22例肝门部胆管癌外科手术治疗分析

目的探讨肝门部胆管癌的外科手术治疗方式和效果。方法回顾性分析2016年1月至2018年9月期间于安徽医科大学器官移植中心肝胆胰二病区接受外科手术治疗的22例肝门部胆管癌患者的临床病例资料。结果 22例肝门部胆管癌患者BismuthⅠ型1例(4. 5%),Ⅱ型2例(9. 0%),Ⅲa型9例(40. 9%),Ⅲb型3例(13. 6%),Ⅳ型7例(31.8%)。8例行术前减黄治疗。22例均接受根治性外科切除手术,其中半肝切除术14例,扩大半肝切除术2例,围肝门切除术6例,联合左尾状叶切除术3例,门静脉部分切除及修补术1例,肝动脉及门静脉切除重建术1例。术后病理证实中分化胆管细胞腺癌16例,低分化胆管细胞腺癌3例,中分化胆管粘液腺癌1例,低分化混合性肝癌1例,胆管细胞不典型增生1例。平均手术时间6. 8±1. 4小时;全组无围手术期死亡病例。术后发生并发症19例(86%),均经保守治疗治愈或好转后出院。术后18例患者得到完整随访,随访时间为3～28个月。随访期间死亡4例,死亡原因为术后肿瘤局部复发或肝内或全身转移。肿瘤局部复发及肝内转移4例,无瘤生存10例。最长无瘤生存时间28个月。结论根治性切除手术是治疗肝门部胆管癌最有效可行的外科治疗手段。     

腹腔镜肝门部胆管癌根治术的临床疗效

目的:探讨腹腔镜肝门部胆管癌根治术的临床疗效。方法:采用回顾性描述性研究方法。收集2017年1月至2019年7月河南省人民医院收治的25例肝门部胆管癌患者的临床病理资料;男16例,女9例;中位年龄为64岁,年龄范围为51~75岁。25例患者均行腹腔镜肝门部胆管癌根治术。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者肿瘤局部复发情况和远处转移情况。随访时间截至2019年12月。正态分布的计量资料以±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果:(1)手术情况:25例患者中,15例BismuthⅠ型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+胆肠吻合术。2例BismuthⅡ型患者行腹腔镜肝门部胆管切除+围肝门切除+区域淋巴结清扫+胆肠吻合术。2例BismuthⅢa型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+右半肝切除+肝尾状叶切除+胆肠吻合术。3例BismuthⅢb型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+左半肝切除+肝尾状叶切除+胆肠吻合术。3例BismuthⅣ型患者行腹腔镜肝门部胆管切除+区域淋巴结清扫+肝尾状叶切除+胆肠吻合术。25例患者手术时间为(388±118)min,术中出血量为200 mL(50~2000 mL),术中输血6例。25例患者中,2例BismuthⅢa型患者手术时间,术中出血量分别为375 min、465 min,200 mL、1000 mL,术中输血1例;3例BismuthⅢb型患者手术时间,术中出血量分别为410 min、465 min、501 min,300 mL、400 mL、450 mL,均未予输血;3例BismuthⅣ型患者手术时间,术中出血量分别为415 min、560 min、600 min,300 mL、600 mL、800 mL,术中输血1例。(2)术后情况:25例患者中,术后发生Ⅰ级并发症4例,其中2例胆瘘(BismuthⅠ型1例,BismuthⅢa型1例),1例肺部感染(BismuthⅣ型)和1例术后肝功能不全(BismuthⅢa型),经保守治疗均好转。25例患者术后病理学检查结果:胆管腺癌23例,高级上皮瘤变2例;神经侵犯8例,淋巴结转移3例,无脉管癌栓患者。25例患者住院时间为24 d(10~45 d),住院费用为9.4万元(5.3~18.7万元)。2例BismuthⅢa型患者住院时间,住院费用分别为36 d、45 d,15.1万元、18.7万元;3例BismuthⅢb型患者住院时间,住院费用分别为15 d、26 d、33 d,7.3万元、11.5万元、15.9万元;3例BismuthⅣ型患者住院时间,住院费用分别为24 d、39 d、41 d,12.1万元、15.2万元、16.7万元。(3)随访情况:25例患者均获得随访,随访时间为2~36个月,中位随访时间为16个月。25例患者中,18例无复发转移。2例BismuthⅣ型患者出现腹腔广泛转移,1例BismuthⅢa型患者出现Trocar孔转移。4例患者死亡。结论:腹腔镜肝门部胆管癌根治术安全、可行,应严格把握手术适应证,根据Bismuth分型施行适宜手术。     

肝门空肠扣式吻合术治疗Ⅲ型和Ⅳ型肝门部胆管癌

目的探讨肝门空肠扣式吻合术治疗Ⅲ型和Ⅳ型肝门部胆管癌的可行性及其疗效。方法对2010年1月至2011年6月行肝门空肠扣式吻合术的12例晚期肝门部胆管癌患者的疗效及近期并发症进行回顾性分析。其中男性7例,女性5例;平均年龄59.83(39～78)岁。患者主要临床表现为黄疸、上腹部钝痛等。血清总胆红素升高12例(100%),10例直接胆红素升高。肿瘤标志物检查,CA199异常(>27U/ml)12例(100%),CEA异常(>5 U/ml)7例(58.33%),CA125异常(>35 U/ml)4例(33.33%)。所有患者均行B超、CT/MRCP检查,均显示肝内胆管扩张,肝门部占位。根据Bismuth-Corlette分型,Ⅲa型3例,Ⅲb型3例,Ⅳ型6例。均行肝门部胆管癌切除,将残留的5支左右胆管断端与空肠襻行胆管空肠扣式吻合术。结果所有患者术后血清总胆红素均明显下降,术后引流有效率100%。术后发生吻合口胆瘘1例,切口感染2例,肺部感染2例,无围手术期死亡病例。2例患者分别于术后3、5个月死于多器官功能衰竭,1例于术后10个月死于肿瘤复发广泛转移,其余均健在。结论对晚期肝门部胆管癌应持积极的手术态度,肝门空肠扣式吻合术能提高Ⅲ型和Ⅳ型肝门部胆管癌切除率,是一种可行的治疗方法。     

全腹腔镜Bismuth Ⅰ型肝门部胆管癌根治术7例

目的探讨全腹腔镜下Bismuth Ⅰ型肝门部胆管癌根治术的安全性、可行性。方法回顾性分析2011年1月~2016年1月7例全腹腔镜下Bismuth Ⅰ型肝门部胆管癌根治术的资料,全腹腔镜下肝外胆道切除,胆道重建,清扫第8、9、12、13组淋巴结。结果 7例手术均顺利完成。手术时间3.5~5 h,(4.13±0.53)h;术中出血量85~250 ml,(156.4±67.6)ml。无胆漏、腹腔感染、术后出血等并发症。术后住院时间9~14 d,(10.7±2.0)d。术后病理均提示胆管中分化腺癌,胆管上下切缘阴性,R0切除,清扫淋巴结7~15枚,平均9.3枚,均未见癌转移。术后随访12~18个月,影像学检查均未见肿瘤复发,血癌胚抗原(CEA)和CA19-9正常。结论术者熟练掌握全腹腔镜下消化道重建及淋巴结清扫等的情况下,全腹腔镜下BismuthⅠ型肝门部胆管癌根治术是安全、可行的。     

腹腔镜根治性切除Bismuth-Corlette Ⅲa型肝门部胆管癌新入路的临床应用分析

目的探讨腹腔镜下左肝优先游离、原位右半肝加尾状叶切除术治疗Bismuth-Corlette Ⅲa型肝门部胆管癌的安全性、可行性。方法回顾性分析2020年6月至2022年4月在河北医科大学第二医院肝胆外科接受腹腔镜左肝优先游离、原位右半肝加尾状叶切除的13例Bismuth-Corlette Ⅲa型肝门部胆管癌患者的临床资料, 其中男性8例, 女性5例, 年龄(60.9±8.4)岁。分析手术时间、术中出血量、并发症以及术后生存等情况。结果术前行经皮肝穿刺胆道引流5例。13例患者均顺利完成腹腔镜下左肝优先游离、原位右半肝加尾状叶切除, 无中转开腹。手术时间[M(Q1, Q3)]390.0(355.0, 435.0)min, 术中出血量[M(Q1, Q3)]800.0(300.0, 1 100.0)ml。术后发生并发症4例, 均为胸腔积液, 其中门静脉血栓伴胸腔积液1例, 经低分子肝素钠抗凝治疗及胸腔积液穿刺后治愈。13例患者术后住院时间(12.5±5.5)d, 无围手术期死亡病例。术中冰冻病理:左肝管切缘阴性12例, 中度异型增生1例。术后病理:胆管腺癌12例, 胆管黏液腺癌1例, 高分化2...     

III|IV 型肝门部胆管癌的手术治疗

目的:探讨Ⅲ,Ⅳ型肝门部胆管癌的手术治疗方式和效果.方法:回顾性分析2010年4月-2013年2月期间采取手术治疗的16例Ⅲ,Ⅳ型肝门部胆管癌患者的临床资料.结果:16例中行手术切除13例,切除率为81.3％ (13/16).其中行根治性切除术(R0切除)7例,非根治性切除术6例;行左半肝+尾叶切除+右肝管成形、肝管-空肠Roux-en-Y吻合术3例,行右半肝切除+尾叶切除+左肝管成形、肝管-空肠Roux-en-Y吻合术3例,行肝方叶切除及围肝门切除+胆管开口肝门区-空肠盆式吻合术7例;其中2例因总胆红素＞400 μmm.l/L而先行经皮肝穿刺胆管引流(PTCD)后再手术.3例患者无法完成手术切除,其中2例肿瘤侵犯门静脉左右支,1例术中发现肝脏多发转移瘤,3例均行肝内扩张胆管的术中置管引流术.所有患者的术后血清总胆红素水平均明显降低或恢复至正常,术后引流有效率为100％.1例围手术期死亡.结论:对于Ⅲ,Ⅳ型肝门部胆管癌,应力争切除肿瘤,解除胆管梗阻.对肝门区胆管解剖的熟知、娴熟的手术技巧和胆大心细的操作,有望提高手术切除率.     

哑铃式肝门部胆管癌根治术

手术切除是目前治疗肝门部胆管癌最有效的手段,切除范围不足是术后肿瘤复发的主要因素之一.近年来国内外趋于实施扩大的根治性切除,能够提高远期生存率,但大范围肝叶切除的主要风险是术后发生肝功能衰竭.本文报道一种既保证足够的肝内外胆管切除范围、又最大限度地减少肝组织切除的肝门部胆管癌根治性切除术式.该术式的切除范围包括肝Ⅳb段、右肝蒂前部分肝Ⅴ段的肝组织,左右肝管、分叉部、肝外胆管及尾状叶(肝Ⅰ段),同时行肝门区血管骨髂化及至少包括第2站淋巴结的清扫.因所切除组织整体上形似哑铃状,我们称之为“哑铃”式肝门部胆管癌根治术.手术指征:(1) BisnuthⅡ型肝门部胆管癌,以及部分肿瘤局限于一级肝管内的Ⅲa、Ⅲb型肝门部胆管癌;(2)无门静脉分叉部或左右支受侵;(3)第3站淋巴结无转移;(4)无肝内或远处组织器官转移.本研究23例患者完成该术式,术前多数患者TBil＞ 300 μmol/L,均未行PTCD或胆管内支架引流.平均手术时间为355 min.术中平均出血量为350 ml.患者1、3年无瘤生存率分别为95.7％(22/23)和7/15.其结果表明:该术式适宜于我国目前条件下BismuthⅡ型肝门部胆管癌及部分肿瘤局限于一级肝管内的Ⅲa型或Ⅲb型的患者.     

肝门部胆管癌患者手术切除后胆漏的影响因素分析

目的:分析肝门部胆管癌患者手术切除后胆漏的影响因素。方法:回顾分析2000年4月至2020年4月在宁波大学附属李惠利医院接受手术切除的179例肝门部胆管癌患者资料。最终纳入160例患者,其中男性86例,女性74例,年龄(63.4±10.8)岁。160例患者手术切除后发生B级胆漏44例、C级5例,均纳入胆漏组,剩余111例术后未发生胆漏的患者纳入对照组。单因素和多因素logistic回归分析肝门部胆管癌手术切除后胆漏的影响因素。结果:胆漏组手术时间≥360 min、保留侧肝门血管切除重建、残余肝断面胆管开口3支及以上等比例明显高于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析,保留侧肝门血管切除重建(OR=2.322,95%CI:1.078~5.002,P=0.028)、残余肝断面胆管开口3支及以上(OR=2.656,95%CI:1.198~5.892,P=0.016)的肝门部胆管癌患者手术切除后更易出现胆漏。结论:保留侧肝门血管切除重建、残余肝断面胆管开口3支及以上是肝门部胆管癌手术切除后胆漏的独立危险因素。     

腹腔镜肝门部胆管癌根治性切除术的初步体会(附13例报告)

目的:探讨腹腔镜手术治疗肝门部胆管癌的临床疗效。方法:回顾分析2017年12月至2021年4月为13例患者行腹腔镜肝门部胆管癌根治术的临床资料。分析术中情况、术后并发症及预后。结果:13例患者均顺利完成手术,无中转开腹,RO切除率100%。均行区域淋巴结清扫,行肝外胆管切除2例,围肝门切除2例,右半肝切除2例,左半肝切除5例,扩大左半肝切除1例,扩大右半肝切除1例。胆管断端数量1～6个,行胆管断端成形5例,胆肠吻合口数量1～3个。手术时间平均(560.3±210.2)min,出血量平均(400.0±260.9)mL。术中3例(23%)患者需要输血,无非计划再手术及死亡病例。术后住院9～31 d,中位住院时间14 d。术后发生并发症4例,B级肝功能衰竭1例,A、B级胆漏各1例,肺部感染1例,均经保守治疗后治愈。13例均为胆管腺癌,其中中-低分化腺癌7例、中分化腺癌5例、中-高分化腺癌1例。淋巴结检出数量6～13枚,其中2例存在区域淋巴结转移。12例(92%)患者获得随访,随访4～46个月,中位随访时间18个月。结论:腹腔镜肝门部胆管癌根治术由有经验的腹腔镜外科医师施术是安全、可行的。     

Ⅲ型肝门部胆管癌的外科治疗(附35例分析)

目的总结Ⅲ型肝门部胆管癌的手术经验。方法回顾性分析我院1999年1月至2006年12月,行手术切除的35例Ⅲ型肝门部胆管癌的临床资料。Ⅲa型16例,行肝门部胆管切除8例,行联合右半肝＋右侧尾状叶切除7例,行联合右半肝＋尾状叶切除、门静脉分叉部切除主干左支吻合1例。Ⅲb型19例,行肝门部胆管切除8例,行联合左半肝＋左侧尾状叶切除9例,行联合左半肝＋尾状叶切除、门静脉分叉部切除主干右支吻合1例．行联合左半肝＋尾状叶切除、门静脉分叉部切除主干右支吻合、肝固有动脉分叉部切除主干右支吻合1例。结果本组32例获得随访,随访时间18～113个月。肝门部胆管切除病例术后病理根治性切除率为37．5％,联合肝叶切除病例术后病理根治性切除率73．7％,3例联合肝叶切除＋血管切除病例均获术后病理根治性切除。肝门部胆管切除术后并发症发生率为31．3％,联合肝叶切除组术后并发症发生率为31．6％。3例联合肝叶切除＋血管切除病例术后均无胆肠吻合口漏、肝断面坏死、胆漏等严重并发症。结论联合肝叶切除,必要时行受累分叉部血管切除重建,有益于提高Ⅲ型肝门部胆管癌的根治性切除率,且不增加术后并发症的发生率。     

18F-FDG PET/CT在胆道系统恶性肿瘤中的应用

目的探讨~(18)F-FDG PET/CT诊断胆道系统恶性肿瘤的价值。方法回顾性分析34例临床疑似胆道恶性肿瘤患者的PET/CT影像资料,均获得术后病理结果,其中12例经手术切除淋巴结或淋巴结穿刺活检对18枚淋巴结获得病理诊断;与病理结果对照,计算PET/CT对胆道恶性病变原发灶、淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果 34例中,31例为恶性病变,3例为良性病变。PET/CT诊断胆道恶性肿瘤原发灶的灵敏度100%(31/31),特异度66.67%(2/3),阳性预测值96.88%(31/32),阴性预测值100%(2/2),准确率97.06%(33/34)。胆道恶性病变原发灶最大标准摄取值(SUV_(max))为8.42±4.27;3例胆道良性疾病SUV_(max)分别为12.90、2.00及1.90。共18枚淋巴结获得病理结果,包括转移性淋巴结13枚,良性增生5枚。PET/CT诊断淋巴结转移的灵敏度76.92%(10/13),特异度60.00%(3/5),阳性预测值83.33%(10/12),阴性预测值50.00%(3/6),准确率72.22%(13/18)。结论 PET/CT对胆道系统恶性肿瘤的诊断具有重要价值。     

Positron emission tomography with 18F-FDG in osteoarthritic knee

OBJECTIVES: To evaluate osteoarthritis (OA) of the knee using positron emission tomography (PET) with 2-(18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG) as a tracer. MATERIALS AND METHODS: Fifteen patients with medial-type knee OA and three healthy subjects were enrolled in the study. After clinical examination and conventional radiography, (18)F-FDG PET and magnetic resonance imaging (MRI) were performed. (18)F-FDG uptake was quantified as a standardized uptake value (SUV) and the localization of (18)F-FDG uptake was identified using fusion images created with MRI scans. RESULTS: (18)F-FDG generally accumulated in periarticular lesions and was absent in the articular cartilage. SUVs of the whole knee were higher in OA than in controls, and those in the medial condyle were higher than in the lateral condyle in OA. Prominent (18)F-FDG uptake was found in the intercondylar notch in OA and extended along the posterior cruciate ligament (PCL) in some cases. Periosteophytic accumulation was found in one-half of cases with definite osteophytes. Accumulation was also found in subchondral lesions and bone marrow, which corresponded with bone edema diagnosed by MRI. No significant correlation was found between SUV and clinical manifestations. CONCLUSIONS: (18)F-FDG uptake was upregulated in OA and generally accumulated in periarticular lesions. Increased uptake was found in the intercondylar notch extending along the PCL, periosteophytic lesions, and bone marrow. These results provide in vivo pathognomonic insights into OA.     

超声对肝门部胆管癌的分型在外科治疗中的价值

目的　探讨超声对肝门部胆管癌分型的可行性及在手术治疗中的应用价值。方法　根据Bismuth-CorletteⅠ～Ⅳ分型法,应用超声将28例肝门部胆管癌分为Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳ型,并与手术结果对照。比较各型肝门部胆管癌的手术方式。采用仪器为Aloka650,EUB420,探头频率3.5MHz。结果　超声对28例肝门部胆管癌的诊断率与分型准确率分别达96%和71%。施行切除术的病例数在Ⅰ+Ⅱ型与Ⅲb型之间差异无显著性意义(P＞0.05),而Ⅳ型的手术切除率明显低于Ⅰ+Ⅱ型、Ⅲb型(P＜0.01,P＜0.05)。结论　超声是肝门部胆管癌术前无创性分型诊断的重要方法,对指导临床制定手术方案具有重要的应用价值。     

肺部病变类型及大小对18F-FDG显像T/NT比值的影响

目的探讨肺部不同病变病理类型及病灶大小对18 F-FDG摄取差异的影响。方法分析155例患者胸部病变的18F-FDG显像,根据手术、活检等病理结果测量病灶T/NT比值及病灶大小,并分析其相关性。结果恶性病变（肺鳞癌、肺腺癌和小细胞肺癌）及结核摄取18 F-FDG均高于炎性改变,恶性病变T/NT比值与病灶大小呈正相关（P均〈0.05）;但结核及炎性改变T/NT比值与病灶大小无相关性（P均〉0.05）。结论恶性肿瘤18 F-FDG显像T/NT比值明显大于炎性病变,但结核仍是导致假阳性的重要因素。恶性病变大小与T/NT比值呈正相关,良性病变大小与T/NT比值无明显相关。     

肝门胆管癌的MDCT诊断及其术前评价

目的 探讨MDCT在肝门胆管癌术前评估中的价值.方法 回顾经病理证实的肝门胆管癌31例,分析术前MDCT检查,观察肿瘤病灶大小、部位、强化方式、周围及远处侵犯情况、肝内胆管扩张以及肝脏、胆囊等改变,并与手术及术后病理结果对照.结果 该组中MDCT定性诊断符合率达93.5%.77.4%的病例MDCT判断梗阻部位及Bismuth-Corlette分型与手术结果相符.MDCT判断分期与临床及TNM分期总的符合率为71.0%,Ⅰ期达100%.结论 MDCT能够较好地检出肝门胆管癌和评价侵犯范围.有助于术前诊断及治疗方案的制定.     

CT检查在肝门部胆管癌诊断与可切除性评估中的价值

CT检查已成为肝门部胆管癌术前检查的一种重要的手段.本研究回顾性分析2010年9月至2012年9月上海交通大学医学院附属瑞金医院收治的20例经手术和活组织病理检查证实的肝门部胆管癌的多排螺旋CT表现,探讨多排螺旋CT检查在肝门部胆管癌诊断与可切除性评估中的价值.所有患者在腹部平扫后行动态增强扫描,包括动脉期和门静脉期,6例行3 ～4 min的延迟期扫描.扫描结束后进行二维和三维重建.观察肿瘤的部位、大小、邻近血管受累的范围、肝门部及腹膜后有无淋巴结的肿大、肝脏有无转移癌.CT平扫仅发现8个肿瘤,表现为肝门部低密度结节样肿瘤.增强扫描所有肿瘤可显示.5例浸润型表现为肝门部胆管壁局限性增厚,动脉期即可出现环形强化,门静脉期和延迟期的强化则更为明显.8例管内生长型表现为胆管内乳头状或结节状的软组织影,延迟强化的特征非常明显,肝内胆管扩张也非常明显.7例包块型表现为肝门部肿瘤,可累及邻近血管和部分肝组织.所有患者显示弥漫性或局灶性的肝内胆管扩张.二维和三维重建结合可以更加清晰地显示肿瘤以及肝动脉或门静脉受累、肝叶萎缩、淋巴结和肝脏转移的情况.多排螺旋CT横断面多期动态增强＋多平面重组＋ CT血管成像的“一站式”检查,可以更好地显示肝门部胆管癌肿瘤,进行术前准确分期,有助于外科精准化治疗方案的制订.     

18F-FDG PET/CT评价伽马刀治疗肿瘤疗效

目的探讨18F-FDG PET/CT在评价伽马刀治疗肿瘤疗效中的价值。方法对39例肿瘤术后复发患者,在伽马刀治疗前和治疗后3个月,根据CT显像的病灶大小、PET显像的平均标准摄取值（SUVmean）变化以及SUV变化率（△SUV）分别进行近期疗效判定。结果治疗前PET/CT全身检查后检出病灶并行伽马刀定位病灶65个,平均直径（3.32±3.57）cm;平均SUVmean5.92±2.62。伽马刀治疗3个月后复查,PET/CT检出病灶50个,平均直径（2.54±2.76）cm;平均SUVmean3.82±3.40。伽马刀治疗后病灶最大直径普遍较前缩小（P〈0.05）,伽马刀治疗后SUVmean显著降低（P〈0.001）。伽马刀治疗后CT显示的总有效率为38.46%（25/65）,PET SUVmean显示总有效率为55.38%（36/65）,二者之间差异有统计学意义（χ2=6.24,P〈0.05）。△SUV的总有效率为49.23%（32/65）。结论 18F-FDG PET/CT可以从病灶的大小和代谢两方面评价伽马刀治疗肿瘤的疗效。     

Metabolic significance of the pattern, intensity and kinetics of 18F-FDG uptake in malignant pleural mesothelioma

BACKGROUND: Malignant pleural mesothelioma is an aggressive neoplasm with a highly variable course. This pilot study evaluated the significance of the pattern, intensity and kinetics of 18F-FDG uptake in mesothelioma in the context of histopathology and surgical staging. METHODS: Sixteen consecutive patients with pleural disease on CT scan underwent 18F-FDG imaging. Imaging was performed with a dual detector gamma camera operating in coincidence mode. Semiquantitative image analysis was performed by obtaining lesion-to-background ratios (18F-FDG uptake index) and calculating the increment of 18F-FDG lesion uptake over time (malignant metabolic potential index (MMPi)). RESULTS: Twelve patients had histologically proven malignant mesotheliomas (10 epithelial, two sarcomatoid). Thirty two lesions were positive for tumour. Patterns of uptake matched the extent of pleural and parenchymal involvement observed on CT scanning and surgery. Mean (SD) 18F-FDG uptake index for malignant lesions was 3.99 (1.92), range 1.5-9.46. Extrathoracic spread and metastases had higher 18F-FDG uptake indices (5.17 (2)) than primary (3.42 (1.52)) or nodal lesions (2.99 (1)). No correlation was found between histological grade and stage. The intensity of lesion uptake had poor correlation with histological grade but good correlation with surgical stage. 18F-FDG lesion uptake increased over time at a higher rate in patients with more advanced disease. The MMPi was a better predictor of disease aggressiveness than the histological grade. CONCLUSIONS: This pilot study suggests that the pattern, intensity, and kinetics of 18F-FDG uptake in mesothelioma are good indicators of tumour aggressiveness and are superior to the histological grade in this regard.     

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??Hilar cholangiocarcinoma: diagnosis and assessment of resectability with multi-slice CT ZOU Jun-min*, CHEN Pei-long, XIE Shu-fei, et al.*Department of Radiology, Hospital of Maoming Nongken of Guangdong Province , Gaozhou 525200,China
Corresponding author: XIE Shu-fei , E-mail??shufeixie@yahoo.com.cn
Abstract Objective To summarize the multi-slice CT(MSCT) features of hilar cholangiocarcinoma??and also try to analyze the value of MSCT in evaluating the feasibility of resection. Methods MSCT features of 28 patients with hilar cholangiocarcinoma confirmed by clinical and pathological examination between August 2004 and June 2009 in the Hospital of Maoming Nongken of Guangdong Province were analyzed retrospectively. Bismuth-Corlette classification of the tumor was performed firstly. Feasibility of resection was then evaluated with MSCT images. The conclusion drawn by radiologists was compared with clinical outcomes finally. Results The accuracy rate of MSCT in diagnosing hilar cholangiocarcinoma is 92.8%(26/28). The accuracy rate of MSCT in classifying tumor is 96.4%??27/28??. Thirteen patients were suggested resection by MSCT, however 10 of them can be resected during the operation. So positive predictive value of MSCT in evaluating the feasibility of resection is 76.9%(10/13). Fifteen patients were suggested to abandon resection by MSCT, and 14 of them were confirmed by operation and performed internal and external drainage. So negative predictive value of MSCT in evaluating the feasibility of resection is 93.3%(14/15). The total accuracy rate of MSCT in evaluating the feasibility of resection of hilar cholangiocarcinoma was 85.7%(24/28). Conclusion MSCT can demonstrate hilar cholangiocarcinoma and assess the extent of tumor involvement accurately. It is an effective modality in assessment of feasibility of resection of hilar cholangiocarcinoma.     

18F-FDG Uptake at Initial Staging of the Adrenocortical Cancers: A Diagnostic Tool but Not of Prognostic Value

Background

Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. ¹⁸F-FDG PET (¹⁸F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, ¹⁸F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative ¹⁸F-FDG PET based on SUVs assessments has a prognostic value in ACC patients.

Methods

A retrospective analysis was performed in patients who underwent ¹⁸F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; ¹⁸F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All ¹⁸F-FDG PET/CT procedures were reinterpreted in a blind fashion.

Results

Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)_max = 11 (range: 3–56) and a tumor/liver SUV_max ratio = 4.2 (range: 1.3–15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. ¹⁸F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis.

Conclusions

At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values.