18F-FDG PET/CT显像在肝脏恶性肿瘤的初步应用

目的：评价^18F-FDGPET／CT对于肝脏恶性肿瘤的诊断、分期及疗效评判的价值。方法：对55例肝脏恶性肿瘤患者的PET／CT检查资料进行回顾性分析。原发性肝细胞性肝癌（PHC）11例，胆管细胞性肝癌1例，转移性肝癌40例，白血病肝浸润1例，淋巴瘤肝浸润2例。其中原发性肝癌经手术或穿刺证实，继发性肝脏恶性肿瘤均有明确肿瘤病史或临床检查随访证实。所有患者均行双时相全身PET／CT显像检查。结果：低分化PHC4例及胆管细胞癌1例，^18F—FDG异常高摄取，延迟后大部分病灶^18F—FDG摄取SUVmax上升；高分化原发性肝癌7例，其中^18F-FDG等摄取5例，相对肝本底为略低摄取2例；9例PHC及1例胆管细胞癌CT表现为低密度灶，2例PHC为等密度，7例患者有肝炎肝硬化基础，另外同时发现肝外病灶6例。继发性肝脏恶性肿瘤43例（含淋巴瘤、白血病肝浸润）中PET／CT上共发现109个病灶；其中99个肝内病灶表现为^18F-FDG高摄取，31个病灶CT未显示，另外有2例患者有4个病灶经手术证实有肝内微小病灶而PET／CT未检出；而淋巴瘤、白血病肝浸润表现为大片状或弥漫性^18F—FDG明显异常高摄取；大部分患者改变了原有的治疗方案。结论：^18F-FDGPET／CT在肝脏恶性肿瘤诊断、分期、评价分化程度及治疗方案的选择有较好的临床价值，PET／CT诊断肝脏恶性肿瘤明显优于单纯PET。充分认识PET／CT在肝脏恶性肿瘤中的应用价值及局限性，有利于临床对肝脏恶性肿瘤的诊治。     

18F-FDG SPECT显像用于食管癌复发的诊断价值

目的：评价^18F-FDG SPECT显像在食管癌手术和／或放射治疗的随访中的临床价值。方法：对15例食管癌手术或放射治疗后的患者同期行^18F-FDG SPECT显像和CT检查，采用双盲法对结果进行比较。结果：15例食管癌患者根据病理活检及临床随访结果最后诊断12例复发和转移，^18F-FDG SPECT显像检出11例病人共17个病灶，胸部CT检出9例病人共13个病灶，其敏感性和特异性分别为83％（10／12），75％（2／3）和67％（2／3）、67％（8／12）。结论：判断食管癌手术或放射治疗后复发和／或转移，一次^18F-FDG SPECT全身显像较CT有更高的准确性和优越性。     

PET/CT对肺内结节诊断及治疗的临床价值

目的 探讨PET／CF显像对肺内结节诊断和治疗的临床应用价值。方法 因肺内结节行^18F-FDG PET／CT检查且得到临床或病理证实的患者20例,其中结节性质不明者15例,临床或病理确诊为肺癌者5例。结合其PET／CT检查结果和临床诊断、治疗资料进行分析。结果 (1)213例PET／CT诊断结果与临床随访或病理诊断结果符合,总诊断符合率100％。15例结节性质不明者经PET／CT检查诊断为良性病变7例,恶性8例．11例CT显示单结节病灶,PET／CT单病灶显影3例,8例除肺内病灶显影外,还可见肺外其他组织显影,6例确诊为有肺外转移,2例肺内单结节病灶系转移灶。(2)PET／CT检查后,20例患者中,16例改变了原治疗方案,继续观察2例,抗炎3例,手术2例,局部放疗4例,单纯化疗3例,综合治疗4例。(3)对8例放射治疗的患者应用PET／CT融合图像指导放疗定位,其中1例MM50适型调强放射治疗1个疗程后1．5个门复查PET／CT,原左侧肺门块状软组织影消失,葡萄糖代谢恢复正常。根据2例手术治疗患者的PET／CT融合图像确定手术路径及切除范围,术后病理结果显示,手术切口边缘及切除淋巴结均未见癌细胞累及和浸润。结论 对于肺内结节性质,PET／CT较单纯CT更容易做出鉴别诊断。PET／CT检查能够更加准确地反映肺癌的临床分期,并辅助临床确定正确的治疗方案。PEW／CT融合图像能够指导放疗生物靶区的精确定位和确定外科手术方案及切除范围。     

背景抑制扩散加权成像与PET/CT在恶性肿瘤转移性病变中的临床应用

背景与目的：抑制扩散加权成像(diffusion-weighted whole-body imaging with background body signal suppression,DWIBS),是一种可用于全身检查的核磁共振成像技术,尤其可以较好的显示转移病灶、淋巴结及骨骼系统病变。该文旨在评价DWIBS与正电子发射计算机体层摄影(positron emission tomography with computed tomography,PET/CT)在恶性肿瘤转移性病变中的临床应用价值。方法：对36例手术或穿刺病理证实为恶性肿瘤且有转移的患者行DWIBS扫描,并与PET/CT结果相对照,统计学采用χ2检验、Kappa一致性检验比较分析。结果：36例恶性肿瘤患者共有238个转移性病灶,其中DWIBS检出218个(91.6%,218/238),PET/CT检出209个(87.8%,209/238),且DWIBS和PET/CT同时检出200个转移性病灶,两者的一致率为88.7%(211/238),但两种检查在检出转移病灶数目方面差异无统计学意义(χ2=1.843,P=0.157);Kappa检验两种检查的一致性程度尚可(P=0.000)。DWIBS和PET/CT在检出脑及骨转移方面差异均有统计学意义(P=0.005和0.031),但在检出淋巴结及肝脏转移方面差异均无统计学意义(P=0.309和1.000)。结论：DWIBS扫描技术可有效检出恶性肿瘤转移性病灶。与PET/CT相比,差异无统计学意义(P>0.05)。DWIBS检出脑、骨转移较PET/CT敏感,临床工作中可根据原发肿瘤特点,有针对性的选择DWIBS作为筛查转移病灶的方法之一。     

PET/CT融合显像分析恶性肿瘤

目的研究PET与CT相结合,检测恶性肿瘤及其转移灶的优势。方法对已病理确诊恶性肿瘤患者98例行PET-CT显像,图像经融合工作站处理后行18F-FDGPET-CT融合图像、PET图像和CT图像帧对帧对比分析。结果初诊者88例,具有恶性病灶396个。396个病灶中,PET与平扫CT病灶皆显示清楚,阅片医师均有肯定诊断结论者192个(48.5%);396个病灶中,PET示病灶浓聚程度高、显示清楚、有肯定诊断结论,但平扫CT所示病灶欠清楚或病灶小、易漏诊、难以有肯定诊断结论者166个(41.9%);396个病灶中,病灶处未见明显浓聚影或仅有轻度浓聚,PET显像为阴性或难定确定,而平扫CT病灶显示清楚、有肯定诊断结论者17例38个病灶,占病灶数9.6%,占病例数的19.3%。PET-CT的总体检出率高于单纯性PET和平扫CT,对病灶的显示、定位,PET-CT也明显优于单纯性PET和平扫CT。10例治疗后患者,平扫CT难以确定肿瘤残余和坏死区域,而PET-CT清楚区分残余和坏死区。结论PET-CT中平扫CT的作用不仅限于对病灶的定位,PET与平扫CT对肿瘤病灶的检出具有相互印证及互补价值,PET-CT在恶性病灶的检出、病灶的清楚显示和准确定位方面优于单纯型PET和CT,可进一步提高恶性肿瘤诊断及分期的准确性。     

^18F-FDG PET显像在食管癌诊断中的临床意义

目的：探讨正电子发射型电子计算机断层(positron emission computed tomography，PET)显像在食管癌早期诊断以及临床分期中的临床应用价值。方法：23例食管癌患者，进行全身^18F-脱氧葡萄糖(^18F-fluorodeoxy-glucose，^18F-FDG)PET显像，并与外科手术或内镜活检病理结果和CT检查结果对照。结果：46倒患者中PET显像食管部位均有异常放射性浓聚灶，经病理确诊，46处食管浓聚灶均为食管癌原发病灶。其中28例为单发病灶，2例为食管多发灶，其余16例除食管原发病灶外，还有其他部位32个病灶，经临床和病理证实为远处转移病灶。与46例PET显像前CT结果相比较，PET共检出食管部位恶性病灶46例，检出率为100．0％，而CT仪检出34例，检出率为73．9％。46例中确诊有其他部位转移者18例，PET检出18例，检出率为100．0％，而PET显像前CT仅检出6例，检出率为33．3％。27例手术治疗者PET分期与临床病理分期一致，而常规检查对食管癌临床分期高估5例，低估12例，PET显像改变了这17例患者的临床治疗方案。结论：^18F-FDG-PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值。     

PET/CT显像在淋巴瘤分期及疗效评价中的价值

目的：探讨正电子发射型断层扫描技术（PET）融合计算机断层扫描（CT）即PET／CT显像在淋巴瘤诊断、分期及疗效评价中的价值。方法：对14例经病理学确诊的淋巴瘤患者行PET／CT显像，显像剂18F-脱氧葡萄糖（18F-FDG）用量10-14mCi（370—518MBq），并与同期CT、MRI或B超等影像检查结果（CI）进行对比分析，随访时间6个月以上。结果：14例PET／CT显像阳性13例（92．8％）。3例（21．4％）为淋巴瘤初诊治疗前检查，PET／CT显像均阳性，PET标准摄取值（SUV，正常〈2．5）分别为3．7、3．5和11．4；11例（78．5％）淋巴瘤治疗2—4疗程后行PET／CT显像，11例中3例（21．4％）肿块全部处于高代谢状态，临床确认有肿瘤明显残余或复发，SUV分别为11．7、10．1和5．7，8例（57．1％）临床疗效为完全缓解（CR）和部分缓解（PR）的患者中，PET／CT显像阳性7例并示肿块处于抑制状态，其中2例SUV升高分别为3．6和2．8，但术后病理证实为假阳性。共有3例（21．4％）淋巴瘤PET／CT显像新发现恶性病灶而提高临床分期，改变了进一步临床治疗方案。结论：18F-FDGPET／CT显像能灵敏、准确地检出淋巴瘤病灶特别是复发及残余病灶，对淋巴瘤诊断、分期、疗效评价及指导临床治疗有重要价值。     

18F-FDG PET/CT在探查腹膜转移性肿瘤中的价值

目的:评价18F-FDG PET/CT探查腹膜转移瘤的价值。方法:39例有腹部原发恶性肿瘤手术史患者行PET/CT首次和延迟扫描,在PET/CT图像上记录病灶大小、分布,结果与常规CT比较。测量62个病灶和对照组32例腹部无病变患者的肠管SUVmax。所有病例经手术、病理、影像学和肿瘤标记物随访作出最后诊断。结果:最终确认39例中31例腹膜转移瘤,病灶均为结节状或沿腹膜条片状分布,多位于肝脏周围和盆腔腹膜,其他部位腹膜少见。PET/CT漏诊的4个病灶主要位于肝脏周围,1例因化疗不久病灶FDG低摄取而漏诊,因此敏感性为87.1%,特异性为87.1%。CT仅检出12例转移瘤。转移瘤SUVmax明显高于对照组肠管SUVmax(P=0.0000)。结论:18F-FDG PET/CT能够较CT更早、更多地检出腹膜转移瘤,病灶体积小、位于基础摄取较高的肝脏周围是漏诊主要原因,而结合原发肿瘤病史和肿瘤标记物检查有利于诊断。     

18F-FDG PET显像在食管癌诊断中的临床意义

目的探讨正电子发射型电子计算机断层(positron emission computed tomography,PET)显像在食管癌早期诊断以及临床分期中的临床应用价值.方法23例食管癌患者,进行全身18F-脱氧葡萄糖(18F-fluoro-deoxy-glucose,18F-FDG ) PET显像,并与外科手术或内镜活检病理结果和CT检查结果对照.结果46例患者中PET显像食管部位均有异常放射性浓聚灶,经病理确诊,46处食管浓聚灶均为食管癌原发病灶.其中28例为单发病灶,2例为食管多发灶,其余16例除食管原发病灶外,还有其他部位32个病灶,经临床和病理证实为远处转移病灶.与46例PET显像前CT结果相比较,PET共检出食管部位恶性病灶46例,检出率为100.0%,而CT仅检出34例,检出率为73.9%.46例中确诊有其他部位转移者18例,PET检出18例,检出率为100.0%,而PET显像前CT仅检出6例,检出率为33.3%.27例手术治疗者PET分期与临床病理分期一致,而常规检查对食管癌临床分期高估5例,低估12例,PET显像改变了这17例患者的临床治疗方案.结论18F-FDG PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值.     

18F-FDG PET/CT鉴别肺占位病变性质方法的研究

目的：探讨^18F-FDG PET／CT对肺占位病变性质鉴别诊断方法的研究。方法：发现肺部占位病变患者74例，不含有支气管阻塞性肺炎，所有患者均进行3-14个月的随访。恶性患者55例（包括1例假阴性）其中23例经手术病理证实，32例临床诊断肺癌；良性患者19例其中7例经手术病理证实，12例经3～14个月随访病灶范围缩小或消失。所有患者均进行^18F-FDG PET／CT全身检查、呼吸控制的CT扫描及重建1．25mm薄层图像。^18F-DDG PET／CT诊断恶性的标准：1）肺病灶的SUVmax≥2．5；2）延迟显像SUVmax升高明显（≥20％～30％）；3）1．25mm薄层CT图像典型形态学征象；4）从病灶中心至各个胸壁变化曲线SUVmax变化曲线。结果：74例肺部痛灶患者中恶性55例，其中临床诊断肺癌32倒，腺癌13例，鳞癌5例，细支气管肺泡癌3倒，小细胞肺癌2例；良性19例，其中慢性炎症13例，肉芽肿2例，炎性假瘤2例，结核2例。PET、图像SUVmax、延迟SUVmax增高情况及薄层CT的典型征象综合最终^18F-FDG PET／CT诊断恶性病灶共57例，其中真阳性54例，假阳性3例；良性病灶共17例．其中真阴性16例，假阴性1例其敏感性、特异性、准确率、阳性预测值及阴性预测值分别为：98．2％，84．2％，94．6％，94．7％及94．1％。结论：PET／CT检查观察病灶SUVmax、延迟SUVmax结合薄层CT图像典型的形态学征象，并从每个病灶中心至各胸壁做SUVmax空间变化曲线等，明显提高了诊断的准确率。     

Application of PET and PEt/CT imaging for cancer screening

The aim of this study was to evaluate the potential application of 18-fluorodeoxyglucose positron emission tomography (FDG PET) and PET/CT for cancer screening in asymptomatic individuals. The subjects consisted of 3631 physical check-up examinees (1947 men, 1684 women; mean age +/- SD, 52.1 +/- 8.2 y) with non-specific medical histories. Whole-body FDG PET (or PET/CT), ultrasound and tumor markers were performed on all patients. Focal hypermetabolic areas with intensities equal to or exceeding the level of FDG uptake in the brain were considered abnormal and interpreted as neoplasia. Follow-up periods were longer than one year. Among the 3631 FDG PET (including 1687 PET/CT), ultrasound and tumor markers examinations, malignant tumors were discovered in 47 examinees (1.29%). PET findings were true-positive in 38 of the 47 cancers (80.9%). In addition, 32 of the 47 cancers were screened with the PET/CT scan. PET detected cancer lesions in 28 of the 32 examinees. However, the CT detected cancer lesions in only 15 out of 32 examinees. The sensitivity of FDG PET in the detection of a wide variety of cancers is high. Most cancer can be detected with FDG PET at a resectable stage. CT of the PET/CT for localization and characteristics of the lesion showed an increased specificity of the PET scan. The use of ultrasound and tumor markers may complement the PET scan in cancer screening for hepatic and urologic neoplasms.     

18FDG PET/CT定位三维适形放疗结合介入治疗原发性肝癌的疗效和预后分析

目的:研究18FDG PET/CT定位三维适形常规分割放疗结合肝动脉化疗栓塞(TACE)治疗原发性肝癌的疗效、不良反应及失败原因。方法:对64例原发性肝癌患者用信封法随机分为18FDG PET/CT定位三维适形放疗组(PET/CT组)和普通CT定位三维适形放疗组(普通CT组)。PET/CT组用PET/CT扫描定位,经PET/CT扫描后将扫描数据输入治疗计划系统,将PET图像和CT图像融合后进行靶区(GTV与PTV)和重要脏器勾画、三维重建,制定治疗计划后常规分割三维适形放疗40Gy左右,然后适当缩野放疗至总剂量50Gy-60Gy;普通CT组用普通CT定位设野,三维适形放疗至相同剂量;两组放疗后均结合4-6周期TACE治疗。结果:PET/CT组共有18例显示GTV有改变,其中7例增大,6例缩小,5例GTV形状改变;放疗后全组AFP值显著下降;PET/CT组的中位复发时间11.3个月,普通CT组的中位复发时间10.2个月,两者差异有显著性统计学意义(P=0.001)。两组死于局部未控、复发或转移者比例占总死亡原因的76.7%;多因素分析表明T分期早和疗前GTV≤100cm3者预后好(P均<0.01)。结论:PET/CT定位三维适形放疗原发性肝癌可以优化放疗计划,结合介入治疗可以延长中位复发时间,分期早的病变预后好。     

FDG PET判断鼻咽癌放疗后鼻咽病灶残留的临床价值

背景与目的：18F－2脱氧葡萄糖（FDG）正电子发射计算机断层显像（PET）在判断恶性肿瘤治疗后病灶残留上的应用是放射肿瘤学目前研究的热点之一,本文旨在探讨FDG PET显像在鼻咽癌放射治疗后鼻咽肿瘤残留中的应用。方法：25例鼻咽癌放疗后,临床疑咽肿瘤残留,均行FDG PET显像,显像时间为放疗后2－6个月,其中23例同期行CT检查,最后诊断依靠病理检查和临床随访。结果：25例患者中FDG PET显像阳性18例,其中4例假阳性,阴性7例,其中2例假阴性,FDG PET显像的准确率为76．0％（19／25）,CT检查的准确率为52．2％（12／23）,11例CT未见鼻咽肿瘤残留,FDG PET显示其中2例有鼻咽局部FDG异常浓聚;7例CT诊为肿瘤残留,FDG PET均显示局部病变有FDG异常浓聚,5例CT未能确定残留,PET显示3例FDG异常浓聚,12例FDG异常浓聚的病变处经活检病理证实为肿瘤残留。结论：判断鼻咽癌放疗后鼻咽肿瘤残留,FDG PET比CT有更高的准确性。     

Positron emission tomography (PET) for staging low-grade non-Hodgkin's lymphomas (NHL)

Although positron emission tomography (PET) imaging is now recognized as a useful tool for staging intermediate and high-grade non-Hodgkin's lymphoma (NHL), few data are available regarding its accuracy in low grade NHL. We therefore studied 36 patients with histologically proven low-grade NHL. Whole-body 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) PET was performed at the time of initial diagnosis (n = 21) or for disease recurrence (n = 15) prior to any treatment. PET results were compared to those of physical examination and computed tomography (CT). PET studies were read without knowledge of any clinical data. Any focus of increased activity was described and given a probability of malignancy using a 5 point-scale (0: normal to 4: definitively malignant). An individual biopsy was available for a total of 31 lesions. The sensitivity and specificity were 87% and 100% for FDG-PET, 100% and 100% for physical examination and 90% and 100% for CT respectively. In addition, 42 of 97 peripheral lymph node lesions observed by FDG-PET were clinically undetected, whereas the physical examination detected 23 additional nodal lesions. PET and CT both indicated 12 extranodal lymphomatous localizations. FDG-PET showed 7 additional extranodal lesions while 5 additional unconfirmed lesions were observed on CT. Regarding bone marrow infiltration, PET and biopsy were concordant in 24 patients with 11 true positive (TP) and 13 true negative (TN). However PET was FN in 11 patients and no biopsy was performed in one patient. The combination PET/CT/physical examination seems to be more sensitive than the conventional approach for staging low grade NHL. Its sensitivity however is unacceptably low for diagnosing bone marrow infiltration.     

Improved detection of second primary cancer using integrated [18F] fluorodeoxyglucose positron emission tomography and computed tomography for initial tumor staging.

PURPOSE: This study evaluated prospectively the value of integrated whole-body positron emission tomography and computed tomography (PET/CT) using [18F] fluorodeoxyglucose (FDG) in detecting a second primary cancer at the time of the initial staging in comparison with a conventional staging work-up (CSW). METHODS: The participants were 547 patients diagnosed with cancer who underwent FDG PET/CT imaging for the initial staging. An additional diagnostic evaluation was performed when there were abnormal findings indicative of a second primary cancer on either PET/CT or CSW considering the site and the biologic behavior of the alleged primary tumor. RESULTS: A total of 27 second primary malignant tumors were identified in 26 of the 547 patients (4.8%). FDG PET/CT found 45 lesions indicative of a second primary cancer, of which 24 lesions were proved to be a second primary cancer, seven were clinically unexpected metastases, and 14 lesions were benign. Therefore, sensitivity and positive predictive value of FDG PET/CT in detecting a second primary cancer or an unexpected metastasis were 91% (31 of 34) and 69% (31 of 45), respectively. In contrast, CSW could not identify 16 second primary cancers and one metastatic lesion. CONCLUSION: FDG PET/CT at the time of the initial staging is useful for screening a second primary cancer with a high sensitivity. An additional diagnostic work-up is essential when abnormal findings, which are indicative of a second primary cancer, are obtained on PET/CT images to rule out the presence of either a second primary cancer or an unexpected metastasis.     

FDG-PET/CT imaging for staging and target volume delineation in preoperative conformal radiotherapy of rectal cancer

PURPOSE: To investigate the potential impact of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on staging and target volume delineation for patients affected by rectal cancer and candidates for preoperative conformal radiotherapy. METHODS AND MATERIALS: Twenty-five patients diagnosed with rectal cancer T3-4 N0-1 M0-1 and candidates for preoperative radiotherapy underwent PET/CT simulation after injection of 5.18 MBq/kg of FDG. Clinical stage was reassessed on the basis of FDG-PET/CT findings. The gross tumor volume (GTV) and the clinical target volume (CTV) were delineated first on CT and then on PET/CT images. The PET/CT-GTV and PET/CT-CTV were analyzed and compared with CT-GTV and CT-CTV, respectively. RESULTS: In 4 of 25 cases (24%), PET/CT affected tumor staging or the treatment purpose. In 3 of 25 cases (12%) staged N0 M0, PET/CT showed FDG uptake in regional lymph nodes and in a case also in the liver. In a patient with a single liver metastasis PET/CT detected multiple lesions, changing the treatment intent from curative to palliative. The PET/CT-GTV and PET/CT-CTV were significantly greater than the CT-GTV (p = 0.00013) and CT-CTV (p = 0.00002), respectively. The mean difference between PET/CT-GTV and CT-GTV was 25.4% and between PET/CT-CTV and CT-CTV was 4.1%. CONCLUSIONS: Imaging with PET/CT for preoperative radiotherapy of rectal cancer may lead to a change in staging and target volume delineation. Stage variation was observed in 12% of cases and a change of treatment intent in 4%. The GTV and CTV changed significantly, with a mean increase in size of 25% and 4%, respectively.     

FDG PET/CT在精确放疗中应用的初步研究

目的：研究FDG PET/CT在肿瘤病例中的成像特点和对精确放疗的影响.方法：2009年8月至2011年5月,72例肿瘤患者在放疗前接受GE Discovery PET/CT定位扫描.图像资料传至Varian Eclipse 8.6治疗计划系统.将FDG在各组织器官及肿瘤病灶中的聚积水平分为四个等级（＋-＋＋＋＋）,分析PET成像特点并探讨PET/CT图像融合对放疗的影响.结果：通常情况下,肿瘤病灶和正常脑组织、膀胱肾盏肾盂FDG聚积水平最高（＋＋＋＋）;肝脏、脾脏、椎体次之（＋＋＋）;大部分肌肉和胃肠道、胰腺FDG稍低（＋＋）;肺和皮肤最低（＋）.非肿瘤性FDG高聚积多见于左心室、咽喉周围、局部肠道内以及创伤或炎症病变等部位.PET/CT图像融合使肿瘤病灶更易被发现,因此约22％病例病灶数增加.此外,约62.5％放疗靶区受PET/CT融合图像影响发生了较明显改变.结论：FDG PET/CT在放疗的应用有利于复杂解剖部位肿瘤的边界确定及早期肿瘤病灶的发现和治疗,而非肿瘤性FDG高聚积是最主要的不良影响因素.     

Dual-time-point (18)F-FDG-PET/CT imaging in the assessment of suspected malignancy

Introduction (purpose of the study): The objective of this study was to assess whether dual‐time‐point ¹⁸F‐fluoro‐2‐deoxyglucose (¹⁸F‐FDG)‐PET/CT imaging improved the evaluation of suspected malignancy and if there was any resulting change in management. Methods: A total of 53 patients with suspected malignancy were investigated by performing two static acquisitions started at mean times t = 64 and t = 155 min after the tracer injection. The total number of malignant lesions was 133 and the total number of benign lesions was 61. Visual and semiquantitative analysis was performed on both the early and delayed images. Results: Overall, there was a significant improvement (P < 0.001) in the sensitivity of delayed imaging (94%) compared with early imaging (77%) in detecting malignant lesions, without a reduction in specificity. In 10 patients, 13 malignant lesions were undetected on early imaging alone but detected on delayed imaging. In seven patients, 10 malignant lesions were incorrectly classified as ‘likely benign’ on early imaging but correctly reported as ‘likely malignant’ on delayed imaging. Management was altered in 2 out of 17 patients. Overall, delayed imaging altered management in 2 out of 53 studied patients. Dual‐time‐point ¹⁸FDG‐PET/CT imaging was useful in differentiating malignant from benign intra‐abdominal lesions but did not improve the evaluation of pulmonary lesions. Conclusions: ¹⁸F‐FDG‐PET/CT imaging should be performed as late as reasonably possible after tracer administration in order to increase tumour‐to‐background contrast and thereby improve the sensitivity of demonstrating additional sites of disease. Dual‐time‐point ¹⁸FDG‐PET/CT may be of benefit in the evaluation of intra‐abdominal lesions but does not improve the overall evaluation of pulmonary lesions.     

子宫内膜癌中错配修复蛋白表达缺失的意义

目的:评价MLH1、MSH2、PMS2和MSH6蛋白在子宫内膜癌中的表达缺失率,探讨MMR蛋白在子宫内膜癌发生、发展中的作用。方法:选取87例子宫内膜癌肿瘤组织,应用免疫组化方法检测子宫内膜癌组织中MLH1、MSH2、PMS2和MSH6蛋白的表达。结果:87例子宫内膜癌中MLH1、MSH2、PMS2和MSH6四种蛋白表达缺失率分别为12.6%(11/87)、2.3%(2/87)、16.1%(14/87)、6.9%(6/87),总的蛋白缺失率为31.0%(27/87)。MMR蛋白在不同年龄段的表达缺失率依次为:≤30岁为0%(0/2)、31-40岁为43.8%(7/16)、41-50岁为44.4%(12/27)、>50岁为19.0%(8/42)。I型子宫内膜样腺癌的MMR蛋白缺失率为36.9%,其中高级别的子宫内膜样腺癌中MMR蛋白表达缺失率为58.3%;II型子宫内膜癌中MMR蛋白的表达缺失率为13.6%。MMR蛋白在黏膜内癌、浅肌层浸润癌及深肌层浸润癌中的表达缺失率分别为14.3%(3/21)、29.6%(16/54)、66.7%(8/12),10例淋巴结转移的子宫内膜癌病例中有6例存在MMR蛋白的表达缺失。结论:MMR蛋白在低年龄段、高级别子宫内膜样腺癌、有深肌层浸润及淋巴结转移的子宫内膜癌病例中表达缺失率高,MMR蛋白在子宫内膜癌的进展中具有重要作用,建议临床常规检测子宫内膜癌中MMR蛋白的表达。