多种正电子示踪剂PET联合显像在肿瘤基础研究、临床诊断和疗效监测中的应用进展

正电子示踪剂PET显像是反映生理和病理状态下在分子水平监测人体组织细胞代谢、酶和受体活性以及基因表达的重要的分子影像技术,PET/CT也是迄今用于临床分子影像成像的最佳设备.PET/CT显像在临床主要用于肿瘤、脑和心血管疾病的早期诊断,疗效监测和对治疗方案的选掸提供参考依据.     

正电子放射性药物的临床应用与进展

正电子发射计算机体层摄影仪(positron em is-sion tom ography,PET)是可反映人体功能、生化代谢及进行分子影像研究的先进功能分子影像设备,PET/CT将能精确反映人体解剖结构的CT与反映功能的PET相整合,是目前临床应用中最佳的分子影像设备。正电子放射性药物是PET或PET/CT进行     

编者的话

<正>目前,核医学分子影像探针以其灵敏、安全而著称,并被研究最多、最活跃,因为任何靶向物质都有可能被微量的正电子核素或单光子核素标记而分别用于PET或SPECT成像研究。现在,PET、SPECT已结合了CT,形成全新的PET/CT、SPECT/CT分子影像设备,产生了既能定性又有定位解剖信息的综合影像图像。PET还与MR结合,诞生了PET/MR,使分子影像设备实现了强强联合。符合测量是正电子核素探测的基本原理,和拥有上万个符合探测单元、临床认可度不断增加的PET/CT     

18F-FDG PET/CT鉴别诊断椎骨良恶性病变的临床价值

随着正电子显像设备,包括带符合线路的单光子发射计算机体层摄影仪(MCD-SPECT)、正电子发射计算机体层摄影仪(PET)以及MCD-SPECT/CT和PET/CT,在国内的推广使用,正电子显像在诊断和鉴别诊断骨骼疾病的应用也越来越广泛。其中,PET/CT作为当今正电子显像的尖端设备,在鉴别椎体良恶性病变的临床应用中,逐渐显示出其独特的优势。目前,用于鉴别诊断椎体良恶性病变的正电子显像中,最常用的是~(18)F-氟脱氧葡萄糖(~(18)F-FDG)代谢显像和18F骨显像。~(18)F-FDG是正电子设备单位的常规显像剂,这与其临床适应证范围广、药物供应相对充…     

核医学显像在肿瘤诊断中的现状与进展

肿瘤核医学是核医学和肿瘤学的组合，又是各自的一个重要分支。肿瘤核医学主要内容是利用核医学的方法研究、诊断和治疗肿瘤。近年来，随着临床正电子发射体层摄影（PET）、PET／CT及正电子核素的广泛应用，放射性核素显像已进入分子水平，以肿瘤代谢、基因、受体等目标为对象的显像范畴称为肿瘤分子影像学。     

正电子示踪剂在肝细胞癌研究中的应用进展

PET(包括PET/CT)在肝细胞癌(HCC)的诊断中具有重要价值。而PET显像的核心就是参与体内生物代谢活动的各类正电子示踪剂。本文就目前肝癌研究中正电子示踪剂的应用做简要概述。     

正电子发射断层成像/X线计算机断层摄影无创检测在主动脉疾病中的应用

正正电子发射断层成像/X线计算机断层摄影(PET/CT)是一种经典代谢显影方式,在肿瘤患者的管理中发挥了重要作用,但其在除恶性肿瘤外的各种疾病中的临床应用也有所增加。越来越多的证据表明PET/CT图像在主动脉疾病中也有很多优势。本文综述了PET/CT在涉及主动脉疾病中的潜在作用,重点介绍了PET/CT在急性胸主动脉综合征、主动脉瘤、动脉粥样硬化病变、主动脉炎和主     

正电子发射计算机断层显像的临床应用及护理

PET的全称为正电子发射计算机断层扫描（position emission computed topography），是同位素发射计算机辅助断层（ECT）的一种，是一种能反映人体功能、生化代谢并可进行分子影像研究的先进的分子影像技术。近年，随着PET／CT的出现，弥补了PET显像解剖定位的不足，加之各类高特异性的正电子受体显像剂不断投入使用，PET将提供综合生化代谢和解剖定位的全面信息，其灵敏度、特异性和准确率比CT、磁共振更高，在各类疾病中必将得到广泛应用，现报道如下。     

18F-氟代脱氧葡萄糖PET/CT在乳腺癌诊疗中的应用

正电子发射断层显像(PET)是利用正电子放射性示踪剂显示活体组织器官内生化状态的显像技术.18F-氟代脱氧葡萄糖(18F-FDG )是目前应用最成熟的放射性示踪剂.PET与计算机辅助断层摄影(CT)同机融合技术(PET/CT)实现了PET与CT技术的优势互补本文重点介绍18F-FDG PET/CT显像原理、在乳腺癌诊断中的应用及早期监测化疗疗效.     

胰高血糖素样肽-1受体PET/CT定位诊断胰岛素瘤的技术规范

胰岛素瘤的诊断和手术治疗依赖于准确的影像学检查定位。以胰腺β细胞为靶点的胰高血糖素样肽-1受体(glucagon-like peptide-1 receptor, GLP-1R)是近年来胰岛素瘤影像研究中的亮点, 推荐临床推广使用⁶⁸Ga-exendin-4进行GLP-1R正电子发射断层显像/计算机体层成像(positron emission tomography/computed tomography, PET/CT)来定位诊断胰岛素瘤。本文介绍GLP-1R显像在胰岛素瘤中的应用概况, 并以⁶⁸Ga-exendin-4 GLP-1R PET/CT显像为例, 介绍该技术的操作规范, 以期为临床提供借鉴。     

Advances in nuclear cardiology instrumentation: Clinical potential of SPECT and PET

Myocardial perfusion imaging using nuclear cardiology techniques has enjoyed widespread clinical use because of its well-documented diagnostic accuracy for assessing coronary artery disease. Industry has begun to create innovative designs of dedicated cardiac single photon emission CT (SPECT) scanners that constrain all detector area to imaging just the heart. New software has also been implemented, which recovers image resolution and limits image noise. Myocardial perfusion positron emission tomography (PET) imaging is experiencing unprecedented growth as evidence mounts of superior cardiac diagnostic performance over SPECT. Advances in PET have been made in gantry and detector design. Improvements in gantry design have been focused on hybrid PET/CT imaging. Improvements in detector design have consisted of using new scintillation crystals and in moving from two- to three-dimensional imaging. These SPECT and PET innovations are resulting in shorter study time and/or reduced radiation dose to the patient and in promoting easier scheduling, higher patient satisfaction, and importantly, higher image quality.     

Skeletal scintigraphy as an important complement for detecting bone metastasis from nasopharyngeal carcinoma

Bone metastasis occurs frequently in patients with nasopharyngeal carcinoma (NPC). Although fluorine-18 fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) has been proven to be more sensitive at detecting bone metastases than Technetium-99m methylene diphosphonate skeletal scintigraphy in pretreatment patients with NPC in most clinical settings, there have been metastatic lesions that were positive on skeletal scintigraphy but negative on PET/CT scans. Herein, we report the case of a patient with stage IV NPC that manifested as multiple metabolically abnormal lesions on pretreatment skeletal scintigraphy and were considered malignant although they were negative on PET/CT examination. Follow-up evaluations with both skeletal scintigraphy and PET/CT scans as post-therapeutic imaging are also presented.     

Positron emission tomographic scans in lymphoma: convention and controversy

The use of sensitive and specific imaging techniques for accurate initial staging and evaluation of response to therapy in patients with lymphoma is essential for their optimal management. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) has emerged as a powerful imaging tool and is being routinely used in staging, response evaluation, and posttreatment surveillance in patients with non-Hodgkin lymphoma and Hodgkin lymphoma. PET/CT is currently widely used in clinical practice, but the established clinical benefit is currently restricted to the posttreatment evaluation of Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Although used in other histologic subtypes and in other clinical situations including response assessment, its impact on patient outcome remains to be demonstrated. We performed a literature search of PubMed from 1999 to 2011 using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. This review addresses the challenges and controversies in the use of PET/CT scans in the management of patients with lymphoma.     

Comparison between 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography and positron emission tomography/computed tomography hardware fusion for staging of patients with lymphoma.

PURPOSE: 2-Deoxy-2-[18F]fluoro-D-Glucose positron emission tomography (FDG-PET) stages patients with Hodgkin's disease (HD) and Non-Hodgkin's lymphoma (NHL) with higher accuracy than computed tomography (CT). We sought to determine whether integrated (hardware) fused PET/CT imaging results in further improvements in staging accuracy. PROCEDURES: Seventy-three patients (age 51 +/- 17 years, 37 female, 36 male) with HD (n = 20) or NHL (n = 53) undergoing staging were studied with an integrated PET/CT system. Image findings were verified by clinical follow up, additional imaging and when available, histology. RESULTS: Thirty-four of 73 patients (46.5%) had evidence of disease and 39 were disease free as confirmed by clinical evaluation and follow-up for 41 +/- 22 weeks (n = 73), including biopsy (n = 26), and other imaging modalities (n = 52) when available. A discordant image interpretation between PET and PET/CT occurred in seven patients (10%). PET/CT correctly upstaged two and downstaged five patients. Overall staging was accurate in 93% with PET/CT and 84% with PET (P = 0.03). CONCLUSION: Lymphoma is staged with higher accuracy using PET/CT than PET alone.     

18F-FDG PET/CT显像在胃癌术后复发和转移中的诊断价值

目的：探讨18F-FDG PET/CT显像在胃癌术后复发及转移灶诊断中的价值。方法：胃癌术后患者112例,共行PET/CT检查150例次,图像分析采用视觉及半定量分析法（SUVave）,病灶根据病理学检查结果、多种影像学检查手段及临床随访确诊,随访时间半年以上。结果：112例患者中,16例存在肿瘤复发和转移,PET/CT诊断残胃复发的灵敏度为81.2%,特异性100%,准确性97.3%。复发病灶SUVave为4.4±1.2,吻合口炎性病灶SUVave为2.6±0.5,两者差异显著（t=3.9370,P=0.0005）。PET/CT诊断胃癌术后肿瘤转移的灵敏度94.1%、特异性96.7%和准确性95.5%。26例行两次以上PET/CT检查,第一次PET/CT检查发现复发或转移15例,经放化疗后6例PET显像示病情好转,随访6个月至2年患者均存活;9例治疗后PET显像示病情无明显变化或者出现新病灶,患者存活时间为3个月至1年。结论：18F-FDG PET/CT在胃癌术后复发和转移中有很好的诊断价值,并在监测胃癌术后复发放化疗疗效有一定的价值。     

18F-FDG PET/CT综合分析法在胰腺癌诊断中的价值

目的探讨利用CT良性征象校正FDG假阳性的PET/CT综合分析方法在胰腺癌诊断中的价值。方法胰腺原发良恶性疾患40例,其中胰腺癌27例(手术6例,临床随访21例),急、慢性胰腺炎13例(腹腔镜2例,临床随访11例)。分别用单纯SUV测量法和PET与CT相结合的综合分析法分析,比较两种方法诊断胰腺恶性肿瘤的敏感性、特异性及准确性。SUV测量法以病灶SUVmax值大于2.5为恶性病变诊断指征,反之为良性。PET/CT综合分析法以PET为主导,CT具有否决权,利用PET/CT融合图像的精确对位,当浓聚热点相应CT表现为明显的良性病变征象时,无论FDG浓聚程度如何,均诊断为良性病变。结果综合分析法对胰腺癌诊断的敏感性、特异性、准确性都是100%;单纯SUV测量法敏感性、特异性、准确性分别为96.3%、76.9%、90.0%。结论CT的良性征象,尤其是炎性渗出征象,对FDG假阳性有校正作用,通过这种校正能够提高PET/CT在胰腺癌诊断的特异性和准确性。     

18F-FDG PET/CT显像在评估宫颈癌根治术后转移或复发的价值分析

[目的] 分析18F氟脱氧葡萄糖(18F-FDG )正电子发射断层显像术/计算机体层摄影术(PET/ CT)评估宫颈癌根治术后转移或复发的临床价值.[方法] 可疑宫颈癌术后复发或转移患者60例,均为宫颈癌根治术术后患者,且有明确病理结果,均进行18F-FDG PET/CT显像检查,与病理及随访结果对照,评定18F-FDG PET/CT在宫颈癌术后转移、复发诊断中的应用价值.[结果] ①18F-FDG PET/CT显像检出宫颈癌根治术后转移或复发阳性47例,阴性13例,其中30例肿瘤转移,17例肿瘤局部复发,其诊断灵敏度、特异性、准确性分别为97.83%、85.71%、95.00%,阳性预测值、阴性预测值分别为95.74%、90.31%;②18F-FDG PET/CT与病理及随访检查结果一致性较高(P=0.000).[结论] 18F-FDG PET/CT显像对宫颈癌根治术后复发、转移诊断价值高,有其较高的敏感度、特异性、准确性,可为患者的临床治疗提供有效参考.     

宫颈癌^18F-FDG PET/CT、增强CT及病理体积的对比研究

目的 通过18-F-氟代脱氧葡萄糖正电子发射型计算机断层扫描仪（18F-FDG PET/CT）代谢体积、增强CT体积及病理体积的对比,探索功能代谢影像是否较解剖影像对于宫颈癌靶区的勾画更具优势.方法 12例宫颈癌患者术前行PET/CT和增强CT扫描,PET图像选取肿瘤最大标准化摄取值（SUVmax）的40％阈值勾画肿瘤边界,生成相应PET的大体肿瘤体积（PET GTV）.增强CT图像按照增强边缘进行勾画,所得体积作为CT的大体肿瘤体积（CT GTV）.术后进行病理切片,确定每层切片肿瘤边缘及面积,面积乘以切片厚度计算每张切片的肿瘤体积,累积所有切片的肿瘤体积为全部肿瘤的病理大体体积（病理GTV）.比较PET GTV、CT GTV及病理体积的差异.结果 12例患者SUVmax 40％阈值勾画肿瘤边界所得PETGTV与病理GTV比较,差异无统计学意义（P=0.352）,并且两者有较好的相关性（r=0.99,P＜0.01）.CT所确定的体积较病理GTV大,仅1例与病理GTV相似,其余11例CT GTV大于病理GTV,最大者为病理GTV的5倍余.PET GTV与CT GTV相关性较差（r=0.70,P=0.816）.结论 在宫颈癌的影像学检查中,对于肿瘤靶区的勾画PET/CT优于增强CT.     

Performance of 2-Deoxy-2-[F-18]fluoro-<Emphasis Type="SmallCaps">d</Emphasis>-glucose Positron Emission Tomography and Integrated PET/CT in Restaged Breast Cancer Patients

PURPOSE: This study was conducted to compare the clinical stage derived from 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) positron emission tomography (PET) to that of integrated PET/computed tomography (CT) in restaged breast cancer patients. PROCEDURES: Fifty-eight female patients (age range 29-80 years, mean age +/-SD, 53.3 +/- 11.7 years) underwent PET/CT restaging for breast cancer. Two experienced nuclear medicine physicians interpreted PET images. A radiologist was added for reading PET/CT studies. A patient-based analysis was performed. Histopathological findings, correlative imaging studies, changes in number, size, and hypermetabolic activity of suspicious lesions and/or patient outcome served as standard of reference for determining the diagnostic accuracy of both modalities. RESULTS: PET staged 79.3% (46/58) of the patients correctly, overstaged seven (12.1%), and understaged five patients (8.6%). Integrated PET/CT staged 89.7% (52/58) of the patients correctly, overstaged four (6.9%), and understaged two patients (3.4%). The staging accuracy of PET/CT was not significantly better than that of PET alone (p = 0.059). Lesions exhibiting mild hypermetabolic activity, benign inflammatory lesions, and physiological variants largely explained incorrect PET findings. CONCLUSION: Integrated PET/CT only marginally improves the restaging accuracy over PET alone (p = 0.059) in breast cancer patients.     

PET/CT-Guided Interventions in Oncology Patients: A Nursing Perspective

In the past 5 years, the utilization of positron emission tomography/computerized tomography (PET/CT) guidance is more commonly used for cancer patients undergoing biopsy and ablations at this National Cancer Institute-designated cancer center. The interventional use of PET/CT imaging requires nurses to have a thorough understanding of the mechanisms involved to provide the best care in an environment that is safe for patients and staff. Evidence suggests cohesive care, and safe practice measures are achieved when patients actively participate and understand their care. This article will discuss how a collaborative patient-centered approach in caring for oncologic patients undergoing PET/CT interventions is necessary for achieving quality patient outcomes.