18F-FDG PET/CT显像诊断子宫良性转移性平滑肌瘤肺转移一例

患者女,43岁,因心悸、咳嗽、胸痛等不适入院.既往史:2005年曾因子宫肌瘤行“肌瘤剔除加子宫次全切术”.本院胸部CT示左肺上叶及右肺多发占位,考虑转移瘤可能.为明确病变性质及原发灶,于本科行全身PET/CT检查.全身PET/CT(美国GE Discovery STE)示子宫呈术后改变,局部囊实性肿块,代谢不高,考虑肌瘤复发并囊肿;左上肺下舌段及右下肺后基底段结节,右下肺背段软组织肿块,大小约8.3 cm×8.6cm,边缘光滑,代谢不高,SUVmax为1.5,考虑良性平滑肌瘤转移可能(图1).在PET/CT引导下经皮穿刺活组织检查,病理诊断符合子宫平滑肌瘤(图2).     

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.     

99Tcm-MDP骨显像发现骨巨细胞瘤肺内多发转移灶一例

患者男，26岁。2004年4月无诱因出现左髋部疼痛伴肿物，在当地医院行“左髋部肿瘤病灶刮除术”；病理诊断为动脉瘤样骨囊肿。2005年拟诊“左髋部肿瘤复发”，入本院骨科行“左髋部肿瘤病灶刮除术＋骨水泥填充术＋动力髋螺钉系统内固定术”和“左髋部肿瘤术后复发肿瘤摘除术＋全髋关节置换术”；病理诊断为左髋部骨巨细胞瘤Ⅲ级，合并骨肉瘤（部分呈小细胞型，部分呈恶性纤维组织瘤样型，部分呈软骨肉瘤形态），部分区域肿瘤浸润横纹肌组织。住院期间患者血清碱性磷酸酶为583（正常值10～121）U／L。     

99Tcm-HL91乏氧显像在恶性肿瘤治疗后随访中的应用

Objective 99Tcm-4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime (HL91) is a new hypoxia imaging agent that demonstrates increased uptake and retention in tumor hypoxic tissues in vivo. The objective of this study was to evaluate the clinical value of 99Tcm-HL91 hypoxia imaging in post-therapeutic patients with cancers. Methods Thirty-seven patients with primary cancers at head and neck and upper aerodigestive region who were suspected to have residual, recurrent, or metastatic disease at either clinical follow-up or by regular CT follow-up, were included. All underwent 99Tcm-HL91 imaging. The radioactivity ratios of tumor to normal tissues (T/NT) were calculated using the region of interest (ROI) technique. A t-test was used for data analysis. The " gold standard" of diagnostic accuracy was based on histopathology or clinical follow-up. Results were compared between 99Tcm-HL91 and CT. Results Of the 37 patients, 11 had either residual or recurrent lesions and 7 had distant disease. (1) A significantly higher 99Tcm-HL91 uptake were noted in residual or recurrent lesions than benign lesions (1.58 ± 0. 16 vs 1.18 ±0.14, t =4. 87, P <0.001). (2) The sensitivity, specificity, and accuracy for residual or recur-rent lesions were 72. 73% (8/11), 63.64% (7/11), 4/4; 89.47% (17/19), 84. 21% (16/19), 94. 12% (16/17), and 83.33% (25/30), 76.67% (23/30), 95.24% (20/21) in 99Tcm-HL91, CT, and combined 99Tcm-HL91 and CT, respectively. (3) For distant sites detection (n = 7), CT detected all but 99Tcm-HL91 missed three. Conclusions A combination of 99Tcm-HL91 and CT in detection either residu-al, recurrent, or metastatic disease would have the highest benefit in patients with cancers at head and neck and upper aerodigestive region.     

^18F-FLT评价食管癌照射后早期生物学响应的实验研究

目的探讨^18F—FLT在评价食管癌细胞及其动物模型经X线照射后早期生物学响应中的应用价值。方法在体外以5、10和15Gyx线分别照射人食管癌细胞Eca-109,照射前及照射后2、4和8h检测细胞对^18F—FLT摄取率的变化、细胞相对存活率和ATP的表达情况。将24只荷食管癌裸鼠按随机数字表法分成4组：对照（未照射）组;10Gy照射后1、7及15d各1组,分别行^18F—FLT PET显像并测量肿瘤对^18F—FLT的摄取值（T／NT）的变化。显像后处死各组荷瘤裸鼠,取肿瘤组织,用免疫组织化学检测照射前、后瘤组织内细胞增殖核抗原（PCNA）及Ki67抗原的表达。组间差异比较用单因素方差分析及两独立样本t检验,数据间相关性分析用Pearson直线相关分析。结果照射前细胞对^18F-FLT摄取率为（4．00±0．42）％;经5、10、15Gy照射后2h分别下降至（3．65±0．41）％、（3．17±0．45）％和（2．53±0．28）％;照射后4h分别下降至（2．84±0．35）％、（2．58±0．39）％和（1．80±0．22）％;照射后8h分别下降至（2．71±0．23）％、（1．89±0．31）％和（1．44±0．20）％。与对照组比较,5、10、15q照射后2、4、8h,细胞相对存活率差异无统计学意义（F=4．02,P〉0．05）;ATP浓度下降明显,呈剂量依赖性。细胞受照后的^18F—FLT摄取率与ATP浓度呈正相关（r=0．89,P〈0．01）。^18F—FLTPET显像示裸鼠肿瘤呈高摄取,照射前T／NT为2．24±0．06,照射后1、7和15d分别下降至1．99±0．09、1．85±0．04和1．15±0．10。瘤组织对^18F-FLT的摄取值与PCNA、Ki67表达均呈正相关（r=0．83和0．88,均P〈0．01）。结论^18F—FLT在食管癌细胞及肿瘤内摄取的变化能较好地评价其照射后早期生物学响应,^18F—FLTPET有望用于监测食管癌照射后早期疗效。     

PET/CT诊断婴儿肾母细胞瘤一例

患儿男,3个月.以"发热2 d、发现右上腹肿物1 d"入院;体格检查:神志清楚,腹部膨隆,右上腹可触及肿物,约10 cm×8 cm,质韧,表面光滑,不易推动;双肺可闻及啰音,心律齐,无杂音;浅表淋巴结未触及.脾未触及.临床诊断:"右上腹肿物待查".入院后第2天在本院行腹部CT平扫,考虑"肝右叶巨大低密度占位";3 d后来本科行18F-脱氧萄葡糖(FOG)PET/CT(Discovery STE 16型)检查(按美国GE公司提供的儿童PET/CT扫描方案,电压100 kV,电流80 mA),     

99Tcm-HL91乏氧显像在恶性肿瘤治疗后随访中的应用

Objective 99Tcm-4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime (HL91) is a new hypoxia imaging agent that demonstrates increased uptake and retention in tumor hypoxic tissues in vivo. The objective of this study was to evaluate the clinical value of 99Tcm-HL91 hypoxia imaging in post-therapeutic patients with cancers. Methods Thirty-seven patients with primary cancers at head and neck and upper aerodigestive region who were suspected to have residual, recurrent, or metastatic disease at either clinical follow-up or by regular CT follow-up, were included. All underwent 99Tcm-HL91 imaging. The radioactivity ratios of tumor to normal tissues (T/NT) were calculated using the region of interest (ROI) technique. A t-test was used for data analysis. The " gold standard" of diagnostic accuracy was based on histopathology or clinical follow-up. Results were compared between 99Tcm-HL91 and CT. Results Of the 37 patients, 11 had either residual or recurrent lesions and 7 had distant disease. (1) A significantly higher 99Tcm-HL91 uptake were noted in residual or recurrent lesions than benign lesions (1.58 ± 0. 16 vs 1.18 ±0.14, t =4. 87, P <0.001). (2) The sensitivity, specificity, and accuracy for residual or recur-rent lesions were 72. 73% (8/11), 63.64% (7/11), 4/4; 89.47% (17/19), 84. 21% (16/19), 94. 12% (16/17), and 83.33% (25/30), 76.67% (23/30), 95.24% (20/21) in 99Tcm-HL91, CT, and combined 99Tcm-HL91 and CT, respectively. (3) For distant sites detection (n = 7), CT detected all but 99Tcm-HL91 missed three. Conclusions A combination of 99Tcm-HL91 and CT in detection either residu-al, recurrent, or metastatic disease would have the highest benefit in patients with cancers at head and neck and upper aerodigestive region.     

99Tcm-HL91乏氧显像在恶性肿瘤治疗后随访中的应用

Objective 99Tcm-4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime (HL91) is a new hypoxia imaging agent that demonstrates increased uptake and retention in tumor hypoxic tissues in vivo. The objective of this study was to evaluate the clinical value of 99Tcm-HL91 hypoxia imaging in post-therapeutic patients with cancers. Methods Thirty-seven patients with primary cancers at head and neck and upper aerodigestive region who were suspected to have residual, recurrent, or metastatic disease at either clinical follow-up or by regular CT follow-up, were included. All underwent 99Tcm-HL91 imaging. The radioactivity ratios of tumor to normal tissues (T/NT) were calculated using the region of interest (ROI) technique. A t-test was used for data analysis. The " gold standard" of diagnostic accuracy was based on histopathology or clinical follow-up. Results were compared between 99Tcm-HL91 and CT. Results Of the 37 patients, 11 had either residual or recurrent lesions and 7 had distant disease. (1) A significantly higher 99Tcm-HL91 uptake were noted in residual or recurrent lesions than benign lesions (1.58 ± 0. 16 vs 1.18 ±0.14, t =4. 87, P <0.001). (2) The sensitivity, specificity, and accuracy for residual or recur-rent lesions were 72. 73% (8/11), 63.64% (7/11), 4/4; 89.47% (17/19), 84. 21% (16/19), 94. 12% (16/17), and 83.33% (25/30), 76.67% (23/30), 95.24% (20/21) in 99Tcm-HL91, CT, and combined 99Tcm-HL91 and CT, respectively. (3) For distant sites detection (n = 7), CT detected all but 99Tcm-HL91 missed three. Conclusions A combination of 99Tcm-HL91 and CT in detection either residu-al, recurrent, or metastatic disease would have the highest benefit in patients with cancers at head and neck and upper aerodigestive region.     

99Tcm-HL91乏氧显像在恶性肿瘤治疗后随访中的应用

Objective 99Tcm-4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime (HL91) is a new hypoxia imaging agent that demonstrates increased uptake and retention in tumor hypoxic tissues in vivo. The objective of this study was to evaluate the clinical value of 99Tcm-HL91 hypoxia imaging in post-therapeutic patients with cancers. Methods Thirty-seven patients with primary cancers at head and neck and upper aerodigestive region who were suspected to have residual, recurrent, or metastatic disease at either clinical follow-up or by regular CT follow-up, were included. All underwent 99Tcm-HL91 imaging. The radioactivity ratios of tumor to normal tissues (T/NT) were calculated using the region of interest (ROI) technique. A t-test was used for data analysis. The " gold standard" of diagnostic accuracy was based on histopathology or clinical follow-up. Results were compared between 99Tcm-HL91 and CT. Results Of the 37 patients, 11 had either residual or recurrent lesions and 7 had distant disease. (1) A significantly higher 99Tcm-HL91 uptake were noted in residual or recurrent lesions than benign lesions (1.58 ± 0. 16 vs 1.18 ±0.14, t =4. 87, P <0.001). (2) The sensitivity, specificity, and accuracy for residual or recur-rent lesions were 72. 73% (8/11), 63.64% (7/11), 4/4; 89.47% (17/19), 84. 21% (16/19), 94. 12% (16/17), and 83.33% (25/30), 76.67% (23/30), 95.24% (20/21) in 99Tcm-HL91, CT, and combined 99Tcm-HL91 and CT, respectively. (3) For distant sites detection (n = 7), CT detected all but 99Tcm-HL91 missed three. Conclusions A combination of 99Tcm-HL91 and CT in detection either residu-al, recurrent, or metastatic disease would have the highest benefit in patients with cancers at head and neck and upper aerodigestive region.     

核素-蓝染法探测乳腺癌前哨淋巴结的临床价值(附27例分析)

目的评价~(99)Tc~m-硫胶体和美蓝联合应用探测乳腺癌前哨淋巴结(SLN)的临床价值。方法27例早期乳腺癌患者,年龄(29～64)岁,采用99Tcm-硫胶体和美蓝联合探测SLN,以腋窝淋巴结(ALN)病理检查结果作为评价标准。结果27例患者SLN的检出率92.6%,探测的准确性96.0%,灵敏度90.0%,假阴性率10.0%,阴性预测值93.8%。结论乳腺癌SLN探测可预测ALN的转移状况,为外科医生确定手术方式提供重要信息。