18F-FDG PET/CT显像在非小细胞肺癌淋巴结转移及分期中的应用

目的 对比^18F—FDG PET／CT和CT评价非小细胞肺癌（NSCLC）患者淋巴结转移及分期（N分期）的价值。方法 回顾性分析68例行根治性手术治疗的NSCLC患者资料（术前同期行增强CT和^18F—FDG PET／CT检查，术中清扫各站淋巴结），根据其术后病理检查结果，结合影像学诊断，比较CT和PET／CT对肺癌淋巴结转移的诊断价值及确定N分期的准确性。结果 CT和PET／CT诊断纵隔淋巴结转移的灵敏度、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为63．6％，64．6％，64．3％，47．7％，77．8％与87．9％，87．7％，87．8％，78．4％，93．4％，差异均有统计学意义（P〈0．05）；CT与PET／CT诊断N分期的准确性分别为54．4％和76．5％，两者差异有统计学意义（P〈0．05）。结论 ^18F—FDG PET／CT在诊断NSCLC纵隔淋巴结转移方面的临床价值高于CT，能够更准确地确定N分期，指导治疗方案的选择。     

18F-FDG PET/CT双时相显像对孤立性肺结节的诊断价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT双时相显像对孤立性肺结节（SPN）的诊断价值。方法31例SPN待查患者行^18F—FDGPET／CT双时相显像，计算标准摄取值（SUV），随访时间5～17个月。结果19例患者（61．3％）有病理学诊断结果，其余为临床诊断。肺癌患者结节的延迟相平均SUV明显高于早期相，早期相和延迟相最大SUV间无差异；单纯以平均SUV变化幅度[ASUV平均=（SUV延迟-SUV早期）／SUV早期×100％]≥15％为诊断肺癌的标准，灵敏度为81．8％，特异性为77．8％，准确性为80．6％；PET／CT综合的诊断灵敏度为95．5％，特异性为85．7％，准确性为87．1％。单纯以ASUV平均≥15％为标准，诊断肺癌的阳性预测值和阴性预测值分别为90．0％和63．6％；以ASUV平均≥15％伴结节放射性高于纵隔血池为标准，阳性预测值和阴性预测值分别为93．3％和85．7％。结论^18F—FDGPET／CT双时相显像鉴别诊断SPN的良恶性有一定的临床价值，其与临床表现结合诊断准确性较高。     

18F-FDG PET/CT结合高分辨率CT对孤立性肺结节的诊断价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT结合高分辨率CT（HRCT）对孤立性肺结节（SPN）的鉴别诊断价值。方法25例经手术病理检查或治疗随访证实的SPN（共27个）患者，同期行^18F—FDGPET／CT显像和病灶部位HRCT检查。^18F—FDGPET／CT用目测法结合半定量法判断良恶性。HRCT则根据病灶形态学特征判断良恶性。所得^18F—FDGPET／CT结果和^18F—FDGPET／CT与HRCT相结合结果分别与病理检查结果对照比较。结果27个SPN中15个恶性，12个良性。PET／CT正确诊断14个恶性和9个良性SPN。3个良性SPNPET／CT显像为阳性，其中2个经PET／CT和HRCT联合诊断为良性。联合诊断灵敏度和单纯PET／CT相同（93．3％），但特异性、阳性预测值、阴性预测值、准确性分别高于PET／CT（91．7％、93．3％、91．7％和93．7％对75．0％、82．4％、90．0％和85．2％）。结论^18F—FDGPET／CT结合HRCT是有效的无创性鉴别SPN良恶性的方法。     

^18F-FDG PET／CT显像诊断妇科肿瘤复发、转移的价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像诊断妇科肿瘤复发、转移的价值,并评价其对临床再分期及治疗决策的影响。方法对47例临床可疑复发、转移的妇科肿瘤患者行^18F—FDG PET／CT显像,对PET、CT及PET／CT图像进行对比分析。采用SPSS12．0软件,对数据行∥检验、校正的,检验及确切概率法分析。结果47例患者中共发现病灶158处,其中恶性病灶149处,良性病灶9处。^18F-FDG PET／CT诊断妇科肿瘤复发、转移的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为95．97％（143／149）,6／9,94．30％（149／158）,97．95％（143／146）及50．00％（6／12）。PET／CT在诊断妇科肿瘤复发、转移的灵敏度、准确性及阴性预测值方面明显优于单纯CT（χ^2=18．198,18．890,6．825,P均〈0．05）;^18F-FDG PET／CT和单纯PET在各项诊断效能指标间差异无统计学意义（χ^2=0．632,0．000,0．459,0．000,0．150,P均〉0．05）,但PET／CT使33．54％（53／158）的单纯PET无法准确定位的病灶得到了准确定位。同单纯CT及PET相比,PET／CT分别使44．68％（21／47）和31．91％（15／47）的患者TNM分期改变,对T分期的影响最明显;共有19．15％（9／47）的患者临床分期改变,并改变相应的治疗决策。结论^18F—FDG PET／CT显像诊断妇科肿瘤复发、转移准确而全面,对临床再分期及治疗决策有重要影响。     

18F-FDG符合线路显像在食管癌术前分期中的价值

目的 探讨^18F-FDG符合线路显像在食管癌术前分期中的价值。方法 35例食管癌患者术前行^18F—FDG符合线路显像及CT检查，其中30例行手术治疗，以术后病理检查结果作为“金标准”，比较^18F—FDG符合线路显像及CT检查对原发肿瘤、淋巴结及远处转移（TNM）分期的价值；另5例发现远处转移，放弃手术治疗。结果 ^18F-FDG符合线路显像T分期与病理T分期比较符合率为63％（19／30）；^18F-FDG与CT探测淋巴结病变的灵敏度为60．00％和54．28％，特异性为94．44％和77．77％，准确性为84．80％和71．20％，阴性预测值为85．86％和81．39％，阳性预测值为80．77％和48．72％，其中特异性、准确性及阳性预测值差异有统计学意义。^18F—FDG符合线路显像发现5例远处转移，改变了其治疗方案。结论 ^18F-FDG符合线路显像对食管癌的术前分期、治疗方案的制定有临床应用价值。     

多层螺旋CT和正电子发射计算机体层成像-CT评价乳腺癌腋窝淋巴结状态的对照研究

目的探讨多层螺旋CT（MSCT）、正电子发射计算机体层成像-CT（PET-CT）评价乳腺癌腋窝淋巴结转移的价值。方法手术病理证实的乳腺癌患者40例均行MSCT增强扫描，其中的13例行^18F脱氧葡萄糖（^18F-FDG）PET—CT检查。3名医师分别采用5分评价法对CT图像中淋巴结进行综合评分，≥3分时该淋巴结记录为阳性（淋巴结有转移），〈3分时记录为阴性。采用目测法和半定量分析法相结合分析PET—CT图像所显示的淋巴结，分别作阴、阳性记数。将PET-CT、增强MSCT对腋窝淋巴结的检出结果与手术病理结果进行对照。用精确概率法对结果进行统计学分析。结果40例患者行MSCT检查共检出腋窝淋巴结158枚，其中CT阳性计数91枚，阴性计数67枚；术后病理阳性99枚，阴性59枚。13例行PET-CT检查者共检出腋窝淋巴57枚，PET-CT显像阳性39枚，阴性18枚；术后病理阳性39枚，阴性18枚。CT对腋窝淋巴结转移定性的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为88．89％、94．91％、91．14％、96．70％和83．58％；PET-CT分别为97．44％、94．44％、96．49％、97．44％和94．44％。CT与PET-CT对腋窝淋巴结转移定性的敏感性、特异性、准确性和阳性预测值差异无统计学意义（P〉0．05）；但PET-CT的阴性预测值高于MSCT，二者之间差异有统计学意义（P〈0．05）。结论CT、PET-CT都能准确评价乳腺癌腋窝淋巴结的状态，但PET-CT检测腋窝淋巴结的阴性预测值高于MSCT，PET-CT能在术前更准确评价乳腺癌患者腋窝淋巴结状态。     

^18F-FDG PET／CT在胰腺癌诊断中的价值

目的评价^18F-脱氧葡萄糖（FDG）PET／CT鉴别诊断胰腺良恶性病变及检测淋巴结和（或）远处转移的价值。方法回顾性分析上海交通大学医学院附属仁济医院行^18F—FDGPET／CT检查的46例临床疑胰腺肿瘤患者的影像学检查资料和临床资料,其中胰腺癌患者26例,良性病变者20例,比较分析PET和CT的特征。结果当选择最大标准摄取值（SUVmax）=2．95为判断良恶性的界值时,对胰腺癌诊断的灵敏度是88．5％（23／26）,特异性是85．0％（17／20）。^18F—FDGPET／CT显像假阳性3例,假阴性3例。同时发现16例检查前未确定的肝、肺、骨及淋巴结转移患者。根据显像结果,11例患者治疗方案得以修正。结论根据现有资料分析,^18F—FDGPET／CT是鉴别诊断胰腺良恶性病变及检测胰腺癌患者淋巴结和（或）远处转移一种较好的方法。     

PET/CT显像在恶性肿瘤治疗中的临床意义

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像在恶性肿瘤治疗中的临床价值。方法选取行^18F—FDG PET／CT显像、最终经病理检查或临床诊断为恶性肿瘤（除脑肿瘤外）的患者96例，所有患者检查前未进行抗癌治疗。采用美国GE Discovery LS PET／CT仪，在PET／CT扫描床上进行CT模拟定位，指导勾画放射治疗靶区。用SPSS 10．0软件进行统计学处理。结果①^18F—FDG PET／CT检查的灵敏度为97．92％；PET／CT检查后45．83％的患者肿瘤分期发生了改变；淋巴转移与脏器和（或）其他转移分别增多了37．50％和23．96％。②PET／CT检查后36．46％的患者改变了原治疗方案。③PET／CT融合图像显示肿瘤的大小、边界及与周围组织结构的关系清楚，能为放疗准确提供生物靶区定位，为外科手术提供切除范围，临床随访效果满意。结论PET／CT可用于肿瘤的早期诊断、准确分期和协助制定治疗方案，指导放射治疗生物靶区定位和确定手术切除范围。     

18F-FDG PET/CT对非小细胞肺癌术前T及N分期的价值

目的 比较^18F—FDG PET／CT与CT在非小细胞肺癌（NSCLC）原发灶（T）及淋巴结（N）分期中的价值。方法 以术后病理诊断为标准，比较30例NSCLC患者^18F-FDG PET／CT与CT在T及N分期中的诊断效能。结果 ^18F—FDG PET／CT和CT在T分期中准确性分别为86．7％，73．3％（P〉0．05）；对115站胸内淋巴结的诊断灵敏度、特异性及准确性分别为68．8％，95．2％，87．8％和43．8％，88．0％，75．7％，2种方法准确性差异有统计学意义（P〈0．05）；对65站纵隔淋巴结诊断灵敏度、特异性、准确性分别为90．5％，97．7％，95．4％和57．1％，81．8％，73．8％，2种方法准确性差异有统计学意义（P〈0．01）；在N分期中准确性分别为76．7％，66．7％（P〉0．05）。结论 ^18F—FDG PET／CT融合图像较CT更有助于NSCLC术前T和N分期，尤其在纵隔淋巴结的诊断中明显优于CT。     

鼻咽癌PET/CT影像表现及临床价值

目的研究鼻咽癌及其颈部淋巴结转移的PET／CT影像表现。方法初诊鼻咽癌患者51例、鼻咽部炎症患者14例及鼻咽癌治疗后患者36例。皆行^18F-脱氧葡萄糖（FDG）PET／CT显像。鼻咽部炎症患者和鼻咽癌治疗后患者临床随访时间皆〉6个月，淋巴结随访时间6～14个月。结果①51例鼻咽癌初诊患者和14例鼻咽部炎症患者的PET和CT影像表现差异明显。以鼻咽部软组织肿块（或组织增厚）处PET呈结节状、块状代谢增高为鼻咽癌PET／CT诊断标准，则灵敏度为96．0％，特异性为85．7％。PET／CT在鼻咽癌病灶的定位、病灶边界的确定及显示病灶对周围组织的侵犯方面优于PET和CT。②36例鼻咽癌治疗后患者，以鼻咽部软组织肿块（或组织增厚）处PET呈结节状或块状代谢增高为PET／CT诊断鼻咽癌复发、残余的标准，而以鼻咽部组织增厚作为CT诊断鼻咽癌复发、残余的标准，则PET／CT和CT对复发、残余病灶的检出灵敏度分别为84．6％和92．3％．特异性分别为91．3％和56．5％，假阳性率分别为8．6％和43．4％。③87例鼻咽癌患者中，6l例有颈部淋巴结增大，PET／CT和MRI诊断淋巴结转移的灵敏度分别为91．8％和88．8％（P〉0．05），特异性分别为82．2％和51．1％（P〈0．05）。结论PET／CT显像在诊断鼻咽癌及其淋巴结转移和复发方面优于单纯PET和CT。     

CT及18F-FDGPET/CT诊断食管癌术前淋巴结转移及N分期对比研究

目的 研究CT及18F-氟脱氧葡萄糖(FDG) PET/CT术前诊断食管癌淋巴结转移及确定N分期的价值.资料与方法 连续随机选择经食管镜或胃镜证实、拟行手术治疗、能够耐受手术的47例食管癌患者,术前1周内行CT及18F-FDG PET/CT检查,以术后病理为“金标准”,比较CT及18F-FDG PET/CT诊断食管癌淋巴结转移及N分期的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 31例存在淋巴结转移,共切除并分离淋巴结387枚(209组),其中65枚(46组)发现转移.CT诊断淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为53.8％、92.8％、86.3％、60.3％和90.9％;18F-FDG PET/CT分别为89.2％、93.8％、93.0％、74.4％和97.7％.PET/CT诊断淋巴结转移的敏感性、准确性及阴性预测值均显著高于CT,差异有统计学意义(P＜0.05),特异性及阳性预测值差异无统计学意义(P＞0.05).CT及18F-FDG PET/CT确定淋巴结分期的准确率分别为74.5％和91.5％,差异有统计学意义(P＜0.05).伴淋巴结转移的食管癌原发灶最大标准摄取值(SUVmax)为( 14.899±3.770),而无淋巴结转移者为(9.427±2.854).结论 18F-FDGPET/CT术前诊断食管癌淋巴结转移及确定N分期优于CT;食管癌原发灶SUVmax在一定程度上可以反映淋巴结转移情况.     

18F-FDG PET/CT with Contrast Enhancement for Evaluation of Axillary Lymph Node Involvement in T1 Breast Cancer

Background

¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography ((PET) safely predicts axillary status in patients with breast cancer, but is not sufficiently accurate in early breast cancer patients. This study analyzed the value of ¹⁸F-FDG PET/computed tomography (CT) with contrast enhancement in detecting axillary lymph node involvement in T1 breast cancer patients.

Methods

Contrast-enhanced ¹⁸F-FDG PET/CT was performed within 20 days of surgery in 143 breast cancer patients with tumors ≤2 cm in size. The patients underwent either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), and histopathology reports were used to provide the definitive diagnosis against which the contrast-enhanced ¹⁸F-FDG PET/CT study results were compared.

Results

The sensitivity, specificity, and negative and positive predictive values of contrast-enhanced ¹⁸F-FDG PET/CT in detecting axillary involvement were 70.0%, 92.2%, 88.8%, and 77.8%, respectively, in the entire series of 143 patients, with eight false-positive and 12 false negative results. The false-negative results were associated with the number of metastatic lymph nodes and the rate of FDG uptake.

Conclusion

Contrast-enhanced ¹⁸F-FDG PET/CT cannot replace histologic staging using SLNB in patients with breast cancer, but ¹⁸F-FDG PET/CT increases the sensitivity for predicting axillary node metastasis, and allows for a selective approach to either ALND or SLNB, even in patients with T1 breast cancer.     

Additional value of PET/CT over PET in assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer.

The aim of this study was to compare the value of reviewing combined 18F-FDG PET/CT images with that of reviewing side-by-side PET and CT images in the diagnosis of locoregional lymph node metastases in patients with esophageal squamous cell cancer. METHODS: From November 2003 to December 2005, 45 patients with thoracic esophageal squamous cell cancer underwent 18F-FDG PET/CT before surgery. The results of reviewing combined PET/CT images and side-by-side PET and CT images for the diagnosis of locoregional lymph node metastases were compared prospectively in relation to pathologic findings. RESULTS: All patients underwent successful surgery, and pathologic examination confirmed nodes positive for metastasis in 32 patients and 82 of 397 excised nodal groups. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 93.90% (77/82 nodal groups), 92.06% (290/315), 92.44% (367/397), 75.49% (77/102), and 98.31% (290/295), respectively, whereas those of PET were 81.71% (67/82), 87.30% (275/315), 86.15% (342/397), 62.62% (67/107), and 94.83% (275/290), respectively. P values were 0.032, 0.067, 0.006, 0.063, and 0.037, respectively. The differences in sensitivity, accuracy, and negative predictive value between PET and PET/CT were statistically significant. CONCLUSION: PET/CT improves the sensitivity, accuracy, and negative predictive value of 18F-FDG imaging in the assessment of locoregional lymph nodes in thoracic esophageal squamous cell cancer and provides data of diagnostic significance.     

Breast cancer staging in a single session: whole-body PET/CT mammography

Our objective was to compare the diagnostic accuracy of an all-in-one protocol of whole-body 18F-FDG PET/CT and integrated 18F-FDG PET/CT mammography with the diagnostic accuracy of a multimodality algorithm for initial breast cancer staging. METHODS: Forty women (mean age, 58.3 y; range, 30.8-78.4 y; SD, 12 y) with suspected breast cancer were included. For the primary tumor, we compared 18F-FDG PET/CT mammography versus MRI mammography; for axillary lymph node status, 18F-FDG PET/CT versus clinical investigation and ultrasound; and for distant metastases, 18F-FDG PET/CT versus a multimodality staging algorithm. Histopathology and clinical follow-up served as the standard of reference. The Fisher exact test evaluated the significance of differences (P < 0.05). Alterations in patient management caused by 18F-FDG PET/CT were documented. RESULTS: No significant differences were found in the detection rate of breast cancer lesions (18F-FDG PET/CT, 95%; MRI, 100%; P = 1). 18F-FDG PET/CT correctly classified lesion focality significantly more often than did MRI (18F-FDG PET/CT, 79%; MRI, 73%; P < 0.001). MRI correctly defined the T stage significantly more often than did 18F-FDG PET/CT (MRI, 77%; 18F-FDG PET/CT, 54%; P = 0.001). 18F-FDG PET/CT detected axillary lymph node metastases in 80% of cases; clinical investigation/ultrasound, in 70%. This difference was not statistically significant (P = 0.067). Distant metastases were detected with 18F-FDG PET/CT in 100% of cases, and the multimodality algorithm identified distant metastases in 70%. This difference was not statistically significant (P = 1). Three patients had extraaxillary lymph node metastases that were detected only by PET/CT (cervical, retroperitoneal, mediastinal/internal mammary group). 18F-FDG PET/CT changed patient management in 12.5% of cases. CONCLUSION: Our data suggest that a whole-body 18F-FDG PET/CT mammography protocol may be used for staging breast cancer in a single session. This initial assessment of the 18F-FDG PET/CT protocol indicates similar accuracy to MRI for the detection of breast cancer lesions. Although MRI seems to be more accurate when assessing the T stage of the tumor, 18F-FDG PET/CT seems able to more accurately define lesion focality. Although 18F-FDG PET/CT mammography was able to detect axillary lymph node metastases with a high sensitivity, this method cannot soon be expected to replace the combination of clinical examination, ultrasound, and sentinel lymph node biopsy for axillary assessment.     

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.     

^18F-FDG PET／CT显像监测胃癌术后复发转移的价值

目的评价^18F-脱氧葡萄糖（FDG）PET／CT监测胃癌术后复发及转移的临床价值。方法回顾性分析胃癌术后临床疑复发或转移而行^18F-FDG PET／CT检查的45例患者临床资料,根据细胞学、病理或随访结果分析PET／CT检查结果,计算残胃及转移灶最大标准摄取值（SUVmax）。采用SPSS11．5软件进行数据处理,SUVmax两样本均数比较采用t检验。结果（1）45例中22例临床疑残胃复发,12例患者最终确定残胃复发,^18F-FDG PET／CT诊断残胃复发的灵敏度、特异性及准确性分别为100．0％（12／12）、70．0％（7／10）和86．4％（19／22）,12例复发病灶SUVmax为6．27±3．42（其中2例低分化腺癌的SUVmax较低,分别为2．5和3．3）,另10例无复发的残胃SUVmax为3．92±2．24（其中3例吻合口炎性病灶局部SUVmax较高,分别为8．3,5．2和6．3）,差异无统计学意义（t=1．862,P〉0．05）。（2）对残胃以外转移灶的检出：PET／CT灵敏度、特异性、准确性在区域淋巴结转移中分别为78．9％（15／19）、92．3％（24／26）和86．7％（39／45）,在腹膜转移中分别为6／9、97．2％（35／36）和91．1％（41／45）,在远处转移中分别为86．7％（13／15）、93．3％（28／30）和91．1％（41／45）。（3）PET／CT假阳性8处为炎性或肠管摄取,假阴性9处多为直径〈1．0cm的转移灶和低分化腺癌及印戒细胞癌的转移灶。结论^18F-FDG PET／CT虽然检测胃癌术后区域淋巴结和腹膜转移的灵敏度较低,但仍是监测其术后复发转移的有效手段。     

基于CT增强图像的影像组学模型评估乳腺癌腋窝淋巴结转移

目的:探讨基于CT增强图像的影像组学在评估乳腺癌腋窝淋巴结转移方面的临床应用价值.方法:回顾性分析402例乳腺癌患者(共825枚短径≥5 mm腋窝淋巴结)的CT增强图像.在每个淋巴结的最大层面勾画ROI,使用AK软件提取淋巴结的纹理特征.对两位医师分别提取的100个淋巴结的纹理特征进行一致性分析.分别采用单因素方差分析...