FDG-PET/CT和MR扩散加权成像评价胃肠道恶性肿瘤腹膜转移癌的比较性研究

摘要目的评价FDG-PET/CT和MR扩散加权成像(MR-DWI)诊断胃肠道恶性肿瘤腹膜转移癌(PC)的准确性。方法在本回顾性研究中,30例病人被推荐进行胃肠道恶性肿瘤分期,均行FDG-PET/CT和MR-DWI检查。将每例病人的腹膜腔分成3部分,即右和左结肠系膜上区以及结肠系膜下区,共90个部位。PC范围根据上述分类决定。通过手术(18/30)或随访(12/30)确诊PC的有无。     

直肠癌CT诊断与分期

目的:评价CT在诊断和直肠癌分期的价值。材料和方法:回顾性分析150例经手术病理证实的直肠癌的CT表现,评价其CT诊断和分期的价值。结果:直肠癌CT的主要表现包括肠壁增厚50例、软组织肿块61例和肠腔狭窄49例;与手术病理对照,CT显示病灶、周围组织侵犯和淋巴结转移的准确性分别为96.7%(145/150)、88.4%(84/95)和51.7%(15/29);CT分期与Dukes分期的总符合率为83.3%。结论:直肠癌的CT诊断和分期与手术病理分期有很好的一致性,CT是直肠癌术前诊断的重要影像检查方法。     

18F-FDG PET/CT显像在非小细胞肺癌术前分期中的价值

目的评价18F-脱氧葡萄糖(FDG)PET/CT显像在非小细胞肺癌(NSCLC)分期中的价值.方法73例经病理检查证实的NSCLC患者行18F-FDG PET/CT显像.两诊断组盲法阅片,所得分期结果与病理检查和(或)随访结果比较、评分后进行统计学分析.结果在总体分期准确性上,18F-FDG PET/CT优于CT、18F-FDGPET(P均＜0.001)及视觉融合分期(P=0.001).25例患者获得T亚分期证实,在T亚分期准确性上,18F-FDG PET/CT优于CT、18F-FDG PET及视觉融合分期(P=0.002、0.001、0.008).29例患者获得N亚分期证实,在N亚分期准确性上,18F-FDG PET/CT优于CT(P=0.001),与18F-FDG PET及视觉融合分期相比没有明显差别(P=0.125、0.219),但18F-FDG PET/CT与18F-FDGPET和视觉融合相比分别在5例及4例患者中准确定位.在M亚分期上,18F-FDG PET/CT较CT、18F-FDGPET探测到更多远处转移灶,且为后两者无法定位的患者准确定位.结论18F-FDG PET/CT显像对NSCLC总体分期及T、N、M亚分期的准确性均有提高.     

螺旋CT三期增强扫描对胃癌TNM分期的研究

目的　评价螺旋CT三期增强扫描对胃癌TNM分期的诊断价值。方法　胃癌 10 1例进行低张水充盈螺旋CT三期增强扫描。结果　 (1)螺旋CT三期增强扫描对胃癌T -分期、N -分期和TNM分期的准确性分别为 81.8%、72 .9%和 80 .2 %。 (2 )动脉期—门脉期胃壁呈多层结构有利于判断胃癌浸润胃壁的深度 (Ρ <0 .0 5 )。 (3 )平衡期肿瘤强化完全有助于判断有无邻近器官受侵。(4 )以淋巴结直径 >5mm为转移标准 ,螺旋CT诊断转移淋巴结的敏感性明显高于以 10mm为转移标准 (Ρ <0 .0 5 )。结论　螺旋CT三期增强扫描能提高胃癌TNM分期的准确性。     

喉癌的CT分期(附91例CT一病理对照分析)

目的探讨CT对喉癌术前分期的准确性.材料与方法91例经手术切除的喉癌,用CT观察肿瘤的侵犯范围、有无喉软骨受侵及颈部淋巴结转移;按双盲法根据CT征象进行分期并与手术病理结果对照分析.结果CT术前肿瘤(T)分期的准确性为84%,诊断颈部淋巴结转移及喉软骨受侵的敏感性、特异性、准确性分别是80%、94%、91%和70%、96%、93%,判断肿瘤侵犯周围结构的准确性在87%～100%之间.结论CT能很好地显示肿瘤的侵犯范围及有无颈部淋巴结转移,对喉癌的术前分期有较高的准确性,失误的主要原因包括不能显示轻微的甲状软骨破坏、不易诊断正常大小的颈部淋巴结转移.     

胆管癌的18F-FDG PET/CT诊断价值

目的 总结胆管癌18F-FDG PET/CT显像表现,提高胆管癌的诊断准确性.方法 回顾经病理或临床综合手段证实的53例胆道疾病的18F-FDG PET/CT表现,分析PET/CT诊断胆管癌的敏感性、特异性和准确性.结果 肝内胆管癌14例、近段胆管癌18例、中远段胆总管癌15例、胆管炎性病变或伴结石6例.肝内转移9例,腹腔及腹膜后淋巴结转移15例,椎体等远处转移3例.PET/CT诊断胆管癌的敏感性为95.7％、特异性为83.3％、准确性为94.3％.结论 18F-FDG PET/CT在胆管癌的诊断与鉴别诊断、分期、检测疗效及预后等具有独特的应用价值.     

18F-FDG PET/CT对非小细胞肺癌淋巴结分期诊断价值的研究进展

非小细胞肺癌（NSCLC）准确的淋巴结分期是确定患者治疗方案的重要因素。18F-FDG PET/CT作为一种同时包含功能代谢与解剖形态信息的高端影像学诊断方法,在NSCLC淋巴结分期（N分期）中呈现出较高的诊断准确率。大量研究已基本证实哪些是影响NSCLC纵隔淋巴结转移的危险因素,笔者主要就近年为提高NSCLC淋巴结分期准确性而探索出的新参数、新技术进行综述。     

非小细胞肺癌术前淋巴结分期采用联合MRI和PET/CT解释标准的建议

摘要目的联合利用MRI及PET/CT为非小细胞肺癌术前淋巴结分期确定阳性的恶性淋巴结判读标准。方法49例经活检证实的非小细胞肺癌病人,同时接受PET/CT及胸部MRI(DWI)检查。在MRI联合PET/CT解释时应用纳入法(任一项判断为阳性即为阳性)及排除法(两者均为阳性者)评估每个淋巴结部位是否存在转移。淋巴结分期由病理证实。以结节分区及病人为分析单位评价MRI联合PET/CT诊断的准确性,并与单独利用PET/CT诊断的准确性比较。     

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.     

鼻咽癌TNM分期的PET/CT表现与血清VEGF表达的关系

目的 探讨鼻咽癌TNM分期的PET/CT表现与血清促血管内皮生长因子(VEGF)表达的关系. 资料与方法 搜集46例鼻咽癌患者首次放疗前行PET/CT检查的资料,用酶联免疫夹心法(ELISA)检测血清VEGF 的表达,并分析T分期、淋巴结及远处转移的PET/CT表现与VEGF表达的关系. 结果 46例中,经PET/CT分析T1期11例、T2期9例、T3期18例、T4期8例;颈部淋巴结转移12例,咽后外侧淋巴结转移5例.M0期37例,M1期 9例.鼻咽癌的血清VEGF表达的水平为(502.63±22.06) ng/l, 与正常组比较差异有统计学意义(P<0.05).T1、T2、T3期血清VEGF表达差异无统计学意义.颈部淋巴结转移组血清VEGF表达水平为(527.61±7.11) ng/l,与非转移组之间的差异有统计学意义(t=15.36,P<0.05);远处转移组血清VEGF表达水平为(522.00±1.54) ng/l,与非远处转移组之间的差异有统计学意义(t=30.30,P<0.05). 结论 鼻咽癌患者有较高的血清VEGF表达; VEGF 的表达水平与淋巴结发生转移及远处转移相关;VEGF的表达水平随着TNM分期升高有增强的趋势.     

CT衰减校正对IQ-SPECT/CT和LEHR-SPECT/CT心肌灌注显像的影响

目的 探讨CT衰减校正（CTAC）对智能（IQ）-SPECT/CT和低能高分辨率（LEHR）-SPECT/CT心肌血流灌注显像（MPI）图像的影响。 方法 收集2018年5月至10月在山西医科大学第一医院行静息心肌灌注显像（MPI）的31例确诊或者可疑的冠心病患者,其中男性21例、女性10例,年龄（49.4±12.01）岁。所有患者同日分别行IQ-SPECT/CT+CTAC及LEHR-SPECT/CT+CTAC。视觉分析IQ-SPECT/CT CTAC前后图像及手动配位后图像、LEHR-SPECT/CT CTAC前后断层图像;同时比较左心室各个室壁（心尖、前壁、侧壁、间壁、下壁）IQ-SPECT/CT和LEHR-SPECT/CT CTAC前后与重新配位后的放射性摄取值（%）。两组间比较采用配对t检验,率的比较采用卡方检验,一致性分析采用Kappa检验。 结果 ①视觉分析:IQ-SPECT/CT与LEHR-SPECT/CT CTAC前图像比较,具有很高的一致性（Kappa值=0.795,P<0.001）。IQ-SPECT/CT CTAC后心肌节段出现放射性分布明显稀疏的比例为77%（24/31）,远高于LEHR- SPECT/CT CTAC后的23%（7/31）,差异有统计学意义（χ2=16.52,P<0.001）。将MPI与CT图像手动重新配位后,IQ-SPECT/CT左心室心尖的放射性分布为16%（5/31）,与LEHR-SPECT/CT的23%（7/31）相比,差异无统计学意义（χ2=0.103,P=0.748）。②放射性摄取值（%）:IQ-SPECT/CT CTAC前后比较,左心室心尖[（65.71±25.69）%对（58.68±20.39）%]、前壁[（204.23±43.24）%对（184.66±41.22）%]及间壁[（316.19±47.43）%对（270.03±65.33）% ] 的放射性摄取值明显降低,且差异均有统计学意义（t=4.014、4.232、5.473,均P<0.05）;LEHR-SPECT/CT CTAC前后比较,左心室前壁[（204.68±41.14）%对[（211.81±35.04）%]、间壁[（319.13±44.90）%对（350.87±44.24）%]及下壁[（185.48±31.06）%对（228.67±29.45）% ]的放射性摄取值显著增高,且差异均有统计学意义（t=?2.471,P =0.019;t=?5.968,P<0.001;t=?11.311,P<0.001）。IQ-SPECT/CT CTAC配位后与IQ-SPECT/CT CTAC前比较,左心室前壁[（212.06±33.59）%对（204.23±43.24）%]、侧壁[（372.84±39.37）%对（355.81±46.79）%]、下壁[（219.13±25.10）%对（191.58±33.06）%]和间壁[（335.00±36.84）%对（316.19±47.43）%]的放射性摄取值均明显增高,且差异均有统计学意义（t=?2.497,P=0.018;t=?2.672,P=0.012;t=?7.632,P<0.001;t=?3.557,P<0.001） 。 结论 LEHR-SPECT/CT CTAC后左心室间壁及下壁的放射性分布得到补偿;而IQ-SPECT/CT CTAC后左心室心尖、前壁及间壁的放射性分布却更加稀疏。在IQ-SPECT/CT采集模式下,CTAC后容易出现矫枉过正,重新手动配位后这种情况将得到明显改善。     

Sources of attenuation-correction artefacts in cardiac PET/CT and SPECT/CT

PURPOSE: Respiratory motion during myocardial perfusion imaging can cause artefacts in both positron emission tomography (PET) and single-photon emission computed tomography (SPECT) images when mismatches between emission and transmission datasets arise. In this study, artefacts from different breathing motions were quantified in both modalities to assess key factors in attenuation-correction accuracy. METHODS: Activity maps were generated using the NURBS-based cardiac-torso phantom for different respiratory cycles, which were projected, attenuation-corrected and reconstructed to form PET and SPECT images. Attenuation-correction was performed with maps at mismatched respiratory phases to observe the effect on the left-ventricular myocardium. Myocardial non-uniformity was assessed in terms of the standard deviation in scores obtained from the 17-segment model and changes in uniformity were compared for each mismatch and modality. RESULTS: Certain types of mismatch led to artefacts and corresponding increases in the myocardial non-uniformity. For each mismatch in PET, the increases in non-uniformity relative to an artefact-free image were as follows: (a) cardiac translation mismatch, 84% +/- 11%; (b) liver mismatch, 59% +/- 10%, (c) lung mismatch from diaphragm contraction, 28% +/- 8%; and (d) lung mismatch from chest-wall motion, 6% +/- 7%. The corresponding factors for SPECT were (a) 61% +/- 8%, (b) 34% +/- 8%, (c) -2% +/- 7)% and (d) -4% +/- 6%. CONCLUSIONS: Attenuation-correction artefacts were seen in PET and SPECT images, with PET being more severely affected. The most severe artefacts were produced from mismatches in cardiac and liver position, whereas lung mismatches were less critical. Both cardiac and liver positions must, therefore, be correctly matched during attenuation correction.     

肾上腺淋巴瘤CT及18F-FDG PET/CT主要特征分析

 目的 探讨肾上腺淋巴瘤的CT及¹⁸F-FDG PET/CT影像学征象,以提高对该病的诊断水平。方法 回顾性分析经手术病理证实10例肾上腺淋巴瘤的临床、影像及病理资料,均行CT平扫及增强扫描及¹⁸F-FDG PET/CT检查,观察和比较肿瘤发生的一般资料(年龄、性别),MSCT表现(部位、最大径、形态、密度、边界、强化方式、腹膜后淋巴结等情况,并计算各期强化率)和计算病灶SUVmax。结果 原发性肾上腺淋巴瘤7例,继发性肾上腺淋巴瘤3例;双侧病灶者7例,单侧病灶者3例,共计17侧病灶;肿瘤最大径不等,平均5.6 cm;肿块呈椭圆形共13侧,三角形3侧,1侧呈结节状增生;13侧边界清晰,4侧边界模糊;病灶平扫CT值平均40.4 Hu;动脉期平均强化率为24.28%;静脉期平均强化率37.46%;大部分(14/17)CT平扫及(13/17)增强密度较均匀一致,动脉期呈轻中度强化,门脉期呈进行性强化;2例发现腹膜后淋巴结肿大。均表现为¹⁸F-FDG高摄取,SUVmax为8.7～23.5,平均值为12.5。结论 肾上腺淋巴瘤CT表现具有一定特征,PET/CT 可准确显示肿瘤累及的范围和淋巴结,在诊断和治疗中具有重要的价值。     

成人型肺母细胞瘤的CT及PET/CT表现

目的探讨成人型肺母细胞瘤(ATPB)的CT及PET/CT表现,提高对其诊断的准确率。方法对9例经手术或穿刺病理证实的ATPB的影像学表现进行回顾性分析。MSCT多期增强扫描检查8例,PET/CT检查4例,其中3例同时做CT及PET/CT检查。结果 9例ATPB均为周围型,均为单发,其中1例合并肺内多发转移。CT表现:8例呈边缘光滑锐利或仅有浅分叶的圆形或类圆形结节或肿块,仅1例可见典型浅分叶、毛刺及胸膜牵拉征象。5例病灶直径≥5 cm且密度不均,7例有坏死液化,增强扫描强化明显。18F-FDG PET/CT显像4例病灶呈均匀或不均匀放射性浓聚,标准摄取值最大值约3.2～4.7。结论 ATPB影像学上缺乏特征性表现,综合CT和PET/CT影像学检查能提高诊断符合率,对部分病例可做出提示性诊断。     

Limitations of CT during PET/CT.

Our aim was to determine the diagnostic limitations of low-dose, unenhanced CT scans performed for anatomic reference and attenuation correction during PET/CT. METHODS: The Radiology Information System at our oncologic hospital was queried during the 9-mo period from July 2002 to April 2003 for patients with PET/CT scans and diagnostic enhanced CT within 2 wk of each other. One radiologist interpreted the CT portion of the PET/CT (CT(p)) unaware of the PET results and the associated enhanced diagnostic CT (CT(d)). A medical student compared this interpretation with the official report of the CT(d) and listed all discrepancies between reports. A separate radiologist compared CT(p) and CT(d) images and classified true discrepant findings as due to lack of intravenous contrast, arm-position artifact, lack of enteric contrast, low milliamperage (mA), and quality of lung images. RESULTS: Among 100 patients, the most common malignancies were lymphoma (n = 37), cancer of the colorectum (n = 31), and esophageal cancer (n = 15). Among 194 true discrepancies in which findings were missed at CT(p), causes were as follows: (a) lack of intravenous contrast (128/194, 66%), (b) arm-down artifact (17/194, 9%), (c) quality of lung images (26/194, 13%), (d) lack of enteric contrast (15/194, 8%), and (e) low mA (8/194, 4%). Discrepancies were seen most commonly in detecting lymphadenopathy and visceral metastases. CONCLUSION: Most missed findings on the unenhanced CT portion of the PET/CT scans were due to technical factors that could be altered. Discrepant findings would have led to altered management in only 2 patients, suggesting a role for limited repeat imaging to reduce radiation and use of valuable resources.     

卵巢颗粒细胞瘤的CT及PET/CT表现

目的 探讨卵巢颗粒细胞瘤(GCT)的CT及PET/CT表现特征.方法 回顾性分析经病理证实的5例GCT患者的影像资料,并与手术病理结果进行对照分析.结果 5例中4例行CT扫描,1例行PET/CT检查.3例为原发,呈单侧附件区边界清晰的类圆形分叶状囊实性(2例)或单房囊性肿块(1例);2例为术后盆腹腔多处复发,多数病灶类似于原发者呈囊实性蜂窝状,最大灶均位于盆腔.平扫实性部分密度低于子宫肌层,增强呈中度或明显强化,但仍低于子宫肌层,可见患侧卵巢、子宫血管增粗;PET/CT检查囊壁放射性分布较浓密.5例均伴中至大量腹水,1例尚伴右侧大量胸水,均未见腹盆腔实质脏器转移及淋巴结肿大.结论 GCT的CT表现具有一定的特征,对其诊断具有指导作用;其PET/CT表现特征尚待更多病例的总结.     

Evaluating and comparing the image quality and quantification accuracy of SiPM-PET/CT and PMT-PET/CT

Annals of Nuclear Medicine - The aim of this study was to evaluate the image quality and the quantification accuracy of Biograph Vision PET/CT scanner as a SiPM-PET in comparison to the...     

Bone invasion in patients with oral cavity cancer: comparison of conventional CT with PET/CT and SPECT/CT

PURPOSE: To prospectively compare the accuracy of helical contrast material-enhanced computed tomography (CT) with that of CT and positron emission tomography (PET) combined and CT and single photon emission CT (SPECT) combined in the detection of bone invasion in patients scheduled to undergo surgery for clinically suspected oral cavity carcinoma with possible bone invasion, with surgical results as the reference standard. MATERIALS AND METHODS: This study had local ethical committee approval, and all patients gave written informed consent. Thirty-four consecutive patients (17 men, 17 women; mean age, 64.2 years; age range, 46.0-84.6 years) who were clinically suspected of having bone invasion from oral cavity carcinoma prospectively underwent helical contrast-enhanced CT, coregistered PET/CT, and coregistered SPECT/CT. Two radiologists assessed the contrast-enhanced CT images and two nuclear medicine physicians separately assessed the PET/CT and SPECT/CT images in consensus and without knowledge of the results of other imaging tests. The presence of bone involvement as suggested with an imaging modality was compared with histologic findings in the surgical specimen. RESULTS: With histologic findings as the standard of reference, the accuracy of SPECT/CT (88% [30 of 34 patients]) was lower than that of PET/CT and contrast-enhanced CT (94% [32 of 34 patients] and 97% [33 of 34 patients], respectively). Sensitivity was highest with PET/CT (100% [12 of 12 patients]), and specificity was highest with contrast-enhanced CT (100% [22 of 22 patients]). Fluorine 18 fluorodeoxyglucose (FDG) uptake seen on two sides of the same cortical bone was not a helpful imaging pattern for better identifying bone invasion in patients without evident cortical erosion on CT scans. CONCLUSION: The assessment of cortical erosion with contrast-enhanced CT and the CT information from PET/CT are the most reliable methods for detecting bone invasion in patients with oral cavity carcinoma. FDG uptake seen on PET/CT images does not improve identification of bone infiltration.