18F-FDG符合线路显像诊断骨转移瘤的价值及与99Tcm-MDP骨显像的比较

目的 评价^18F-脱氧葡萄糖(FDG)符合线路显像在骨转移瘤诊断中的价值，并与^99Tc^m-亚甲基二膦酸盐(MDP)骨显像进行比较。方法因怀疑恶性肿瘤或骨转移而行^18F-FDG符合线路显像者55例，41例于^18F-FDG检查前后4周内进行了^99Tc^m-MDP全身骨显像。其中30例骨转移瘤患者，15例无骨转移瘤，10例^18F-FDG显像示可疑肿瘤直接骨侵犯(单独进行分析)。结果 ^18F-FDG符合线路显像和骨显像对骨转移瘤的灵敏度、特异性、阳性预测值、阴性预测值、诊断准确性分别为100％，93％，97％，100％，98％和95％，50％，75％，86％，77％，前者特异性、阳性预测值、诊断准确性显著高于骨显像(P=0．024，0．035，0．007)；^18F-FDG显像发现30例骨转移瘤患者中的20例有骨外原发或转移肿瘤。10例^18F-FDG显像示可疑肿瘤直接骨侵犯患者中，4例被证实有骨受累，6例无骨受累，而骨显像对骨受累情况均作出了正确判断。结论 ^18F-FDG符合线路显像对骨转移瘤的诊断有较高的灵敏度和特异性，并能发现骨外原发或转移性肿瘤；^99Tc^m-MDP骨显像对骨转移瘤也有较高的灵敏度，但特异性较差。     

骨骼和软组织肿瘤18F-FDG PET的应用进展

18F-FDG(18F-氟代脱氧葡萄糖)PET在肿瘤学领域已经得到了深入研究和广泛应用,尽管有关骨与软组织肿瘤的研究报告相对较少,但是近年来陆续发表的有关文献内容已涉及骨与软组织肿瘤病变良恶性鉴别、肿瘤恶性程度判断、治疗反应监测、肿瘤复发评价和骨转移肿瘤探测等诸多方面.     

^18F—FDG PET显像与^99Tc^m—MDP全身骨显像诊断肿瘤远处转移的比较

目的 评价^18F-脱氧葡萄糖（FDG）PET肿瘤显像与^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像对检出骨和远处转移的价值。方法 对16例恶性肿瘤放化疗后的患者进行^18F-FDG PET显像和^99Tc^m-MDP全身骨显像，并对两种结果进行了比较。结果 16例肿瘤患者中^18F-FDG PET显像皆阳性，其中14例患者有远处转移，转移病灶共62处，其中骨转移病灶20处；在全身骨显像中，11例有局限性异常放射性浓聚，其中2例为单一病灶，9例为多发病灶，共检出病灶57处，另5例骨显像正常。结论 ^18F-FDG PET对恶性肿瘤的诊断具有较高的准确性和特异性，但对骨转移灶的诊断价值相对较差；^99Tc^m-MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行^18F－FDG PET检查，以明确诊断其他远处转移灶。     

18F-氟化钠P ET/CT诊断肿瘤骨转移应用进展

18F-氟化钠（18F-NaF）作为骨扫描示踪剂已有50多年的历史,期间由于正电子探测器的缺乏等因素被99Tcm-MDP替代。随着PET/CT的发展,将18F-NaF作为PET/CT示踪剂的研究逐渐增多。18F-NaF本身的药物特性以及PET/CT相对于SPECT/CT的优势,使得18F-NaF PET/CT诊断恶性肿瘤骨转移的灵敏度、特异度优于99Tcm-MDP骨扫描。与99Tcm-MDP骨显像、18F-FDG PET/CT和MRI相比,18F-NaF PET/CT在诊断恶性肿瘤骨转移时具有更高的灵敏度,并且对于不同肿瘤的骨转移有不同的诊断价值。18F-NaF联合18F-FDG PET/CT扫描被证明具有一定的应用价值。18F-NaF PET/CT是诊断恶性肿瘤骨转移的安全、有效、简便、无创的方法。     

18F-FDG符合线路显像与99Tcm-MDP骨显像在肺癌骨转移瘤中的比较研究

目的探讨双探头带符合线路18F-脱氧葡萄糖(FDG)显像和99Tcm-亚甲基二磷酸盐(MDP)骨显像对肺癌骨转移瘤的诊断价值。资料与方法38例经病理证实的肺癌患者于2周内分别行18F-FDG符合显像和99Tcm-MDP骨显像。比较两种显像方式对两侧肩关节、脊柱、肋骨和骨盆骨转移灶检出的敏感性、特异性及准确性。最终骨转移瘤诊断标准由手术病理、CT/MR检查或临床随访半年以上范围扩大证实。结果根据骨转移的最终标准,38例患者共158处骨转移病灶,18F-FDG检出119个,99Tcm-MDP骨显像检出142个。18F-FDG与99Tcm-MDP骨显像探测骨转移的敏感性、特异性及准确性分别为65.8%、84.2%、72.7%,78.5%、81.1%、79.4%。99Tcm-MDP骨显像对骨转移灶的诊断敏感性高于18F-FDG,差异有统计学意义(χ2=6.30,P<0.05),但特异性和准确性差异均无统计学意义(χ2=0.33、3.14,P>0.05)。结论 99Tcm-MDP骨显像检测肺癌骨转移灶具有较高的敏感性,18F-FDG符合线路显像对诊断骨转移灶有一定帮助,两者联合可以提高肺癌骨转移的诊断。     

18F-FDG PET显像在恶性淋巴瘤中的应用

18F-FDG(18F-氟代脱氧葡萄糖)PET显像作为一种功能显像技术,能反映肿瘤组织中的生化变化和代谢状态,对淋巴瘤的准确分期、恶性程度评价、治疗疗效评价、治疗后复发的诊断以及预后估计等方面均具有重要作用.     

18F-FDG hPET/CT显像与99Tcm-MDP骨显像探测骨转移瘤的价值

目的　探讨1 8F 脱氧葡萄糖 (FDG)hPET CT与99Tcm 亚甲基二膦酸盐 (MDP)骨显像探测骨转移瘤的临床价值。方法　临床拟诊恶性肿瘤或肿瘤术后复发合并骨病变患者 34例 ,均于 2周内分别行FDG和MDP骨显像 ,其中 31例经手术或活组织病理检查证实为原发肿瘤患者 ,余 3例为原发灶不明但广泛骨转移者。结果　 34例患者中 2 6例有骨转移 ,共探测到 75个骨病灶 ,其中骨转移灶 6 3个 ,良性病灶 12个 (其中骨退行性变 8个 ,肋骨骨折 2个 ,结核和慢性炎症各 1个 )。1 8F FDGhPET CT显像探测骨转移瘤灵敏度为 90 5 % ,特异性为 83 3% ,准确性为 89 3% ;99Tcm MDP骨显像分别为 79 4 % ,75 0 %和 78 7% (P均 >0 0 5 )。结论　99Tcm MDP骨显像仍为诊断骨转移瘤的首选方法 ,1 8F FDGhPET CT显像对鉴别诊断骨转移瘤具有一定临床价值。     

18F-FDG和18F-FET PET脑显像诊断垂体腺瘤

目的 比较^18F-脱氧葡萄糖(FDG)和^18F-酪氨酸(FET)PET显像对垂体腺瘤的诊断价值。方法 正常对照者7例同期行^18F-FDGPET脑显像和^13N-NH3PET脑血流显像。20例垂体腺瘤患者行^18F-FDG PET脑显像，其中10例同期行^18F-FETPET脑显像，并参照近期MRI结果进行分析。加例患者均行经口鼻蝶窦垂体腺瘤切除术，术后行病理检查及免疫组织化学分型。结果①正常对照组垂体^18F-FDG摄取明显低于周围组织。②对于分泌激素和无分泌功能的垂体腺瘤，^18F-FDGPET和^18F-FETPET均可显示病灶。③垂体腺瘤在^18F-FDG显像中多表现为均匀的放射性摄取增高，而^18F-FET。显像则多表现为散在的摄取增高，与MRI所示等瓦长T2或稍长瓦长T2信号的肿瘤组织分布相似。④7例微腺瘤^18F-FDG PET检出5例，MRI检出3例。⑤不同激素分泌型和无分泌功能垂体腺瘤的瘤体大小、激素水平与^18F-FDG或^18F-FET显像标准摄取值(SUV)间无明显相关。结论 ^18F-FDG和^18F-FET PET脑显像均可显示垂体腺瘤,而以前者更佳。     

骨骼和软组织肿瘤^18F—FDG PET的应用进展

^18F—FDG(1^18F-氟代脱氧葡萄糖)PET在肿瘤学领域已经得到了深入研究和广泛应用，尽管有关骨与软组织肿瘤的研究报告相对较少，但是近年来陆续发表的有关文献内容已涉及骨与软组织肿瘤病变良恶性鉴别、肿瘤恶性程度判断、治疗反应监测、肿瘤复发评价和骨转移肿瘤探测等诸多方面。     

18F-FDG正电子显像质量保证

18F-FDG(18F-氟代脱氧葡萄糖)正电子显像(包括传统的PET和符合线路显像)的重要价值已为大量临床研究所证实,但其结果的影响因素比较复杂.本文就仪器验收和日常质量控制、检查前准备、数据采集和处理,以及结果分析等方面,介绍18F-FDG正电子显像的质量保证措施.     

Comparison of18FDG-PET with99mTc-HMDP scntigraphy for the detection of bone metastases in patients with breast cancer

OBJECTIVE: Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients. METHODS: Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards. RESULTS: On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%). CONCLUSIONS: This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.     

PET在前列腺癌中的应用

前列腺癌是老年男性最常见的恶性肿瘤之一,PET在其早期诊断和准确分期方面具有重要价值。18F-氟代脱氧葡萄糖(18F-FDG)PET对前列腺癌的检出并不敏感,也不能可靠进行淋巴结分期,但18F-FDG摄取与疾病进展程度相关。11C-胆碱PET诊断前列腺癌的准确率高,在淋巴结及骨转移的检出方面也明显优于18F-FDGPET,但其半衰期短而限制了临床应用。18F-胆碱的肿瘤摄取与11C-胆碱相似,但在泌尿系统排泄较高。其他示踪剂如11C-乙酸、11C-甲硫氨酸、18F标记的雄激素等在前列腺癌的诊断、分期及疗效评价方面也具有一定价值。     

18F-氟脱氧葡萄糖PET-CT与99mc-亚甲基二膦酸盐骨显像诊断转移性骨肿瘤的对比研究

目的 探讨18F-氟脱氧葡萄糖(18F-FDG)PET-CT与唧99mTc-亚甲基二膦酸盐(99mTc-MDP)全身骨显像对转移性骨肿瘤的诊断价值.方法 93例经病理证实为恶性肿瘤的患者同时接受18F-FDG PET-CT和99mTc-MDP全身骨显像(时间间隔在1周之内),对比分析两种显像结果,骨转移的诊断通过随访2年,由病理、X射线片、CT或MRI检查结果综合决定.结果 93例恶性肿瘤患者中,经过2年随访或病理证实骨转移44例,其中18F-FDG PET-CT灵敏度、特异度和准确率分别为95.4%、91.8%和93.5%,99mTc-MDP全身骨显像分别为90.9%、63.3%和76.3%.18F-FDG PET-CT对转移性骨肿瘤诊断的灵敏度与99mTc-MDP全身骨显像相近,但特异度(t=2.53,P＜0.05)和准确率t=2.47,P＜0.05)均明显高于99mTc-MDP全身骨显像.结论 PET-CT对转移性骨肿瘤有较高的诊断价值.     

Radiological imaging for the diagnosis of bone metastases.

Primary neoplasms of the skeleton are rare, but metastatic involvement is, unfortunately, a common occurrence. This is particularly true for certain primary tumors. Skeletal metastases are clinically significant because of associated symptoms, complications such as pathological fracture and their profound significance for staging, treatment and prognosis. Detection of bone metastases is, thus, an important part of treatment planning. The frequency with which metastases are detected varies considerably with the type of primary tumor and with the methodology utilized for detection. Four main modalities are utilized clinically: plain film radiography, CT scan, nuclear imaging and magnetic resonance imaging. In this discussion, we will review literature on the radiology of skeletal metastases with respect to lesion detection, assessment of response to treatment and possible therapeutic implications. The bulk of the discussion will focus on MRI and nuclear studies since most of the recent advances have been made in these areas.     

18F-FDG PET与99Tcm- MDP显像诊断肿瘤骨转移的比较

目的　研究1 8F 脱氧葡萄糖 (FDG)PET显像对肿瘤骨转移的诊断价值 ,并与99Tcm 亚甲基二膦酸盐 (MDP)骨显像比较。方法　 4 3例确诊的肿瘤患者在 1个月内先后行1 8F FDGPET及99Tcm MDP骨显像 ,其中 2 4例经其他检查及随访证实为骨转移。对比分析 2种显像结果。结果　 2 4例骨转移患者FDGPET显像均为阳性 ,骨显像阳性 2 2例 ,灵敏度分别为 10 0 %和 91.7% ,差异无显著性 (P >0 0 5 )。19例无骨转移患者中FDGPET显像阴性 18例 ,骨显像阴性 11例 ,特异性分别为 94 .7%和5 7 9% ,差异有显著性 (P <0 0 5 )。 2种方法检测骨转移的准确性分别为 97.7%和 76 .7% ,差异有显著性 (P <0 0 5 )。结论　1 8F FDGPET显像诊断肿瘤骨转移的灵敏度与99Tcm MDP骨显像无明显差别 ,但有更高的特异性和准确性。     

18 F-FDG PET显像与99Tcm-MDP全身骨显像诊断肿瘤远处转移的比较

目的　评价18F 脱氧葡萄糖 (FDG)PET肿瘤显像与99Tcm 亚甲基二膦酸盐 (MDP)全身骨显像对检出骨和远处转移的价值。方法　对 16例恶性肿瘤放化疗后的患者进行18F FDGPET显像和99Tcm MDP全身骨显像 ,并对两种结果进行了比较。结果　 16例肿瘤患者中18F FDGPET显像皆阳性 ,其中 14例患者有远处转移 ,转移病灶共 62处 ,其中骨转移病灶 2 0处 ;在全身骨显像中 ,11例有局限性异常放射性浓聚 ,其中 2例为单一病灶 ,9例为多发病灶 ,共检出病灶 5 7处 ,另 5例骨显像正常。结论　18F FDGPET对恶性肿瘤的诊断具有较高的准确性和特异性 ,但对骨转移灶的诊断价值相对较差 ;99Tcm MDP显像阴性或单一病灶的可疑转移瘤患者有必要进行18F FDGPET检查 ,以明确诊断其他远处转移灶     

99Tcm-MDP全身骨显像、99Tcm-MDP SPECT-CT和18F-FDG SPECT-CT探测脊柱转移瘤的比较

目的 比较99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨显像、99Fcm-MDPSPECT-CT与18F-FDG SPECT-CT诊断脊柱转移瘤的临床价值.方法 对行常规99Tcm-MDP全身骨显像的88例肿瘤患者同时行99Tcm-MDP SPECT-CT,同期(2周内)行18F-FDG SPECT-CT.回顾...     

Detection of metastatic bone lesions in breast cancer patients: fused (18)F-Fluoride-PET/MDCT has higher accuracy than MDCT. Preliminary experience

Purpose

So far, no studies comparing ¹⁸F-Fluoride-PET/CT and MDCT for the detection of bone metastases are available. We compared the accuracy of ¹⁸F-Fluoride-PET/CT (MDCT: 3.75 mm thickness-image-reconstruction), whole-body Multi-Detector-CT (MDCT: 1.25 mm thickness-image-reconstruction) and ¹⁸F-Fluoride-PET/MDCT (MDCT: 1.25 mm thickness-image-reconstruction) in identifying bone metastases in breast cancer patients.

Methods

We studied 39 breast cancer patients for bone metastases. Imaging was performed on an integrated PET/MDCT-system; CT images were reconstructed at 3.75 mm and 1.25 mm thickness. Two nuclear medicine physicians and one radiologist interpreted blindly ¹⁸F-Fluoride-PET/CT, ¹⁸F-Fluoride-PET/MDCT and MDCT. MDCT at 12 months served as the standard of reference.

Results

Overall, 662 bone lesions were detected in our analysis. Of these, 542 were malignant and 120 were benign according to the standard of reference. ¹⁸F-Fluoride-PET/CT detected 491 bone metastases, 114 (23%) of which displayed no clear morphological changes on MDCT, whereas MDCT detected 416 bone metastases, 39 (9.3%) of which showed no ¹⁸F-Fluoride-PET uptake. Overall sensitivity and specificity were: 91% and 91%, respectively, for ¹⁸F-Fluoride-PET/CT, and 77% and 93% for MDCT. The integrated assessment of ¹⁸F-Fluoride-PET/MDCT yielded sensitivity and specificity values of 98% and 93%, respectively.

Conclusions

¹⁸F-Fluoride-PET/MDCT has higher diagnostic accuracy than ¹⁸F-Fluoride-PET/CT and MDCT for the evaluation of bone metastases in breast cancer.     

Usefulness of whole-body (18)F-FDG PET in patients with suspected metastatic brain tumors.

The aim of this study was to evaluate the diagnostic value of whole-body (18)F-FDG PET imaging in the differentiation of metastatic brain tumor from primary brain tumor and in the localization of the primary lesion in patients with metastatic brain tumor. METHODS: The subjects consisted of 127 patients (77 men, 50 women; mean age +/- SD, 55 +/- 12 y) with brain masses that were suspected to be metastatic brain tumors on radiologic studies: 77 with confirmed metastatic brain tumor and 50 with primary brain tumor. Whole-body (18)F-FDG PET was performed on all patients. When the abnormal lesion was detected outside the brain, we interpreted the brain lesion as metastatic brain tumor. RESULTS: In 61 of the 77 patients with metastatic brain tumor, primary lesions were detected using whole-body (18)F-FDG PET. Of the remaining 16 patients (all false-negative cases), 7 were classified as metastases of unknown origin. In 47 of the 50 patients with primary brain tumor, whole-body (18)F-FDG PET did not show any other abnormal lesions. The sensitivity, specificity, positive and negative predictive values, and accuracy of PET for the detection of primary origin were 79.2%, 94.0%, 95.3%, 74.6%, and 85.0%, respectively. The most common primary origin of metastatic brain tumors on PET examination was lung cancer (48/61, 78.7%). The concordance rate between (18)F-FDG PET and conventional radiologic work-up was 80% in identifying primary lesion. Unknown bone or bone marrow metastases and unsuspected distant metastases were found in 14 patients (18%) and 24 patients (31%), respectively, on PET examination. CONCLUSION: Screening the patients with suspected metastatic brain tumors using whole-body (18)F-FDG PET could be helpful in differentiating metastatic brain tumor from primary brain tumor and in detecting the primary lesion.