PET/CT对鼻咽癌颅底颅内侵犯的诊断价值及T分期影响

[目的]对比PET/CT与MRI诊断鼻咽癌颅底、颅内侵犯的效能,评估PET/CT对以MRI为基础的鼻咽癌T分期影响.[方法]2005年1月至2009年12月,60例患者均行PET/CT和MRI检查,对比PET/CT和MRI的诊断效能及T分期结果.[结果]PET/CT和MRI对鼻咽癌颅底侵犯的敏感性、特异性、准确率分别为96.7％、60.0％和78.3％;76.7％、93.3％和85.0％.PET/CT使28.3％病例T分期提高,8.3％病例T分期下降.[结论]虽然PET/CT对鼻咽癌原发灶侵犯范围的评估效能与MRI相仿,但如以PET/CT作为鼻咽癌分期基础,可能使T分期提高,临床需予以重视.     

18F-FDG PET/CT在鼻咽癌诊断及分期中的临床价值

背景与目的:PET/CT能够通过准确显示肿瘤形态、大小及相邻关系从而对鼻咽癌(NPC)进行诊断及分期研究.本研究结合PET/CT、MRI结果及部分颈部小淋巴结病理结果,探讨18SF-FDG PET/CT在鼻咽癌TNM分期中的价值.方法:从2005年9月至2007年3月.选取行PET/CT和MRI检查的鼻咽癌患者68例.PET数据采用2D采集模式,CT扫描电压140 kV,采用自动毫安量跟踪扫描加血管增强的扫描方案,18F-FDG按3.7～5.5 MBq/kg剂量静脉注射.MRI检查采用T1W和T2W成像及T1W增强扫描成像.并对其中10例患者颈部小淋巴结切除和穿刺组织病理检查,进行图像与病理对照.结果:68例鼻咽癌患者所有鼻咽区域的病灶PET/CT均可以清晰显示,MRI和PET/CT显示病灶一致:对于直径≤1 cm的138枚PET/CT示阳性小淋巴结,MRI仅有约28%可作不肯定提示.10例鼻咽癌患者颈部16枚PET/CT显示阳性小淋巴结与病理结果相符14枚,符合率达87.5%.对于颈部肿大淋巴结PET/CT.和MRI均能显示,对部分放疗过程PET/CT示增殖活性明显受抑制的肿大淋巴结,MRI和PET/CT增强扫描可见强化.对于其中8例Ⅳb期鼻咽癌患者肺、骨、肝脏等转移灶,PET/CT全身扫描可清晰显示病灶,而MRI具有较多限制.由于18F-FDG PET/CT检查使其中24例的分期进行调整.结论:18F-FDG-PET/CT扫描采用自动毫安量跟踪扫描加血管增强的扫描方案,充分利用PET/CT信息进行鼻咽癌的临床分期,其结果较MRI全面、可靠.     

18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值及优势

  目的   探讨18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值, 并与增强CT、B超及MRI进行比较。   方法   收集2006年3月至2011年12月期间38例临床疑似胆囊癌而在本院行PET/CT检查的患者, 其中男26例, 女12例; 年龄46~82岁, 中位年龄69岁。患者均行PET/CT、增强CT、B超及MRI检查。全部病例均经手术病理及临床随访证实, 其中35例为原发胆囊癌, 3例为胆囊炎。分别统计4种影像诊断方法的真阳性率、假阳性率、真阴性率、假阴性率及诊断正确率。   结果   PET/CT、增强CT、B超及MRI检查的真阳性率分别为100.0%、74.3%、60.0%、71.4%;假阴性率分别为0、25.7%、40.0%、28.6%;增强CT、B超及MRI检查真阴性率分别为66.7%、33.3%、66.7%;假阳性率分别为33.3%、66.7%、33.3%。诊断正确率分别为92.1%、71.1%、60.5%、68.4%。PET/CT与增强CT、B超及MRI结果比较, P值分别为0.036、0.002、0.019, 均P < 0.05。   结论   在原发性胆囊癌诊断中, PET/CT较其他3种传统影像诊断方法准确率高。如将PET/CT结合增强CT检查, 可使诊断正确率提高2.6%。故18F-FDG PET/CT显像对原发性胆囊癌的诊断具有重要的临床应用价值。      

PET/CT和MRI在鼻咽癌早期诊断中的价值对比分析

[目的]探讨PET/CT和MRI在鼻咽癌早期诊断中的价值.[方法]回顾性分析2010年1月至2012年5月经确诊的21例早期鼻咽癌和11例鼻咽部炎性肿块患者的临床资料,所有患者均行鼻咽部PET/CT、MRI检查及鼻内镜下取材病理检查确诊.依据病理组织活检和临床随访分别评价PET/CT和MRI对鼻咽癌早期诊断的灵敏度、特异性、准确率,并对两者的结果比较.[结果] MRI和PET/CT诊断鼻咽癌灵敏度分别为84.09％和97.67％;特异性分别为69.23％和57.14％;准确率分别为80.70％和87.72％;PET/CT在灵敏度方面较MRI有明显优势(P＜0.05).[结论]PET/CT和MRI在鼻咽癌诊断中均有较高的价值,两种诊断方法有各自的优缺点,应将两者结合起来,以提高早期诊断鼻咽癌的准确率.     

MRI、PET/CT对N0期鼻咽癌GTV的影响

目的:比较MRI、PET/CT检查对N0期鼻咽癌肿瘤靶区(GTV) 的影响.探讨18F-FDG PET/CT 检查对于确定鼻咽癌GTV的意义.方法:已确诊的N0期鼻咽癌患者40例,所有患者治疗前一周内在同一固定体位完成MRI、 PET/CT扫描并分别阅片判定鼻咽癌GTV.结果:MRI、PET/CT对鼻咽腔、口咽、咽旁间隙、颈动脉鞘区、颞下窝、翼腭窝、颅底骨质的检查无明显差异;对海绵窦、鼻窦、咽后淋巴结侵犯MRI优于 PET/CT.结论:对于N0期鼻咽癌放疗GTV的确定,PET/CT较MRI无明显优势.     

Rh-Apo2L联合长春瑞滨杀伤人肺腺癌A549细胞的作用研究

[目的]对比PET／CT与MRI诊断鼻咽癌颅底、颅内侵犯的效能．评估PET／CT对以MRI为基础的鼻咽癌T分期影响。[方法]2005年1月至2009年12月,60例患者均行PET／CT和MRI检查,对比PET／CT和MRI的诊断效能及T分期结果。[结果]PET／CT和MRI对鼻咽癌颅底侵犯的敏感性、特异性、准确率分别为96．7％、60．0％和78-3％;76．7％、93.3％和85．0％。PET／CT使28.3％病例T分期提高,8．3％病例T分期下降。[结论]虽然PET／CT对鼻咽癌原发灶侵犯范围的评估效能与MRI相仿,但如以PET／CT作为鼻咽癌分期基础,可能使T分期提高,临床需予以重视。     

18F-FDG PET/CT显像在诊断头颈部肿瘤残留复发灶中的临床价值

目的:探讨18F-FDG PET/CT在诊断头颈部肿瘤残留复发灶中的临床价值。方法:以病理学检查结果为标准,回顾性对比分析35例完成治疗的头颈部肿瘤患者18F-FDG PET/CT结果和临床资料。结果:PET/CT对残留复发灶的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为93.1%,85.7%,90.0%,90.0%和90.0%,明显优于CT或MRI。和早期显像相比,延迟显像更有助于炎症病灶与残留复发灶的鉴别。结论:判断头颈部癌治疗后残留复发,PET/CT比CT或MRI有更高的准确性。     

18F-脱氧葡萄糖PET对判断脑胶质瘤手术并放疗后肿瘤残留的价值

背景与目的:恶性肿瘤治疗后残留的判断靠CT或MRI有时是很困难的,18F-脱氧葡萄糖(fluorodeoxyglucose,FDG)正电子发射型体层摄影术(positron emission tomography,PET)在这方面的应用是放射肿瘤学目前研究的热点之一.本研究旨在探讨18F-FDG PET在判断脑胶质瘤手术后并放疗后肿瘤残留的临床价值.方法:对23例脑胶质瘤手术后并放疗后临床疑肿瘤残留患者同期行18F-FDG PET和CT/MRI检查,最后诊断结合手术后病理检查和临床随访.结果:23例患者中18F-FDGPET显像阳性12例,阴性11例,其中3例为假阴性.9例CT/MRI未能确定肿瘤残留,PET显示其中7例FDG异常浓聚,2例FDG摄取缺损;8例CT/MRI诊断为肿瘤残留者PET显示FDG异常浓聚.18F-FDG PET显像检查的准确率为87.0%(20/23),而CT/MRI检查的准确率为60.9%(14/23),前者准确率明显高于后者(P＜0.05).结论:18F-FDG PET在判断脑胶质瘤手术后并放疗后的脑损伤和肿瘤残留方面具有明显的优势,结合CT和MRI能更好的提供解剖结构和功能改变的综合信息.     

鼻咽癌放射治疗后FDG PET显像的临床价值

目的 探讨核医学影像诊断技术--FDG PET在鼻咽癌放射治疗后随诊中的临床价值。方法 12例鼻咽癌患者放射治疗后12～18个月同期行FDG PET和CT、MRI检查,并采用双盲法将PDG PET与CT和MRI结果进行比较,其中6例经活检病理证实,余6例经CT动态观察10个月后确诊。结果 9例CT和MRI未见肿瘤复发,PET显示其中3例有局灶性FDG代谢明显增高病变,2例CT和MRI提示肿瘤复发,FDG PET均显示局部病变有放射性摄取浓聚;该5例FDG摄取浓聚的病变处均经活检病理证实为肿瘤复发。另1例MRI提示鼻咽癌颅内转移,而FDG PET诊断为放射治疗后脑损伤,后经CT随访证实。结论 与CT和MRI检查相比,FDG PET在鼻咽癌放射治疗后肿瘤复发的早期定性诊断上具有明显的优势,若结合CT和MRI多种影像结果分析,更能提供局部病变结构与代谢改变的复合信息,尤其对局部复发病灶精确的适形放射治疗非常重要。     

18F-FDG PET显像在鼻咽癌诊断治疗中的价值

目的:探讨18F-FDG PET显像在鼻咽癌诊断治疗中的价值.方法:35例鼻咽癌PET与同期CT、MRI、骨ECT诊断结果比较分析,全部经病理组织学证实.结果:35例鼻咽癌PET与临床和CT、MRI、骨ECT诊断相符31例(88.6%),诊断不符4例(11.4%),其中真阴性2例和假阴性2例,1例ECT疑为多处骨转移,PET未发现核素浓聚改变,随访排除了骨转移;1例MRI疑为复发,PET未发现核素浓聚改变,病理及随访排除了复发;1例CT诊断肝转移,1例MRI诊断桥脑转移,PET均未发现核素浓聚改变.PET检测出CT、MRI和ECT未发现的转移灶6例(17.1%).结论:18F-FDG PET对鼻咽癌定性诊断具有较高的准确性和特异性,在诊断淋巴结和远处转移方面优于CT和MRI;诊断肝、脑转移有假阴性表现,提示PET应结合CT、MRI进行综合分析,才能作出正确的诊断.     

Fluorodeoxyglucose-positron-emission tomography findings in mantle cell lymphoma

ObjectiveMantle cell lymphoma (MCL) is an aggressive type of non-Hodgkin lymphoma with a propensity for extranodal involvement. The role of fluorodeoxyglucose (FDG)–positron emission tomography (PET) imaging in common types of lymphoma has been well-established. However, there is limited information in the literature about the utility of FDG-PET imaging in patients who have MCL. The aim of this study was to determine the role of FDG-PET imaging in assessment of disease activity in MCL compared with conventional imaging techniques such as computerized tomography/magnetic resonance imaging (CT/MRI).MethodsFDG-PET images of 20 patients with MCL who were referred to our center for assessment of extent of disease were reviewed retrospectively. The FDG-PET findings were compared with those of CT/MRI and were correlated with clinical information, histopathology, and outcome.ResultsThe diagnostic sensitivity for PET was 90% (17/19), and specificity was 100% (1/1). For CT/MRI, the sensitivity was 87% (14/16) and specificity was 50% (2/4). PET was better than CT/MRI in detecting nodal involvement. With respect to extranodal involvement, PET detected more cases of spleen involvement than CT/MRI. PET was equivalent to conventional imaging in detecting bowel involvement.ConclusionsPET imaging has a high sensitivity in detecting both nodal and extranodal involvement in patients who have MCL. Based on the available data in patients who had other subtypes of non-Hodgkin lymphoma, the specificity of PET also appears to be superior to anatomic imaging techniques. FDG-PET imaging may prove to be the single most effective method for detection.     

18F-脱氧葡萄糖PET判断头颈部癌复发的价值

目的：探讨^18F-脱氧葡萄糖（FDG）正电子发射型体层摄影术（PET）在头颈部癌瘤复发的临床价值。方法：37例头颈部恶性肿瘤，临床疑复发行FDG PET显像（19例全身显像，18例局部显像），其中34例同期行CT或MRI检查，最后诊断依靠病理检查和临床随访。结果：37例患者中FDG PET显像阳性25例，其中3例假阳性；阴性12例，其中假阴性2例。FDG PET显像的敏感性、特异性和准确率分别为91．7％、76．9％和86．5％，CT或MRI检查的分别为68．2％、75．0％和61．8％。在19例FDG PET全身显像中，11例除头颈FDG异常浓聚外，6例还发现有远地转移。结论：评价头颈部癌瘤复发，FDG PET比CT或MRI有更高准确性。     

Simultaneous positron emission tomography and magnetic resonance imaging for the detection and characterisation of liver lesions in patients with colorectal cancer: A pictorial review

Patients with colorectal cancer undergo frequent diagnostic imaging to stage the extent of metastatic disease and assess response to treatment. Imaging is typically via diagnostic contrast‐enhanced CT or combined FDG‐PET/CT. However, recent research has demonstrated promising benefits of combined FDG‐PET/MRI in oncologic imaging due to the superior soft‐tissue contrast of MRI. The extent of both intrahepatic and extrahepatic disease is important in establishing treatment options for colorectal cancer patients, and FDG‐PET/CT and dedicated liver imaging are often both required. FDG‐PET/MRI offers the advantage of a single examination which can be completed within a similar duration as dedicated liver MRI imaging. This improves patient convenience and anatomical co‐registration between PET and MRI imaging and provides a potential cost benefit. The diagnostic benefits of FDG‐PET/MRI include the simultaneous characterisation of focal liver lesions, exclusion of extrahepatic disease, the detection of additional hepatic metastases and extrahepatic disease, and the multi‐parametric assessment of treatment response. This pictorial review highlights examples of these benefits.     

Diagnosis of non-osseous spinal metastatic disease: the role of PET/CT and PET/MRI

The spine is the third most common site for distant metastasis in cancer patients with approximately 70% of patients with metastatic cancer having spinal involvement. Positron emission tomography (PET), combined with computed tomography (CT) or magnetic resonance imaging (MRI), has been deeply integrated in modern clinical oncology as a pivotal component of the diagnostic work-up of patients with cancer. PET is able to diagnose several neoplastic processes before any detectable morphological changes can be identified by anatomic imaging modalities alone. In this review, we discuss the role of PET/CT and PET/MRI in the diagnostic management of non-osseous metastatic disease of the spinal canal. While sometimes subtle, recognizing such disease on FDG PET/CT and PET/MRI imaging done routinely in cancer patients can guide treatment strategies to potentially prevent irreversible neurological damage.     

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma

The combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) has been reported to be more accurate than CT or PET alone in a preoperative setting. We compared the diagnostic utility of preoperative PET/CT, PET and CT/MRI in 167 patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), of whom 104 underwent FDG PET and 63 underwent combined PET/CT with all receiving CT/MRI. These preoperative PET, PET/CT, and CT/MRI results were reviewed and their accuracies were compared in patients in whom diagnosis was confirmed histopathologically. Age, sex, primary sites and stage, and nodal involvement were comparable between two groups. The accuracy of PET and PET/CT for detecting primary tumors and cervical metastases was comparable, but significantly higher than that of CT/MRI (98%-97% vs. 86-88% for primary; 92%-93% vs. 85%-86% for neck on a level-by-level basis; P<.05). PET and PET/CT gave false negative results: in 2 (2%) and 2 (3%) patients for primary tumors; in 6 (6%) and 3 (5%) patients for neck metastases, respectively. PET and PET/CT also gave false-positive results for cervical metastases in 5 (5%) and 4 (6%) patients, respectively. Compared with PET alone, preoperative FDG PET/CT may not yield significantly improved diagnostic accuracy in patients with HNSCC. Moreover, despite their high accuracy, PET and PET/CT may not abrogate the need for conventional imaging and pathologic staging based on primary resection and neck dissection.     

Interest of positron-emission tomography and magnetic resonance imaging for radiotherapy planning and control

Computed tomography (CT) in the treatment position is currently indispensable for planning radiation therapy. Other imaging modalities, such as magnetic resonance imaging (MRI) and positron emission-tomography (PET), can be used to improve the definition of the tumour and/or healthy tissue but also to provide functional data of the target volume. Accurate image registration is essential for treatment planning, so MRI and PET scans should be registered at the planning CT scan. Hybrid PET/MRI scans with a hard plane can be used but pose the problem of the absence of CT scans. Finally, techniques for moving the patient on a rigid air-cushioned table allow PET/CT/MRI scans to be performed in the treatment position while limiting the patient's movements exist. At the same time, the advent of MRI–linear accelerator systems allows to redefine image-guided radiotherapy and to propose treatments with daily recalculation of the dose. The place of PET during treatment remains more confidential and currently only in research and prototype status. The same development of imaging during radiotherapy is underway in proton therapy.     

18F-FDG PET/CT在探测卵巢癌术后复发和转移中的价值

[目的]评价^18F-FDG PET/CT显像在探测卵巢癌术后复发病灶中的应用价值。[方法]采用仪器为Siemens Biograph Sensation 16 PET/CT，43例卵巢癌术后患者禁食4～6h，静脉注射^18F-FDG60min后进行PET/CT检查，采集方式为3D模式。PET/CT图像结果与血清CA125、B超及CT或MRI影像学资料进行比较。并与手术病理或临床随访结果比较判断其诊断的准确性。[结果]FDG PET/CT诊断卵巢癌复发的灵敏度、特异性和准确性分别为92.3%、100%和93.0%。血清CA125水平与FDG PET结果有一定相关性，33例CA125升高患者中31例PET显像阳性，10例CA125正常水平患者中仅有5例PET显像阳性。[结论]当常规影像学检查阴性或可疑时，PET/CT显像对卵巢癌复发的检测具有较高的灵敏度和准确性，特别术后患者CA125升高的情况下，FDG PET/CT有助于探测隐匿性复发或转移病灶，指导进一步的治疗。