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.     

18F-FDG PET/CT全身显像在原发灶不明转移癌中的临床应用

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT全身显像在原发灶不明转移癌(CUP)诊断中的临床应用价值.方法 回顾性分析2006年1月至2007年6月2589例18F-FDG PET/CT显像患者中169例CUP患者的显像结果,通过分析病历记录、病理检查结果及临床随访确定最终原发灶诊断结果.结果 169例CUP患者中19例失访,150例有完整资料.70例成功探测到原发灶,总检出率为46.7%(70/150),其中52例得到病理检查证实,18例为临床诊断;肺癌38例,占54.3%,鼻咽癌8例,占11.4%,消化系统肿瘤13例,占18.6%,其他肿瘤11例,占15.7%.3例临床怀疑转移瘤,18F-FDG PET/CT未见明显恶性征象,经随访证实为良性病变.6例PET/CT诊断错误.15例患者没有确诊.56例未探测到原发灶,其中3例在随访过程中得到确诊,分别为鼻咽癌、膀胱癌、食管癌各1例.结论 18F-FDG PET/CT全身显像对诊断CUP具有重要临床价值.     

18F-FDG PET/CT和增强MSCT评价食管癌淋巴结转移

目的 探讨18F-FDG PET/CT显像和增强多层螺旋CT(MSCT)检查评价食管癌淋巴结转移的价值.方法 食管癌患者46例,均在18F-FDG PET/CT检查前1周内行MSCT检查,并在18F-FDGPET/CT检查后1周内接受手术治疗,切除组织均行病理检查.采用16层MSCT增强扫描和18F-FDG PET/CT显像检查颈、胸和上腹部,分别观察食管癌原发病灶、转移淋巴结的部位及转移淋巴结组数,其结果与病理检查结果对照.比较18F-FDG PET/CT和增强MSCT诊断食管癌淋巴结转移的灵敏度、特异性、准确性、阳性预测值和阴性预测值.结果 46例食管癌中位于上胸段6例,中胸段32例,下胸段8例.手术清除326组淋巴结,病理检查证实其中83组内有肿瘤转移.18F-FDG PET/CT与增强MSCT诊断淋巴结转移的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为83.1%(69/83),96.3%(234/243),92.9%(303/326),88.5%(69/78),94.4%(234/248)与72.3%(60/83),98.4%(239/243),91.7%(299/326),93.7%(60/64),91.2%(239/262).2种方法诊断食管癌淋巴结转移的灵敏度差异有统计学意义(P=0.022),余诊断效能指标差别无统计学意义(P均＞0.05).在诊断食管旁淋巴结转移方面,18F-FDG PET/CT与增强MSCT的灵敏度分别为79.2%(19/24)与54.2%(13/24),差异有统计学意义(P=0.031).结论 18F-FDG PET/CT诊断食管癌淋巴结转移,尤其食管旁淋巴结转移的灵敏度高于增强MSCT,但MSCT增强扫描对于发现18F-FDG PET/CT显像阴性的淋巴结转移有重要价值,两者结合应用可明显提高对食管癌淋巴结转移的判断准确性.     

18 FDG PET监测肺癌化疗反应的临床应用

目的 ^18FDG PET监测肺癌化疗效果以调整治疗方案。方法：18例肺癌患者经化疗后1—3月行^18FDG PET全身扫描，评价化疗后疗效，18例均有CT结果比较。结果：18例复发和转移者15例，^18FDG PET发现14例，CT发现13例。原发病灶消失且无复发和转移者3例，^18FDG PET确定3例，CT检查确定2例。监测肺癌化疗效果^18FDG PET敏感性为93．3％，特异性为100％。CT检查敏感性为86．7％，特异性为66．7％。结论：^18FDG PET全身扫描监测肺癌化疗效果优于CT检查。是监测肺癌化疗效果较好的影像方法，能预测治疗效果。     

初步探讨适合心脏、心包病变的~(18)F-FDG PET/CT显像前准备方法

目的通过比较不同显像前准备方法的心肌摄取~(18)F-FDG程度,制定适合心脏、心包病变的~(18)F-FDG PET/CT显像前准备方法。方法 100例临床怀疑心脏、心包病变患者分别采用禁食(50例)和低碳水化合物高脂肪蛋白质允许饮食(50例)两种显像前准备,接着进行~(18)F-FDG PET/CT扫描。分别测量两组心肌SUVmax有无统计学差异(Mann-Whitney U Test)。结果禁食组与饮食组的患者的心肌SUVmax分别为4.6±4.0、1.9±0.9。两者之间差别有统计学意义(Z=-6.348,P=0.000),饮食组心肌SUVmax低于禁食组。结论患者行PET/CT检查前2餐采用低碳水化合物高脂肪蛋白质允许饮食,餐后3~6h内进行PET/CT扫描能够较为有效的抑制心肌摄取~(18)F-FDG,使心肌的显影程度不影响诊断,为一种较为合理的适合心脏、心包病变的~(18)F-FDG PET/CT显像前准备方法。     

18F-FDG PET/CT在原发灶不明的脑转移瘤中的诊断价值

目的 探讨18F-FDG PET/CT在查找原发灶不明的脑转移瘤中的价值。 方法 回顾性分析17例原发灶不明的脑转移瘤患者的全身18F-FDG PET/CT检查资料。 结果 17例患者均经活检确诊原发灶,准确率100%。原发性肺癌13例,占76%,其中有2例在第二次行PET/CT检查时才检出原发灶;原发性肝癌2例,占12%;原发性贲门癌1例,占6%;原发性升结肠癌1例,占6%。在检查到原发灶的基础上,18F-FDG PET/CT亦发现10例合并转移者,其中合并肺转移者2例、合并淋巴结转移者3例、合并骨转移者2例及合并其他部位转移者3例,共发现病灶61处;2例肝癌患者单发脑转移灶中均有脑卒中。 结论 18F-FDG PET/CT在查找原发灶不明的脑转移瘤原发灶中有重要价值,并为临床分期及治疗提供有利帮助。     

18F-FDG PET/CT对可疑复发性宫颈癌的临床价值

目的 探讨18F-FDG PET/CT在可疑复发性宫颈癌临床诊疗中的价值.方法 回顾性分析51例宫颈癌根治后随访期间临床可疑复发的患者,记录患者的治疗资料、可疑复发表现、18F-FDG PET/CT显像结果、同期常规影像检查结果、病理及临床随访结果、PET/CT结果对临床诊疗的影响.结果 PET/CT诊断宫颈癌复发43例,最终经病理检查及临床随访证实复发性宫颈癌40例,盆腔脓肿2例,放射性肠炎1例;PET/CT未见恶性征象8例,病理检查及临床随访均未见异常.PET/CT诊断复发性宫颈癌灵敏度为100.00%(40/40),特异性为72.73%(8/11),准确性为94.12%(48/51).PET/CT指导制订临床诊疗及随访计划34例,改变治疗计划7例.与其他影像检查相比,PET/CT可发现更多的病灶.结论 18F-FDG PET/CT能有效诊断复发性宫颈癌,指导临床诊疗.     

18F-FDG PET/CT在癫痫病灶定位诊断中的应用

【摘要】目的：观察氟18脱氧葡萄糖（18F-FDG）正电子发射体层摄影（PET）/计算机体层摄影（CT）在癫痫病灶定位诊断中的应用价值。方法：回顾性搜集2019年1月-2022年1月诊治的62例癫痫患者临床资料,手术切除治疗前均接受核磁共振（MRI）、18F-FDG PET/CT检查,以手术结果为参考标准,评估不同检查方案对癫痫阳性检出率、癫痫致痫灶定位诊断的价值。据癫痫患者治疗后疗效不同分为预后良好组、预后不良组,比较两组FDG PET/CT检查显示的脑代谢异常差异。结果：18F-FDG PET/CT联合MRI阳性检出率98.39%,较术前18F-FDG PET/CT检查的87.10%、术前MRI检查的72.58%明显高（P＜0.05）。18F-FDG PET/CT联合MRI对癫痫病灶类别（单发病灶）诊断的准确率较术前18F-FDG PET/CT检查、术前MRI检查的明显高（χ2=5.899、5.309,P＜0.017）。术前18F-FDG PET/CT检查对癫痫病灶定位诊断的符合率较术前MRI检查的略高,差异无统计学意义（χ2=4.060,P＞0.017）,但较18F-FDG PET/CT联合MRI的明显低（χ2=15.676,P＜0.017）。62例癫痫患者预后良好患者37例（37/62）,预后不良患者25例（25/62）,预后良好组18F-FDG PET/CT联合MRI检查显示的病灶分布与预后不良组比较差异有统计学意义（P＜0.05）。结论：18F-FDG PET/CT联合MRI检查可明显提高对癫痫病灶的定位诊断价值,对指导癫痫患者手术选择和评估治疗疗效有积极意义。     

^18FDG—PET诊断卵巢癌术后复发

目的 :评价18FDG PET诊断卵巢癌治疗后复发的价值。材料和方法 :对 2 0例临床疑有复发的卵巢癌患者进行了18FDG PET全身及腹部成像 ,并与CT、B超及CA12 5等进行比较。结果 :9例PET与CT、B超显示为阴性 ,且CA12 5正常。11例经病理证实肿瘤复发 :8/11例血清CA12 5升高 ;B超及CT等常规影像检查 9/11例阳性 ;10 /11例18FDG PET显示阳性。结论 :18FDG PET全身显像作为无创伤性检查技术 ,能及时探测到复发或扩散肿瘤的代谢变化 ,可以为卵巢癌术后随访提供一种有效的非侵入性影像学诊断方法。     

18F-FDG PET/CT在宫颈癌诊断中的应用

目的 探讨18F-脱氧葡萄糖(FDG) PET/CT在宫颈癌诊断及其复发、转移灶探测中的应用价值.方法 88例患者行腹部或全身18F-FDG PET/CT显像,其中初诊者30例(宫颈良性病变11例,宫颈癌19例),宫颈癌治疗后58例.病灶根据病理检查、多种影像诊断技术及临床随访确诊,随访时间均为6个月～3年.结果 30例初诊者中,PET/CT诊断宫颈癌的灵敏度、特异性和准确性分别为17/19,10/11和27/30(90.0%).58例治疗后患者中,11例存在肿瘤复发或残余,PET/CT诊断肿瘤复发、残余的灵敏度、特异性和准确性分别为10/11,47/47(100.0%)和57/58(98.3%).41例有肿瘤转移,PET/CT诊断转移灶的灵敏度、特异性和准确性分别为92.7%,88.9%和90.9%;转移灶以盆腹腔淋巴结为主,39.0%有盆腔淋巴结转移,27.3%有腹膜后淋巴结转移,所有淋巴结转移患者中PET/CT发现26.8%病灶直径＜1.0cm.28.6%(22/77)的患者PET/CT发现腹腔外远处转移灶.18例输尿管梗阻患者中,16例PET/CT发现为肿瘤侵犯压迫所致.结论 18F-FDG PET/CT显像在宫颈癌的诊断及其复发、转移灶探测中有良好的应用价值,尤其是对远处转移灶和小淋巴结转移灶的检测,可使临床分期更准确.     

Optimized contrast-enhanced CT protocols for diagnostic whole-body 18F-FDG PET/CT: technical aspects of single-phase versus multiphase CT imaging.

The purpose of this study was to compare various PET/CT examination protocols that use contrast-enhanced single-phase or contrast-enhanced multiphase CT scans under different breathing conditions. METHODS: Sixty patients with different malignant tumors were randomized into 4 different PET/CT protocols. Single-phase protocols included an intravenous contrast-enhanced (Ultravist 370; iodine at 370 mg/mL) single-phase whole-body CT scan (90 mL at 1.8 mL/min; delay, 90 s) during shallow breathing (protocol A) or during normal expiration (NormExp; protocol B). Multiphase protocols included 2 separate CT scans in the arterial contrast enhancement phase (90 mL at 2.5-2.8 mL/min; bolus tracking; scan range, base of the skull to the kidneys) and the portal-venous contrast enhancement phase (delay, 90 s; scan range, base of the lungs to the proximal thighs) during shallow breathing (protocol C) or during NormExp (protocol D) followed by a low-dose CT scan during shallow breathing for attenuation correction and whole-body PET. Feasibility was assessed by comparing the misalignment of the upper abdominal organs quantitatively by means of the craniocaudal, lateral, and anterior-posterior differences on coregistered PET/CT images. For image quality, the occurrence of CT artifacts and mismatching of rigid body points were evaluated qualitatively. RESULTS: Misalignment was significantly lower for protocol B in almost all organs and represented the best coregistration quality. Surprisingly, protocol A showed significantly better alignment than the multiphase CT scans during NormExp. Misalignment values between the multiphase protocols were not significantly different, with a trend toward lower values for protocol D. The best CT image quality, with a significantly lower occurrence of artifacts, was found for protocols B and D (NormExp). The levels of mismatching of rigid body points because of patient movement in between the transmission and emission scans were similar for all protocols. CONCLUSION: Multiphase CT protocols presented a technical disadvantage represented by suboptimal image coregistration compared with single-phase protocols. Nevertheless, multiphase protocols are technically feasible and should be considered for patients who will benefit from a contrast-enhanced multiphase CT examination for diagnosis.     

阿尔茨海默病患者基于体素形态学的CT和磁共振影像的比较研究

目的：探讨基于体素形态学的CT和磁共振（MR）影像对阿尔茨海默病（AD）患者的诊断价值。方法 AD患者和健康志愿者各5例,用3．0 T的扫描仪行MR检查,用3D矢状磁化预备快速梯度回波序列获取3D数据。1月后,所有参与者行正电子发射计算机断层显像（PET/CT）检查;然后静脉注射11C-PIB 600 MBq,并再次行PET/CT检查。完毕后,用统计参数图-8（SPM8）软件对MRI和PET/CT影像进行重建,并将两者进行比较分析。结果和志愿者相比,不管是MR还是PET/CT影像,AD患者两侧颞叶区域灰质均明显减少（P＜0．001）;与MR影像对比,PET/CT影像所示的变化区域更大。结论基于体素形态学的CT和MR影像均可对AD患者进行准确的诊断,但CT的敏感性更高。     

18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究进展

18F-FDG PET/CT心肌代谢显像是目前被公认的监测患者存活心肌的"金标准",在冠心病的临床诊疗、血管再通术的预后评价等方面起指导作用。保证合格的图像质量是发挥其作用的关键。然而,18F-FDG PET/CT心肌代谢显像图像质量受到许多因素影响,其中血糖水平、胰岛素功能是主要的影响因素。通过调整显像前饮食结构、禁食时间、长期服用药物、检查日的血糖水平、调节血糖的方法以及注射显像剂的时间等可提高图像质量,并提升显像的成功率。为此,笔者对18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究现状及最新进展进行综述。     

Accuracy of image fusion of normal upper abdominal organs visualized with PET/CT

Although PET/CT scanners have the potential for precise fused registration of structures visualized on both PET and CT, physiological motion during the acquisition of both studies may alter the appearance of organ shape, size or location. The degree of possible mismatch in abdominal organ size and position between PET and CT has not been evaluated. The aim of this study was to assess the consistency in location and measured size of upper abdominal organs with PET and CT using a combined PET/CT system. Forty-six consecutive inpatients who underwent clinical PET/CT scans for suspected cancer were evaluated. CT and PET images attenuation corrected by both CT and germanium-68 transmission scans were obtained, and we separately determined the location of the top and bottom (height), anterior and posterior margins (thickness), and right and left margins (width) for each organ, including liver, spleen, and bilateral kidneys, using CT and both sets of PET images. Differences between the two modalities in terms of location and measured organ size were investigated. In the upper margin of the liver and lower margin of the spleen, more than 10% of the cases showed a larger discrepancy (>20 mm) between CT-based and Ge-corrected PET-based measurements, although the differences in the positions of the edges were less than 10 mm in most cases. The center of the liver tended to be located cephalad and to the right of the body, and that of the spleen tended to be cephalad and posterior on PET, as compared with CT. Moreover, the center of both kidneys tended to be seen cephalad, posterior, and to the right on PET. The liver appeared slightly larger on PET than CT in thickness (CT vs CT-corrected PET vs Ge-corrected PET = 156 mm vs 162 mm vs 162 mm) and width (186 mm vs 189 mm vs 188 mm). By contrast, the spleen appeared slightly smaller on PET than CT in height (84 mm vs 77 mm vs 80 mm) and width (85 mm vs 81 mm vs 80 mm). A similar tendency was observed in the left kidney (105 mm vs 100 mm vs 99 mm in height, and 64 mm vs 59 mm vs 58 mm in width) and the right kidney (99 mm vs 93 mm vs 93 mm in height, and 64 mm vs 59 mm vs 60 mm in width). These differences between the two modalities were statistically significant ( P<0.05). In conclusion, minor mismatches in location and organ size were found to exist between CT and PET images, in part due to physiological motion. Although these differences could potentially affect the quality of the image registrations, they were generally of a modest nature.     

Simultaneous PET/MR imaging in a human brain PET/MR system in 50 patients-Current state of image quality

Objectives

The present work illustrates the current state of image quality and diagnostic accuracy in a new hybrid BrainPET/MR.

Materials and methods

50 patients with intracranial masses, head and upper neck tumors or neurodegenerative diseases were examined with a hybrid BrainPET/MR consisting of a conventional 3T MR system and an MR-compatible PET insert. Directly before PET/MR, all patients underwent a PET/CT examination with either [¹⁸F]-FDG, [¹¹C]-methionine or [⁶⁸Ga]-DOTATOC. In addition to anatomical MR scans, functional sequences were performed including diffusion tensor imaging (DTI), arterial spin labeling (ASL) and proton-spectroscopy. Image quality score of MR imaging was evaluated using a 4-point-scale. PET data quality was assessed by evaluating FDG-uptake and tumor delineation with [¹¹C]-methionine and [⁶⁸Ga]-DOTATOC. FDG uptake quantification accuracy was evaluated by means of ROI analysis (right and left frontal and temporo-occipital lobes). The asymmetry indices and ratios between frontal and occipital ROIs were compared.

Results

In 45/50 patients, PET/MR examination was successful. Visual analysis revealed a diagnostic image quality of anatomical MR imaging (mean quality score T2 FSE: 1.27 ± 0.54; FLAIR: 1.38 ± 0.61). ASL and proton-spectroscopy was possible in all cases. In DTI, dental artifacts lead to one non-diagnostic dataset (mean quality score DTI: 1.32 ± 0.69; ASL: 1.10 ± 0.31). PET datasets of PET/MR and PET/CT offered comparable tumor delineation with [¹¹C]-methionine; additional lesions were found in 2/8 [⁶⁸Ga]-DOTATOC-PET in the PET/MR. Mean asymmetry index revealed a high accordance between PET/MR and PET/CT (1.5 ± 2.2% vs. 0.9 ± 3.6%; mean ratio (frontal/parieto-occipital) 0.93 ± 0.08 vs. 0.96 ± 0.05), respectively.

Conclusions

The hybrid BrainPET/MR allows for molecular, anatomical and functional imaging with uncompromised MR image quality and a high accordance of PET results between PET/MR and PET/CT. These results justify the application of this technique in further clinical studies and may contribute to the transfer into whole-body PET/MR systems.     

Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT.

Standard application of CT intravenous contrast agents in combined PET/CT may lead to high-density artifacts on CT and attenuation-corrected PET. To avoid associated diagnostic pitfalls, we designed and compared different intravenous contrast injection protocols for routine whole-body PET/CT. METHODS: Whole-body PET/CT included a topogram and a single spiral CT scan (2-row) with or without intravenous contrast, followed by an emission scan. The CT scan was used for attenuation correction of the emission data. Four groups of 10 whole-body PET/CT referrals each were investigated: (A) no intravenous contrast agent, (B) biphasic injection (90 and 50 mL at 3 and 1.5 mL/s, respectively) of intravenous contrast (300 mg/mL iodine) and CT in the craniocaudal direction with a 30-s delay, (C) triple-phase injection (90, 40, and 40 mL at 3, 2, and 1.5 mL/s, respectively) in the craniocaudal direction with a 50-s delay, and (D) dual-phase injection (80 and 60 mL at 3 and 1.5 mL/s, respectively) in the caudocranial direction with a 50-s delay. CT image quality was assessed on a scale from 1 to 3, and CT and attenuation-corrected PET images were reviewed separately for contrast-induced artifacts. RESULTS: Average CT image quality was poorest for protocol A (1.0) but improved to 2.8 when using intravenous contrast agents (protocols B-D). Only protocols B and C resulted in contrast-induced image artifacts that were limited to the thorax. The most homogeneous intravenous contrast enhancement without high-density image artifacts on either CT or PET after CT-based attenuation correction was achieved with protocol D. CONCLUSION: Dual-phase intravenous contrast injection and CT in the caudocranial direction with a 50-s delay yields reproducible high image quality and is now used routinely for combined diagnostic PET/CT at our hospital.     

Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management.

The aim of this study was to investigate the diagnostic accuracy and impact on patient management of the new integrated PET/CT modality in patients with suspected iodine-negative, differentiated thyroid carcinoma (DTC). METHODS: Forty patients with DTC and a suggestion of iodine-negative tumor tissue underwent PET/CT examination (370 MBq (18)F-FDG, coregistered PET/CT whole-body images). As the first step of analysis, PET and CT images were scored blindly and independently by 2 nuclear medicine physicians and 2 radiologists. A 5-point scale was used. The second step consisted of a consensus reading, during which a virtual side-by-side fusion of PET and CT images was initially evaluated and afterward the "real" fusion (i.e., coregistered) PET/CT images were also scored with the same 5-point scale. The imaging results were compared with histopathologic findings and the course of disease during further follow-up examinations. RESULTS: One hundred twenty-seven lesions in 40 patients were evaluated. Diagnostic accuracy was 93% and 78% for PET/CT and PET, respectively (P = 0.049, per-patient analysis). In 17 (74%) of 23 patients with suspicious (18)F-FDG foci, integrated PET/CT added relevant information to the side-by-side interpretation of PET and CT images by precisely localizing the lesion(s). In tumor-positive PET patients, PET/CT fusion by coregistration led to a change of therapy in 10 (48%) patients. Futile surgery was prevented in an additional 3 patients. CONCLUSION: Integrated PET/CT is able to improve diagnostic accuracy in a therapeutically relevant way in patients with iodine-negative DTC. By precisely localizing tumor tissue, image fusion by integrated PET/CT is clearly superior to side-by-side interpretation of PET and CT images.     

PET/CT融合三维图像定位肺穿刺活检靶点的增益价值

目的:探讨PET/CT融合三维图像定位肺穿刺活检靶点的增益价值。方法:分析54例PET/CT引导和93例单纯CT引导的范围≥3cm或疑似合并坏死、阻塞性炎症、实变及不张的肺部病变活检资料,比较2种引导方法总的检出率、假阴性率、阴性预测值、准确率,采用配对四格表资料的χ~2检验,进行统计学分析。结果:PET/CT引导组的检出率为98.1%(53/54),假阴性率为5.3%(2/38),阴性预测值为88.2%(15/17),准确率为96.2%(51/53)。单纯CT引导组的检出率为84.9%(79/93),假阴性率为23.3%(10/43),阴性预测值为78.3%(36/46),准确率为87.3%(69/79)。采用配对四格表资料的χ~2检验,2种引导方法的检出率的差异(χ~2=6.50,0.010.05)和准确率的差异(χ~2=2.05,P>0.05)无统计学意义。结论:对于范围≥3cm或疑似合并坏死、阻塞性炎症、实变及不张的肺部病变,PET/CT融合三维图像引导穿刺活检的有效率高于单纯CT形态学引导,有一定的临床增益价值。     

PET/CT of the abdomen: optimizing the patient breathing pattern

The aim of this study was to evaluate the respiration position, which is optimal for co-registration of abdominal CT images, and the corresponding positron emission tomography (PET) scan in a new combined PET/CT system. Ten patients (5 men, 5 women; age 57.7±15.3 years, age range 34–80 years) underwent imaging for tumor staging on a combined PET/CT scanner (Discovery LS, GE Medical Systems, Milwaukee, Wis.). The PET emission images were acquired during normal shallow breathing and during CT scanning the patients performed four different breathing tasks: free breathing (FB); maximum inspiration (MaxInsp); maximum expiration (MaxExp); and normal expiration (NormExp). NormExp was defined as the respiratory level that was reached when the patient first inhaled and then exhaled without forcing expiration, and then held the breath in this position. Movements of the spleen, liver, left and right kidney, and the bladder were measured by using the promontory of the sacrum as a reference point and measuring the distance from this point to the abdominal organs in the PET and CT images by two independent observers. Statistical comparison of the measured distances between the CT scans and the PET scan were made using a Wilcoxon signed-rank test with Bonferroni correction. Repeated-measures analysis of variance served for the assessment of intraobserver and interobserver agreement. There was no significant difference between NormExp and FB indicating that both respiration protocols are suitable for PET/CT image co-registration of abdominal studies. In contrast, the MaxExp and MaxInsp protocol are not suitable. The NormExp and FB respiration protocol are both suitable for the co-registration of abdominal PET/CT studies. In most patients the mismatch of abdominal organs will be lower than the resolution of the final co-registered PET/CT image. Electronic Publication     

十六层螺旋CT多平面重组在腹部检查中的应用

目的:探讨十六层螺旋CT多平面重组在腹部检查中的临床价值以及应用技巧。方法:使用SIEMENS Sensation16多层螺旋CT对45例常规腹部扫描病人进行层厚和层间距为2 mm的回顾性多平面重组,将以多平面重组图像为依据作出的诊断与横断面图像的结论对照。结果:除在影像描述上存在微小差别外,以多平面重组图像为依据作出的诊断与横断面图像的诊断基本一致。多平面重组图像较横断面图像更直观明确,对沿上下方向走行的组织结构尤为突出。结论:多层螺旋CT多平面重组,操作简便,图像清晰直观,可作为腹部CT诊断的主要方法。