^18F-FDG PET/CT确诊8例;全雄激素阻断治疗（MAB）后前列腺特异性抗原（PSA）值较稳定者及逐渐升高者共5例,PET/CT均准确显示;6例MAB反应良好者,^18F-FDG PET/CT示其病灶均无放射性浓聚（即阴性）.②6例盆腔淋巴结转移和6例骨转移者中^18F-FDG PET/CT分别发现5例和4例,假阴性者均为MAB后反应良好患者.结论^18F-FDG PET/CT显像是评估进展期前列腺癌激素治疗效果的无创性检查方法,有利于未治疗、激素治疗有部分反应及激素难治性进展期前列腺癌的诊断和临床分期.     

~(18)F-FDGPET/CT显像用于胃癌术后远期生存的预测价值

目的探讨~(18)F-FDG PET/CT显像对胃癌术后远期生存的预测价值。方法回顾性分析2017年1至6月于我院发现胃部肿瘤的患者在上级医院行PET/CT显像检查的36例胃癌患者的临床资料。所有患者均行胃癌手术治疗,电话随访2年,根据患者的生存、死亡情况,分成生存组、死亡组。比较两组原发病灶最大径、原发病灶最大标准摄取值(SUVmax)、胃壁厚度,分析各指标与患者生存、死亡的关系。绘制受试者工作特征(ROC)曲线分析各指标预测患者术后2年的预后情况。采用Pearson线性相关模型分析SUVmax与原发病灶最大径、胃壁厚度的相关性。结果在36例胃癌患者中,2年内有13例(36. 11%)死亡,纳入死亡组,其余23例(63. 89%)纳入生存组。生存组原发病灶最大径、SUVmax、胃壁厚度均低于死亡组,差异有统计学意义(P 0. 05)。原发病灶最大径、SUVmax、胃壁厚度预测胃癌术后2年内死亡的曲线下面积分别为0. 693、0. 737、0. 709,三项联合预测的曲线下面积为0. 789。经Pearson线性相关分析提示SUVmax与胃壁厚度呈正相关(r=0. 775,P0. 05),其与原发病灶最大径无相关性(r=0. 265,P 0. 05)。结论~(18)F-FDG PET/CT显像能明确胃癌患者的原发病灶最大径、SUVmax、胃壁厚度,对胃癌术后远期生存有一定预测价值。     

PET/CT显像在肺癌胰腺转移中的应用价值

目的评估肺癌胰腺转移瘤的CT表现及FDG代谢程度。方法对24例经确诊的肺癌胰腺转移瘤病例进行分析。所有患者都接受18F-FDG PET/CT显像,病灶FDG代谢程度增高(SUVmax2.5),则被视为阳性转移灶。结果 24例肺癌胰腺转移瘤中,腺癌10例(41.7%),鳞癌8例(33.3%),小细胞癌6例(25%)。16例为单发病灶,7例为多发病灶,1例为弥漫性病灶。病灶SUVmax:3.68~13.76不等,平均值为7.08,其中SUVmax≤5的5例、5SUVmax10的15例、SUVmax≥10的4例,病灶SUVmax 5~10之间发生率与其他区间差异具有统计学意义(P0.05)。结论 PET/CT在发现肺癌胰腺转移诊断正确率较高。     

^18F-FDG PET／CT显像监测卵巢癌患者术后复发／转移的临床价值分析

目的 探讨18-氟代脱氧葡萄糖（^18F-FDG）PET／CT显像在卵巢癌术后监测中的价值。方法回顾性分析19例卵巢癌术后患者的全身PET／CT显像结果,并以病理和随访诊断结果为标准计算其诊断卵巢癌复发／转移的灵敏度、特异性等。结果 “F-FDGPET／CT显像预测卵巢癌术后复发／转移的灵敏度为100．O％（14／14）、特异性为60．0％（3／5）、阳性预测值为87．5％（14／16）、阴性预测值为100．O％（3／3）。结论”F-FDGPET／CT显像对监测卵巢癌术后复发／转移的价值优于传统影像学方法,与血清癌胚抗原（CAl25）联合检查可早期检出复发／转移灶。     

18F-FDG PET/CT显像判断乳腺癌复发及转移的价值

目的探讨^18F-FDG PET/CT显像判断乳腺癌复发和转移的临床价值.方法28例手术治疗后临床疑有肿瘤复发或转移的乳腺癌患者均进行^18F-FDG PET/CT全身显像,应用目测法和半定量分析法判断结果（标准摄取值,SUV）.结果病理、活检、细胞学检查等证实17例有局部复发和（或）转移,^18F-FDG PET/CT显像正确诊断16例,检测灵敏度、特异性（94.12%,90.91%）明显高于传统影像学方法;在62个肿瘤复发和（或）转移灶中,PET/CT及常规影像学检查检出率分别为91.94%（57/62）、72.58%（45/62）,P＜0.05.结论^18F-FDG PET/CT显像是早期诊断乳腺癌复发和（或）转移良好的、无创性方法.     

Diagnostic value for extrahepatic metastases of hepatocellular carcinoma in positron emission tomography/computed tomography scan

AIM: To evaluated the value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan in diagnosis of hepatocellular carcinoma (HCC) and extrahepatic metastases.METHODS: A total of 138 patients with HCC who had both conventional imaging modalities and ¹⁸F-FDG PET/CT scan done between November 2006 and March 2011 were enrolled. Diagnostic value of each imaging modality for detection of extrahepatic metastases was evaluated. Clinical factors and tumor characteristics including PET imaging were analyzed as indicative factors for metastases by univariate and multivariate methods.RESULTS: The accuracy of chest CT was significantly superior compared with the accuracy of PET imaging for detecting lung metastases. The detection rate of metastatic pulmonary nodule ≥ 1 cm was 12/13 (92.3%), when < 1 cm was 2/10 (20%) in PET imaging. The accuracy of PET imaging was significantly superior compared with the accuracy of bone scan for detecting bone metastases. In multivariate analysis, increased tumor size (≥ 5 cm) (P = 0.042) and increased average standardized uptake value (SUV) uptake (P = 0.028) were predictive factors for extrahepatic metastases. Isometabolic HCC in PET imaging was inversely correlated in multivariate analysis (P = 0.035). According to the receiver operating characteristic curve, the optimal cutoff of average SUV to predict extrahepatic metastases was 3.4.CONCLUSION: ¹⁸F-FDG PET/CT scan is invaluable for detection of lung metastases larger than 1 cm and bone metastases. Primary HCC having larger than 5 cm and increased average SUV uptake more than 3.4 should be considered for extrahepatic metastases.     

Bone metastasis versus bone marrow metastasis? Integration of diagnosis by 18F-fluorodeoxyglucose positron emission/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) diagnosis simultaneously. Based on imaging of ¹⁸F-FDG PET/CT, diffusely incremental ¹⁸F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the ¹⁸F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.     

18F-FDG PET/CT扫描对肺结节病诊断价值的探讨

目的评价18F-FDG PET/CT在肺结节病诊断中的价值。方法 5例经外科手术病理活检确诊的肺结节病患者,分析其18F-脱氧葡萄糖（FDG）PET/CT图像特征,结合病灶累及部位、分布特点、大小等进行分析总结。结果 5例患者临床症状多不典型;胸部CT示肺门或纵膈淋巴结肿大;PET/CT示均存在双侧肺门淋巴结肿大,1例患者腹腔内可见多枚肿大淋巴结;手术病理均考虑结节病。结论 18F-FDG PET/CT可灵敏、准确地反映结节病的全身病灶分布范围和病灶良恶性,提高非典型、复杂型结节病诊断的准确率。     

Metabolic restaging of hepatocellular carcinoma using whole-body 18F-FDG PET/CT

AIM: To evaluate the ability of ¹⁸F-fluorodeoxyglucose positron emission and computed tomography (¹⁸F-FDG PET/CT) in restaging of hepatocellular carcinoma (HCC) after treatment.METHODS: We reviewed a database of the diagnostic performance of ¹⁸F-FDG PET/CT scan for patients with HCC following local or regional treatment. The database consisted of ¹⁸F-FDG PET/CT information of 21 male and 4 female (age range, 27-81 years; mean age, 51.6 years) patients who had received surgical resection and/or interventional treatments and then underwent ¹⁸F-FDG PET/CT scan. All patients had received enhanced CT scan of the liver two weeks before or after the ¹⁸F-FDG PET/CT scan. Intrahepatic recurrence and/or extrahepatic metastases were confirmed by histological analysis or clinical and imaging follow-up. The accuracy of ¹⁸F-FDG PET/CT study was determined by histopathological results or by clinical and imaging follow-up.RESULTS: ¹⁸F-FDG PET/CT was abnormal in 19 of the 25 (76.0%) patients. In detecting HCC recurrence, ¹⁸F-FDG PET/CT scored 17 true positives, 5 true negatives, 2 false positives and 1 false negative. The sensitivity, specificity and accuracy of ¹⁸F-FDG PET/CT in detecting HCC recurrence was 89.5%, 83.3% and 88%, respectively. ¹⁸F-FDG PET/CT had an impact on management of these patients by settling the problem of an unexplained increase in alpha-fetoprotein after treatment (14 patients), by monitoring response to the treatment and guiding additional regional therapy (12 patients), by identifying extrahepatic metastases (10 patients), by identifying tumor growth or thrombosis in the portal vein (6 patients), or by guiding surgical resection of extrahepatic metastases (2 patients).CONCLUSION: Our results suggest that whole body ¹⁸F-FDG PET/CT may be useful in the early evaluation of residual, intrahepatic recurrent or extrahepatic metastatic lesions and able to provide valuable information for the management of HCC recurrence.     

氟脱氧葡萄糖F18正电子发射体层摄影术在肺癌诊断及分期中的价值

目的　探讨氟脱氧葡萄糖F18正电子发射体层摄影术(18FFDGPET)在肺癌诊断及分期中的价值。方法　94例疑诊为肺部肿瘤的患者进行了CT、18FFDGPET全身或局部检查,并对这些患者手术切除及活检的组织标本及痰液、胸腔积液的细胞标本进行了病理学检查。18FFDGPET图像分析采取单纯标准摄取值(SUV)法及目测与SUV值结合两种方法进行。SUV值法判定标准为:SUV值>25为恶性病灶,SUV值≤25为良性病灶;目测与SUV值结合法:根据病灶18FFDG摄取量与纵隔血池结构相比,并考虑SUV值、病变大小、形态及病史资料做出诊断。以病理及试验性治疗结果为确诊标准,分别计算18FFDGPET及CT在病变的定性、纵隔淋巴结转移、全身远端转移方面的敏感性、特异性、准确性、阳性预测值及阴性预测值,同时对18FFDGPETSUV值法与目测结合SUV值法的诊断效能进行比较。结果　(1)确诊情况:本组58例患者肺部病灶经组织病理学或细胞病理学检查证实为恶性;36例经病理检查或试验治疗证实为良性。(2)定性诊断:CT对肺部肿块定性诊断的敏感性、特异性、准确性、阳性及阴性预测值分别为:69%、65%、68%、82%、49%;18FFDGPET单纯SUV法分别为91%、89%、90%、93%和87%,目测+SUV值法分别为95%、94%、95%、97%和92%。(3)纵隔淋巴结转移:34例病理证实有纵隔淋巴结转移     

Localization of medullary thyroid carcinoma after surgery using (11)C-methionine PET/CT: comparison with (18)F-FDG PET/CT

Tumor localization is difficult in patients with medullary thyroid carcinoma (MTC) that have persistent hypercalcitoninemia after thyroidectomy. In this study, the (11)C-methionine positron emission tomography/computed tomography (PET/CT) was compared with the (18)F-FDG PET/CT for diagnostic sensitivity in detecting residual or metastatic disease. (11)C-methionine PET/CT and (18)F-FDG PET/CT were performed on 16 consecutive patients with MTC that had persistent hypercalcitoninemia after surgery in this prospective, single-center study. Patient- and lesion-based analyses were performed using a composite reference standard which was the sum of the lesions confirmed by all combined modalities, including neck ultrasonography (US) with or without fine needle aspiration cytology, CT, bone scan, magnetic resonance imaging (MRI), and surgery. By patient-based analysis, the sensitivities of (11)C-methionine PET/CT and (18)F-FDG PET/CT were both 63%. By lesion-based analysis, the sensitivity of (11)C-methionine PET/CT was similar to (18)F-FDG PET/CT (73% vs. 80%). Excluding hepatic lesions, which could not be detected because of physiological uptake of methionine by the liver, the sensitivity of (11)C-methionine PET/CT was better than (18)F-FDG PET/CT especially for detecting cervical lymph node lesions; however, it was not superior to US. All patients with serum calcitonin levels ≥370 pg/mL showed uptake by (11)C-methionine PET/CT and (18)F-FDG PET/CT. This preliminary data showed that despite its similar sensitivity to (18)F-FDG PET/CT for detecting residual or metastatic MTC, (11)C-methionine PET/CT provided minimal additional information compared to combined (18)F-FDG PET/CT and neck US.     

18F-FDGPET/CT和CA125在胸腔积液鉴别诊断中的临床意义

目的探讨18F-FDG PET/CT显像和血、胸水CA125检测对胸腔积液鉴别诊断的临床意义。方法 40例胸腔积液患者行18F-FDG PET/CT显像以及血、胸水CA125检测,结合最终病理诊断分组,评价其临床意义。结果血、胸水CA125检测结果在良恶性胸腔积液中不具有显著的统计学差异(P>0.05)。18F-FDG PET/CT显像对胸腔积液鉴别诊断的敏感性为92.3%,特异性为85.7%,ROC曲线下面积为0.890。血CA125检测敏感性为84.6%,特异性为28.6%,ROC曲线下面积为0.566。胸水CA125检测敏感性为100%,特异性为14.3%,ROC曲线下面积为0.571。三项联合检测ROC曲线下面积为0.890。结论18F-FDG PET/CT显像对于胸腔积液的鉴别诊断有较好的临床价值,血、胸水CA125检测不能单独用于胸腔积液鉴别诊断,且与前者联合并不能提高检测敏感性和特异性。