18F-FDG PET/CT显像在恶性胸膜间皮瘤诊断中的价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在恶性胸膜间皮瘤(MPM)诊断中的临床价值及原发肿瘤病灶平均标准摄取值(SUVmax)对患者预后的判断价值.方法 回顾性总结17例2002-2008年临床疑诊MPM患者18F-FDG PET/CT显像资料,测量病灶的SUVmax.将病理检查及临床随访证实的MPM患者按照有无转移分为2组,测定每例患者原发肿瘤病灶的SUVmax,用受试者工作特征(ROC)曲线评价SUVmax对患者转移与否的诊断价值,判断预后.采用SPSS 11.0软件进行t检验.结果 经病理及随访结果证实MPM 12例,良性胸膜病变5例,二者的SUVmax分别为5.78±1.81和2.72±2.51,差异有统计学意义(t=2.8,P<0.05).全身18F-FDG PET/CT显像诊断MPM的灵敏度为100%(12/12),特异性为4/5,准确性为94%(16/17),18F-FDG PET/CT显像有7例MPM伴有骨和(或)淋巴结转移.SUVmaxROC曲线分析表明曲线下面积(AUC)为0.80.结论 全身18F-FDG PET/CT显像对于MPM的诊断有重要价值.原发肿瘤病灶SUVmax越高越易发生转移,预后越差.     

Morphologic and functional imaging of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG-PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases.     

Imaging before and after multimodal treatment for malignant pleural mesothelioma

PURPOSE: Computed tomography (CT), magnetic resonance (MR) and positron emission tomography (PET) have a very important role in the diagnosis of malignant pleural mesothelioma (MPM) in the choice of chemoradiotherapy alone or in combination with surgery and in evaluating possible recurrence. It is also essential for assessing the possible benefits of radical surgery (pleuropneumonectomy) in terms of patient survival. MATERIALS AND METHODS: We considered 28 patients suffering from MPM whose mean survival after diagnosis was 15-18 months. Sixteen of these patients had radiotherapy or chemoradiotherapy alone, according to standard protocols, while 12 also underwent surgery. The CT features of MPM were thoroughly examined, as was the role of PET and CT-PET in achieving accurate disease staging and consequent selection of candidates for surgery. RESULTS: Nine of the 12 patients who underwent pleuropneumonectomy had no significant survival advantage over the mean survival in the 16 who were not operated whereas the other three lived 1-3 years longer. Two patients underwent surgery after an optimal response to chemoradiotherapy, but both survived less than a year due to particularly aggressive recurrences. CONCLUSIONS: CT, PET and CT-PET are indicated for diagnosis and, above all, for staging of MPM, in the selection of patients who might benefit from surgery after neoadjuvant therapy and also in identifying small recurrences and/or remote metastases. Being highly specific, PET is essential in the follow-up of patients undergoing chemoradiotherapy alone and/or surgery. Each imaging modality has its advantages and limitations, but their combined use is crucial in determining the most appropriate treatment options for patients with MPM.     

Malignant Peritoneal Mesothelioma Masquerades as Peritoneal Metastasis on 18F-FDG PET/CT Scans; a Rare Diagnosis that Should Not Be Missed

Malignant peritoneal mesothelioma (MPM) is a rare but fatal tumor. The clinical presentations and imaging findings are nonspecific and resemble various diseases, including peritoneal metastasis. Imaging findings of MPH on ¹⁸F-¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) are diverse and not well described. We report the two cases of biopsy-proven MPH using ¹⁸F-FDG PET/CT. In our cases, interesting disease patterns—including MPH arising from visceral peritoneal lining of kidney that suffer from polycystic disease and from the parietal peritoneum beneath the appendectomy scar—were presented. One case showed classical metastases localized within the abdominal cavity; while the other case exhibited the rare pattern of extensive multi-organ metastases. By knowing the possible variations and diagnostic pitfalls of ¹⁸F-FDG PET/CT findings in MPM, more accurate interpretation of such mysterious cancer is attainable.     

Value of contrast CT in combination with PET/CT in mesothelioma staging: Optimal protocol for initial assessment

Purpose

To assess the value of contrast enhanced CT (ceCT) when added to positron emission tomography combined with the standard low-dose non-contrast CT (PET/CT) protocols for staging patients with malignant pleural mesothelioma (MPM).

Motion management in positron emission tomography/computed tomography for radiation treatment planning

Hybrid positron emission tomography (PET)/computed tomography (CT) scanners combine, in a unique gantry, 2 of the most important diagnostic imaging systems, a CT and a PET tomograph, enabling anatomical (CT) and functional (PET) studies to be performed in a single study session. Furthermore, as the 2 scanners use the same spatial coordinate system, the reconstructed CT and PET images are spatially co-registered, allowing an accurate localization of the functional signal over the corresponding anatomical structure. This peculiarity of the hybrid PET/CT system results in improved tumor characterization for oncological applications, and more recently, it was found to be also useful for target volume definition (TVD) and treatment planning in radiotherapy (RT) applications. In fact, the use of combined PET/CT information has been shown to improve the RT treatment plan when compared with that obtained by a CT alone. A limiting factor to the accuracy of TVD by PET/CT is organ and tumor motion, which is mainly due to patient respiration. In fact, respiratory motion has a degrading effect on PET/CT image quality, and this is also critical for TVD, as it can lead to possible tumor missing or undertreatment. Thus, the management of respiratory motion is becoming an increasingly essential component in RT treatment planning; indeed, it has been recognized that the use of personalized motion information can improve TVD and, consequently, permit increased tumor dosage while sparing surrounding healthy tissues and organs at risk. This review describes the methods used for motion management in PET/CT for radiation treatment planning. The article covers the following: (1) problems caused by organ and lesion motion owing to respiration, and the artifacts generated on CT, PET, and PET/CT images; (2) data acquisition and processing techniques used to manage respiratory motion in PET/CT studies; and (3) the use of personalized motion information for TVD and radiation treatment planning.     

Is 18F-FDG PET/CT useful for imaging and management of patients with suspected occult recurrence of cancer?

Rising serum tumor markers may be associated with negative imaging in the presence of cancer. CT and (18)F-FDG PET may yield incongruent results in the assessment of tumor recurrence. The present study evaluates the incremental role of (18)F-FDG PET/CT for the diagnosis and management of cancer patients with increasing levels of tumor markers as the sole indicator of potential recurrence after initial successful treatment. METHODS: Thirty-six cancer patients with increasing levels of tumor markers during follow-up and negative CT underwent (18)F-FDG PET/CT, which showed 111 sites of increased tracer uptake. PET/CT was compared with PET results on a site-based analysis for characterization of (18)F-FDG foci and on a patient-based analysis for diagnosis of recurrence. The clinical impact of PET/CT on further patient management was evaluated. RESULTS: Thirty patients (83%) had recurrence in 85 malignant sites (77%). For the site-based analysis, PET had a sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 96%, 50%, 85%, 85%, and 82%, respectively, as compared with the performance indices of PET/CT of 100%, 89%, 97%, 97%, and 100%, respectively. There was a statistically significant difference between the specificity (P < 0.05) and accuracy (P < 0.001) of PET and PET/CT for precise characterization of suspected lesions. For the patient-based analysis, PET had a sensitivity, specificity, and accuracy of 93%, 50%, and 86%, respectively, as compared with PET/CT with values of 93%, 67%, and 89%, respectively (P = not significant). PET/CT was the single modality that directed further management and treatment planning in 12 patients (33%). CONCLUSION: The results of this study indicate that PET/CT may improve the accuracy of occult cancer detection and further lead to management changes in patients with increasing levels of tumor markers as the sole suspicion of recurrent malignancy.     

^18F—FDG PET／CT在探测头颈部肿瘤治疗后复发及转移中的应用

目的:评价~(18)F-FDG PET/CT在探测头颈部肿瘤治疗后复发及转移的价值,并与单独的PET和CT进行比较。材料和方法:对20例头颈部肿瘤病人行回顾性分析,以病灶为观察对象分析PET/CT、PET及CT对头颈部肿瘤复发转移灶诊断的灵敏性、特异性和准确性,行卡方检验比较诊断差异。结果:20例病人中11例有复发转移,共有105个复发转移灶,其中PET/CT检出102个,遗漏3个病灶;PET检出77个;CT检出68个;PET/CT、PET及CT的诊断灵敏度、特异性和准确性分别为97.1%、100%、97.6%;73.3%、60%、71.2%;64.8%、40%、60.8%。20例病人中的4例因PET/CT的结果而改变治疗方案。结论:PET/CT对治疗后头颈部肿瘤的复发转移灶的诊断准确性高,优于单独的PET或CT,尤其对术后解剖结构紊乱和不愿行活检的病人。PET/CT还能指导临床及时更改治疗方案。     

Unknown primary tumors: detection with dual-modality PET/CT--initial experience

PURPOSE: To retrospectively evaluate fused positron emission tomography (PET)/computed tomography (CT) in depicting the primary lesion in cancer of an unknown primary tumor, compared with PET, CT, and PET and CT side-by-side evaluation. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Forty-five patients (26 men and 19 women) with metastatic cervical adenopathy (n = 18) or extracervical metastases (n = 27) of unknown primary tumor were included. The mean age of the patients was 57 years (range, 29-95 years). PET/CT imaging was performed in all patients 1 hour after administration of 350 MBq of fluorodeoxyglucose with a whole-body field of view. Contrast agents were administered orally and intravenously in all patients to ensure diagnostic CT data. PET/CT data sets were evaluated for the primary tumor, and imaging results were compared with those of CT, PET, and PET and CT side-by-side evaluation. Differences in diagnostic performance were assessed by using the McNemar test with Bonferroni correction, which accounts for multiple comparisons. RESULTS: PET/CT depicted the primary tumor in 15 (33%) of 45 patients. In 30 (67%) patients, the primary tumor site remained occult (P > .05). PET and CT side-by-side evaluation depicted 13 (29%) of 45 tumors (P > .05). PET alone revealed the primary tumor in 11 (24%) of 45 patients (P > .05), while CT alone helped in the correct diagnosis in eight (18%) of 45 patients (P > .05). There were no significant differences between the diagnostic accuracies of PET/CT and the other imaging modalities. CONCLUSION: PET/CT was able to depict more primary tumors, though not significantly, than either of the other imaging modalities, but larger patient cohorts are required to finally judge its value for revealing the primary tumor site.     

The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma

Purpose

Malignant pleural mesothelioma (MPM) is a disease with poor prognosis despite multimodal therapy but there is variation in survival between patients. Prognostic information is therefore potentially valuable in managing patients, particularly in the context of clinical trials where patients could be stratified according to risk. Therefore we have evaluated the prognostic ability of parameters derived from baseline 2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT).

Methods

In order to determine the relationships between metabolic activity and prognosis we reviewed all ¹⁸F-FDG PET/CT scans used for pretreatment staging of MPM patients in our institution between January 2005 and December 2011 (n?=?60) and measured standardised uptake values (SUV) including mean, maximum and peak values, metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Overall survival (OS) or time to last censor was recorded, as well as histological subtypes.

Results

Median follow-up was 12.7 months (1.9–60.9) and median OS was 14.1 months (1.9–54.9). By univariable analysis histological subtype (p?=?0.013), TLG (p?=?0.024) and MTV (p?=?0.038) were significantly associated with OS and SUV_max was borderline (p?=?0.051). On multivariable analysis histological subtype and TLG were associated with OS but at borderline statistical significance (p?=?0.060 and 0.058, respectively). No statistically significant differences in any PET parameters were found between the epithelioid and non-epithelioid histological subtypes.

Conclusion

¹⁸F-FDG PET/CT parameters that take into account functional volume (MTV, TLG) show significant associations with survival in patients with MPM before adjusting for histological subtype and are worthy of further evaluation to determine their ability to stratify patients in clinical trials.     

F-18-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the follow-up of breast cancer with elevated levels of tumor markers

OBJECTIVE: The value of combined positron emission tomography (PET)/computed tomography (CT) in the follow-up of patients with breast cancer with elevated tumor markers but without proven metastases or local recurrence was assessed. METHODS: Thirty-four women underwent PET/CT. The PET and CT images were first analyzed separately; fused findings were then interpreted, blinded to the results of the other modalities. The results of CT, PET, and PET/CT were compared with each other and correlated to the final diagnosis. RESULTS: The PET/CT identified 149 malignant foci in 24 patients (71%). The CT detected 96 of these foci in 18 patients, whereas PET identified 124 foci in 17 patients. Differences between CT and PET were not significant. Differences between PET/CT and CT (P < 0.01) and PET/CT and PET (P < 0.01) were significant. The person-based sensitivity of PET/CT, PET, and CT was 96%, 88% and 96%, respectively. Specificity of PET/CT, PET, and CT was 89%, 78%, and 78%, respectively. CONCLUSIONS: The PET/CT is a valuable modality for the follow-up of patients with breast cancer and elevated levels of tumor markers.     

Incidental Finding of Appendiceal Adenocarcinoma in F-18 FDG PET/CT for Health Screening

F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) that simultaneously offers anatomic and metabolic information is widely used and has become an effective modality in many clinical fields, especially oncology, and also may detect an unexpected primary cancer. Appendiceal carcinoma is relatively uncommon and not associated with characteristic symptoms. We report the case of a 53-year-old man with appendiceal adenocarcinoma, who had only mild fever. The tumor was detected early on F-18 FDG PET/CT for health screening.     

Continued pemetrexed and platin-based chemotherapy in patients with malignant pleural mesothelioma (MPM): value of 18F-FDG-PET/CT

Purpose

To prospectively analyze different FDG-PET/CT-parameters (modified RECIST, SUVmax, TLG, PETvol) in patients with malignant pleural mesothelioma (MPM) under continued pemetrexed and platin based treatment.

Methods

Patients with biopsy proven MPM undergoing treatment with pemetrexed and platin based treatment were prospectively included in the study. Integrated FDG-PET/CT imaging was performed within 2 weeks before therapy and after every three consecutive cycles of combined chemotherapy. All CT-images were evaluated according to the modified RECIST (modRECIST) criteria. All FDG-PET/CT images were analyzed using SUVmax (maximum Standard Uptake Value) according to the EORTC criteria, change in Total Lesion Glycolysis (TLG) and FDG volume (PETvol). Percent change in all parameters compared to the initial, pre-therapeutic and the previous FDG–PET/CT scan. ModRECIST, EORTC guidelines, increase or decrease in TLG and PETvol was correlated with overall survival (OS) using the Log Rank Test.

Results

41 patients with MPM were prospectively included in this study. The median OS of the study population is 439 days (111–1128). 41 patients had initial staging, 41 patients completed 3 cycles, 28 patients completed 6 cycles, 19 patients completed 9 cycles, 11 patients completed 12 cycles, 5 patients completed 15 cycles, 4 patients completed 18 cycles and 1 patient completed 21 cycles of chemotherapy. Chemotherapy was well tolerated up to 21 cycles. SUVmax showed a high variance over time for individual patients and change in SUVmax using EORTC guidelines did not predict OS at any time point. Ongoing morphological response in CT using modRECIST had highest correlation with OS and predicted survival up to the 15th cycle of continued permetrexed and platin based treatment. The correlations of response of the volume based PET parameters (TLG and PETvol) and OS are inferior to the morphological modRECIST parameter.

Conclusion

Permetrexed and platin based treatment in MPM patients can be given over a prolonged time with good tolerance. Therapy response should be assessed by modRECIST in CT but not with SUVmax in FDG-PET. Long term permetrexed and platin therapy should be considered in MPM patients with good tolerance of treatment and ongoing morphological response in CT.     

18-FDG PET/CT在肝癌治疗后AFP升高患者中的应用

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检测肝癌治疗后甲胎蛋白(AFP)升高患者肿瘤复发和(或)转移病灶的价值.方法 原发性肝细胞癌治疗后血清AFP升高患者123例,皆行全身18F-FDG PET/CT显像.所有图像经图像融合后,进行PET/CT融合图像、PET图像和CT图像帧对帧对比分析.肿瘤复发和(或)转移病灶根据病理检查结果、多种影像学诊断及临床随访而确诊.随访时间均>6个月.采用SPSS 11.5软件进行统计学处理,进行X2检验.结果 123例患者中,明确诊断肿瘤复发和(或)转移者111例.18F-FDG PET显像诊断肿瘤复发和(或)转移78例,其灵敏度为70.3%(78/111);18F.FDG PET/CT显像诊断肿瘤复发和(或)转移97例,灵敏度提高至87.4%(97/111,χ2=9.744,P=0.002).18F.FDG PET/CT诊断肝癌复发和转移的特异性、准确性、阳性预测值和阴性预测值分别为83.3%(10/12)、87.0%(107/123)、98.0%(97/99)和41.7%(10/24).9例高分化肝细胞癌患者均确诊为肿瘤复发和(或)转移,18F-FDG PET/CT显像诊断其肿瘤复发和(或)转移5例,灵敏度(5/9)明显低于总体灵敏度(87.4%;χ2=6.616,P=0.01).结论 18F-FDG PET/CT显像在检测原发性肝癌治疗后AFP升高患者肿瘤复发和(或)转移病灶中有较好的应用价值,但高分化肝细胞癌可能出现假阴性.     

FDG PET/CT imaging to rule out extrahepatic metastases before liver transplantation

FDG PET/CT, an established imaging modality for staging and restaging workup of malignancies, also demonstrates increased uptake in infectious or inflammatory conditions, including both infectious and noninfectious granulomatous processes. A 65-year-old man with a history of hepatocellular carcinoma status post-wedge resection and chemoembolization of the primary tumor referred for evaluation of extrahepatic metastases for determining the surgical eligibility for a liver transplantation. The patient underwent FDG PET/CT imaging associated with a separately acquired contrast enhanced CT (CECT) of the chest, abdomen, and pelvis. FDG PET/CT imaging revealed multiple FDG-avid pulmonary nodules that were subsequently confirmed to represent Mycobacterium avium intracellular infection on histology.     

^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.     

FDG PET or PET/CT in Evaluation of Renal Angiomyolipoma

Objective

Angiomyolipoma is the most common benign kidney tumor. However, literature describing FDG PET findings on renal angiomyolipoma (AML) is limited. This study reports the FDG PET and PET/CT findings of 21 cases of renal AML.

Materials and Methods

The study reviews FDG PET and PET/CT images of 21 patients diagnosed with renal AML. The diagnosis is based on the classical appearance of an AML on CT scan with active surveillance for 6 months. The study is focused on the observation of clinical and radiographic features.

Results

Six men and 15 women were included in our study. The mean age of the patients was 57.14 ± 9.67 years old. The mean diameter of 21 renal AML on CT scans was 1.76 ± 1.00 cm (Min: 0.6 cm; Max: 4.4 cm). CT scans illustrated renal masses typical of AMLs, and the corresponding FDG PET scans showed minimal FDG activities in the area of the tumors. None of the 21 AMLs showed a maximum standardized uptake value (SUV_max) greater than 1.98. No statistically significant correlation was present between SUV_max and tumor size.

Conclusion

Renal AMLs demonstrate very low to low uptake on FDG PET and PET/CT imaging in this study. When a fat-containing tumor in the kidney is found on a CT scan, it is critical to differentiate an AML from a malignant tumor including an RCC, liposarcoma, and Wilms tumor. This study suggests that FDG PET or PET/CT imaging is useful for differentiating a renal AML from a fat-containing malignant tumor.     

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.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.