脊椎结核的18F-FDG PET/CT表现及诊断价值

目的探讨18F-FDG PET/CT对脊椎结核的诊断价值。方法回顾我院10例脊椎结核的PET/CT表现,SUV>2.5定为放射性摄取增高,并对比MRI图像,分析其对脊椎结核的诊断符合率。随访时间为12～24个月。结果有完整资料的10例脊椎结核患者,MRI诊断脊柱结核6例(60%),其余均诊断为转移瘤。18F-FDG PET/CT诊断脊椎结核10例,共计16个椎体,其中4例为单一椎体受累,6例患者表现为2个连续椎体同时受累,以胸腰段椎体为主。PET/CT和MRl检出病灶率相同,均为100%,定性诊断正确率分别为100%和60%,二者定性诊断比较有统计学意义。结论 PET/CT在诊断脊椎骨结核方面优于MRI,能为临床的诊治提供更准确的影像信息。     

核磁共振、正电子发射扫描在感染性脊柱炎诊断中的应用价值研究

目的 探讨核磁共振(MRI)、18氟-氟代脱氧葡萄糖(18F-FDG)正电子发射断层扫描成像/计算机断层扫描成像(PET/CT)在感染性脊柱炎诊断中的应用价值.方法 回顾2001年1月～2019年12月期间在河北北方学院附属第一医院进行感染性脊柱炎筛查的100例患者的临床资料.所有受试者经组织病理学和细菌学检查,有明确的诊断结果,并接受MRI及18 F-FDG PET/CT检查.分析MRI、18 F-FDG PET/CT检查在感染性脊柱炎诊断中的意义.结果 MRI、18 F-FDG PET/CT检查均为感染性脊柱炎诊断结果的独立影响因素.ROC曲线分析结果显示,MRI、18 F-FDG PET/CT及联合预测因子在诊断感染性脊柱炎中的曲线下面积(AUC)分别为0.896、0.958、0.973,均有统计学意义(P<0.01).MRI与18F-FDG PET/CT联合检测在感染性脊柱炎诊断中的诊断效能最理想,准确度、敏感度、特异度分别为99.00％、100.00％、97.50％.结论 将MRI与18 F-FDG PET/CT联合检测感染性脊柱炎,能够明显提升诊断的准确率.     

单发脑转移瘤的18F-FDG PET/CT显像特点

目的探讨单发脑转移瘤的18F-FDG PET/CT显像特点,以提高其诊断准确率。方法回顾性分析62例单发脑转移瘤患者的头部18F-FDG PET/CT显像资料,根据最大径将病灶分为1.0cm和≥1.0cm 2组,采用χ2检验比较2组病灶的瘤周水肿及18F-FDG摄取情况。依据CT表现将病灶分为高密度结节、等密度结节及囊性密度结节3种形式,采用χ2检验分析不同CT表现形式病灶的18 F-FDG摄取情况。结果本组62例单发脑转移瘤,发生于幕上52例(52/62,83.87%),幕下10例(10/62,16.13%)。1.0cm和≥1.0cm两组病灶的瘤周水肿差异有统计学意义(χ2=7.414,P=0.006),而18F-FDG摄取差异无统计学意义(χ2=2.647,P=0.104)。不同CT表现形式18 F-FDG摄取情况差异有统计学意义(χ2=14.480,P=0.001);大部分(11/12,91.67%)高密度结节型的病例18 F-FDG摄取不超过2级;而等密度结节型18F-FDG摄取均不低于1级,并以3级居多(17/34,50.00%);56.25%(9/16)的囊性密度结节型表现为18 F-FDG无摄取。结论单发脑转移瘤的18 F-FDG PET/CT表现形式多种多样,掌握其18 F-FDG PET/CT显像特点,有助于提高诊断准确率。     

18氟脱氧葡萄糖正电子扫描和计算机断层扫描应用于胃癌术前分期的研究

目的 研究18氟脱氧葡萄糖正电子扫描(18F-FDG PET)和计算机断层扫描(CT)融合显像(18F-FDG PET/CT)在胃癌术前分期中的作用.方法 2006年1月至2009年12月间经内镜活检与病理学检查确诊、并使用18F-FDG PET/CT作术前评估的胃癌患者67例.对比分析18F-FDG PET/CT的术前分期和手术病理学检查结果,探讨18F-FDG PET/CT在胃癌术前分期中的敏感度、特异性和准确度.结果 癌细胞转移到淋巴结50例,肝2例,网膜3例,肠系膜2例,肠壁2例,腹膜4例,肺1例,骨1例,子宫、附件2例.18F-FDG PET/CT对胃癌术前分期的敏感度、特异性和准确度分别是87%,96%和88%.18F-FDG PET/CT对不同TNM分期胃癌的敏感度、特异性和准确度并不相同,分别是Ⅰ期50%,100%,50%;Ⅱ期89%,87%,89%和Ⅲ期86%,97%,86%.但Ⅳ期胃癌的敏感度、特异性和准确度均为100%.结论 18F-FDG PET/CT不仅能检测肿瘤原发灶和周围淋巴结,且能全面了解病变全身的累及范围,对制定合理的治疗方案有重要的参考价值.特别是对不能根治的胃癌具有极高的诊断率,可避免不必要的手术探查.     

~(18)F-FDG PET/CT和PET/MRI在前列腺癌诊断及分期中的效能研究

目的对比前列腺癌2-氟-2脱氧-D-葡萄糖(~(18)F-FDG)正电子发射断层扫描/计算机断层成像(PET/CT)和正电子发射断层扫描/核磁共振成像(PET/MRI)影像学特征,探讨两种方法在前列腺癌筛查、诊断及分期中的价值。方法回顾性分析20例组织学证实为前列腺癌患者的~(18)F-FDG PET/CT和PET/MRI图像资料,比较两种方法影像学结果,并采用配对t检验和卡方检验进行统计学分析。结果 ~(18)F-FDG PET/CT和PET/MRI对病灶定量的最大标准摄取值(SUVmax)(2.9±0.25 vs.3.2±0.26)有统计学差异(P0.05),PET/CT和PET/MRI探查原发性前列腺癌阳性结果(11例vs.18例)有统计学差异(P0.05),探查周围组织(1例vs.4例)、盆腔淋巴结(4例vs.4例)及骨盆(6例vs.5例)的转移效能无统计学差异(P0.05)。结论 ~(18)F-FDG PET/MRI诊断原发性前列腺具有优势,在探查周围侵犯、盆腔淋巴或骨盆转移时和PET/CT无明显差异。临床工作中合理选择或联合应用有助于前列腺癌筛查、诊断及分期的全面评估。     

18F-FDG PET/CT显像在肾癌中的临床应用价值

目的:评价18F-脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)正电子发射计算机断层扫描(PET)/CT显像对肾癌诊断和治疗方案选择的临床应用价值.方法:回顾性分析56例临床诊断为肾癌患者的全身18F-FDG PET/CT和CT平扫加增强扫描的影像学资料.比较两者对肾癌的诊断价值.结果:56例患者中,经手术病理检查实为肾癌者47例.其余9例因18F-FDG PET/CT显像发现有转移病灶者放弃手术.18F-FDG;PET/CT 榆古敏感度为80.4%;CT平扫加增强扫描的敏感度为92.9%.9例转移病例中,3例为腹膜后淋巴结转移,3例两肺多发转移,2例骨转移并肝转移,1例伴有下腔静脉和肾静脉癌栓形成,而CT平扫加增强扫描仅发现1例肾静脉和下腔静脉痛栓形成.结论:18F-FDG PET/CT显像对诊断原发性肾癌的敏感性不如CT,但对淋巴结转移及远处转移的诊断优于CT,对肾癌的分期、治疗方案的选择及预后的判断有重要意义.     

18F-FDG PET/CT结肠空气造影在结肠病变应用中的诊断价值

【摘要】 目的 探讨18F-FDG PET/CT结肠空气造影术对结肠病变的诊断效能。方法 临床连续纳入70例怀疑结肠息肉（肿瘤）的患者及常规PET/CT检查发现肠道局灶性浓聚患者。患者注射18F-FDG（0.1mCi/Kg）60分钟后进行第一次非造影扫描。扫描结束后,行结肠空气造影扫描。所有患者行电子纤维肠镜检查,非造影扫描及空气造影扫描图像影像诊断均分别与电子纤维肠镜作为金标准进行统计,分析18F-FDG PET/CT结肠空气造影检查对结肠息肉、结肠肿瘤的灵敏度、特异度。结果70例患者电子肠镜共发现23处恶性肿瘤病灶,15处息肉等良性病灶,其中常规PET/CT对恶性肿瘤的诊断灵敏度为86.96%,对息肉的诊断诊断灵敏度为46.67%。结肠空气造影PET/CT对恶性肿瘤的诊断灵敏度为95.65%（22/23）,对良性息肉的诊断灵敏度为86.67% （13/15）。11个息肉在造影后显示病灶形态更为清晰（73.33%）。1例患者造影后显示肠道内瘘清晰。23例患者在结肠空气造影PET/CT检查后对常规PET/CT检查报告做出了较大修改,占32.86%（23/70）。结论18F-FDG PET/CT结肠空气造影检查能提高结肠良性息肉的检出灵敏度,能较好的鉴别生理性浓聚,提高诊断特异度;18F-FDG PET/CT结肠造影空气检查对显示病灶的形态、大小及肿瘤侵犯转移情况优于非造影检查,18F-FDG PET/CT结肠造影空气检查可以作为常规PET/CT扫描检查的重要补充方法。     

18F-FDG PET/CT在胆道系统恶性肿瘤中的应用

目的探讨~(18)F-FDG PET/CT诊断胆道系统恶性肿瘤的价值。方法回顾性分析34例临床疑似胆道恶性肿瘤患者的PET/CT影像资料,均获得术后病理结果,其中12例经手术切除淋巴结或淋巴结穿刺活检对18枚淋巴结获得病理诊断;与病理结果对照,计算PET/CT对胆道恶性病变原发灶、淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果 34例中,31例为恶性病变,3例为良性病变。PET/CT诊断胆道恶性肿瘤原发灶的灵敏度100%(31/31),特异度66.67%(2/3),阳性预测值96.88%(31/32),阴性预测值100%(2/2),准确率97.06%(33/34)。胆道恶性病变原发灶最大标准摄取值(SUV_(max))为8.42±4.27;3例胆道良性疾病SUV_(max)分别为12.90、2.00及1.90。共18枚淋巴结获得病理结果,包括转移性淋巴结13枚,良性增生5枚。PET/CT诊断淋巴结转移的灵敏度76.92%(10/13),特异度60.00%(3/5),阳性预测值83.33%(10/12),阴性预测值50.00%(3/6),准确率72.22%(13/18)。结论 PET/CT对胆道系统恶性肿瘤的诊断具有重要价值。     

18F-FDG PET/CT显像在结直肠癌肝转移中的应用探讨

目的 通过对结直肠癌疑肝转移患者肝脏手术前18F-FDG PET/CT显像研究其敏感性及特异性.方法 对143例确定或怀疑结直肠癌肝转移患者在肝脏手术前进行18F-FDG PET/CT显像,通过双盲回顾性的方法进行研究,以病理活检或临床/影像学随访确定病灶的发展或转归.结果 18F-FDG PET/CT显像在疑诊132例中确诊有肝转移的127例显示阳性,确诊无肝转移的患者11例均显示阴性,经统计学处理对于肝转移的确定PET/CT敏感性96.2%,特异性100%.用传统的诊断方法(CT、MRI、超声等)未发现的肝外转移病灶26例中有13例患者排除肝转移,故有27.3%的患者改变了手术治疗措施.结论 18F-FDG PET/CT显像对于结直肠癌肝转移的发现有很高的敏感性和特异性,对于肝外转移灶的发现也优于传统的诊断手段.建议18F-FDG PET/CT显像应被加入到结直肠癌肝转移肝脏手术前患者的诊疗计划中.     

PET/CT复合功能成像系统诊断乳腺癌

目的评价18F-FDG PET复合CT灌注成像诊断原发性乳腺癌的价值。方法对33例疑似乳腺癌病人行CT灌注成像和PET成像检查,并进行真实性和可靠性评价。结果27例乳房肿块经病理证实为乳腺癌。PET/CT诊断乳腺癌的敏感度、特异度和精确度分别为92.6%、100%、93.9%。结论PET/CT诊断乳腺癌有着较高的敏感度、特异度和可靠性,作为一种非侵袭性检查方法,可提供乳腺癌在活体内的代谢和血流灌注信息。     

肾上腺肿瘤44例分析

目的提高对肾上腺肿瘤的诊断水平。方法肾上腺肿瘤共44例，11例行18F-氟脱氧葡萄糖（18F—FDG）PET／CT、CT及MRI检查，余行CT和18F—FDG PET／CT检查，所有病例均行高血压试验和24h尿肾上腺素2项检测，术后病理或临床随访确诊。结果18F—FDG PET／CT对肿瘤良恶性诊断的敏感性、特异性分别为93．7％、100％，肿瘤诊断准确性为82．9％。CT分别为87．5％、96．4％和77．3％。MRI的肿瘤诊断准确性为81．8％。血浆醛固酮最高浓度在各肿瘤中差异无统计学意义（P〉0．05）。髓质肿瘤与其他肾上腺肿瘤相比尿去甲基肾上腺素（NMN）、尿甲氧基肾上腺素（MN）、收缩压、舒张压差异均有统计学意义（P〈0．05）。以3．1作为SUV临界值，得出PET／CT区分肿瘤良恶性敏感性和特异性最佳，分别为100％和96．2％。结论18F—FDGPET／CT在诊断肾上腺肿瘤良恶性上优于MRI和CT。高血压和尿NMN／MN成3倍以上升高对嗜铬细胞瘤的诊断意义重大。髓脂瘤、囊肿和嗜铬细胞瘤运用CT或MRI能较好诊断，非功能性和皮质肿瘤以PET／CT诊断为佳。     

Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective?

BACKGROUND: Multimodality staging is recommended in patients with periampullary tumors to optimize preoperative determination of resectability. We investigated the potency of currently used diagnostic procedures in order to determine resectability. METHODS: Ninety-five consecutive patients with periampullary tumors prehospitally staged resectable underwent preoperative diagnostic tests: helical-computed tomography (CT) with maximum intensity projection of arterial vessels (MIP), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreaticography (ERCP), digital subtraction angiography (DSA), and positron emission tomography (PET). Diagnoses were verified by surgery and histopathology. RESULTS: In 45 patients with benign and 50 patients with malignant periampullary tumors sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET. Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy. Arterial vessel infiltration was best predicted by CT/MIP with an accuracy of 85%. For venous vessel infiltration MRI reached 85% accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92% (MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases were identified by CT and PET, respectively. The correct diagnosis of malignancy and determination of resectability was made by CT in 71% and by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was the single most useful test, providing correct diagnosis in 88% and resectability in 71% of patients. If no tumor is depicted in CT, EUS should be added. Uncertain venous vessel infiltration can be verified by MRI or EUS. Angiography should no longer be a routine diagnostic procedure. Equivocal tumors or possible metastasis may be further examined with PET.     

What is the best way to diagnose and stage malignant pleural mesothelioma?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was which diagnostic modality [computed tomography (CT), positron emission tomography (PET), combination PET/CT and magnetic resonance imaging (MRI)] provides the best diagnostic and staging information in patients with malignant pleural mesothelioma (MPM). Overall, 61 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that fluorodeoxyglucose (FDG)-PET is superior to MRI and CT but inferior to PET-CT, in terms of diagnostic specificity, sensitivity and staging of MPM. Four studies reported outcomes using FDG-PET to diagnose MPM. PET diagnosed MPM with high sensitivity (92%) and specificity (87.9%). Mean standardised uptake value (SUV) was higher in malignant than benign disease (4.91 vs. 1.41, P<0.0001). Lymph node metastases were detected with higher accuracy (80% vs. 66.7%) compared to extrathoracic disease. Three studies assessed the utility of PET-CT to diagnose MPM. Mean SUV was higher in malignant than benign disease (6.5 vs. 0.8, P<0.001). MPM was diagnosed with high sensitivity (88.2%), specificity (92.9%) and accuracy (88.9%). PET-CT had low sensitivity for stage N2 (38%) and T4 (67%) disease. CT-guided needle biopsy definitively diagnosed MPM after just one biopsy (100% vs. 9%) much more often than a 'blind' approach. CT had a lower success rate (92% vs. 100%) than thoracoscopic pleural biopsy but was equivalent to MRI in terms of detection of lymph node metastases (P=0.85) and visceral pleural tumour (P=0.64). CT had a lower specificity for stage II (77% vs. 100%, P<0.01) and stage III (75% vs. 100%, P<0.01) disease compared to PET-CT. Overall, the high specificity and sensitivity rates seen with open pleural biopsy make it a superior diagnostic modality to CT, MRI or PET for diagnosing patients with MPM.     

MRI诊断转移性骨肿瘤

目的探讨常规MR检查及类PET成像技术诊断转移性骨肿瘤的价值。方法对30例转移性骨肿瘤患者进行MR检查,其中25例接受CT检查,17例接受X线检查,对检查结果进行对比分析。行常规MR T1W/T2W序列及DWI成像后,通过三维图像重组、黑白翻转技术获得类PET图像。结果 MRI对30例患者（30/30,100%）均做出正确诊断,诊断准确率高于CT平扫（21/25,84.00%）及X线平片（12/17,70.59%,P均〈0.05）。结论常规MR检查及类PET成像技术可以提高对转移性骨肿瘤的准确诊断率。     

多模态影像学诊断心脏占位性病变

目的 观察多模态影像学诊断心脏占位性病变的价值。方法 回顾性分析70例接受超声心动图及心脏CT(CCT)检查的心脏占位性病变患者,其中35例接受心脏MRI(CMRI);根据术后病理或临床诊断结果评估多模态影像学诊断心脏占位性病变的价值。结果 70例中,经手术病理证实43例良性肿瘤,经手术病理证实3例、经临床诊断1例恶性肿瘤;经临床诊断23例非肿瘤占位性病变,治疗后病变均明显缩小。超声心动图正确诊断57例、误诊8例、5例诊断不明确,诊断准确率为81.43%(57/70);CCT正确诊断63例、误诊4例、漏诊3例,诊断准确率为90.00%(63/70)。35例CMRI诊断结果均与术后病理结果一致,诊断准确率100%(35/35)。结论 多模态影像学检查可为临床诊断及治疗心脏占位性病变提供客观依据。     

68Ga-PSMA PET/CT在前列腺癌术前诊断及手术策略制订中的应用

目的评估⁶⁸Ga标记的前列腺特异性膜抗原(⁶⁸Ga-PSMA)PET/CT对前列腺癌的诊断效能,并探讨⁶⁸Ga-PSMA PET/CT对术前制订保留血管神经束(NVB)和淋巴结清扫策略的指导作用。方法回顾性分析2018年6月至2019年10月中国医学科学院肿瘤医院行⁶⁸Ga-PSMA PET/CT检查的46例初诊疑似前列腺癌患者的临床资料。中位年龄66.50(60.00,69.25)岁,中位前列腺特异性抗原(PSA)值15.97(8.58,33.10)ng/ml。46例中,41例⁶⁸Ga-PSMA PET/CT检查诊断为肿瘤,6例诊断有淋巴结转移;5例诊断为前列腺增生或前列腺炎。46例中40例同期行mpMRI检查,33例诊断为肿瘤,6例诊断有淋巴结转移;46例中17例同期行^11C-胆碱PET/CT检查,12例诊断为肿瘤,4例诊断有淋巴结转移。41例PSMA-PET/CT诊断为前列腺癌的患者中,高危22例,中危19例;其中37例行mpMRI检查,15例行^11C-胆碱PET/CT检查。41例均行根治性前列腺切除术。根据⁶⁸Ga-PSMA PET/CT显示的肿瘤位置,术前制订NVB处理策略:若肿瘤邻近前列腺单侧包膜,则保留健侧的NVB;若肿瘤局限于前列腺内,则保留双侧NVB。共16例保留了NVB(单侧6例,双侧10例)。对中高危组患者常规行淋巴结清扫。采用配对χ²检验或Fisher精确检验比较⁶⁸Ga-PSMA PET/CT、mpMRI、^11C-胆碱PET/CT对病灶检出的敏感性和特异性。采用Spearman相关分析检测⁶⁸Ga-PSMA PET/CT的SUV_max值与Gleason评分和治疗前PSA值的相关性。结果 41例行根治术患者术后病理确诊为前列腺癌,手术切缘均未见癌组织;中位Gleason评分8(7,9)分;病理分期20例≤pT_2c期,21例≥pT₃期;7例淋巴结阳性(11枚阳性淋巴结)。术后30 d内7例(17.1%)发生并发症,Clavien-Dindo分级均≤2级。41例术后随访中位时间16(12,20)个月,术后1、6、12个月分别有19例(46.3%)、39例(95.1%)、41例(100.0%)恢复控尿。5例未行手术的患者中,4例行抗生素治疗后PSA下降;1例PSA未下降者行穿刺活检,病理未见癌。⁶⁸Ga-PSMA PET/CT诊断前列腺癌的敏感性为100.0%(41/41),显著优于^11C-胆碱PET/CT[80.0%(12/15),P=0.016]和mpMRI[83.7%(31/37),P=0.009];特异性为100.0%(5/5),与^11C-胆碱PET/CT[100.0%(2/2),P=1.000]和mpMRI [33.3%(1/3),P=0.107]的差异均无统计学意义。41例中,⁶⁸Ga-PSMA PET/CT诊断淋巴结转移的敏感性[71.4%(5/7)]与^11C-胆碱PET/CT的差异无统计学意义[75.0%(3/4),P=1.000],与mpMRI的差异有统计学意义[16.7%(1/6),P=0.016]。Gleason评分≥8分与<8分患者⁶⁸Ga-PSMA PET/CT的原发灶SUV_max值分别为19.60(9.58,24.38)与8.55(5.18,12.88);治疗前PSA值≥20 ng/ml与<20 ng/ml患者的SUV_max值分别为19.40(13.00,23.5)与8.40(5.35,13.95),差异均有统计学意义(P<0.05)。结论 ⁶⁸Ga-PSMA PET/CT对前列腺癌原发病灶诊断的敏感性高、特异性高,术前可根据PSMA PET/CT显示的肿瘤位置,制订是否保留NVB的处理策略;但其对淋巴结转移灶诊断的敏感性还不足以指导术前制订淋巴结清扫策略。     

Added value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of post-operative instrumented spine infection

PurposePost-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection.MethodsThis retrospective study attempts to evaluate the diagnostic performance of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected chronic spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient's conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUV_max). MRI results were collected from medical records. The final diagnosis of infection was based on bacteriological cultures or a twelve-month follow-up.ResultsForty-nine PET/CT were performed in 44 patients (22 women, median age 65.0 years). Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity, specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 50.0%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP). Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of extensive instrumented arthrodesis or infection with low virulence bacteria.ConclusionPET/CT is useful for the diagnosis of PISI. These results should be evaluated in further prospective study.     

肾上腺损伤的影像学诊断特点

目的 总结肾上腺损伤的影像学诊断特点. 方法 回顾性分析29例外伤性肾上腺挫伤及形成血肿患者的影像学表现.男20例,女9例.平均年龄37岁.患者临床表现腰背部疼痛、局部叩痛及伴发伤症状.右侧肾上腺损伤25例(86%)、左侧2例(7%)、双侧2例(7%).相关内分泌检查均未见明显异常.行CT检查29例、MRI检查5例、超声检查6例,CT随访观察23例,MRI及超声复查各1例. 结果 29例患者中CT、MRI及超声首次检查符合率分别为97%(28/29)、100%(5/5)和50%(3/6).1例单纯性右侧肾上腺血肿CT未确诊,经MRI检查确诊.肾上腺挫伤CT表现为肾上腺局限性或弥漫性肿大及灶性高密度出血影;急性期血肿表现为类圆形无强化高密度影,直径1～3 cm,周围脂肪组织内可见不同程度的高密度索条影;1～26周CT复查示血肿密度逐渐减低,体积逐渐缩小至消失,无假性囊肿形成.5例亚急性及慢性期血肿MRI表现为T1WI、T2WI及DWI呈典型高信号,T2WI周边呈环形低信号,CT或MRI增强扫描时血肿不强化,与周边形成的环状高密度或高信号强化影形成特征性"坚果"样影像改变.3例肾上腺血肿超声表现为肾上腺低回声肿块,未见血流信号. 结论 CT是肾上腺挫伤及血肿首选的影像学检查方法 ,在患者病情发展转归中有其不同的影像学特点.对CT和超声诊断困难的病例MRI检查有助于正确诊断.     

对比基于PET/CT的不同方法定性诊断孤立性肺结节的效能

目的对比观察基于PET/CT的不同方法定性诊断孤立性肺结节(SPN)的效能。方法收集161接受PET/CT检查的SPN患者,比较良恶性SPN患者间临床表现、高分辨率CT(HRCT)征象及SUV max值的差异;通过二元Logistic回归构建SPN的数学诊断模型,比较诊断模型、PET/CT及HRCT的诊断效能。结果161例SPN中,经病理诊断恶性131例,良性30例。PET/CT诊断恶性SPN的灵敏度、特异度及准确率分别为98.47%(129/131)、76.67%(23/30)及94.41%(152/161),HRCT分别为59.54%(78/131)、83.33%(25/30)及63.98%(103/161)。经单因素及多因素分析后,将SUV max、年龄、钙化及气管血管集束纳入回归方程并建立模型,模型诊断恶性SPN的敏感度、特异度及准确率分别为82.44%(108/131)、86.67%(26/30)及83.23%(134/161)。ROC曲线结果显示,模型、PET/CT及HRCT诊断恶性SPN的AUC分别为0.909、0.876及0.714,PET/CT及模型的AUC均高于HRCT(P均<0.001),模型与PET/CT差异无统计学意义(P=0.468)。结论基于PET/CT的Logistic回归模型及PET/CT定性诊断SPN的效能优于HRCT,且特异度高于PET/CT。     

神经外科术后颅脑感染CT和MRI诊断价值及对照研究

目的探讨神经外科术后患者颅脑感染CT和MIU的诊断价值及对照研究。方法收集整理本院2009年1月至2012年12月神经外科颅脑手术后发生颅内感染的患者8060的临床资料,所有患者均进行西门子MRI、CT设备进行常规检查2～3次,分析对比MRI和CT分别对神经外科术后颅脑感染者诊断的准确率及不同发病阶段的诊断阳性率。结果CT图像结果显示,正常图像4160（51.3％）,异常图像39例（48．7％）;MRI图像结果显示,正常1260（15．0％）,异常68例（85．5％）。MRI组图像诊断阳性率显著高于CT组,两组患者比较差异具有统计学意义（P均〈0．05）。CT组早期异常者32例（40．0％）,后期异常者15例（18．8％）;MRI组早期异常者72例（90．0％）,后期异常者1860（26．3％）,MRI组对处于不同时期的颅脑损伤患者图像诊断阳性率显著高于CT组,两组患者比较差异具有统计学意义（P均〈0．05）。结论CT及MRI对于神经外科术后患者颅脑感染的诊断有很大的帮助,同时MRI检查可以更好地协助颅脑感染者的诊断,提高患者的诊断阳性率。