用全身PET/CT寻找转移瘤患者的原发灶

目的:对不明原因转移瘤患者,探讨利用正电子发射计算机断层显像（positron emission tomography/computed tomography,PET/CT）寻找肿瘤原发灶的临床价值。方法:回顾性收集经病理学证实或影像学检查诊断为转移瘤的137例住院患者的临床及PET/CT成像资料,计算全身PET/CT显像对不明原因转移瘤患者肿瘤原发灶的检出率,分析不同部位转移瘤原发灶检出率间的差异。结果:确诊1例淋巴瘤患者被排除,18F-FDG PET/CT正确检出原发病灶89例,检出率为65.4%（89/136）。18F-FDG PET/CT对于淋巴结转移、骨转移、肝转移及脑转移瘤肿瘤原发灶检出率分别为63.2%（36/57）、60.0%（18/30）、86.7%（13/15）和57.1%（8/14）。结论:全身PET/CT显像在不明原因转移瘤寻找肿瘤原发灶方面具有重要临床应用价值。     

18F-FDG PET/CT or PET Role in MALT Lymphoma: An Open Issue not Yet Solved—A Critical Review

Mucosa-associated lymphoid tissue (MALT) lymphoma involves the mucosa-associated lymphoid tissue potentially arising from any mucosal site, with the stomach as the most common site of involvement. MALT lymphoma is not usually an aggressive disease with a good prognosis except for selected cases. Fluorine-18 (¹⁸F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a noninvasive imaging tool used for staging, restaging, and evaluation of the treatment response in non-Hodgkin and Hodgkin lymphoma. However, its effective role in MALT lymphoma is not yet clear. The open question is whether these lymphomas are ¹⁸F-FDG avid or not, with conflicting results reported in the literature. Consequently, the possible clinical role of ¹⁸F-FDG PET/CT for staging and restaging purposes is under debate. The aim of the present review was to analyze the reported data about the role of ¹⁸F-FDG PET or PET/CT in patients with MALT lymphoma. We performed a comprehensive computer literature search of the Scopus, Cochrane, PubMed/MEDLINE, and Embase databases, including articles reported up to August 2019. We included 32 studies that had analyzed ¹⁸F-FDG PET or PET/CT for patients with MALT lymphoma. We analyzed the metabolic behavior of MALT lymphoma using ¹⁸F-FDG PET and the effect of the PET findings in the staging, treatment response evaluation, and prognosis.     

18F-FDG PET/CT显像在鼻咽癌分期与疗效监测中的临床应用价值

背景与目的:18F-脱氧葡萄糖(fluorine-18 fluorodeoxyglucose,18F-FDG)PET/CT显像可明显提高肺癌、食管癌等多种肿瘤的诊断、分期与疗效监测的准确性,有助于更准确地制定治疗方案.本研究探讨全身18F-FDG PET/CT显像在鼻咽癌首次分期、再分期及疗效监测中的临床应用价值.方法:回顾性分析澳大利亚Peter MacCallum肿瘤中心2002年2月至2005年12月43例鼻咽癌患者的18F-FDG PET/CT全身扫描报告,根据临床资料、病理结果及临床随访结果,计算18F-FDG PET/CT与传统影像学检查CT、MRI的准确性、特异性、灵敏度、阳性预测值与阴性预测值,并对结果进行比较和分析.结果:18F-FDGPET/CT诊断鼻咽癌总的准确率、敏感性、特异性、阳性预测值与阴性预测值分别为95.3%、100.0%、85.7%、93.8%、100.0%,传统影像学检查CT、MRI分别为65.5%、79.4%、64.7%、81.8%、57.9%. 18F-FDG PET/CT诊断结果使2例首次分期、7例再分期患者治疗方案得到改变,并影响1例首次分期和3例再分期患者治疗方案的制定;在疗效监测组中,指导医生修改治疗方案共11例(其中5例为原则性的修改).18F-FDG PET/CT检测到2例第二原发肿瘤,1例是甲状腺癌,1例是低度恶性胃癌.结论:18F-FDG PET/CT全身显像对鼻咽癌N、M分期与疗效监测的临床作用可能优于CT、MR检查.     

Clinical value of F-FDG PET/CT in assessing suspicious relapse after rectal cancer resection

AIM: To evaluate the value of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in the restaging of resected rectal cancer.METHODS: From January 2007 to Sep 2008, 21 patients who had undergone curative surgery resection for rectal carcinoma with suspicious relapse in conventional imaging or clinical findings were retrospectively enrolled in our study. The patients underwent 28 PET/CT scans (two patients had two scans, one patient had three and one had four scans). Locoregional recurrences and/or distant metastases were confirmed by histological analysis or clinical and imaging follow-up.RESULTS: Final diagnosis was confirmed by histopathological diagnosis in 12 patients (57.1%) and by clinical and imaging follow-up in nine patients (42.9%). Eight patients had extrapelvic metastases with no evidence of pelvic recurrence. Seven patients had both pelvic recurrence and extrapelvic metastases, and two patients had pelvic recurrence only. ¹⁸F-FDG PET/CT was negative in two patients and positive in 19 patients. ¹⁸F-FDG PET/CT was true positive in 17 patients and false positive in two. The accuracy of ¹⁸F-FDG PET/CT was 90.5%, negative predictive value was 100%, and positive predictive value was 89.5%. Five patients with perirectal recurrence underwent ¹⁸F-FDG PET/CT image guided tissue core biopsy. ¹⁸F-FDG PET/CT also guided surgical resection of pulmonary metastases in three patients and monitored the response to salvage chemotherapy and/or radiotherapy in four patients.CONCLUSION: ¹⁸F-FDG PET/CT is useful for evaluating suspicious locoregional recurrence and distant metastases in the restaging of rectal cancer after curative resection.     

18F-FDG PET-CT在非小细胞肺癌术前区域淋巴结分期中的价值

目的 探讨18F-FDG PET-CT在非小细胞肺癌(NSCLC)患者术前区域淋巴结(N)分期方面的价值,以及CT密度和双时相扫描在淋巴结性质判定方面的作用.方法 43例手术病理证实的NSCLC患者均于术前行18F-FDG PET-CT扫描,对常规扫描图像采用PET法(单纯根据18F-FDG摄取水平判断淋巴结性质)和PET+CT密度法(结合CT密度和摄取水平判断淋巴结性质)分析.摄取水平通过目测法和半定量分析法结合判定.双时相扫描的储留指数(RI)>10%为摄取升高.以病理检查作为金标准对所得结果进行分析.结果 以区域淋巴结组为单位,PET法的诊断敏感度、特异度、准确度、阳性预测值和阴性预测值分别为88.0%、88.4%、88.3%、59.5%和97.4%,PET+CT密度法的相应值分别为84.0%、94.6%、92.9%、75.0%和96.8%,其中2种方法的特异度和准确度之间差异有统计学意义(P<0.05).28组淋巴结行双时相扫描,良恶性组摄取变化值(△SUVmax)之间和砒之间差异无统计学意义(P>0.05);在23组延迟相摄取升高的淋巴结中,11组为转移;在5组无摄取升高的淋巴结中,1组为转移.结论 18F-FDG PET-CT在肺癌患者术前N分期方面有较高的诊断价值,结合淋巴结CT密度和18F-FDG摄取水平可进一步提高诊断的特异度和准确度.对于常规相摄取增高的淋巴结,延迟相摄取升高对判断淋巴结性质的价值有限,但无摄取升高则更支持良性诊断.     

ORIGINAL ARTICLE: Pilot comparison of 18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT with conventional imaging in prostate cancer

Introduction: Conventional imaging (CI) is known to have limitations with respect to staging of patients with primary or relapsed prostate cancer. Positron emission tomography/computed tomography (PET/CT) with ¹⁸F-flurodeoxyglucose (FDG) is also often suboptimal because of low tracer avidity, but ¹⁸F-fluorocholine (FCH) appears to be a promising alternative molecular imaging probe. We report a prospective pilot study of PET/CT comparing both tracers for staging and restaging of patients with prostate cancer. Methods: Sixteen prostate cancer patients were evaluated (7 for staging and 9 for restaging). All patients also underwent CI, comprising at least an abdominopelvic CT and a bone scan. All imaging results and other relevant data were extracted from the imaging reports and medical charts. Results: Based on all imaging-detected disease sites, both FCH-PET/CT and FDG-PET/CT (79%) were more sensitive than CI (14%), with the highest number of sites of nodal and distant disease on FCH PET/CT. FCH-PET/CT alone would have provided sufficient clinical information to form an appropriate management plan in 88% of cases, as compared with 56% for CI. Conclusion: FCH-PET/CT has the potential to impact on the management of patients with prostate cancer significantly more often than CI.     

Present role and future prospects of positron emission tomography in clinical oncology

Positron emission tomography (PET) has emerged as a significant molecular imaging technique in clinical oncology and cancer research. PET with (18)F-fluorodeoxyglucose ((18)F-FDG) demonstrates elevated glucose consumption by tumor cells, and is used clinically for the accurate staging and restaging of cancer, planning of radiotherapy, and predicting response or lack of response in the early stages of treatment. Combined PET and computed tomography (PET-CT) provides both functional and morphological information of the disease to allow accurate diagnosis of cancer. PET with new radiotracers such as protein synthesis markers and proliferation markers, as well as hypoxia and receptor-binding agents, will offer patient-specific images in order to yield tailored diagnostic and prognostic information.     

Diagnostic and Clinical Impact of Staging 18F-FDG PET/CT in Mantle-Cell Lymphoma: A Two-Center Experience

IntroductionThe diagnostic accuracy of fluorine-18–fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in staging mantle-cell lymphoma has not yet investigated. The aim of this 2-center retrospective study was to investigate the utility of ¹⁸F-FDG PET/CT in assessing nodal, splenic, bone marrow (BM), and gastrointestinal (GI) disease compared to CT, BM, and GI endoscopy; and to assess its clinical impact.Patients and MethodsOne hundred twenty-two patients with histologically proven mantle-cell lymphoma were included. PET/CT BM findings were considered positive if isolated/multiple focal uptake in the BM not explained by benign findings and/or diffuse BM uptake higher than liver with/without focal uptakes were present. PET/CT findings were considered positive for GI involvement in the presence of isolated/multiple focal uptake in the GI organ.ResultsAll patients had positive PET/CT showing the presence of at least one hypermetabolic lesion, with the exception of one case. PET/CT results, compared to CT, detected more nodal and/or splenic lesions in 26 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT for BM were 52%, 98%, 97%, 65%, and 74%; for GI 64%, 91%, 69%, 90%, and 85%; and for GI excluding diabetic patients, 78%, 92%, 72%, 94%, and 89%. PET/CT permitted upstaging of 21 cases and downstaging of 2.Conclusion¹⁸F-FDG PET/CT showed excellent detection rate in nodal and splenic disease—a rate better than CT. For BM and GI evaluation, in order to reach good accuracy, the selection of patients and the use of specific criteria for evaluation of these organs seems to be crucial. Moreover, PET/CT altered the management and therapeutic approach in about 20% of patients.     

Extending positron emission tomography scan utility to high-risk neuroblastoma: fluorine-18 fluorodeoxyglucose positron emission tomography as sole imaging modality in follow-up of patients.

PURPOSE: Although positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ((18)F-FDG) has a major impact on the treatment of adult cancer, the reported experience with extracranial tumors of childhood is limited. We describe a role for PET in patients with neuroblastoma (NB). PATIENTS AND METHODS: In 51 patients with high-risk NB, 92 PET scans were part of a staging evaluation that included iodine-123 or iodine-131 metaiodobenzylguanidine (MIBG) scan, bone scan, computed tomography (and/or magnetic resonance imaging), urine catecholamine measurements, and bone marrow (BM) examinations. The minimum number of tests sufficient to detect NB was determined. RESULTS: Of 40 patients who were not in complete remission, only 1 (2.5%) had NB that would have been missed had a staging evaluation been limited to PET and BM studies, and 13 (32.5%) had NB detected by PET but not by BM and urine tests. PET was equal or superior to MIBG scans for identifying NB in soft tissue and extracranial skeletal structures, for revealing small lesions, and for delineating the extent and localizing sites of disease. In 36 evaluations of 22 patients with NB in soft tissue, PET failed to identify only two long-standing MIBG-negative abdominal masses. PET and MIBG scans showed more skeletal lesions than bone scans, but the normally high physiologic brain uptake of FDG blocked PET visualization of cranial vault lesions. Similar to MIBG, FDG skeletal uptake was diffusely increased with extensive or progressing BM disease but faint or absent with minimal or nonprogressing BM disease. CONCLUSION: In the absence or after resolution of cranial vault lesions, and once the primary tumor is resected, PET and BM tests suffice for monitoring NB patients at high risk for progressive disease in soft tissue and bone/BM.     

Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients

BACKGROUND: Integrated (18)fluorine fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) has shown somewhat variable sensitivity and specificity for mediastinal nodal staging in granulomatous disease endemic areas. The purpose of the study was to prospectively evaluate the efficacy of PET/CT for mediastinal nodal staging in nonsmall cell lung cancer (NSCLC) patients in a tuberculosis-endemic country. METHODS: Prospective assessment of the diagnostic efficacy of integrated PET/CT for detecting mediastinal nodal metastasis was performed in 674 patients (M:F ratio = 502:172; mean age, 61 years) with NSCLC. Patients underwent an integrated PET/CT examination and subsequent surgical nodal staging (by mediastinoscopy only in 121 patients and by thoracotomy in 553). Nodes showing greater (18)F-FDG uptake than mediastinum at PET without benign calcification or high attenuation >70 household unit (HU) at unenhanced CT were regarded as being positive for malignancy. The histologic nodal assessment results were used as reference standards. RESULTS: Of 2477 mediastinal nodal stations evaluated in 674 patients, 275 (11%) stations in 180 (27%) patients proved to be malignant. On a per-person basis, the overall sensitivity, specificity, and accuracy of PET/CT for mediastinal nodal staging were 61% (110 of 180), 96% (473 of 494), and 86% (583 of 674), respectively. On a per-nodal station basis, they were 46% (126 of 275), 98% (2154 of 2202), and 92% (2280 of 2477). CONCLUSIONS: Integrated PET/CT provides high specificity and reasonably high accuracy, but somewhat low sensitivity for mediastinal nodal staging of NSCLCs. The high specificity is achieved at the expense of sensitivity by interpreting calcified nodes or nodes with high attenuation at CT, even with high FDG uptake at PET, as benign in a tuberculosis-endemic region.     

Towards a minimally invasive staging strategy in NSCLC: analysis of PET positive mediastinal lesions by EUS-FNA

STUDY OBJECTIVE: To asses the value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the nodal staging of patients with (suspected) non-small cell lung cancer (NSCLC) and a (18)FDG positron emission tomography (PET) scan suspect for N2/N3 mediastinal lymph node (MLN) metastases. BACKGROUND: Due to the imperfect specificity of positron emission tomography, PET positive MLN should be biopsied in order to confirm or rule out metastasis. Currently, invasive surgical diagnostic techniques such as mediastinoscopy/-tomy are standard procedures to obtain MLN tissue. The minimally invasive technique of EUS-FNA has a high diagnostic accuracy (90-94%) for the analysis of MLN in patients with enlarged MLN on computed tomography of the chest (CT). DESIGN AND PATIENTS: Thirty-six patients with proven n=26 or suspected n=10 non-small cell lung cancer and a PET scan suspect for N2/N3 lymph node metastases underwent EUS-FNA. When EUS-FNA did not confirm metastasis and the PET lesion was within reach of mediastinoscopy, a mediastinoscopy was performed. EUS-FNA negative patients with PET lesions beyond the reach of mediastinoscopy or those with a negative mediastinoscopy were referred for surgical resection of the tumour and MLN sampling or dissection. RESULTS: EUS-FNA confirmed N2/N3 disease in 25 of the 36 patients (69%) and was highly suspicious in one. In the remaining 10 patients, one PET positive and one PET negative N2 metastasis was detected at thoracotomy. The PPV, NPV, sensitivity, specificity and accuracy of EUS-FNA in analysing PET positive MLN were 100%, 80%, 93%, 100% and 94%, respectively. No complications of EUS-FNA were recorded. CONCLUSIONS AND SIGNIFICANCE: EUS-FNA yields minimally invasive confirmation of MLN metastases in 69% of the patients with potential mediastinal involvement at FDG PET. The combination of PET and EUS-FNA might qualify as a minimally invasive staging strategy for NSCLC.     

[F-18]-Fluorodeoxyglucose PET and PET-CT in diagnostic imaging evaluation of locally recurrent and metastatic bladder transitional cell carcinoma

Background Little data is available on the utility of positron emission tomography (PET) and positron emission tomography-computed tomography (PET-CT) with [F-18]-fluorodeoxyglucose (FDG) in patients with bladder cancer. We retrospectively assessed the diagnostic utility of dedicated PET and hybrid PET-CT scans with [F-18]-FDG in the imaging evaluation of recurrent and metastatic bladder transitional cell carcinoma. Methods The study group included 35 patients who were previously treated for the primary disease. We performed PET in 17 patients and 23 PET-CT scans in 18 patients. Diagnostic validation was by biopsy in 1 patient and clinical and radiological follow-up for up to 5 years in the remaining patients. Results PET and CT were true negative (TN) in 12 patients and true positive (TP) in 19 patients. In 4 patients in this group, both locally recurrent pelvic mass and distant metastases were demonstrated, while in 3 of these patients, unsuspected skeletal and/or nodal metastases were detected by PET-CT and these patients received additional courses of chemotherapy. PET was discordant with CT in 4 patients. PET was negative in 2 of these patients, while post-chemotherapy CT showed enlarged nodes that were determined to represent successfully treated disease. In another patient, a hypometabolic soft-tissue mass was considered to represent a scar, and a wait-and-watch strategy was pursued. In the remaining patient, PET showed random hypermetabolic osseous lesions that represented early marrow metastatic infiltration. The combined diagnostic information provided by PET-CT affected the clinical management in 17% of patients. Conclusion FDG PET and PET-CT scanning may improve the imaging evaluation of patients with recurrent and metastatic bladder cancer. All authors have no financial disclosures     

Stage Migration in Planning PET/CT Scans in Patients Due to Receive Radiotherapy for Non–Small-Cell Lung Cancer

IntroductionThis study examined rates of tumor progression in treatment-naive patients with non–small-cell lung cancer (NSCLC) as determined by repeat treatment-planning fluorine-18 (¹⁸F) fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT).Methods and MaterialsThis study assessed patients who underwent PET/CT simulation for NSCLC stage II/III, radiation-naive, nonmetastatic NSCLC. It compared planning PET/CT with previous PET/CT images. Patients were analyzed for change in stage, treatment intent, or both. Progression was defined as a change in TNM status leading to upstaging, and standardized uptake value (SUV) velocity was defined as [(SUV_scan2 − SUV_scan1)/interscan interval in days].ResultsOf 149 consecutive patients examined between April 2009 and April 2011, 47 had prior PET/CT scans and were included. The median age was 68 years. New nodal disease or metastatic disease was identified in 24 (51%) of 47 patients. Fourteen (30%) had evidence of extrathoracic metastatic disease; the remaining 10 (21%) had new nodal disease that required substantial alteration of treatment fields. At a scan interval of 20 days, the rate of upstaging was 17%. SUV velocity was analyzed in the subset of patients who had their studies on the identical PET/CT scanner (n = 14). Nonupstaged patients had a mean SUV velocity of 0.074 units per day, compared with 0.11 units per day in patients that were upstaged by their second PET/CT scan (P = .020).ConclusionRadiation treatment planning with hybrid PET/CT scans repeated within 120 days of an initial staging PET/CT scan identified significant upstaging in more than half of patients. For a subset of patients who underwent both scans on the same instrument, SUV velocity predicts upstaging, and the difference between those upstaged and those not was statistically significant.     

Clinical impact of (18)F fluorodeoxyglucose positron emission tomography in patients with non-small-cell lung cancer: a prospective study.

PURPOSE: To prospectively study the impact of (18)F fluorodeoxyglucose (FDG) positron emission tomography (PET) on clinical management of patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: One hundred five consecutive patients with NSCLC undergoing (18)F FDG PET were analyzed. Before PET, referring physicians recorded scan indication, conventional clinical stage, and proposed treatment plan. PET scan results were reported in conjunction with available clinical and imaging data, including results of computed tomography (CT). Subsequent management and appropriateness of PET-induced changes were assessed by follow-up for at least 6 months or until the patient's death. RESULTS: Indications for PET were primary staging (n = 59), restaging (n = 34), and suspected malignancy subsequently proven to be NSCLC (n = 12). In 27 (26%) of 105 of cases, PET results led to a change from curative to palliative therapy by upstaging disease extent. Validity of the PET result was established in all but one case. PET appropriately downstaged 10 of 16 patients initially planned for palliative therapy, allowing either potentially curative treatment (four patients) or no treatment (six patients). PET influenced the radiation delivery in 22 (65%) of 34 patients who subsequently received radical radiotherapy. Twelve patients considered probably inoperable on conventional imaging studies were downstaged by PET and underwent potentially curative surgery. PET missed only one primary tumor (5-mm scar carcinoma). CT and PET understaged three of 20 surgical patients (two with N1 lesions < 5 mm and one with unrecognized atrial involvement), and PET missed one small intrapulmonary metastasis apparent on CT. No pathological N2 disease was missed on PET. CONCLUSION: FDG PET scanning changed or influenced management decisions in 70 patients (67%) with NSCLC. Patients were frequently spared unnecessary treatment, and management was more appropriately targeted.     

Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin's lymphoma: is [18F]FDG-PET a valid alternative to conventional diagnostic methods?

PURPOSE: A complete remission (CR) after first-line therapy is associated with longer progression-free survival (PFS). However, defining CR is not always easy because of the presence of residual masses. Metabolic imaging with fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) offers the ability to differentiate between viable and fibrotic inactive tissue. In this study, we evaluated the value of PET in detecting residual disease and, hence, predicting relapse after first-line treatment in patients with non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Ninety-three patients with histologically proven NHL, who underwent a whole-body [18F]FDG-PET study after completion of first-line chemotherapy and who had follow-up of at least 1 year, were included. Persistence or absence of residual disease on PET was related to PFS using Kaplan-Meier survival analysis. RESULTS: Sixty-seven patients showed a normal PET scan after first-line chemotherapy; 56 of 67 remained in CR, with a median follow-up of 653 days. Nine of these patients with a residual mass considered as unconfirmed CR received additional radiotherapy. Only 11 of 67 patients relapsed (median PFS, 404 days). Persistent abnormal [18F]FDG uptake was seen in 26 patients, and all of them relapsed (median PFS, 73 days). Because standard restaging also suggested residual disease, 12 patients received immediate secondary treatment. In 14 of 26 patients, only PET predicted persistent disease. From these patients, relapse was proven either by biopsy (n = 8) or by progressive disease on computed tomography or magnetic resonance imaging (n = 6). CONCLUSION: Persistent abnormal [18F]FDG uptake after first-line chemotherapy in NHL is highly predictive for residual or recurrent disease. In relapsing patients, PFS was significantly shorter after a positive scan than after a negative scan.     

18F-FDG与11C-MET PET-CT显像对磁共振成像中环形强化脑肿瘤和非肿瘤性病变的鉴别诊断

目的 探讨18F-FDG与11C-MET PET-CT显像对常规磁共振成像(MRI)不易鉴别的环形强化脑肿瘤与非肿瘤性病变的鉴别诊断价值.方法 对41例病史及临床体征不典型、MRI上呈相似明显环形强化的脑内病变患者,分别行18F-FDG及11C-MET PET-CT头部扫描,其中15例不除外脑转移瘤者加行18F-FDG PET-CT体部扫描,并对扫描结果进行视觉分析和半定量分析.经病理或临床证实为肿瘤性病变30例,非肿瘤性病变11例.结果 视觉分析结果显示,18F-FDG PET-CT正确诊断肿瘤性病变16例,假阴件14例,假阳性3例,诊断的敏感度、特异度和准确度分别为53.3%、72.7%和58.5%.9例脑转移瘤均通过体部扫描准确发现了肿瘤原发灶.11C-MET PET-CT正确诊断肿瘤性病变29例,假阴性和假阳件各1例,诊断的敏感度、特异度和准确度分别为96.7%、90.9%和95.1%.半定量分析结果显示,高度恶性脑肿瘤的L/WMFDC和L/WMMET均明显高于低度恶性脑肿瘤和非肿瘤性病变(均P<0.01),低度恶性脑肿瘤与非肿瘤性病变间仅L/WMMET的差异有统计学意义(P<0.01),转移瘤和胶质母细胞瘤间L/WMFDG和L/WMMET盯的差异均无统计学意义(均P>0.05).结论 18F-FDG和11C-MET PET-CT在鉴别MRI环形强化脑肿瘤中均有一定的价值,11C-MET PET-CT更有助于低度恶性肿瘤与非肿瘤性病变的鉴别,而18F-FDG PET-CT体部扫描有助于脑转移瘤的诊断;两种显像剂联合使用能提高对环形强化脑肿瘤诊断的准确度.     

(18)F-FDG PET/CT in the evaluation of recurrent ovarian cancer: a prospective study on forty-one patients.

AIM: Many patients with ovarian cancer are at high risk of recurrence especially in the 2 years following first-line therapy. CA125 serum levels measurement associated to computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) are currently used during follow-up to detect recurrent disease. Unfortunately, in a relevant percentage of cases all of these traditional imaging techniques provide a significant number of doubtful/equivocal results or turn out negative even in presence of elevated Ca125 levels. Aim of our study was to evaluate sensitivity, specificity and accuracy of (18)F-FDG PET/CT in a group of patients with suspicion of ovarian cancer recurrence. METHODS: We prospectively evaluated 41 patients with a mean age of 59.4 years who had been previously treated for ovarian cancer with surgery and radio-chemotherapy or radio-chemotherapy alone. Following the performance of traditional radiologic imaging (US, CT, MRI) and Ca125 measurement, all patients underwent additional (18)F-FDG PET/CT. PET/CT results were compared with histologic findings or clinical, laboratory and repeated traditional imaging techniques during subsequent follow-up data. RESULTS: Of 41 patients 32 had a positive PET-CT (30 true positive, two false positive) whereas nine a negative PET/CT (five true negative, four false negative). Overall, in our experience (18)F-FDG PET/CT provided a good sensitivity (88.2%), specificity (71.4%) and accuracy (85.4%), superior to that reported in literature for traditional radiologic imaging. CONCLUSIONS: It can be concluded that (18)F-FDG PET/CT appears to be a useful and accurate tool in disclosing early recurrent ovarian cancer.     

18F-FDG PET or PET/CT in Mantle Cell Lymphoma

The aim of this systematic review was to examine published data about the potential role of Fluorine-18-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography (¹⁸F-FDG PET or PET/CT) in patients affected by mantle cell lymphoma (MCL).A comprehensive computer literature search of Scopus, PubMed/MEDLINE, and Embase databases was conducted, including articles indexed up to November, 2019; 25 studies or subsets in studies analyzing the value of ¹⁸F-FDG PET or PET/CT in patients with MCL were eligible for inclusion.From the analyses of the selected studies, the following main findings are described: (1) MCL are ¹⁸F-FDG-avid in most of cases, especially nodal lesions, but bone marrow and gastrointestinal disease localizations have low ¹⁸F-FDG avidity; (2) ¹⁸F-FDG PET/CT seems to be helpful in staging setting, showing a better diagnostic performance than conventional imaging and a positive impact on clinical stage; (3) ¹⁸F-FDG PET/CT is useful in evaluating treatment response, especially after chemotherapy and transplantation; and (4) metabolic response after therapy seems to have a prognostic role.Despite several limitations affecting this analysis, especially related to the heterogeneity of the studies included, MCL is an ¹⁸F-FDG-avid lymphoma in most of the cases, with the exception of bone marrow and gastrointestinal disease. Moreover, ¹⁸F-FDG PET/CT seems to be useful in evaluating treatment response and prognosis.     

Advantages of positron emission tomography (PET) with respect to computed tomography in the follow-up of lymphoma patients with abdominal presentation

For abdominal lymphoma patients, fluorine-18 fluorodeoxyglucose positron emission tomography (PET) provides unique information on the presence of residual active disease. We provide an update on the largest reported cohort of patients whose management following induction therapy was based on routine PET and computed tomography (CT) restaging. Fifty-nine patients with Hodgkin's disease or aggressive non-Hodgkin's lymphoma presenting abdominal involvement (35% with bulky disease) were studied with both PET and CT following combined chemotherapy/radiation treatment. After treatment, 3/3 (100%) patients who were PET+/CT- relapsed, compared with 0/7 patients in the PET-/CT- subset. Among the 49 patients who were CT+, six of the 10 (60%) who were PET+ relapsed, as compared with only two of the 39 (5%) who were PET-. The actuarial relapse-free survival (RFS) rates were 0 and 100% in the PET+/CT- and PET-/CT- subsets, respectively. In the PET+/CT+ subset, RFS was 94% at 5 years. PET restaging is very valuable for the identification of patients who would need appropriate second-line therapy because of the presence of residual active abdominal disease and should be made widely available in combination with CT.     

Lymph node uptake of 18F-fluorodeoxyglucose detected with positron emission tomography/computed tomography mimicking malignant lymphoma in a patient with Kikuchi disease

[18]F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is sensitive in detecting a variety of malignancies; however, the specificity is low in differential infections or inflammatory diseases from tumors. We present the case of a female with right cervical lymphadenopathy and fever for 3 weeks who underwent an 18F-FDG PET/CT scan. The imaging showed multiple lymph node enlargement and agglomeration with increased metabolic activity even with the involvement in the abdomen, giving the impression of malignant lymphoma. However, biopsy of the affected nodes proved it to be Kikuchi-Fujimoto disease and the patient was cured after steroid therapy.