18F-FLT PET/CT与18F-FDG PET/CT在鼻咽癌诊断和分期中的应用比较

目的 通过与18F-FDG PET/CT显像对比,探讨18 F-FLT PET/CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性.方法 12例初治且经病理确诊的鼻咽癌患者(年龄22～62岁)自愿进入该前瞻性临床研究.每位患者先行18F-FDG PET/CT检查,次日行18F-FLF PET/CT检查.至少有2位核医学科和放射科医师阅片,比较18F-FDG PET/CT和18F-FLT PET/CT图像,采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对18F-FDG、18F-FLT的SUVmax、SUVmean和MTV.采用非参数Wilcoxon秩和检验比较组间摄取和MTV差异.结果 12例鼻咽癌患者病灶均明显摄取18F-FLT.18F-FLT PET/CT和18F-FDG PET/CT均可准确诊断该组病例,二者对原发灶和淋巴结转移灶的检测结果无明显差别.鼻咽癌病灶的18F-FDG和18F-FLT SUVmax分别为10.7±5.8和6.0±2.4,SUVmean分别为5.8±3.0和3.6±1.5;SUVmax和SUVmean组间差异均有统计学意义(Z=-2.589和-2.353,P均＜0.05),而 MTV在18F-FDG和8F-FLT PET/CT 2种显像方法之问的差异无统计学意义(15.9±9.2和18.1±11.1;Z=-0.786,P＞0.05).6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义(8.5±6.2比6.4±2.5、5.3±4.2比3.8±1.4、6.5 ±4.8比6.0±4.4;Z=-0.734、-0.734和-0.674,P均＞0.05).18F-FLT在颞叶摄取(SUVmax 0.7±0.3)明显低于18F-FDG(SUVmax 8.3±2.7;Z=-3.062,P＜0.01),其对于原发灶颅内浸润显示较18F-FDG更清晰.结论 18F-FLT PET/CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与18F-FDG PET/CT相当,对于显示原发灶的颅底附近侵犯更有利,其临床应用值得进一步研究.     

颈部淋巴结病变的影像学诊断进展

颈部淋巴结引流丰富,全身800多个淋巴结中,约300个位于颈部.颈部淋巴结病变的原因也很多,良性的有结核、淋巴结反应性增生等,恶性的有淋巴瘤、转移瘤等.颈部淋巴结是头颈部肿瘤最常转移的部位之一,也是呼吸、消化系统肿瘤的终末转移站.有颈部淋巴结转移者,其5年生存率要下降50%[1],因此明确肿大淋巴结的良恶性对临床选择正确的治疗方案有重要的作用.由于临床及实验室检查缺乏特异的诊断指标,影像学检查在颈部淋巴结病变的诊断及鉴别诊断中起着越来越重要的作用.随着超声、CT、MRI、PET、PET/CT的应用,对颈部淋巴结病变诊断的准确度有所提高.本文就颈部淋巴结病变的各种影像学检查技术的现状及进展作一综述.     

18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在诊断乳腺癌及其区域淋巴结转移中的临床价值.方法 对27例疑原发性乳腺癌及经临床随访(＞12个月)证实的12例单发乳腺良性病变患者行18F-FDG PET/CT显像,患者均为女性.对显像结果分别行定性、半定量分析.27例疑乳腺癌患者均行手术治疗.结果 疑乳腺癌患者术后病理检查示24例为乳腺癌,共25个病灶;良性病灶7个.18F-FDG PET/CT显像定性分析诊断乳腺癌的灵敏度为76.0%(19/25),特异性为94.7%(18/19);以最大标准摄取值(SUVmax)＞2.5为界值,18F-FDG PET/CT诊断乳腺癌的灵敏度为72.0%(18/25),特异性为63.2%(12/19);以病灶SUVmax大于对侧正常乳腺腺体SUVmax的-x+2s为界值,PET/CT诊断乳腺癌的灵敏度为96.0%(24/25),特异性为63.2%(12/19),其灵敏度明显高于前2种分析方法(X2=4.15,4.14;P均＜0.05).定性方法的特异性明显高于半定量分析(X2值均为5.7,P均＜0.05).23例行区域淋巴结廓清术的患者病理检查示10例有淋巴结转移.18F-FDGPET/CT定性诊断乳腺癌区域淋巴结转移的灵敏度为60.0%(6/10),特异性为84.6%(11/13);以SUVmax＞2.5为界值,18F-FDG PET/CT诊断淋巴结转移的灵敏度为60.0%(6/10),特异性为92.3%(12/13).结论 在18F-FDG PET/CT诊断乳腺癌中,以病灶SUVmax大于正常乳腺腺体sUVmax的-x+2s为界值的半定量分析有较好的灵敏度;定性分析的诊断特异性优于半定量分析.     

18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术的临床应用

目的 评价一日法18F-脱氧葡萄糖(FIX;)PET/CT全身扫描联合18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术用于恶性实体肿瘤分期与定性诊断的临床价值.方法 16例实体占位病变患者,全部行一日内全身18F-FDG PET/CT扫描结合18F-FDG PET/CT影像辅助CY引导下经皮穿刺活组织检查术.每例患者的2种检查均在同一台PET/CT扫描仪上完成.共获18份适合病理分析的标本.分别以活组织检查标本结合外科术后病理检查,或临床随访结果为依据,建立最后诊断.采用SPSS 13.0软件,对2种检查结果进行比较(Fisher精确概率法).结果 16例患者中,最后诊断恶性12例,良性4例.有10例18F-FDG;PET/CT影像诊断与穿刺活组织病理检查结果一致.10例18F-FDG PET/CT诊断为恶性病变者中,最终诊断为恶性8例,良性2例.6例18F-FDGPET/CT诊断为良性者中,最终诊断为良性2例,恶性4例.穿刺活组织检查结果与最后手术病理检查和随访诊断结果全部符合.PET/CT影像诊断与穿刺活组织检查结果之间差异无统计学意义(P=0.604).所有最后诊断为恶性实体肿瘤的患者,定性与分期在一日内完成;诊断为良性者则规定门诊长期随访,排除假阴性.穿刺获取组织学标本时间为平均每例15 min.该组病例均无严重并发症发生.结论 全身18F-FDG PET/CT扫描联合18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术,有助于提高PET/CT诊断效能与穿刺活组织检查的成功率与准确性.当18F-FDG PET/CT影像诊断出现定性困难时,其价值尤为明显.     

肺癌性淋巴管炎的~(18)F-FDG PET/CT及同机HRCT研究

目的探讨~(18)F-FDG PET/CT结合同机HRCT对肺癌性淋巴管炎(pulmonary lymphangitic carcinomatosis,PLC)的诊断价值。方法回顾性分析经病理及临床确诊的52例PLC的~(18)F-FDG PET/CT及同机HRCT影像学表现,观察指标包括肺部PET、衰减校正CT及HRCT图像特点,测量患处SUVmean值、对侧正常肺组织SUVmean值、纵隔血池SUVmean值,并行统计分析。结果 52例PLC患者,男性32例,女性20例,年龄32~83岁,平均年龄62岁。累及单侧肺30例(58%),两肺22例(42%),局限性分布40例(77%),弥漫性分布12例(23%);患处SUVmean值(1.34±0.68),对侧正常肺组织SUVmean值(0.55±0.17),患处SUVmean值明显高于对侧正常肺组织(P0.01);两肺弥漫分布性两侧患处各自SUVmean值/纵隔血池SUVmean值的比值、正常肺组织SUVmean值/纵隔血池SUVmean值的比值分别为(0.82±0.28)、(0.73±0.29)、(0.39±0.14),患处SUVmean值/纵隔血池SUVmean值的比值与正常肺组织SUVmean值/纵隔血池SUVmean值的比值之间有显著统计学差异(P0.01)。52例PLC单纯经PET/CT诊断46例,特异性100%,敏感性88%,另6例经同机肺HRCT结合PET/CT全身成像及患处SUVmean值定量测量得以补充诊断。结论~(18)F-FDG PET/CT结合同机HRCT明显提高PLC诊断的敏感性、特异性。     

细针穿刺、超声及甲状腺球蛋白对分化型甲状腺癌清甲后颈部肿大淋巴结诊断价值的比较

目的 探讨DTC手术和131I治疗后细针穿刺细胞学（FNAC）检查对颈部肿大淋巴结定性诊断的价值,并与超声、Tg和TgAb检测作比较.方法 61例经手术和131I清除残余甲状腺组织（简称清甲）治疗后的DTC患者,经体格检查或超声检查发现颈部淋巴结肿大,随后1周内对可疑淋巴结行超声引导下FNAC检查,并将检查结果与同期超声、Tg和TgAb结果进行对比.最终诊断根据病理、治疗后131I全身显像（Rx-WBS）及临床随访作出.3种检查方法间诊断效能的比较采用x2检验和Fisher确切概率法.结果 61例患者中,共58例患者获FNAC诊断,3例不能定性,经综合评判,淋巴结恶性40例,良性18例.39例经FNAC检查确诊为恶性者中20例经手术切除,19例行131I清除转移灶治疗;FNAC与术后病理诊断符合率为100％ （20/20）,与Rx-WBS的符合率为78.9％（15/19）;19例经FNAC检查确诊为良性淋巴结者中15例持续随访3～6个月,余4例行131I治疗;FNAC与随访结果符合率为93.3％（14/15）,与Rx-WBS均符合（4/4）.FNAC检查、超声、Tg和TgAb检测诊断DTC转移淋巴结良恶性的灵敏度分别为97.5％ （39/40）、87.5％（35/40）、92.5％ （37/40）,特异性分别为100％（18/18）、55.6％ （10/18）、72.2％ （13/18）,准确性分别为98.3％（57/58）、77.6％（45/58）、86.2％（50/58）;FNAC检查的准确性明显高于超声、Tg和TgAb（x2=4.336和11.697,均P＜0.05）,而超声与Tg和TgAb检测之间准确性的比较差异无统计学意义（X2=1.450,P〉0.05）.超声与TS和TgAb检测结果一致者39例,与FNAC检查的符合率为97.4％ （38/39）;超声与Tg和TgAb检测结果不一致者19例,经FNAC检查证实4例为恶性,15例为良性.结论 对DTC患者颈部肿大淋巴结的良恶性诊断,FNAC检查明显优于超声与Tg和TgAb检测.当随访中超声与Tg和TgAb结果不一致,可作为FNAC检查的应用指征.     

肺内病灶18F-FDG PET/CT显像与手术病理结果之对比研究

目的：评价^18F-脱氧葡萄糖（FGD）PET／CT显像在非小细胞肺癌（NSCLC）诊断中的价值及显像特征。方法：回顾性分析53例手术病例的碍F-FDGPET／CT显像诊断结果。PET／CT用目测法结合半定量法判断病灶良恶性，所得诊断结果与病理结果进行对照。结果：53个肺内病灶，49个恶性、4个良性，PET／CT正确诊断45个恶性病灶；灵敏度为91．8％，准确性为84．9％；4个良性病灶，其中炎性假瘤1例、结核3例。53例肺内病变，纵隔淋巴结病理诊断转移阳性者16例（45个淋巴结），PET／CT正确诊断10例，灵敏度为62．5％，纵隔淋巴结病理诊断阴性者37例（32个淋巴结），PET／CT正确诊断30例，特异性为81．1％，准确性为75．5％。结论：^18F-FDGPET／CF显像是评价肺内病灶良恶性的一种有效、无创性检查方法，有重要临床应用价值。     

皮病性淋巴结炎的FDG PET/CT表现及临床病理研究(附2例报告及文献复习)

目的 探讨皮病性淋巴结炎(DL)的临床病理及18F-FDG PET/CT表现特点,提高对本病的诊断水平.方法 搜集本院2例病理确诊为DL的患者资料,并检索国内外近10年关于DL的文献,回顾性分析DL的临床病理及PET/CT表现特点.结果 2例患者临床均表现为反复发热,全身浅表淋巴结肿大,皮肤瘙痒伴红斑,骨髓增生活跃.PET/CT检查发现2例患者全身多处淋巴结肿大伴糖代谢增高,SUVmax＞ 2.5,摄取18FDG最高的部位在腋窝,SUVmax达12,同时均伴有脾肿大伴糖代谢增高,骨髓浓聚增高.结论 DL患者在PET/CT上多表现为全身多处淋巴结肿大伴18FDG摄取增高,腋窝、腹股沟、颈部多见,呈对称性分布,无融合趋势.DL的主要临床表现为全身多发无痛性淋巴结肿大,常伴有皮肤改变.病理为非特异性淋巴结反应性增生.     

CT对头颈部恶性肿瘤颈淋巴结转移的诊断价值——临床／CT／病理对照研究

对３９例头颈部恶性肿瘤患者的５０例拟行预防性颈淋巴清扫术的颈部，术前应用ＣＴ扫描其颈部前瞻性评估其颈淋巴结内是否有肿瘤转移，并与颈部触诊检查及术后颈清标本的病理检查结果对照。结果表明：ＣＴ对头颈部恶性肿瘤颈淋巴结转移诊断的准确率（９０．００％，４５／５０）显著地高于（Ｐ＜０．００５）触诊检查的结果（６６．００％，３３／５０）。这表明：在诊断头颈部恶性肿瘤颈淋巴结转移方面，颈部ＣＴ扫描比颈部触诊检查更准确、可靠，并能提供更多有关淋巴结的融合、被膜外转移的资料，从而有助于临床医生术前为病人制定出更加准确、合理的治疗方案。     

PET／CT在胸段食管癌诊断与淋巴分期中的应用价值

目的：探讨^18F-脱氧葡萄糖（FDG）正电子发射型计算机断层（PET／CT）在胸段食管癌诊断与淋巴分期中的应用价值。方法：回顾性分析了经PET／CT显像的34例患者资料。患者在显像后2-3周内行手术治疗,手术时对颈、胸、上腹部三野淋巴结清扫,所有淋巴结送病理学检查。病理学证实34例患者均为鳞状细胞癌。胸上段食管癌4例,中段食管癌16例,下段食管癌14例。结果：34例患者食管肿瘤长度为1-8．3cm（4．5±1．6cm）。PET／CT均显示FIX;代谢增高,SUV最高值范围4．3-23．2（10．84±5．32）,平均SUV值3。16．7（8．92±4．09）。作为对照,分析36例PET／CT健康查体人员,发现有2例食管平滑肌瘤显示假阳性。PET／CT诊断食管癌的准确度、灵敏度、特异度、阳性预测值和阴性预测值分别为：97．1％、100％、94．4％、94．4％和100％。34例患者中有20例发生不同程度的淋巴结转移,PET／CT显示转移淋巴结高FDG代谢,SUV最高值为2．7-13．9（7．28±2．75）,SUV平均值为2．3-10．7（5．63±2．49）;其中有6例患者转移到腹腔内,6例腹腔淋巴结转移患者中有5例为下段食管癌,1例为中段食管癌。4例转移至颈部淋巴结,为中上段食管癌转移。手术清除淋巴结163枚,其中病理示转移淋巴结52枚,PET／CT显像结果与病理结果比较,有7枚小淋巴结未能显示,排除了3枚直径大于1cm的可疑转移淋巴结,有13个良性淋巴结显示假阳性,对淋巴结诊断的准确度、灵敏度、特异度、阳性预测值和阴性预测值分别为：87．7％、86．2％、88．2％、77．6％和85．2％。结论：PET／CT对食管癌原发灶的诊断有很高的价值,对淋巴结分期有较高的灵敏度与特异性。     

3.0T MR多b值DWI对鼻咽癌患者颈部良恶性淋巴结的鉴别诊断价值

目的探讨3.0T磁共振多b值扩散加权成像(DWI)对鼻咽癌患者颈部良恶性淋巴结的鉴别和诊断价值。方法收集本院66例鼻咽癌患者的临床资料,并以35例良性淋巴结肿大患者为对照。所有患者均行MR常规平扫、增强和多b值DWI影像学检查,比较不同b值下鼻咽癌患者原发灶、颈部转移性小淋巴结、转移性大淋巴结与良性淋巴结肿大患者表观扩散系数(ADC)值的差异。通过绘制受试者工作特征(ROC)曲线计算诊断阈值、ROC曲线下面积、敏感度和特异度,评价不同b值下ADC值对鼻咽癌颈部良恶性淋巴结的鉴别和诊断价值。结果随着b值的增加,鼻咽癌患者原发灶、颈部转移性小淋巴结、转移性大淋巴结与良性淋巴结肿大患者ADC值呈现减少的趋势;鼻咽癌患者原发灶、颈部转移性小淋巴结、转移性大淋巴结之间ADC值的比较,差异均无统计学意义(P>0.05);鼻咽癌患者原发灶、颈部转移性小淋巴结、转移性大淋巴结ADC值均显著低于良性淋巴结肿大患者(P<0.05)。在b值分别取400、600、800、1000s/mm^2时,其对应的ROC曲线下面积分别为0.77、0.82、0.91、0.87。当b=800s/mm^2时,其鉴别和诊断淋巴结良恶性的价值最高,此时ADC值诊断鼻咽癌颈部转移性小淋巴结的阈值为0.945×10^-3mm^2/s,诊断敏感度为98.49%,特异度为79.63%,约登指数为0.78。结论3.0T MR多b值DWI检查可有效区分良恶性淋巴结的性质,并且在b值为800s/mm^2时,其鉴别和诊断不同淋巴结性质的能力最强,可用于临床鉴别和诊断鼻咽癌患者颈部淋巴结转移瘤。     

The role of whole-body FDG-PET in preoperative assessment of tumor staging in oral cancers

OBJECTIVE: The aim of this study is to clarify the clinical utility of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) in determining the TNM classification in patients with oral cancer. METHODS: Twenty-five consecutive patients (14 male and 11 female; age range, 40 yr to 86 yr) with oral cancer were included in this study. The diagnostic accuracy for detecting cervical lymph nodes was investigated by comparing the results of CT and/or MRI and physical findings. For the semi-quantitative analysis, the tumor standardized uptake value (SUV) and tumor to background SUV ratio (T/B ratio) were assessed in primary tumors and cervical lymph nodes. RESULTS: All primary lesions were visualized on FDG-PET images. Even though artifacts from dental materials near the lesion hampered the delineation of primary tumors on CT/MRI, the extent of primary tumors was accurately assessed by FDG-PET. The SUV and T/B ratio in the primary tumor classified in higher T grade (T3 and T4) was significantly higher than that in lower T grade (T1 and T2) (mean +/- SD of SUV; 8.32 +/- 2.99 vs. 5.15 +/- 3.77, p < 0.01, mean +/- SD of T/B ratio; 6.96 +/- 3.23 vs. 3.61 +/- 2.76, p < 0.01). The SUV and T/B ratio of metastatic lymph nodes were also significantly higher than those of normal lymph nodes (mean +/- SD of SUV; 3.39 +/- 1.69 vs. 1.55 +/- 0.57, p < 0.001, mean +/- SD of T/B ratio; 2.46 +/- 1.08 vs. 1.03 +/- 0.22, p < 0.001). Among these three methods, FDG-PET in conjunction with CT/MRI showed the highest accuracy of 92%, but there were no significant differences in diagnostic accuracy among the three methods. For the semi-quantitative analysis, a threshold SUV of 2.0 provided 100% sensitivity, 82% specificity, and 88% accuracy. Furthermore, a threshold T/B ratio of 1.5 provided 100% sensitivity, 100% specificity, and 100% accuracy. Regarding the detection of distant metastasis, there was one positive result in FDG-PET showing distant pulmonary metastasis. CONCLUSIONS: Whole-body FDG-PET is an effective and convenient diagnostic tool for the evaluation of tumor staging in patients with oral cancer. Tumor staging by whole-body FDG-PET may, in fact, supplement the conventional staging by means of CT/MRI and physical findings.     

口腔鳞癌的18F-FDG PET/CT的影像学表现以及与CT平扫的比较研究

目的 评价18F-FDG PET-CT检查在口腔鳞癌患者的诊断和淋巴结转移灶发现的价值.方法 回顾性地分析了18例口腔癌(其中包括16例舌癌和2例口底癌患者)的临床和18F-FDG PET-CT影像学表现及CT平扫的影像学资料.结果 (1)原发病灶的发现全部病例中有5例患者是由PET/CT检查首次发现口腔癌的;PET/CT对原发部位肿瘤病变显示的灵敏度100%(15/15),特异性100%(3/3);CT对原发病灶显示的灵敏度为73.3%(11/15),特异性为66.7%(2/3).(2)18例口腔癌患者中PET/CT诊断颈部淋巴结转移灶共26个,大小介于0.8～1.5 cm之间,标准摄取值(SUV)介于2.5～3.2之间;其中仅有5个淋巴结经病理组织活检证实为淋巴结转移灶.(3)通过PET/CT检查新发现全身其他部位的侵犯和远处转移性病灶8个.结论 PET/CT对口腔鳞癌原发灶诊断的灵敏度和特异性均比CT平扫高;全身PET/CT扫描对舌癌和口底癌的临床分期、术后复发的判定更具价值.     

Characteristics of Metastatic Mediastinal Lymph Nodes of Non-Small Cell Lung Cancer on Preoperative F-18 FDG PET/CT

Purpose

The aim of this study was to evaluate the characteristics of PET and CT features of mediastinal metastatic lymph nodes on F-18 FDG PET/CT and to determine the diagnostic criteria in nodal staging of non-small cell lung cancer.

Methods

One hundred four non-small cell lung cancer patients who had preoperative F-18 FDG PET/CT were included. For quantitative analysis, the maximum SUV of the primary tumor, maximum SUV of the lymph nodes (SUVmax), size of the lymph nodes, and average Hounsfield units (aHUs) and maximum Hounsfield units (mHUs) of the lymph nodes were measured. The SUVmax, SUV ratio of the lymph node to blood pool (LN SUV/blood pool SUV), SUV ratio of the lymph node to primary tumor (LN SUV/primary tumor SUV), size, aHU, and mHU were compared between the benign and malignant lymph nodes.

Results

Among 372 dissected lymph node stations that were pathologically diagnosed after surgery, 49 node stations were malignant and 323 node stations benign. SUVmax, LN SUV/blood pool SUV, and size were significantly different between the malignant and benign lymph node stations (P < 0.0001). However, there was no significant difference in LN SUV/primary tumor SUV (P = 0.18), mHU (P = 0.42), and aHU (P = 0.98). Using receiver-operating characteristic curve analyses, there was no significant difference among these three variables (SUVmax, LN SUV/blood pool SUV, and size). The optimal cutoff values were 2.9 for SUVmax, 1.4 for LN SUV/blood pool SUV, and 5 mm for size. When the cutoff value of SUVmax ≥2.9 and size ≥5 mm were used in combination, the positive predictive value was 44.2 %, and the negative predictive value was 90.9 %. When we evaluated the results based on the histology of the primary tumor, the negative predictive value was 92.3 % in adenocarcinoma (cutoff values of SUVmax ≥2.3 and size ≥5 mm) and 97.2 % in squamous cell carcinoma (cutoff values of SUVmax ≥3.6 and size ≥8 mm), separately.

Conclusions

In the lymph node staging of non-small cell lung cancer, SUVmax, LN SUV/blood pool SUV, and size show statistically significant differences between malignant and benign lymph nodes. These variables can be used to differentiate malignant from benign lymph nodes. The combination of the SUVmax and size of lymph node might have a good negative predictive value.     

Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy

OBJECTIVES: The purpose of the study was to evaluate the efficacy of colour Doppler ultrasound (CDUS) to differentiate between benign and malignant cervical lymph nodes. METHODS: During a period of 12 months, 100 untreated patients with clinical evidence of cervical lymphadenopathy (50 patients with clinically suspected malignant/metastatic cervical lymphadenopathy and 50 patients with clinically suspected reactive/benign cervical lymphadenopathy) were prospectively evaluated with CDUS. CDUS was performed for 168 cervical lymph nodes in these 100 patients. Histopathological confirmations were obtained by fine needle aspiration biopsy and/or excisional biopsy. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological/histological features of enlarged cervical lymph nodes was then done. RESULTS: Initially, clinical examination evaluated 143 cervical lymph nodes. CDUS evaluation discovered additional 25 lymph nodes (143+25 = 168). Correlation of patterns of colour Doppler flow signals with pathological diagnosis showed that central flow for benign nodes and peripheral flow for malignant nodes were highly significant parameters (P < 0.01). CDUS has a higher specificity than clinical evaluation, being 94.28% and 58.76%, respectively. Accuracy of the CDUS examination was also definitely higher than clinical evaluation at 92.85% and 63.67%, respectively. CONCLUSIONS: Nodal vascularity can be used to differentiate benign from malignant lymphadenopathy. Proper judicious CDUS examination provides an opportunity to eliminate the need for biopsy/FNAC in reactive nodes.     

CT findings in Kikuchi disease: analysis of 96 cases

BACKGROUND AND PURPOSE: Although CT findings of Kikuchi disease (KD), or histiocytic necrotizing lymphadenitis, are reported in several case reports, large-scale analysis of the disease has not been undertaken. We characterized the clinical and CT findings in a large group of patients with KD. METHODS: Between 1990 and 2002, 96 patients (68 women, 28 men; mean age, 24.4 years) underwent biopsy of the cervical lymph nodes and had histologically proved KD at our institution. We reviewed their clinical and CT findings and recorded the total number of affected nodes; location and size of the lymph nodes; and characteristic findings including necrosis, perinodal infiltration, and contrast enhancement. RESULTS: We identified 1196 affected lymph nodes (12.5 nodes per patient). The affected lymph nodes were 0.5-3.5 cm (mean, 1.62 cm). Perinodal infiltration was found in 78 patients (81.3%). Eighty (83.3%) had homogeneous nodal contrast enhancement. Nine patients (9.4%) had lymph nodes with a focal low attenuation, and seven (7.3%) had ring-shaped lymph nodes. Unilateral and bilateral cervical lymph nodes were affected in 76 and 20 patients, respectively. Lymph nodes were mainly located at levels II (IIA, 174 nodes; IIB, 254 nodes), III (222 nodes), IV (160 nodes), and V (VA 126 nodes, VB 130 nodes). Follow-up CT in 32 patients showed complete resolution in 14 and partially improved lymphadenopathy in 18. CONCLUSION: Awareness of the various CT appearances of KD and follow-up CT may be helpful for more accurate diagnosis of the disease.     

头颈部恶性肿瘤隐匿性颈淋巴结转移的CT诊断

作者对２２例病人２６侧拟行预防性颈淋巴结清扫术而临床触诊阴性的头颈部恶性肿瘤病人颈淋巴结状态行术前ＣＴ扫描评估，并与术后颈淋巴结病理检查结果相对照，表现：ＣＴ检查头颈部恶性肿瘤病人颈部，可使隐匿性颈淋巴结转移的误诊率从临床触诊检查的４６．１５％（１２／２６侧）下降为ＣＴ检查的１８．７５％（３／１６侧）。说明ＣＴ在诊断头颈部恶性肿瘤隐匿性颈淋巴结转移方面确有一定的价值。     

256层CT全颈灌注成像在鼻咽癌颈部淋巴结转移中的应用研究

目的探讨256层CT全颈部灌注成像对鼻咽癌颈部淋巴结转移的临床应用价值。资料与方法采用256层CT对经临床及病理证实的25例患者行全颈部CT灌注成像,其中鼻咽癌15例,颈部转移淋巴结65枚,同时取颈部正常肌肉组(65枚淋巴结);结节性甲状腺肿10例,颈部有未转移淋巴结55枚。记录转移淋巴结、未转移淋巴结及颈部正常肌肉的灌注参数值[灌注(P)、血流量(BF)、血容量(BV)、达峰时间(TTP)],并比较各灌注参数值在转移淋巴结与未转移淋巴结及正常肌肉间的差异。结果转移淋巴结组、正常肌肉组及未转移淋巴结组P值中位数分别为32.54HU、8.04HU和20.92HU,PEI均数分别为36.14HU、14.74HU和35.95HU,TTP值均数分别为36.35s、53.05s、48.65s,BV值中位数分别为31.17ml/100g、8.28ml/100g和18.98ml/100g。转移淋巴结P值、PEI值与BV值均高于正常肌肉组织(P<0.01),TTP值小于正常肌肉组织(P<0.01)。转移淋巴结与未转移淋巴结间P值、PEI值、BV值差异无统计学意义(P>0.05),转移淋巴结TTP值小于未转移淋巴结(P<0.0...     

CT及18F-FDGPET/CT诊断食管癌术前淋巴结转移及N分期对比研究

目的 研究CT及18F-氟脱氧葡萄糖(FDG) PET/CT术前诊断食管癌淋巴结转移及确定N分期的价值.资料与方法 连续随机选择经食管镜或胃镜证实、拟行手术治疗、能够耐受手术的47例食管癌患者,术前1周内行CT及18F-FDG PET/CT检查,以术后病理为“金标准”,比较CT及18F-FDG PET/CT诊断食管癌淋巴结转移及N分期的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 31例存在淋巴结转移,共切除并分离淋巴结387枚(209组),其中65枚(46组)发现转移.CT诊断淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为53.8％、92.8％、86.3％、60.3％和90.9％;18F-FDG PET/CT分别为89.2％、93.8％、93.0％、74.4％和97.7％.PET/CT诊断淋巴结转移的敏感性、准确性及阴性预测值均显著高于CT,差异有统计学意义(P＜0.05),特异性及阳性预测值差异无统计学意义(P＞0.05).CT及18F-FDG PET/CT确定淋巴结分期的准确率分别为74.5％和91.5％,差异有统计学意义(P＜0.05).伴淋巴结转移的食管癌原发灶最大标准摄取值(SUVmax)为( 14.899±3.770),而无淋巴结转移者为(9.427±2.854).结论 18F-FDGPET/CT术前诊断食管癌淋巴结转移及确定N分期优于CT;食管癌原发灶SUVmax在一定程度上可以反映淋巴结转移情况.