PET/CT在肺癌诊断中的应用

目的探讨PEC/CT多种示踪剂及诊断性CT的应用对肺癌的诊断价值。方法对62例资料完整的肺癌患者PET/CT检查结果进行分析。结果62例肺癌患者中,中央型肺癌7例,周围型肺癌55例,明确诊断59例,诊断率95.16%。18F-FDG PET/CT检查见病灶有不同程度放射性异常浓聚,最大SUV1.0～22.3;11C-MET PET/CT检查的病灶均见不同程度放射性摄取,SUV0.5～4.9;CT增强扫描病灶边界清晰,明显强化,可见血管"集束征",HRCT检查见病灶有分叶、毛刺征、胸膜凹陷征及支气管阻断。结论18F-FDG PET/CT能较准确地对肺癌做出明确诊断,多种示踪剂及诊断性CT的联合应用能极大地提高肺癌尤其是小肺癌的诊断准确率。     

PET/CT检查在乳腺癌患者复发中的作用

目的研究乳腺癌患者血清肿瘤标志物出现异常后,PET/CT对早期发现乳腺癌复发的部位,及早进行治疗的价值。方法 82位乳癌患者,术后行常规复查时,出现1项或多项肿瘤标志物增高,常规行CT检查,检查后1-3个月内行PET/CT检查。当影像学检查提示阳性结节后,结果的最终判定是通过组织病理学诊断及随访。结果 PET/CT检查提示异常结节368个。真阳性：310个,假阳性：11个,真阴性：41个,假阴性：6个。在82名患者中,确诊为复发的真阳性患者：38名,假阳性：11名,真阴性：28名,假阴性：5名。结论乳腺癌患者血清肿瘤标志物异常后,PET/CT诊断复发的敏感性、特异性、准确性指标均高于CT。     

Pretreatment with Diphenoxylate Hydrochloride/Atropine Sulfate (Lomotil) does not Decrease Physiologic Bowel FDG Activity on PET/CT Scans of the Abdomen and Pelvis

Purpose  Physiologic uptake of 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) by bowel can confound positron emission tomography/computed tomography (PET/CT) assessment for abdominal pathology, particularly within the bowel itself. We wished to determine if oral administration of the antimotility agent, Lomotil (5 mg diphenoxylate hydrochloride/0.05 mg atropine sulfate; G.D. Searle and Company, a division of Pfizer), prior to PET/CT scanning would reduce physiologic uptake of FDG by the small bowel and colon (lower gastrointestinal [GI] tract). Procedures  Patients undergoing PET/CT scans for lymphoma were enrolled in a prospective, randomized, double-blinded study and received either 10 mL water (control group) or 10 mL Lomotil (experimental group) orally 30–60 min prior to scanning. Scans were reviewed independently by two blinded experienced readers and scored for the degree of FDG activity in the lower GI tract relative to liver activity. Results  The administration of Lomotil prior to PET/CT scanning did not reduce physiologic FDG activity in the small bowel and colon. In contrast, increased radiotracer uptake by the lower GI tract was observed in the Lomotil group compared to the control group. Conclusions  Pretreatment with Lomotil prior to PET/CT scanning confers no benefit toward the reduction of physiologic FDG uptake by the small bowel and colon.     

^18F—FDGPET／CT在乳腺疾病中的临床应用价值

目的探讨^18F-FDGPET／CT显像对乳腺良恶性病变的诊断、治疗及疗效观察的临床价值。方法26例乳腺疾病患者进行^18F-FDGPET／CT显像，检查结果与病理对照分析。结果26例患者中乳腺癌20例（其中7例为乳癌术后随访），乳腺良性病变6例；^18F-FDG PET／CT诊断符合率分别为95％（19／20）、100％（6／6），诊断准确率为96．15％。结论^18F-FDG PET／CT对乳腺良恶性病变的鉴别诊断、乳腺癌分期及疗效观察等方面具有更多的优越性。     

18F-FDG PET/CT显像在胃癌术后复发和转移中的诊断价值

目的：探讨18F-FDG PET/CT显像在胃癌术后复发及转移灶诊断中的价值。方法：胃癌术后患者112例,共行PET/CT检查150例次,图像分析采用视觉及半定量分析法（SUVave）,病灶根据病理学检查结果、多种影像学检查手段及临床随访确诊,随访时间半年以上。结果：112例患者中,16例存在肿瘤复发和转移,PET/CT诊断残胃复发的灵敏度为81.2%,特异性100%,准确性97.3%。复发病灶SUVave为4.4±1.2,吻合口炎性病灶SUVave为2.6±0.5,两者差异显著（t=3.9370,P=0.0005）。PET/CT诊断胃癌术后肿瘤转移的灵敏度94.1%、特异性96.7%和准确性95.5%。26例行两次以上PET/CT检查,第一次PET/CT检查发现复发或转移15例,经放化疗后6例PET显像示病情好转,随访6个月至2年患者均存活;9例治疗后PET显像示病情无明显变化或者出现新病灶,患者存活时间为3个月至1年。结论：18F-FDG PET/CT在胃癌术后复发和转移中有很好的诊断价值,并在监测胃癌术后复发放化疗疗效有一定的价值。     

PET/CT显像在胃癌转移灶诊断中的应用

目的 评价18F-FDG PET/CT显像在胃癌转移灶诊断中的应用价值.方法 回顾性分析80例胃癌患者PET/CT的影像学资料,并与胃镜的细胞学检查,手术病理检查和临床表现做比较,所有病例均经过2年以上的随访.探讨18F-FDG PET/CT显像在胃癌转移灶诊断中的价值.结果 80例胃癌患者中,PET/CT显示43例有淋巴结高摄取(SUV＞2.5),经手术病理或临床随访2年证实42例为淋巴结转移;l例为淋巴结反应性增生.PET/CT对胃癌淋巴结转移诊断的敏感性为100％,特异性97.4％,准确性98.8％.80例患者中,PET/CT提示远处器官转移12例(部分患者有多器官转移),其中肝转移5例,胰腺转移1例,腹膜转移4例,肠系膜及子宫附件转移各2例,PET/CT对胃癌远处器官转移诊断的敏感性为92.3％,特异性100％,准确性98.8％.结论 18F-FDG PET/CT显像对于胃癌转移灶的诊断及胃癌的分期有较大的临床意义.     

Incremental value of CT in PET/CT of patients with colorectal carcinoma

Background: We assessed the contribution of dedicated computed tomographic (CT) interpretation to the accuracy of positron emission tomography (PET) plus CT in imaging patients with suspected primary or metastatic colorectal carcinoma.Methods: One hundred PET/CT scans in 90 consecutive patients were evaluated retrospectively. Imaging was performed on a GE Discovery LS PET/CT scanner. PET images were obtained from the skull base through the midthigh after intravenous administration of 15 to 20 mCi of [¹⁸F] fluorine-18-fluoro-2-deoxyglucose. Noncontrast axial CT images were obtained at the same anatomic locations, with 140 kV, 80 mA, 0.8 s/CT rotation, a pitch of 6, and a table speed of 22.5 mm/s. The CT component of the PET/CT study was reviewed independently by consensus of two blinded readers. Scans were evaluated for the presence of primary disease, local recurrence, and distant metastases. Results were compared with the PET/CT report. The gold standard was clinical and imaging follow-up for at least 6 months, surgery, or biopsy.Results: The study included 40 males and 50 females, with a mean age of 63 years (range, 31–92 years). The indications for the examination were to evaluate for recurrence of colorectal cancer in 83 cases, determine disease spread in 15 cases, and evaluate for possible primary malignancy in two cases with rising carcinoembryonic antigen. Sensitivity, specificity, and accuracy of the PET/CT report and of the combined PET/CT with dedicated CT interpretation were 0.914, 0.633, and 0.830 and 0.986, 1.000, and 0.980, respectively. The difference between PET/CT and the combined PET/CT with dedicated CT interpretation with respect to accuracy was statistically significant (p < 0.05).Conclusion: The CT portion of PET/CT provides valuable anatomic and pathologic information to the functional information provided by PET and helps improve the overall accuracy of the combined study.     

Staging and follow-up of gastrointestinal tumors with PET/CT

Positron emission tomography (PET) is a functional imaging modality that has been documented to be useful in patient care. Oncologic PET imaging is used for a wide variety of neoplasms, mainly for staging and follow-up, differentiation of equivocal morphologic findings, therapy stratification, and monitoring. Because PET imaging is based on the physiologically mediated distribution of the administered tracer but not on anatomic information, the addition of computed tomography (CT) to PET may improve the interpretation of PET. Combined PET and CT offers several potential advantages over PET alone that may influence the clinical routine. PET/CT was introduced into clinical use only 3 years ago and has found widespread application within only 1 to 2 years. This article summarizes preliminary data of clinical applications for PET/CT in gastrointestinal tumors.     

18F-FDG PET/CT对宫颈癌术后临床怀疑复发和转移病人中的应用价值

目的观察¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射断层显像技术/计算机体层扫描(PET/CT)对宫颈癌术后临床怀疑复发与转移患者的诊断价值。方法前瞻性纳入喀什地区第一人民医院2018年7月至2020年11月期间收治的118例宫颈癌术后怀疑复发与转移患者为研究对象,采用随机数字表法其分为观察组(n=59)与对照组(n=59)。对照组予给予以常规血清癌抗原19-9(CA19-9)检测,观察组行¹⁸F-FDG PET/CT检查。2组均以组织病理学结果为金标准,评估2组对宫颈癌怀疑复发与转移的诊断价值并对比组间差异。结果¹⁸F-FDG PET/CT检查诊断对宫颈癌复发及转移的特异度(76.92%)、灵敏度(93.48%)以及准确率(89.83%)均显著高于CA19-9检测(38.46%、60.87%、55.93%),2组比较差异有统计学意义(P<0.05),同时观察组诊断结果与组织病理学结果吻合度较高(Kappa=0.766,P<0.05)。结论¹⁸F-FDG PET/CT检查应用于宫颈癌术后临床怀疑复发与转移的诊断,可清晰显示其状况,灵敏度、准确率等均明显高于血清CA19-9检测。     

18F-FDG PET/CT综合分析法在胰腺癌诊断中的价值

目的探讨利用CT良性征象校正FDG假阳性的PET/CT综合分析方法在胰腺癌诊断中的价值。方法胰腺原发良恶性疾患40例,其中胰腺癌27例(手术6例,临床随访21例),急、慢性胰腺炎13例(腹腔镜2例,临床随访11例)。分别用单纯SUV测量法和PET与CT相结合的综合分析法分析,比较两种方法诊断胰腺恶性肿瘤的敏感性、特异性及准确性。SUV测量法以病灶SUVmax值大于2.5为恶性病变诊断指征,反之为良性。PET/CT综合分析法以PET为主导,CT具有否决权,利用PET/CT融合图像的精确对位,当浓聚热点相应CT表现为明显的良性病变征象时,无论FDG浓聚程度如何,均诊断为良性病变。结果综合分析法对胰腺癌诊断的敏感性、特异性、准确性都是100%;单纯SUV测量法敏感性、特异性、准确性分别为96.3%、76.9%、90.0%。结论CT的良性征象,尤其是炎性渗出征象,对FDG假阳性有校正作用,通过这种校正能够提高PET/CT在胰腺癌诊断的特异性和准确性。     

The additional diagnostic value of contemporary evaluation of FDG PET/CT scan and contrast enhanced CT imaging both acquired by a last generation PET/CT system in oncologic patients

Last generation PET tomographs are equipped with a state-of-the-art CT scanner. Normally, CT images are acquired with suboptimal parameters and without intravenous contrast media, being used for attenuation correction and localization only. For this reason, no CT report is usually provided. Most of the patients who are referred for an FDG PET/CT scan, however, present with a diagnostic CT indicating that a PET/CT is required to characterize otherwise equivocal findings and, in the end, undergo both the techniques to reach a final diagnosis. The aim of this study was to evaluate the impact of the contemporary execution of both the techniques employing a PET/CT scanner on the conclusiveness of the final report. Secondary aim was to verify the concordance of the two reports.     

CT 相对于18F-FDG PET 对脊椎转移瘤的诊断评价

目的评价比较ＣＴ与ＰＥＴ对脊椎转移瘤的诊断价值。方法３４例病人,男２８例,女６例,年龄２４－７４岁。３４例原发灶明确。分别对其ＣＴ与ＰＥＴ检查结果进行比较。结果３４例中共侵犯椎骨５９个,包括颈椎１个,胸椎２４个,腰骶椎３４个,ＣＴ与ＰＥＴ结果完全符合２５例,占７３．５％（２５／３４）;部分符合７例,占２０．６％（７／３４）;完全不符合２例,占５．９０％（２／３４）。５９个椎骨中完全符合４５个椎骨,     

治疗前18F-FDG PET/CT代谢参数对原发宫颈癌预后的预测价值

目的：评估不同百分比SUVmax阈值分段代谢参数预测经同步放化疗宫颈癌预后的价值。方法：45名宫颈癌患者经治疗前18F-FDG PET/CT检查,获得代谢参数SUVmax、MTV、TLG。利用不同百分比SUVmax阈值分割法分割MTVs、TLGs(SUVmax的阈值范围为10%-85%,以5%的递增量递增)。通过ROC曲线分析找出最佳cut-off值,Kaplan-Meier曲线进行生存分析。结果:本研究患者的中位随访时间为18.5月(3.0-39.0)。进展组与非进展组SUVmax、MTV10%、MTV75%-MTV85%、TLG75%-TLG85%差异无统计学意义(P＞0.05),MTV15%-MTV70%、TLG10%-MTV70%在进展组和非进展组间差异有统计学意义(P＜0.05)。对宫颈癌预后预测作用最强的SUVmax阈值为40%。ROC曲线分析,MTV40%的cut-off值为21.09,此时AUC最大(AUC=0.823),敏感性为78.60%,特异性为87.10%；TLG40%的cut-off值为136.71,此时AUC最大(AUC=0.788),敏感性为78.60% ,特异性为77.40% 。结论：治疗前18F-FDG PET/CT代谢参数MTV40%、TLG40%可用于预测经同步放化疗治疗的原发宫颈癌预后。     

Diagnostic Accuracy of Ultrasound and 18-F-FDG PET or PET/CT for Patients with Suspected Recurrent Papillary Thyroid Carcinoma

The purpose of this study was to evaluate the diagnostic accuracies of ultrasound (US) and 18-F-FDG positron emission tomography (PET) or PET/computed tomography (CT) for detecting recurrent papillary thyroid carcinoma (PTC) after total thyroidectomy. Our study enrolled 76 postoperative patients who underwent both neck US and PET because of the suspicion of recurrence. The results of US and PET were correlated with the histopathology, the radioactive iodine whole body scan (WBS) or the clinical follow-up results. Among them, 53 patients had recurrent disease (local recurrence, 42; distant metastasis, 3; elevated Tg level, 8) and 23 showed no evidence of disease. From the analysis, US showed higher diagnostic accuracy, sensitivity and specificity compared with those of PET (71.1%, 71.7% and 69.6% vs. 55.3%, 56.6%, and 52.2%). PET added diagnostic information in a limited number of patients with negative results on neck US (3 with neck recurrence and 2 with distant metastasis). (E-mail: jeonghlee@hanmir.com)     

氟-18-氟代脱氧葡萄糖PET/CT不同时相延迟显像的比较

目的:比较研究氟-18-氟代脱氧葡萄糖(18F-FDG)PET/CT不同时相延迟显像对良恶性肿瘤的鉴别诊断价值,确定延迟显像的最佳时间选择。方法:回顾分析80例明确诊断且同时进行18F-FDGPET/CT三时相显像的患者共148个病灶。第1次显像时间为药物注射后64min;第2次(早期延迟显像)时间为110min;第3次(晚期延迟显像)时间为233min。分析每个病灶的最大标准摄取值(SUV),并根据公式滞留指数(RI1)=(SUV2-SUV1)/SUV1×100%;RI2=(SUV3-SUV1)/SUV1×100%进行计算。通过特征工作曲线(ROC)比较分析两次延迟显像的诊断效率。结果:80例患者共148个病灶。109个为恶性病灶,39个为良性病灶。恶性病灶的RI1和RI2分别为(14.8±13.1)%和(10.8±20.5)%;良性病灶的RI1和RI2分别为(11.3±28.2)%和(9.3±42.4)%。RI1的曲线下面积为0.627±0.050(P=0.013),RI2的曲线下面积为0.57±0.06(P<0.05)。早期延迟显像的诊断效率明显高于晚期延迟显像。结论:在应用18F-FDGPET/CT延迟显像进行良恶性鉴别诊断时,采取早期延迟显像可以获得较高的诊断效率。     

Giant cell arteritis on 18F‐FDG PET/CT

Purpose: We present a case of incidentally noted giant cell arteritis in a patient undergoing 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. The patient was originally referred to PET/CT for staging of his renal transitional cell carcinoma. Methods: The patient was injected intravenously with 370 MBq of 18F‐FDG. After a 60 min uptake period, PET/CT imaging was performed from the skull base to the mid thighs. Results: A small para‐aortic node in the region of the surgical bed showed increased tracer uptake of concern for malignancy. In addition, there were several non‐calcified pulmonary nodules present, also concerning for malignancy. Incidentally noted was diffusely increased tracer uptake throughout the aorta and a thickened aortic wall on CT images. Diffuse tracer uptake was also present in the proximal branches of the aorta, including the carotid, iliac, femoral, and subclavian arteries. The patient had biopsy proven giant cell arteritis. Conclusion: Increased 18F‐FDG uptake by the aorta on PET/CT imaging is an abnormal finding that prompts a more thorough assessment for malignancy, and also can indentify important co‐morbidities in cancer patients. Evaluation of aortic uptake should be a routine practice in the interpretation of 18F‐FDG PET/CT scans.     

中国PET、PET/CT的分布调研和分析

目的：系统调研、并分析中国PET和PET/CT的应用、发展现状。方法：根据GE、Siemens、Philips等公司提供的PET和PET/CT用户名单,通过问卷形式调研国内100家PET或PET/CT用户现状,其临床应用情况则通过重庆维普数据库检索1995年1月至2006年12月在国内期刊发表的相关论文,并进行分类、统计。结果：1995年6月至2007年6月,我国大陆拥有PET15台,PET/CT85台,加速器51台,占拥有PET/CT单位的60%。符合电路测定单光子发射型计算机断层显像仪（MCD-SPECT）96台,主要分布于北京及广东、上海等沿海地区,以教学医院和部队医院最多,各占27%。目前临床PET应用主要为18F-FDG肿瘤显像诊断,也开展一些11C-胆碱等正电子显像;人员培训则采用考察和继续教育等方式。此外,上海等地已建立核医学质控中心,监测PET/CT质控情况。结论：本调查为了解我国PET和PET/CT现状、地域分布及临床应用等提供了详实资料,可为我国PET/CT的规划和决策提供参考。     

PET/CT无创检测实验性动脉粥样硬化斑块的初步研究

目的 探讨PET/CT无创检测动脉粥样斑块的可行性.方法 6只新西兰大白兔随机分成实验组和对照组.实验组通过球囊拉伤膈下降主动脉内膜,并饲喂含2%胆固醇的高脂饲料20周,制造动脉粥样硬化模型;对照组仅饲喂普通饮食20周.静脉注射FDG(1 mCi/kg)180 min后,将对照组和实验组动物置于PET/CT设备下进行降主动脉活体成像,之后处死实验组动物,进行降主动脉标本游离,数码照相,降主动脉标本分段,测定其放射强度和靶非靶比值.结果 注药180 min后18F-FDG PET/CT活体显像显示:所有实验性动脉粥样硬化兔均可见沿降主动脉分布的放射性浓集显像.离体大体标本数码照相病变斑块与活体显像相一致.活体SUV以及离体标本放射性技术显示靶-非靶比值均相对较高.结论 18F-FDG PET/CT无创检测动脉粥样斑块具有一定的可行性,有可能发展成为一种临床无创评价斑块稳定性的方法.     

~(18)F-FDG PET/CT在皮肤淋巴瘤中的初步应用

目的皮肤淋巴瘤是较常见的结外淋巴瘤,本文初步探讨PET/CT在皮肤淋巴瘤中的价值。方法回顾性分析我院近5年来的12例皮肤淋巴瘤患者PET/CT图像,根据治疗情况分为治疗组(A组)及未治疗组(B组),比较皮肤病变与PET/CT结果的关系。结果 A组中6例行PET/CT随访及再分期,其中2例PET/CT显像未见FDG高代谢病变;3例患者复发的皮肤病变具有不同程度的FDG摄取,1例患者肺部转移。B组中6例皮肤淋巴瘤PET均有阳性病变,但2例患者皮损或皮下结节无FDG摄取。综合分析10例PET/CT显像阳性者,8例患者有皮肤红斑和皮下结节,其中2例皮肤病变未见FDG摄取,2例仅部分皮肤病变摄取FDG。10例分期及再分期的淋巴瘤中,与常规方法比较PET/CT使2例(20%)分期上调。结论 FDGPET/CT对皮肤淋巴瘤的诊治有一定的临床价值。     

18F-FDG PET/CT在健康体检中的应用价值

目的 探讨18F-FDG PET/CT显像在健康体检中的应用价值.方法 对1301例以健康体检为目的的受检者行全身18F-FDG PET/CT显像检查资料进行回顾性分析.结果 18F-FDG PET/CT检查阳性1275例(98%),仅26例(2%)检查为阴性,放射性分布异常565例(43.43%),其中发现恶性肿瘤32例(2.46%),良性肿瘤241例(18.52%),炎性病变292例(22.44%).结论 18F-FDG PET/CT显像应用于健康人群体检,尤其是在肿瘤筛查中具有积极意义.