18F-FDG PET显像在判断胰腺占位性质和术后随访的价值

目的评价18F-FDG PET显像在判断胰腺占位性质和肿瘤术后随访中的作用.方法检查33例胰腺疾病患者,以18F-FDG显像.结果 23例胰腺占位性病变PET检查发现14例胰腺高代谢区(SUV 3.1～6.8),其中3例伴多发性肝转移,1例肝转移伴腹膜后淋巴结转移;2例CT诊断为胰腺癌合并肝转移经检查显示胰腺高代谢区,但肝脏无阳性表现; 1例左肺中部稍高代谢区(SUV 1.31),诊断为良性结节,经随访证实.3例因发现其他部位转移寻找原发灶,PET见胰腺放射性浓聚影.5例胰腺癌术后PET发现1例肝脏、腹腔淋巴结转移.结论 18F-FDG PET显像对胰腺占位定性、鉴别诊断和术后随访具有重要的价值.     

晚期帕金森病患者^18F—脱氧葡萄糖PET脑影像学特征的研究

目的探讨晚期帕金森病(PD)患者静止期18F-脱氧葡萄糖(FDG)PET的脑影像学特征及其意义.方法对8例双侧症状的晚期帕金森病患者(男5例,女3例;平均年龄64.5±3.7岁;H-Y分级4.1±0.5)和8例正常人(对照组),经静脉注射FDG后行脑造影断层显像,获得脑局部葡萄糖代谢图像,通过SPM99统计学软件进行数据分析,比较两组之间脑内代谢的差异.结果与正常人相比,帕金森病患者双侧丘脑、中央前回皮质(BA6)以及豆状核代谢增加(P＜0.001);前额叶运动区(BA46)以及顶枕部代谢减低(P＜0.001).结论帕金森病患者丘脑、豆状核代谢增加,其相应的前额叶运动区以及顶枕部代谢减低,帕金森病的这一脑内代谢特点有助于帕金森病的辅助诊断及对其发病机制的探讨.     

~(18)F氟脱氧葡萄糖正电子发射断层显像鉴别阿尔茨海默病和额颞叶痴呆的价值

目的探讨~(18)F-氟脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像(positron emission tomography,PET)/CT对阿尔茨海默病(AD)和额颞叶痴呆(FTD)的鉴别诊断价值。方法回顾性分析临床诊断为AD 20例和FTD 10例的~(18)F-FDG PET/CT脑代谢显像资料,采用脑代谢影像进行视觉分析,测量相应部位的标准摄取值(standard up take value,SUV),以小脑为参考脑区,以放射性摄取减低脑区的SUV与小脑SUV的比值(SUVr)表示。采用NeuroQ脑分析软件进行定量分析其代谢模式特点。结果 20例AD患者视觉分析显示,16例(80.0%)伴有双侧顶叶代谢减低,8例(40.0%)伴有双侧颞叶代谢减低,5例(25.0%)伴有单侧额叶代谢减低,2例(10.0%)伴有单侧颞叶代谢减低;定量分析显示,全部患者(100.0%)均伴有双侧顶叶代谢减低,18例(90.0%)伴有后扣带回代谢减低,17例(85.0%)伴有双侧颞叶代谢减低,7例(35.0%)伴有单侧额叶代谢减低。10例FTD患者视觉分析显示,8例(80.0%)患者伴有颞叶代谢减低,6例(60.0%)患者伴有额叶代谢减低,3例(30.0%)伴有双侧顶叶代谢减低;定量分析显示,10例患者(100.0%)均伴有额叶代谢减低,8例(80.0%)伴有颞叶代谢减低,4例(40.0%)伴有双侧顶叶代谢减低,4例(40.0%)伴有基底节代谢减低,3例(30.0%)伴有后扣带回代谢减低。AD患者和FTD患者额叶、顶叶和颞叶SUVr比较,差异有统计学意义(1.08±0.13 vs 0.75±0.09,0.78±0.14 vs 1.06±0.05,0.81±0.14 vs 0.95±0.12,P<0.01)。结论 ~(18)F-FDG PET/CT脑显像显示的AD和FTD患者不同的代谢减低模式,有助于临床进行鉴别诊断。     

PET-CT显像在直肠癌术后局部复发诊断中的价值

目的评价^18F-脱氧葡萄糖（FDG）PET—CT定性及半定量显像技术在直肠癌术后局部复发诊断中的临床价值。方法对20例临床可疑直肠癌术后局部复发的患者行全身^18F—FDGPET—CT显像，将显像结果与病理组织学及临床随访结果对比。结果病理组织学及临床随访证实，局部复发15例。采用定性方法诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、60％。采用半定量法显示恶性肿瘤的标准摄取值（SUV，范围为2．7～17．2，平均9．9）明显高于良性病变者（SUV为1．3～4．0，平均2．6），诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、80％。结论全身^18F—FDGPET-CT显像有利于直肠癌术后局部复发的定性及定位诊断；半定量方法较定性法更具有特异性。     

18F-FDG符合探测正电子显像对淋巴瘤的临床应用研究

目的探讨氟[     

^18F-FDG PET／CT显像监测卵巢癌患者术后复发／转移的临床价值分析

目的 探讨18-氟代脱氧葡萄糖（^18F-FDG）PET／CT显像在卵巢癌术后监测中的价值。方法回顾性分析19例卵巢癌术后患者的全身PET／CT显像结果,并以病理和随访诊断结果为标准计算其诊断卵巢癌复发／转移的灵敏度、特异性等。结果 “F-FDGPET／CT显像预测卵巢癌术后复发／转移的灵敏度为100．O％（14／14）、特异性为60．0％（3／5）、阳性预测值为87．5％（14／16）、阴性预测值为100．O％（3／3）。结论”F-FDGPET／CT显像对监测卵巢癌术后复发／转移的价值优于传统影像学方法,与血清癌胚抗原（CAl25）联合检查可早期检出复发／转移灶。     

~(18)F-氟化钠正电子发射断层显像和CT对动脉粥样硬化易损斑块检测价值的初步探讨

目的应用兔动脉粥样硬化模型,联合正电子发射断层显像(PET)和CT血管造影检查,比较~(18)F-氟化钠(~(18)F-NaF)和~(18)F-氟脱氧葡萄糖(~(18)F-FDG)对动脉粥样硬化斑块微钙化的检测价值。方法选择雄性新西兰大白兔18只,采用球囊拉伤的方法制作动脉粥样硬化模型,术前2周及术后高脂饲料喂养。手术过程由于球囊拉伤血管破裂或术后感染死亡4只,共14只在第16周末接受PET/CT显像、病理及血液采集,其中2只未发现明显粥样硬化斑块及微钙化形成。取病变部位和邻近部位做钙化染色及免疫组织化学染色,比较2种显像最大标准化摄取值(SUVmax),分析钙化和炎症与PET显像的关系。结果病变部位与对照部位~(18)F-FDG的SUVmax比较,差异无统计学意义(P0.05)。与对照部位比较,病变部位~(18)F-NaF的SUVmax明显升高(P0.05)。病变部位~(18)F-NaF的SUVmax与Von kossa及茜素红阳性面积百分比呈正相关(r=0.865,P0.01;r=0.880,P0.01),病变部位~(18)F-FDG的SUVmax与Von kossa及茜素红不相关(r=-0.272,P0.05;r=-0.085,P0.05)。~(18)F-NaF的SUVmax与病变部位CD68阳性面积百分比相关(r=0.714,P0.01),但~(18)F-FDG的SUVmax与病变部位CD68阳性面积百分比不相关(r=-0.405,P0.05)。结论 ~(18)F-NaF较~(18)F-FDG能够更准确地用于检测微钙化,并进一步发现易损斑块,可用于冠心病的诊断和预防。     

18F-FDG显像和CEA、CA242联合诊断结、直癌术后复发临床研究

对52例结、直肠癌术后可疑复发或转移的患者行^18F-脱氧葡萄糖（FDG）双探头符合线路显像，同时检测癌胚抗原（CEA）、糖蛋白（CA242），并与同期CT、核磁共振（MR）、B超影像进行对比。经^18F—FDG显像发现复发患者36例，1例CEA明显升高而FDG显像未见异常，经CT和MR发现复发，行手术切除为黏液癌。提示“^18F-FDG显像联合血肿瘤标志物检测能明显提高结、直肠癌复发的检出率。     

基于~(18)F-氟脱氧葡萄糖正电子发射断层显像/CT探讨炎症在兔腹主动脉瘤进展中的作用

目的利用18F-氟脱氧葡萄糖(18F-FDG)正电子发射断层显像(PET)/CT扫描,探讨兔腹主动脉瘤进展与炎症的关系。方法 20只新西兰雄白兔给予弹力蛋白酶腔内灌注,制备肾下腹主动脉瘤模型,术后2周和4周各取10只白兔行超声、PET/CT扫描,耳缘静脉采血后处死,检测基质金属蛋白酶(MMP)-2及MMP-9,留取动脉组织标本进行病理及免疫组织化学染色,计算最大标准化摄取值(SUVmax)及标准化靶-本底比。结果与术前比较,术后2周动脉瘤最大直径增长率为(89.21±0.02)%;与术后2周比较,术后4周动脉瘤最大直径增长率为(15.80±0.01)%。与术前比较,术后2周MMP-2、MMP-9明显升高(P0.05);与术后2周比较,术后4周MMP-2、MMP-9明显降低(P0.05)。术后4周SUVmax较术后2周明显降低(0.35±0.05 vs 0.90±0.03,P0.05)。术后2周巨噬细胞染色面积百分比明显高于术后4周(P0.05)。结论炎症在腹主动脉瘤早期进展中起重要作用。     

2型糖尿病患者氟-18标记脱氧葡萄糖心肌代谢显像图像质量与相关代谢因素的分析

目的 探讨2型糖尿病患者氟-18标记脱氧葡萄糖(18FDG)心肌代谢显像图像质量与相关代谢因素的关系. 方法 70例年龄≥60岁的2型糖尿病并存冠心病患者,行18F-FDG心肌代谢显像.并于显像当日测定血糖、糖化血红蛋白(HbA1c)、胰岛素和C肽、总胆固醇、三酰甘油、低密度脂蛋白胆同醇和高密度脂蛋白胆固醇等指标,计算HOMA胰岛素抵抗指数和HOMA胰岛β细胞功能指数.图像质量评定采用评分法. 结果与图像质量不佳组(36例)比较,图像质量良好组(34例)的患者年龄较小,分别为(62.2±8.5)岁和(67.6±8.3)岁(P<0.01);体质指数(body massindex,BMI)较小,分别为(24.7±2.6)kg/m2和(26.1±2.5)kg/m2(P<0.05);空腹胰岛素和C肽水平明显降低,分别为8.3(5.1～12.4)mlu/L和12.2(6.1～17.9)mlu/L(P<0.05)、0.6(0.5～0.9)nmol/L和0.9(0.6～1.2)nm01/L(P<0.05).图像质量好组HOMA胰岛素抵抗指数低于图像质量不佳组,分别为2.7(1.6～4.0)和4.1(1.7～6.5)(P<0.05).Logistic回归分析显示,肥胖是图像质量不佳的独立因素,校正其它代谢指标后的OR值为3.73(95%CJ为1.12～12.45,P<0.05).年龄也是影响图像质量的危险因素,大于65岁的OR值为4.64(95%CI,1.46～14.7,P<0.05),校正BMI等因素后OR值为3.75(95%CI,0.96～14.6,P>0.05) 结论影响2型糖尿病患者18F-FDG心肌代谢显像图像质量的主要代谢因素是胰岛素抵抗,此外年龄、肥胖也是影响图像质量的重要因素.     

FDG PET与增强CT异机融合图像在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值

目的 探讨FDG PET与增强CT（CECT）异机融合技术在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值.方法 回顾性分析2010年9月至2013年10月在上海长海医院行CECT和常规PET/CT检查的70例胰腺病患者的资料,其中男性45例,女性25例,中位年龄57岁;恶性50例,良性20例.使用西门子Multimodality Workplace TureD软件获得PET/CECT异机融合图像.以病理及临床影像随访结果作为标准,比较CECT、PET/CT、PET/CECT异机融合图像对胰腺病变鉴别诊断以及胰腺癌分期的效能.结果 CECT、PET/CT、PET/CECT异机融合在胰腺病灶良恶性诊断方面的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确率和Kppa值分别为82.0％、65.0％、85.4％、59.1％、77.1％及0.465; 92.0％、65.0％、86.8％、76.5％、84.2％及0.597; 96.0％、90.0％、96.0％、90.0％、94.3％及0.860,其中CECT与PET/CECT诊断良恶性病变的敏感性、NPV及准确率的差异有统计学意义（P值均＜0.05）.31例胰腺癌经手术证实,其中15例发现伴胰周血管侵犯,3种检查方法诊断的敏感性、特异性、PPV、NPV和准确率分别为93.3％、93.7％、93.3％、93.8％及93.5％;26.7％、75.0％、50.0％、52.2％及51.6％;93.3％、93.7％、93.3％、93.8％及93.5％,其中PET/CT与CECT、PET/CECT诊断胰周血管侵犯的敏感性、PPV、NPV及准确性的差异有统计学意义（P值均＜0.05）.19例病理证实有区域淋巴结转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为63.2％、91.7％、92.3％、61.1％及74.2％; 78.9％、83.3％、88.2％、71.4％及80.6％; 89.5％、91.7％、94.4％、84.6％及90.3％,差异均无统计学意义.50例恶性病变中17例经组织学或临床随访证实有远处转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为58.8％、100％、100％、82.5％及86％;82.4％、91.0％、82.4％、90.9％及88％;94.1％、97.0％、94.1％、97.0％及96.0％,     

18F-FDG PET/CT诊断转移性甲状旁腺癌一例

患者男性,47岁,于1989年诊断为甲状旁腺癌(当时主因下颌骨肿胀就诊,手术病理证实为棕色瘤,结合患者无症状高钙血症诊断为原发甲状旁腺功能亢进(甲旁亢),行甲状旁腺腺瘤切除术后,患者血钙恢复正常.甲状旁腺癌以骨骼病变为首发症状的不多见.因术后再次出现高血钙,二次手术发现颈部淋巴结转移故诊断为甲状旁腺癌,行颈部淋巴结清扫术后血钙再次恢复正常.     

18F‐FDG PET/CT influences management in patients with known or suspected pancreatic cancer

Background: The aims of this study were (i) to assess and validate the incremental information of positron emission tomography/computed tomography (PET/CT) over conventional staging investigations (CSI) and (ii) to assess the management impact of PET/CT in patients with known or suspected pancreatic cancer. Methods: Between October 2007 and September 2008, 22 PET/CT scans were performed using a dedicated PET/CT scanner in 21 patients with known or suspected pancreatic cancer. Follow up was used to reconcile discordance between PET/CT and CSI. The pre‐PET/CT management plan and/or intent were prospectively recorded in all scans. The post‐PET/CT management plan was determined from the medical record and/or discussions with treating clinicians. The management impact of PET/CT was classified as high, medium, low or none defined using Australian and New Zealand Association of Physicians in Nuclear Medicine PET data collection project criteria. Results: PET/CT and CSI were discordant in 14/22 (64%: 95% CI; 43–84%) scans. Of the 14 discordant scans, PET/CT assessment was correct in eight, conventional imaging in four and there was insufficient information in two. Overall, PET/CT management impact was classified as high (n= 6), medium (n= 3), low (n= 9) or none (n= 4). Significant changes in management (high or medium impact) were induced by PET/CT in 9/22 scans (41%: 95% CI; 20–62%) predominantly by correctly modifying the disease extent. Conclusion: PET/CT has an incremental benefit over CSI and has a significant impact on management in patients with known or suspected pancreatic cancer. PET/CT merits consideration as part of the non‐invasive evaluation of patients with known or suspected pancreatic cancer.     

Technical limits of PET/CT with 18FDG in prostate cancer

There is increasing evidence that (18)FDG-PET is not useful for the imaging of primary prostate cancer. The aim of this examination was to prove whether or not these poor results are due to technical deficiencies of the examination method like older image reconstruction techniques, extensive (18)FDG-tracer activity in the bladder or improper contrast staining of the rectum. We examined three patients with primary prostate cancer using a modern combined PET/CT system, continuous irrigation of the bladder and an air-inflated rectal balloon catheter. PET/CT images show an exact depiction of both the prostate and all surrounding anatomic structures but no enhanced uptake of radiotracer in the tumour. Therefore, the mentioned poor results of (18)FDG-PET seem not to be due to technical deficiencies.     

谐波造影增强超声内镜技术在胰腺占位性疾病中的诊断作用研究

目的探讨谐波造影增强超声内镜技术（CEH—EUS）在胰腺占位性疾病中的诊断作用。方法选择胰腺疾病患者为检查对象,以EUS—FNA或组织病理学结果以及随访结果为最终诊断,评价CEH—EUS诊断胰腺疾病的准确性,并分析CEH—EUS检查下受检部位的增强情况,包括增强顺序、增强时向特点、增强模式分级以及静脉洗脱程度。结果共23例胰腺疾病患者入选本研究,经FNA和（或）组织病理确诊,13例为胰腺癌,7例为慢性胰腺炎,2例为胰管内乳头状产黏蛋白肿瘤,1例为胰腺微囊型浆液性囊腺瘤。CEH—EUS诊断准确率为95．65％,明显高于普通EUS诊断准确率（78．2％）。其中CEH—EUS显示13例胰腺癌病灶增强晚于周围组织或与周围组织同步,呈不均匀低增强或存在充盈缺损区域,无显著达峰表现,消退明显早于周围组织。慢性胰腺炎等良性胰腺疾病病灶处增强与周围组织基本同步,充盈均匀,消退与周围组织同步。结论CEH—EUS在胰腺疾病的诊断中可以安全、简便、准确地显示病灶血供情况,不仅可成为EUS—FNA的有力补充,同时为胰腺疾病的鉴别诊断提供了直接且有效的帮助。     

18FDG PET/CT在非小细胞肺癌疗效评估及预后的价值

PET/CT实现了CT解剖结构与PET代谢信息的融合,提高了肺癌诊断的敏感性及特异性,已经广泛用于肺癌的TNM分期.越来越多研究显示它在评估肺癌化放疗疗效及判断预后也有应用前景.目前研究示18FDG PET/CT可以早期准确评估肺癌患者化放疗后疗效,但PET机型,疗效评估最佳时间及评价标准尚未统一.回顾性研究提示原发肿瘤的标准摄取值(standard uptake value,SUV)可能是肿瘤生物侵袭性的预后因子,但需大样本的前瞻性研究证实,并探讨其潜在细胞机制及确定其作为预后的18FDG摄取阈值.     

F-18FDGPET／CT在肺癌诊断中的应用价值

据世界卫生组织（World Health Organization．WHO）统计,每年肺癌的新增病例及死亡病例数在26种常见恶性肿瘤中居首位,且5年生存率低于15％。在我国,原发性肺部恶性肿瘤主要是原发性支气管肺癌,居肿瘤死亡率之首,即使早期非小细胞肺癌在手术后进行化疗,其5年生存率也仅为40％左右。     

Human adipose tissue glucose uptake determined using [18F]-fluoro-deoxy-glucose ([18F]FDG) and PET in combination with microdialysis

Aims/hypothesis: To determine the lumped constant (LC), which accounts for the differences in the transport and phosphorylation between [¹⁸F]-2-fluoro-2-deoxy-d-glucose ([¹⁸F]FDG) and glucose, for [¹⁸F]FDG in human adipose tissue. Methods: [¹⁸F]FDG-PET was combined with microdialysis. Seven non-obese (29 ± 2 years of age, BMI 24 ± 1 kg/m²) and seven obese (age 32 ± 2 years of age, BMI 31 ± 1 kg/m²) men were studied during euglycaemic hyperinsulinaemia (1 mU/kg · min^–1 for 130 min). Abdominal adipose tissue [¹⁸F]FDG uptake (rGU_FDG) and femoral muscle glucose uptake were measured using [¹⁸F]FDG-PET. Adipose tissue perfusion was measured using [¹⁵O]-labelled water and PET, and interstitial glucose concentration using microdialysis. Glucose uptake (by microdialysis, rGU_MD) was calculated by multiplying glucose extraction by regional blood flow. The LC was determined as the ratio of rGU_FDG to rGU_MD. Results: Rates of adipose tissue glucose uptake (rGU_MD) were 36 % higher in the non-obese than in the obese patients (11.8 ± 1.7 vs 7.6 ± 0.8 μmol/kg · min^–1, p < 0.05, respectively) and a correlation between rGU_MD and rGU_FDG was found (r = 0.82, p < 0.01). The LC averaged 1.14 ± 0.11, being similar in the obese and the non-obese subjects (1.01 ± 0.15 vs 1.26 ± 0.15, respectively, NS). Muscle glucose uptake was fourfold to fivefold higher than adipose tissue glucose uptake in both groups. Conclusion/interpretation: [¹⁸F]FDG-PET seems a feasible tool to investigate adipose tissue glucose metabolism in human beings. Direct measurements with [¹⁸F]FDG-PET and microdialysis suggest a LC value of 1.14 for [¹⁸F]FDG in human adipose tissue during insulin stimulation and the LC does not appear to be altered in insulin resistance. Furthermore, the obese patients show insulin resistance in both adipose tissue and skeletal muscle. [Diabetologia (2001) 44: 2171–2179] Received: 10 May 2001 and in revised form: 29 August 2001