18F-FDG代谢显像对原发性乳腺癌的诊断价值

目的探讨利用符合线路(DHC)18F-FDG代谢显像对原发性乳腺癌鉴别诊断的临床价值.方法51例乳腺包块患者行DHC18F-FDG代谢显像,利用计算机感兴趣区(ROI)技术,计算靶/非靶比值(T/NT),全部患者均显像后经细针穿刺组织学活检确诊分为良性组和恶性组.结果活检病理组织学确诊乳腺癌33例(65%),良性乳腺包块18例(35%);定性诊断18F-FDG代谢显像33例,恶性患者中29例显像阳性,4例阴性;良性组3例为阳性,其余为阴性;DHC18F-FDG显像定性诊断的灵敏度、特异性和准确度分别为88%、83%和86%.恶性组和良性组摄取18F-FDG的T/NT比值分别为2.25±0.18和1.35±0.37(P＜0.01);以T/NT比值1.5为诊断阈值,DHC18F-FDG显像诊断的灵敏度、特异性和准确度分别为94%、89%和92%.结论 DHC18F-FDG显像诊断乳腺癌具有一定的临床价值,定性与定量结合有利于提高诊断效能.     

18F-FDG PET/CT评价兔VX2移植瘤对顺铂化疗的早期反应

目的 探讨18F-FDG PET/CT评价兔VX2移植瘤顺铂化疗早期反应的最佳时间,观察移植瘤摄取FDG的变化规律及其与病理变化的相关性.方法 将30只VX2荷瘤兔按随机数字表法分为5组,每组6只.化疗组在按体质量静脉注射顺铂(7 mg/kg)化疗前和化疗后6、12、24及36h分别行18F-FDG PET/CT显像;对照组用等体积的生理盐水进行干预;勾画ROI,计算SUVmax、T/NT.采用HE染色观察肿瘤细胞坏死率,TUNEL法检测细胞凋亡.统计学分析采用配对t检验、Games-Howell检验及曲线相关分析.结果 对照组干预后SUVmax为9.77±2.45,明显高于干预前(6.58±1.67;t=-5.480,P＜0.05),干预后T/NT为29.34±3.31,明显低于干预前(52.93±3.90;t=17.593,P＜0.05).化疗组化疗后6 h 18F-FDG摄取减低,SUVmax平均减低率为(11.83±8.89)％,T/NT平均减低率为(59.00±8.22)％,与对照组间的差异有统计学意义(均P＜0.05).化疗后24 h 18F-FDG摄取减低最明显,SUVmax平均减低率为(42.33±33.80)％,T/NT平均减低率为(83.50±7.69)％,与对照组和化疗后6h显像组间的差异均有统计学意义(均P＜0.05).SUVmax和T/NT变化率与凋亡指数呈正相关(r=0.750、0.794,均P＜0.05),与肿瘤细胞坏死率亦呈正相关(r=0.804、0.874,均P＜0.05).结论 18F-FDG PET/CT能够灵敏检测早期化疗反应,化疗后24 h是最佳早期化疗反应评价时间点.     

11C-蛋氨酸PET/CT显像在脑胶质瘤中的初步应用

目的探讨11C-蛋氨酸(MET)PET/CT显像对脑胶质瘤的应用价值.方法2例正常对照者、2例脑胶质瘤初诊患者和23例脑胶质瘤术后患者行11C-MET PET/CT显像;25例患者中有17例同时行18F-脱氧葡萄糖(FDG)PET/CT显像.临床随访时间3～17个月.结果4例脑胶质瘤术后无肿瘤残余或复发者11C-MET显像为阴性,其中3例同时行18F-FDG显像也为阴性.2例胶质瘤Ⅱ级初诊者和19例脑胶质瘤术后残余、复发者中,20例11C-MET显像阳性(肿瘤/灰质、肿瘤/白质比值分别为2.02±0.96、3.01±1.79),其中14例同时行18F-FDG显像中12例为阳性.11C-MET显像所见病灶远较18F-FDG显像清晰.14例患者11C-MET、18F-FDG显像的肿瘤/灰质、肿瘤/白质比值分别为2.15±1.16比0.97±0.43(P＜0.01)、3.31±2.16比1.90±0.67(P＜0.05).结论11C-MET对脑胶质瘤的显像、定位优于18F-FDG.     

18F-FDG PET/CT与3.0T MRI联合显像在乳腺癌原发病灶诊断中的价值

目的 探讨18F-FDG PET/CT与3.0T MRI联合显像在乳腺癌原发病灶诊断中的价值。 方法 对38例临床怀疑为乳腺癌的女性患者于一周内分别行18F-FDG PET/CT、3.0T MRI和病理学检查。 结果 组织病理学检查结果证实,全部患者中,24例为乳腺癌患者,14例为乳腺良性肿瘤患者。3.0T MRI诊断乳腺癌的灵敏度、特异度、准确率分别为91.7%、78.6%、86.8%;PET/CT诊断乳腺癌的灵敏度、特异度、准确率分别为87.5%、92.9%、89.5%;PET/CT和3.0T MR联合显像诊断乳腺癌的灵敏度、特异度、准确率分别为100.0%、92.9%、97.4%;3种显像方法间灵敏度、特异度、准确率差异无统计学意义（χ2=2.987、1.612和2.955,P均＞0.05）。 结论 18F-FDG PET/CT和3.0T MRI联合显像在乳腺癌原发病灶诊断中具有重要价值;但与单独18F-FDG PET/CT和3.0T MRI显像比较,3种显像方法在乳腺癌原发病灶的诊断效能上差异无统计学意义。     

18F-FDG hPET/CT显像对肿瘤的诊断价值

目的探讨18F-脱氧葡萄糖(FDG)hPET/CT显像在肿瘤诊断中的价值.方法对27例经病理组织学或临床诊断的恶性肿瘤患者(包括15例原发性肿瘤、12例转移性肿瘤)和33例良性病变(18例甲状腺腺瘤、7例桥本氏甲状腺炎和8例肺部良性肿瘤)进行18F-FDG hPET/CT显像,勾画病灶感兴趣区(ROI),在对侧相应位置复制相同大小ROI,测定计数得靶/非靶比值(T/N),并对良恶性病变的T/N比值进行比较.结果27例恶性肿瘤患者中(T/N比值为10.47±8.22),22例FDG显像示单个或多处呈不同程度异常浓聚灶,5例未见异常FDG浓聚灶.33例良性病变中(T/N比值4.51±12.14),10例见病变处FDG异常摄取增高.以T/N比值≥2.0作为判断良恶性病变的标准,18F-FDG hPET/CT诊断的灵敏度为81.48%,特异性为69.70%,准确性为75.00%,阳性预测值为68.75%,阴性预测值为82.14%.结论18F-FDG hPET/CT显像对肿瘤良恶性鉴别、解剖定位的判断、分期及疗效观察具有一定的优势.     

18F-FDG PET显像在乳腺癌中的应用

^18F-FDG(^18F-氟脱氧葡萄糖)PET(正电子发射型计算断层显像)是反映恶性肿瘤代谢特征的一种无创性的功能显像方法。在绝大多数肿瘤中均得到广泛应用。本文通过对国内外乳腺癌^18F-FDG PET。显像的文章进行全面综合分析，旨在探讨^18F-FDG PET显像在乳腺癌中的应用原理及其临床应用价值。与传统影像学相比，^18F-FDG PET。显像能够更为准确地发现原发性乳腺癌远处转移和局部复发，可以在治疗早期及时评价化疗疗效以指导临床治疗。对于原发性乳腺癌的诊断。PET显像不作为首选检查。但对于临床检查或常规影像检查难以进行或无明确结论的病人。PET显像可以作为其乳腺肿块定性诊断的最佳选择。     

18F-氟代脱氧葡萄糖应用于肺癌术中导向的实验研究

目的研究放射导向手术(RGS)在肺肿瘤外科中的应用价值.方法根据有无肺转移,40只荷肺腺癌小鼠被随机配对分成两组,并经尾静脉注入200μl(100μCi)18F-氟代脱氧葡萄糖(18F-FDG).注药后进行体外放免显像、手持型γ探测仪(GDP)体内探测及井型探测仪分析.结果注药后2h肿瘤显像最清晰.井型探测仪显示心脏与肿瘤的放射性分布(%ID/g)高于其他脏器.GDP显示肿瘤/正常组织放射性比值(T/NT)为3.71～13.57(除肿瘤/心脏以外).肺转移组肺组织的%ID/g及T/NT比值与对照组肺组织相比存在显著性差异(P<0.01).肺转移癌的T/NT为2.91±0.45.结论肺癌组织能够大量摄取18F-FDG,利用GDP可准确区分肿瘤及正常组织并探测出转移病灶.     

11C-MET PET/CT 脑肿瘤显像临床初步应用

目的:初步评价11C-MET PET/CT脑显像临床应用价值.方法:研究对象为5例健康志愿者和36例脑部肿瘤患者,健康志愿者行11C-MET PET/CT脑显像,并作为对照组,36例脑部肿瘤患者中19例同时行11C-MET及18F-FDG PET/CT显像,17例仅行11C-MET PET/CT显像;结合健康对照组图像,对本组36例脑部肿瘤患者11C-MET PET/CT脑显像进行分析,并对同时进行18F-FDG PET显像者进行配对比较.结果:所有患者中11C-MET PET/CT显像阳性者30例,T/B均值为1.72±0.39,18F-FDG PET/CT显像阳性者9例,T/B均值为1.49±0.13.19例患者接受11C-MET PET/CT及18F-FDG PET/CT脑显像,T/B均值分别为1.64±0.49及1.16±0.36 (t=3.33,P<0.01).11C-MET PET/CT显像诊断脑肿瘤初诊患者灵敏度、特异度及准确度均为100%,其诊断脑肿瘤复发的灵敏度、特异度及准确度分别为94.7%(18/19)、100%(5/5)、95.8%(23/24).结论:单独行11C-MET PET/CT脑显像可满足大多数脑肿瘤患者治疗前定位与治疗后疗效监测的需要;若与18F-FDG PET显像联合应用,更可能在肿瘤分级上获得帮助.     

~(18)F-FDG PET/CT在弥漫大B细胞淋巴瘤诊断和化疗中期疗效评价的研究

目的应用氟标记的氟代脱氧葡萄糖(~(18)F-FDG)正电子发射计算机断层显像及传统CT显像在弥漫大B细胞淋巴瘤(DLBCL)化疗中期治疗前分期及治疗2～4疗程后疗效评价,应用新的肿瘤评价系统PERCIST标准草案(PER-CIST),将病例图像进行归一化和标准化后进行疗效评估。方法回顾分析我院2011年9月～2015年9月,在本科检查经病理确诊DLBCL 66例,均为初诊患者。66例患者均进行国际预后指数评分及分期,评价初诊患者分期及临床分期。在治疗前及化疗2～4个周期后行~(18)F-FDG PET/CT显像及CT显像,依据中国DLBCL诊断与治疗指南(2013年版),所有患者均根据行免疫化疗(R-CH0P)治疗方案,根据疗效分为有效组及无效组。PET/CT与传统影像CT比较灵敏度、特异性、准确率、阳性预测值及阴性预测值及化疗前后最大病灶标准化摄取值(SUVmax)。应用肿瘤评价系统PERCIST标准,对66例患者中21例行图像处理,得到完全代谢缓解(CMR)和代谢恶化(PMD)等对疗效进行评价。结果 1)本研究~(18)F-FDG PET/CT与CT二者在灵敏度、准确率、阳性预测值及阴性预测值等方面比较,PET/CT比CT分别提高了17. 77%、21. 44%、5. 6%、86. 2%,差异均有统计学意义(X~2=36. 43,P=0. 00;X~2=45. 62,P=0. 00;X~2=6. 25,P=0. 01;X~2=30. 78,P=0. 00); 2) 66例DLBCL患者化疗后:CT评价中的19名PR患者中,10位患者在PET/CT疗效评价标准中为重新修定为CR; CT评价27例CR患者中,8位患者PET/CT发现新增病灶; 3) DLBCL患者行化疗前、2～4疗程化疗后病灶SUVmax之间差异具有统计学意义(t=3. 58,P 0. 05),治疗有效组SUVmax呈下降趋势,无效组呈上升趋势; 4)应用肿瘤评价系统PERCIST标准疗效评价,能够更好的从定量水平观察病变代谢水平变化,评价肿瘤是否有活性,进行中期疗效评价。结论在化疗中期对DLBCL患者行~(18)F-FDG PET/CT显像对临床诊断、分期及疗效评价有较大的临床价值。     

肺部病变18F-FDG符合线路显像不同参照点半定量值的对比研究

目的 探讨18 F-FDG符合线路显像诊断肺部病变良恶性的最佳半定量阈值.方法 对137例肺部病变患者(男89例,女48例,年龄33 ～ 78岁)行18F-FDG符合线路显像,测量肺部病变(T)、正常胸壁软组织(NT1)及对侧相应肺组织(NT2)的最大放射性.以正常胸壁软组织和对侧相对应肺组织为参照点,分别计算肺部病变半定量摄取比值R1(T/NT1)及R2(T/NT2),应用ROC曲线确定肺部病变良恶性的最佳临界值R1(cutoff)、R2(cutoff),并计算其对应的灵敏度、特异性、准确性.结果 R1(cutoff)取3.58,R2(cutoff)取4.40;按此2个最佳临界值,18F-FDG符合线路显像诊断肺部病变的灵敏度、特异性、准确性分别为90.0％ (90/100)、89.2％ (33/37)、89.8％ (123/137)和90.0％ (90/100)、78.4％(29/37)、86.9％ (119/137).结论 以胸壁软组织为参照点,半定量摄取比值取3.58作为18F-FDG符合线路显像诊断肺部病变良恶性的阈值更可靠.     

Breast cancer staging in a single session: whole-body PET/CT mammography

Our objective was to compare the diagnostic accuracy of an all-in-one protocol of whole-body 18F-FDG PET/CT and integrated 18F-FDG PET/CT mammography with the diagnostic accuracy of a multimodality algorithm for initial breast cancer staging. METHODS: Forty women (mean age, 58.3 y; range, 30.8-78.4 y; SD, 12 y) with suspected breast cancer were included. For the primary tumor, we compared 18F-FDG PET/CT mammography versus MRI mammography; for axillary lymph node status, 18F-FDG PET/CT versus clinical investigation and ultrasound; and for distant metastases, 18F-FDG PET/CT versus a multimodality staging algorithm. Histopathology and clinical follow-up served as the standard of reference. The Fisher exact test evaluated the significance of differences (P < 0.05). Alterations in patient management caused by 18F-FDG PET/CT were documented. RESULTS: No significant differences were found in the detection rate of breast cancer lesions (18F-FDG PET/CT, 95%; MRI, 100%; P = 1). 18F-FDG PET/CT correctly classified lesion focality significantly more often than did MRI (18F-FDG PET/CT, 79%; MRI, 73%; P < 0.001). MRI correctly defined the T stage significantly more often than did 18F-FDG PET/CT (MRI, 77%; 18F-FDG PET/CT, 54%; P = 0.001). 18F-FDG PET/CT detected axillary lymph node metastases in 80% of cases; clinical investigation/ultrasound, in 70%. This difference was not statistically significant (P = 0.067). Distant metastases were detected with 18F-FDG PET/CT in 100% of cases, and the multimodality algorithm identified distant metastases in 70%. This difference was not statistically significant (P = 1). Three patients had extraaxillary lymph node metastases that were detected only by PET/CT (cervical, retroperitoneal, mediastinal/internal mammary group). 18F-FDG PET/CT changed patient management in 12.5% of cases. CONCLUSION: Our data suggest that a whole-body 18F-FDG PET/CT mammography protocol may be used for staging breast cancer in a single session. This initial assessment of the 18F-FDG PET/CT protocol indicates similar accuracy to MRI for the detection of breast cancer lesions. Although MRI seems to be more accurate when assessing the T stage of the tumor, 18F-FDG PET/CT seems able to more accurately define lesion focality. Although 18F-FDG PET/CT mammography was able to detect axillary lymph node metastases with a high sensitivity, this method cannot soon be expected to replace the combination of clinical examination, ultrasound, and sentinel lymph node biopsy for axillary assessment.     

Prognostic significance of (18)F-FDG and (99m)Tc-methylene diphosphonate uptake in primary osteosarcoma.

The purpose of this retrospective analysis was to evaluate the prognostic significance of both initial glucose metabolism as measured by (18)F-FDG PET and osteoblastic activity as measured by (99m)Tc-methylene diphosphonate (MDP) bone scintigraphy in osteosarcoma. METHODS: In 29 patients (18 male, 11 female; age range, 5-41 y) with primary osteosarcoma, (18)F-FDG uptake and (99m)Tc-MDP uptake were measured semiquantitatively (average and maximum tumor-to-nontumor ratios [T/NT(av) and T/NT(max), respectively]) using PET and bone scintigraphy at the time of diagnosis. After chemotherapy, the patients underwent surgery for their primary tumor, and the response was determined histologically. Cumulative overall survival and event-free survival were determined by clinical and imaging follow-up of 7-72 mo (median, 28 mo). RESULTS: Clinical and imaging follow-up revealed that the disease relapsed or failed to achieve complete remission in 9 patients and that 6 patients died of the disease. Both overall and event-free survival were significantly better in patients with a low (18)F-FDG T/NT(max) (less than the median) than in patients with a high (18)F-FDG T/NT(max) (at least the median). The negative relationship of (18)F-FDG T/NT(av), (99m)Tc-MDP T/NT(max), and (99m)Tc-MDP T/NT(av) with overall and event-free survival did not reach a level of significance. (18)F-FDG uptake values correlated moderately and positively with (99m)Tc-MDP uptake values, but a level of significance was reached only between (18)F-FDG T/NT(max) and (99m)Tc-MDP T/NT(av). CONCLUSION: The initial glucose metabolism of primary osteosarcoma as measured by (18)F-FDG PET using T/NT(max) provides prognostic information. High (18)F-FDG uptake correlates with poor outcome. Thus, (18)F-FDG uptake may be complementary to other well-known factors in judging the prognosis in osteosarcoma.     

PET/CT在乳腺癌疗效监测中的作用

18F-FDG PET集合了形态学与功能学成像的优势,可通过观察肿瘤细胞内FDG的浓聚程度变化来评价药物治疗的效果,因此在乳腺癌新辅助化疗(NAC)及复发/转移性乳腺癌的综合治疗中颇受关注。本文就18FFDG PET/CT在乳腺癌NAC及复发/转移性乳腺癌治疗中的作用进行总结,同时对近期较受关注的新型显像方式,如雌激素受体显像、细胞乏氧显像、细胞增殖显像、Her-2/neu显像等在乳腺癌中的应用进行归纳及展望。     

Early prediction of response to chemotherapy in metastatic breast cancer using sequential 18F-FDG PET.

Chemotherapy is currently the treatment of choice for patients with high-risk metastatic breast cancer. Clinical response is determined after several cycles of chemotherapy by changes in tumor size as assessed by conventional imaging procedures including CT, MRI, plain film radiography, or ultrasound. The aim of this study was to evaluate the use of sequential 18F-FDG PET to predict response after the first and second cycles of standardized chemotherapy for metastatic breast cancer. METHODS: Eleven patients with 26 metastatic lesions underwent 31 (18)F-FDG PET examinations (240-400 MBq of 18F-FDG; 10-min 2-dimensional emission and transmission scans). Clinical response, as assessed by conventional imaging after completion of chemotherapy, served as the reference. 18F-FDG PET images after the first and second cycles of chemotherapy were analyzed semiquantitatively for each metastatic lesion using standardized uptake values (SUVs) normalized to patients' blood glucose levels. In addition, whole-body 18F-FDG PET images were viewed for overall changes in the 18F-FDG uptake pattern of metastatic lesions within individual patients and compared with conventional imaging results after the third and sixth cycles of chemotherapy. RESULTS: After completion of chemotherapy, 17 metastatic lesions responded, as assessed by conventional imaging procedures. In those lesions, SUV decreased to 72% +/- 21% after the first cycle and 54% +/- 16% after the second cycle, when compared with the baseline PET scan. In contrast, 18F-FDG uptake in lesions not responding to chemotherapy (n = 9) declined only to 94% +/- 19% after the first cycle and 79% +/- 9% after the second cycle. The differences between responding and nonresponding lesions were statistically significant after the first (P = 0.02) and second (P = 0.003) cycles. Visual analysis of 18F-FDG PET images correctly predicted the response in all patients as early as after the first cycle of chemotherapy. As assessed by 18F-FDG PET, the overall survival in nonresponders (n = 5) was 8.8 mo, compared with 19.2 mo in responders (n = 6). CONCLUSION: In patients with metastatic breast cancer, sequential 18F-FDG PET allowed prediction of response to treatment after the first cycle of chemotherapy. The use of 18F-FDG PET as a surrogate endpoint for monitoring therapy response offers improved patient care by individualizing treatment and avoiding ineffective chemotherapy.     

Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods

The aim of this study was to evaluate the usefulness of 18F-FDG PET in the diagnosis and staging of primary and recurrent malignant head and neck tumours in comparison with conventional imaging methods [including ultrasonography, radiography, computed tomography (CT) and magnetic resonance imaging (MRI)], physical examination, panendoscopy and biopsies in clinical routine. A total of 54 patients (13 female, 41 male, age 61.3+/-12 years) were investigated retrospectively. Three groups were formed. In group I, 18F-FDG PET was performed in 15 patients to detect unknown primary cancers. In group II, 24 studies were obtained for preoperative staging of proven head and neck cancer. In group III, 18F-FDG PET was used in 15 patients to monitor tumour recurrence after radiotherapy and/or chemotherapy. In all patients, imaging was obtained at 70 min after the intravenous administration of 180 MBq 18F-FDG. In 11 of the 15 patients in group I, the primary cancer could be found with 18F-FDG, yielding a detection rate of 73.3%. In 4 of the 15 patients, CT findings were also suggestive of the primary cancer but were nonetheless equivocal. In these patients, 18F-FDG showed increased 18F-FDG uptake by the primary tumour, which was confirmed by histology. One patient had recurrence of breast carcinoma that could not be detected with 18F-FDG PET, but was detected by CT. In three cases, the primary cancer could not be found with any imaging method. Among the 24 patients in group II investigated for staging purposes, 18F-FDG PET detected a total of 13 local and three distant lymph node metastases, whereas the conventional imaging methods detected only nine local and one distant lymph node metastases. The results of 18F-FDG PET led to an upstaging in 5/24 (20.8%) patients. The conventional imaging methods were false positive in 5/24 (20.8%). There was one false positive result using 18F-FDG PET. Among the 15 patients of group III with suspected recurrence after radiotherapy and/or chemotherapy, 18F-FDG was true positive in 7/15 (46.6%) and true negative in 4/15 (26.6%). The conventional imaging methods were true positive in 5/15 (33.3%) and true negative in 4/15 (26.6%). One false negative (6.6%) and three false positive findings (20%) on 18F-FDG PET were due to inflamed tissue. The conventional imaging methods were false positive in three (20%) and false negative in three cases (20%). It is concluded that in comparison to conventional diagnostic methods, 18F-FDG PET provides additional and clinically relevant information in the detection of primary and metastatic carcinomas as well as in the early detection of recurrent or persistent head and neck cancer after radiotherapy and/or chemotherapy. 18F-FDG PET should therefore be performed early in clinical routine, usually before CT or MRI.     

18F-FDG PET/CT with Contrast Enhancement for Evaluation of Axillary Lymph Node Involvement in T1 Breast Cancer

Background

¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography ((PET) safely predicts axillary status in patients with breast cancer, but is not sufficiently accurate in early breast cancer patients. This study analyzed the value of ¹⁸F-FDG PET/computed tomography (CT) with contrast enhancement in detecting axillary lymph node involvement in T1 breast cancer patients.

Methods

Contrast-enhanced ¹⁸F-FDG PET/CT was performed within 20 days of surgery in 143 breast cancer patients with tumors ≤2 cm in size. The patients underwent either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), and histopathology reports were used to provide the definitive diagnosis against which the contrast-enhanced ¹⁸F-FDG PET/CT study results were compared.

Results

The sensitivity, specificity, and negative and positive predictive values of contrast-enhanced ¹⁸F-FDG PET/CT in detecting axillary involvement were 70.0%, 92.2%, 88.8%, and 77.8%, respectively, in the entire series of 143 patients, with eight false-positive and 12 false negative results. The false-negative results were associated with the number of metastatic lymph nodes and the rate of FDG uptake.

Conclusion

Contrast-enhanced ¹⁸F-FDG PET/CT cannot replace histologic staging using SLNB in patients with breast cancer, but ¹⁸F-FDG PET/CT increases the sensitivity for predicting axillary node metastasis, and allows for a selective approach to either ALND or SLNB, even in patients with T1 breast cancer.     

Usefulness of 18F-fluoride PET/CT in Breast Cancer Patients with Osteosclerotic Bone Metastases

Purpose

Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and ¹⁸F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of ¹⁸F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that ¹⁸F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of ¹⁸F-fluoride PET/CT by comparing it with WBBS and ¹⁸F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.

Materials and Methods

Nine breast cancer patients with suspected bone metastases (9 females; mean age ± SD, 55.6 ± 10.0 years) underwent ^99mTc-MDP WBBS, ¹⁸F-FDG PET/CT and ¹⁸F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.

Results

¹⁸F-fluoride PET/CT, ¹⁸F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of ¹⁸F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on ¹⁸F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on ¹⁸F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and ¹⁸F-FDG PET/CT were identified on ¹⁸F-fluoride PET/CT.

Conclusion

¹⁸F-fluoride PET/CT is superior to WBBS or ¹⁸F-FDG PET/CT in detecting osteosclerotic metastatic lesions. ¹⁸F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients.     

乳腺癌18F-FDG PET/CT和3.0T MRI联合显像评分与Ki-67表达水平的相关性分析

目的 探讨18F-FDG PET/CT和3.0T MRI联合显像评分与Ki-67（一种增殖细胞核抗原）表达水平的相关性。 方法 18例经病理确诊的原发性乳腺癌患者术前行18F-FDG PET/CT和3.0T MRI联合显像,对显像结果进行评分并与Ki-67的表达水平进行相关性分析。联合显像和术后病理标本的免疫组化检测在一周内完成。 结果 ① 乳腺癌最大标准化摄取值与Ki-67的表达水平呈正相关（r=0.473,P＜0.05）;②PET/CT和3.0T MRI联合显像评分与Ki-67的表达水平呈明显正相关（r=0.674,P＜0.01）。 结论 18F-FDG PET/CT和3.0T MRI联合显像在乳腺癌的预后判断中可能具有重要的潜在价值。     

Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods

The aim of this study was to evaluate the usefulness of ¹⁸F-FDG PET in the diagnosis and staging of primary and recurrent malignant head and neck tumours in comparison with conventional imaging methods [including ultrasonography, radiography, computed tomography (CT) and magnetic resonance imaging (MRI)], physical examination, panendoscopy and biopsies in clinical routine. A total of 54 patients (13 female, 41 male, age 61.3ᆠ years) were investigated retrospectively. Three groups were formed. In group I, ¹⁸F-FDG PET was performed in 15 patients to detect unknown primary cancers. In group II, 24 studies were obtained for preoperative staging of proven head and neck cancer. In group III, ¹⁸F-FDG PET was used in 15 patients to monitor tumour recurrence after radiotherapy and/or chemotherapy. In all patients, imaging was obtained at 70 min after the intravenous administration of 180 MBq ¹⁸F-FDG. In 11 of the 15 patients in group I, the primary cancer could be found with ¹⁸F-FDG, yielding a detection rate of 73.3%. In 4 of the 15 patients, CT findings were also suggestive of the primary cancer but were nonetheless equivocal. In these patients, ¹⁸F-FDG showed increased ¹⁸F-FDG uptake by the primary tumour, which was confirmed by histology. One patient had recurrence of breast carcinoma that could not be detected with ¹⁸F-FDG PET, but was detected by CT. In three cases, the primary cancer could not be found with any imaging method. Among the 24 patients in group II investigated for staging purposes, ¹⁸F-FDG PET detected a total of 13 local and three distant lymph node metastases, whereas the conventional imaging methods detected only nine local and one distant lymph node metastases. The results of ¹⁸F-FDG PET led to an upstaging in 5/24 (20.8%) patients. The conventional imaging methods were false positive in 5/24 (20.8%). There was one false positive result using ¹⁸F-FDG PET. Among the 15 patients of group III with suspected recurrence after radiotherapy and/or chemotherapy, ¹⁸F-FDG was true positive in 7/15 (46.6%) and true negative in 4/15 (26.6%). The conventional imaging methods were true positive in 5/15 (33.3%) and true negative in 4/15 (26.6%). One false negative (6.6%) and three false positive findings (20%) on ¹⁸F-FDG PET were due to inflamed tissue. The conventional imaging methods were false positive in three (20%) and false negative in three cases (20%). It is concluded that in comparison to conventional diagnostic methods, ¹⁸F-FDG PET provides additional and clinically relevant information in the detection of primary and metastatic carcinomas as well as in the early detection of recurrent or persistent head and neck cancer after radiotherapy and/or chemotherapy. ¹⁸F-FDG PET should therefore be performed early in clinical routine, usually before CT or MRI.