~(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显像在肿瘤治疗后残存组织性质鉴别中的应用

目的 探讨^18F-脱氧葡萄糖（FDG）正电子发射型计算机断层扫描（PET）显像在肿瘤思者手术及放化疗后残存组织性质的鉴别及其评价临床治疗效果的应用价值。方法30例手术和（或）放化疗后3～8周的肿瘤患者，男18例．女12例，年龄25～72岁。均在治疗前或手术中经病理活检证实为原发性癌，临床怀疑治疗后残存组织部位有恶性组织残存，所有患者均行^18F-FDGPET全身显像及病灶区CT扫描。PET与CT检查间隔时间不超过1周。PET图像分析采用目测法及半定量分析法，最后诊断以组织病理及临床随访为依据。结果30例治疗后患者中经病理及临床随访证实有23例患者残存组织部位仍有癌组织存活。PET显像诊断为治疗后有恶性组织残存者24例，其中21例患者经病理及临床随访证实；PET显像诊断为治疗后无恶性组织残存者6例，其中4例患者经临床随访证实，其阳性预测值为87．5％（21/24），阴性预测值为66．6％（4／6），准确度为83．3％（25/30）。CT诊断为治疗后有恶性组织残存者19例，其中14例经病理及随访证实；CT诊断为治疗后未见异常者11例，2例与病理及随访结果相符，其阳性预测值为73．6％（14／19），阴性预测值为18．1％（2／11），准确度为53．3％（16／30）。另外，有7例患者的PET显像发现了原发病灶部位以外的显著FDG摄取灶，改变了其临床分期。同时，依据PET显像结果，还为12例患者改进了治疗方案。结论 ^18F-FDG PET显像是鉴别肿瘤治疗后残存组织性质的较为灵敏、可靠的方法，同时，PET显像还可以发现肿瘤转移病灶，修改临床分期，评价临床疗效，为肿瘤患者治疗方案的制定与修改提供依据，其临床应用价值优于CT。     

18F-FDG PET颅内肿瘤显像特征和临床意义

目的探讨18F-脱氧葡萄糖(FDG)PET颅内肿瘤显像的影像特征和临床意义.方法对24例患者进行FDG PET颅脑显像,包括胶质瘤、脑膜瘤、脑转移瘤、部分颅内良性病变和正常者,并对结果进行半定量分析.结果 9例胶质瘤6例病灶FDG摄取高于正常灰质或与灰质相当,3例未见摄取异常;2例脑膜瘤患者病灶FDG摄取均低于正常白质;5例脑转移瘤3例病灶FDG摄取高于正常灰质,2例病灶摄取低于正常灰质;4例颅内良性病变2例病灶FDG摄取高于正常灰质,2例病灶摄取低于正常灰质.结论在FDG PET图像上,脑实质肿瘤(胶质瘤)和脑膜肿瘤存在差异,原发性颅内肿瘤和继发性肿瘤(脑转移瘤)也具有各自的影像特征.作为反映体内代谢状况的功能影像技术,FDG PET显像可提供颅内肿瘤类型、级别、预后和对治疗反映的重要信息.     

~(18)FDG-PET在淋巴瘤诊断和疗效评价中的作用

18氟-脱氧葡萄糖(18FDG)-正电子发射计算机断层显像(PET)不仅可以通过解剖显像全面了解病变部位,而且可以发现解剖显像未能显示的代谢性病灶或尚未出现结构变化的轻微病灶,因此18FDG-PET在理论上优于计算机断层显像(CT)等常规影像学方法[1-3]。本研究回顾性分析了18FDG-PET对15例淋巴瘤患者的检测结果,并与CT、骨髓穿刺、超声等     

符合线路SPECT^18F—FDG显像在淋巴瘤患者诊断及监测复发中的意义

本研究探讨符合线路SPECT^18F—FDG显像检查对淋巴瘤患者诊断及治疗后监测复发的应用价值。回顾性分析我院1998—2008年病理活检和免疫组织化学确诊的淋巴瘤患者71例次的SPECT／PET检查结果。结果表明：28例患者初次治疗前行SPECT／PET检查的准确率100％,而CT准确率为81．7％。SPECT／PET和CT对病灶的检出灵敏度分别为85．7％和53．5％,两者有显著性差异（P=0．003）。SPECT／PET和CT对结外病灶的检出灵敏度分别为91．3％和56．5％,两者有显著性差异（P=0．007）。32例淋巴瘤患者在治疗结束后随访阶段共进行了43例次SPECT／PET检查。SPECT／PET对复发的阳性预测值为100％、阴性预测值为92．9％。6例患者为SPECT／PET先于临床症状、体征及其他实验室、影像学检查发现疾病复发。结论：SPECT／PET检查结果对淋巴瘤患者诊断和监测复发有重要意义。     

非小细胞肺癌PET／CT显像中非增强CT对FDG摄取阴性病灶的价值

目的：评价非小细胞肺癌PET／CT显像中非增强CT对FDG摄取阴性病灶的临床价值。材料和方法：回顾2006年5～12月期间在本中心接受^18F—FDG PET／CT检查并具有病理结果的119例非小细胞肺癌患者。记录FDG低，无摄取病灶即FDG摄取阴性病灶，根据Ford研究中的标准，分为有显著价值组、有部分价值组及无显著价值组3种。结果：119例非小细胞肺癌患者中，55．5％（66／119）为初次分期，44．5％（53／119）为治疗后再分期或疗效评价。283个FDG摄取阴性的异常病灶主要分布在头颈部（n=40）、胸部（n=97）、腹部和盆腔（n=128）、骨骼（n=18）。其中显著价值组n=9（3％）、部分价值组n=121（43％）、无显著价值组n=153（54％）。本次研究中检出9个有显著价值异常病灶，包插转移性肺结节4个、成骨性转移病灶1个、脑转移病灶1个、肝血管瘤1个和肾脏占位2个。结论：PET／CT中非增强CT扫描不仅可进行衰减校正和解剖定位，而且低剂量CT还可以提供一定的诊断信息；非小细胞肺癌患者FDG摄取阴性的异常病灶中仅少数病灶具有重要的价值，临床上需要进一步处理；诊断性CT无疑可得到更多的诊断信息。     

18F-FDG PET鉴别脑肿瘤放射治疗后复发和坏死的价值

目的评价FDG PET鉴别脑肿瘤治疗后复发和坏死的价值.方法 32例临床怀疑复发的恶性脑肿瘤病人,18例脑胶质瘤,14例脑转移瘤,分别于治疗后6～23个月行FDG PET显像,图像分析采用目测法,将FDG 摄取分为3级,≥2级视为复发.最后诊断以病理活检(18例病人经过病理活检)或CT、MRI检查以及长期临床随访为准.结果 PET检出的21例复发病灶中,20例为真阳性;11例坏死病灶中,6例为真阴性.灵敏度、特异度分别为80%、86%.结论 FDG PET可以有效鉴别脑肿瘤放射治疗后复发和坏死.     

^18F-FDGPET/CT在非霍奇金淋巴瘤疗效评价中的应用价值

目的探讨18F-FDGPET/CT显像对非霍奇金淋巴瘤治疗疗效的价值。方法收集2004.9～2008.11在我院PET中心接受至少2次PET/CT检查,分为初诊的在PET/CT扫描前未治疗非霍奇金淋巴瘤组（A组）或经过放疗及化疗后的治疗组（B组）为研究对象。所有病例随访至少6个月。结果未治疗的非霍奇金淋巴瘤组的32例中,3例颅内淋巴瘤中2例在9个月内复发;21例经过6个疗程化疗后PET/CT为阴性,仅有1例复发（5%）;1例3个疗程化疗后SUV降低达92.9%的化疗效果佳;而8例PET/CT阳性者预后不理想。治疗组病例中,PET/CT阴性的11例NHL,复发3例（27%）;而PET/CT阳性的25例中,19例复发（76%）,PET阳性组的肿瘤复发与阴性组差异有显著性（P〈0.05）。结论本研究表明18F-FDGPET/CT显像能很好的评价非霍奇金淋巴瘤的治疗效果,且可早期预测治疗效果及预后。     

18氟-氟代脱氧葡萄糖-正电子发射计算机断层显像在淋巴瘤分期和疗效评价中的作用

目的 探讨18氟-氟代脱氧葡萄糖(FDG)-正电子发射计算机断层显像(PET)在淋巴瘤分期和疗效评价中的应用价值.方法 回顾性分析179例淋巴瘤患者FDG-PET检测淋巴结和结外病变的结果,并与计算机断层显像(CT)和骨髓活检结果进行比较.采用国际工作组织淋巴瘤疗效标准(IWC)和修订完善的国际工作组织淋巴瘤疗效标准(IWC+PET)评估患者的疗效.结果 治疗前98例患者286处病灶FDG-PET检出219处,检出率为77%;其中结内215个病灶检出157个(73%),结外检出62个(87%);CT则共检出182个(64%),其中结内检出150个(70%),结外仅检出32个(45%).FDG-PET对结内、结外病灶的检m阳性检出率远高于CT(P＜0.01).治疗后81例患者104处病灶,FDG-PET阳性率和特异性分别为81%和68%;CT的阳性检出率和特异性分别为55%和33%,FDG-PET的阳性检出率和特异性高于CT(P＜0.01).IWC标准完全缓解(CR)或不确定的完全缓解(CRu)患者33例,其中8例(24%)复发,FDG-PET阴性患者复发率为21%,而FDG-PET阳性患者复发率为40%.33例患者使用IWC+PET标准重新评估,25例患者CR,其中5例复发(20%).179例患者中133例(74%)FDG-PET检查结果与骨髓活检结果一致,22例FDG-PET阳性患者骨髓活检阴性,FDG-PET的阳性检出率为52%,特异性为83%.结论 FDG-PET在淋巴瘤的分期和疗效评价中具有较高的阳性检出率和特异性,有助于患者准确分期和残余病变性质的鉴别.     

18F-FDG PET/CT、CT在乳腺癌治疗疗效评估中的对比研究

目的：评价¹⁸F-脱氧葡萄糖（¹⁸F-FDG）PET/CT显像、CT在乳腺癌术后复发和转移诊断中的应用价值。方法：37例临床疑乳腺癌术后复发的患者行18F-FDG PET/CT全身显像。图像分析采用视觉和半定量方法（标准摄取值，SUV）分析肿瘤病灶摄取FDG的程度，并参考近期病理检查及CT结果。结果：27例复发患者经组织病理学、活检或细胞学检查和临床随访证实有局部转移，PET/CT显像和CT检查灵敏度分别为96.30%，62.96%，PET/CT显像和CT检查的灵敏度的差异有显著性（χ2=9.247，P<0.05）。14例患者行PET/CT双时相检查，乳腺癌术后患者确诊为转移的9例患者，SUV值均有不同程度增高。结论：¹⁸F-FDG PET/CT显像对于乳腺癌术后复发和转移病灶的定性、定位准确性更高，优于CT，是一种有效的诊断方法。     

The role of FDG-PET imaging in the management of lymphoma

Positron emission tomography (PET) imaging using [F-18]fluorodeoxyglucose (FDG) has become a useful imaging modality in the staging and treatment evaluation algorithm for lymphoma, providing unique metabolic information. Increased FDG uptake in lymphoma tumor masses is a function of increased anaerobic metabolism and longer residence time of FDG in malignant cells relative to most normal tissues. The information provided by FDG-PET appears to result in greater sensitivity compared to anatomic imaging modalities, particularly computed tomography (CT). Over several decades CT has been the principal imaging modality for the staging and restaging of lymphoma, although it can have significant shortcomings stemming from its sized-based criteria, particularly in the post-therapy setting. Gallium-67 (Ga-67) scintigraphy has played an important role in monitoring response to therapy; however, the sensitivity of Ga-67 depends on histologic subtype of lymphoma, size, and location of disease. Published results suggest that FDG-PET is superior to Ga-67 imaging and equal or superior to CT for the detection of nodal and extranodal lymphoma at initial staging. Furthermore, persistent FDG uptake during and after chemotherapy has a high sensitivity and specificity for prediction of subsequent relapse. While in some cases FDG-PET imaging can yield findings that prompt a change in treatment strategy, prospective studies are necessary to better establish the ability of routine FDG-PET imaging to impact therapeutic outcomes for patients with lymphoma.     

Increased radiotracer uptake on positron emission tomography after invasive thoracic procedures: a case series

OBJECTIVE: To investigate the hypothesis that tissue changes induced by invasive thoracic procedures may be associated with increased fluorine 18-labeled fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scans, potentially leading to these tissue changes being mistaken for malignancies. PATIENTS AND METHODS: We retrospectively reviewed the records of all patients undergoing bronchoscopies and FDG-PET at Mayo Clinic Jacksonville from February 2002 to September 2004 and identified patients who had undergone computed tomography (CT) of the chest and bronchoscopy before FDG-PET. We identified and reviewed the imaging studies of patients who had increased FDG uptake on PET scans and whose CT scans showed no corresponding abnormalities suggestive of malignancy. RESULTS: Eighty-one patients had undergone both bronchoscopy and PET within the defined study period. Of these, 45 (56%) underwent PET within 4 weeks after bronchoscopy, and 13 (29%) of these 45 patients had increased FDG uptake on PET scans that did not correlate with pathological findings on CT. We judged that increased uptake on 3 (23%) of the 13 PET scans was most likely related to the bronchoscopic procedure. Additionally, 2 patients who had undergone thoracoscopy after bronchoscopy but before PET had discordant CT and PET findings. CONCLUSION: Invasive thoracic procedures may cause an increased uptake of radiotracer on PET scans that could be mistakenly interpreted as evidence of malignancy. To avoid clinical misjudgment, clinicians should perform PET before invasive thoracic procedures.     

Characterization of uptake of 2-deoxy-2-[18F] fluoro-D-glucose by fungal-associated inflammation: the standardized uptake value is greater for lesions of blastomycosis than for lymphoma in dogs with naturally occurring disease.

PURPOSE: Based on limited reports, fungal lesions can have remarkably high intensity uptake of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) on positron emission tomography (PET) images. The purpose of this investigation was to compare the standardized uptake value (SUV) of naturally occurring lesions of blastomycosis with the SUV of naturally occurring lymphoma in a series of dogs. PROCEDURES: Five dogs with naturally occurring blastomycosis and three dogs with lymphoma underwent whole-body FDG-PET prior to receiving any treatment for their disease. RESULTS: The (mean +/- SD) SUV for 13 blastomycosis lesions was 7.7 +/- 2.0 versus a mean for 17 lymphomas of 4.8 +/- 1.8. These values were significantly different (P = 0.0537). There was overlap between the SUV of Blastomyces-associated lesions versus lymphomas, but a cut-off SUV of 7.0 was 100% specific for Blastomyces lesions. Numerous sites of disease were detected on the FDG-PET images that were not detected clinically. CONCLUSIONS: FDG-PET is useful for determining the extent of disease in dogs with blastomycosis. The SUV for Blastomyces-associated lesions are as high or higher than for malignant lymphoma. Due to the similarities in canine and human blastomycosis and lymphomas, similar results would be predicted in human patients. In regions where blastomycosis is endemic, Blastomyces granulomas should be considered a differential diagnosis for lesions with high intensity uptake of FDG.     

The utility of 2-deoxy-2-[18F]fluoro-D-glucose-positron emission tomography and combined positron emission tomography and computed tomography in lymphoma and melanoma.

The purpose of this article is to review the clinical utility of FDG and FDG PET/CT imaging in lymphoma and melanoma. A review of the important articles supporting the use of FDG PET imaging in the staging, restaging, and monitoring of response to therapy in lymphoma and melanoma is provided. The intent is to give the nuclear medicine physician and or radiologist the perspective of what may be important clinically to make FDG PET imaging an integral part of the workup of lymphoma and melanoma patients. Specific clinical scenarios and uptake patterns that are unique for lymphoma and melanoma are discussed to ensure relevant and proper interpretation of the FDG PET scans. FDG PET scanning in summary is a useful imaging modality in the staging, restaging, and response evaluation of patients with lymphoma and melanoma.     

2-Deoxy-2-[18F]fluoro-D-glucose positron emission tomography uptake in systemic lupus erythematosus-associated adenopathy.

Systemic lupus erythematosus (SLE) and lymphoma are disease entities that often have similar presenting signs and symptoms that can complicate or delay definitive diagnosis. 2-Deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography (FDG-PET) has become a valuable tool in the diagnosis, staging, and evaluation of response to therapy in lymphoma patients. However, its utility in patients with SLE has been limited to the central nervous system. Significant FDG uptake has not been previously reported in lymphadenopathy associated with SLE. The case presented is an example of histologically proven benign adenopathy in a 16-year-old female with SLE that was hypermetabolic on FDG-PET imaging. It highlights the importance of recognizing that widespread inflammatory adenopathy in SLE can mimic the pattern of FDG uptake seen with lymphoma at PET imaging.     

Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography evaluation of subcutaneous panniculitis-like T cell lymphoma and treatment response

Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a very rare variant of non-Hodgkin’s lymphoma. Currently, there is no standard imaging method for staging of SPTCL nor for assessment of treatment response. Here, we describe our use of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging and monitoring of treatment response in 3 cases of SPTCL. Primary staging by PET/CT showed that all 3 patients had multiple foci in the subcutaneous fat tissue, with SUVmax from 10.5 to 14.6. Involvement of intra-abdominal fat with high SUVmax was identified in 2 of the patients. Use of the triple drug regimen of gemcitabine, cisplatin and methylprednisolone (commonly known as “GEM-P”) as first-line therapy or second-line therapy facilitated complete metabolic response for all 3 cases. FDG PET/CT provides valuable information for staging and monitoring of treatment response and can reveal occult involvement of the intra-abdominal visceral fat. High FDG uptake on pre-treatment PET can identify patients with aggressive disease and help in selection of first-line therapy.     

The role of 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography in monitoring the immunosuppressive therapy response of inflammatory myofibroblastic tumor.

PURPOSE: To compare the pre and post treatment 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging findings of an inflammatory myofibroblastic tumor (IMT) with its clinical response to immunosuppressive therapy. PROCEDURE: Forty-nine-year-old female presented with dyspnea, chest pain, and weight loss and underwent an FDG-PET/CT scan before and after mediastinal biopsy and treatment with dexamethasone and thalidomide. RESULTS: FDG-PET/CT scan demonstrated a hypermetabolic mediastinal mass. The biopsy of the lesion was consistent with IMT. Following immunosuppressive therapy, the patient's clinical findings resolved, and PET/CT showed a significant decrease in the FDG uptake and the size of the mass. CONCLUSION: Pre-treatment imaging features and post-treatment imaging characteristics of IMT correlate with clinical findings and suggest that FDG-PET/CT may be useful as an adjunct to clinical evaluation in monitoring of immunosuppressive therapy of IMT.     

Merkel Cell Carcinoma: Is there a Role for 2-Deoxy-2-[F-18]fluoro-d-glucose-Positron Emission Tomography/Computed Tomography?

Purpose 2-Deoxy-2-[F-18]fluoro-d-glucose (FDG)–positron emission tomography (PET)/computed tomography (CT) is becoming widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single study. The role of FDG-PET/CT is proven in lymphoma, melanoma, colorectal carcinoma, and other cancers. However, there are rare malignancies such as Merkel cell carcinoma that can potentially be evaluated with PET/CT. We were therefore prompted to review our experience with FDG-PET/CT in the management of patients with Merkel cell carcinoma.Procedures This is a retrospective case series of six patients with Merkel cell carcinoma, 58–81 years old (average 69 ± 8.3), who had whole-body PET/CT at our institution from January 1st, 2003 to August 31st, 2005. Two patients were women and four were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.Results Twelve examinations were acquired for the six patients (one patient had six PET/CT, one patient had two PET/CT, and four patients had one PET/CT). The injected FDG doses ranged 381.1–669.7 MBq (average 573.5 ± 70.3). Four patients had the PET/CT as part of initial staging, and two patients had the exam for restaging (after surgery and XRT). A total of six Merkel lesions (pancreas, adrenal, lip, submandibular lymph nodes, cervical lymph nodes, and parapharyngeal soft tissue) were identified in three patients and confirmed on histopathological examination. The FDG uptake in these areas was intense, with maximum standardized uptake value (SUVmax) values of 5–14 (average 10.4 ± 3.8). In one patient, the PET/CT scan identified abnormal focal distal sigmoid uptake that was biopsied and diagnosed as adenocarcinoma. Two patients had negative scans and had no clinical evidence of disease on follow-up office visits (up to one year after PET/CT).Conclusions This case series suggests that FDG-PET/CT may have a promising role in the management of patients with Merkel cell carcinoma.