18F-FDG PET/CT显像诊断结直肠癌术后复发和转移的价值

目的 探讨18F-FDG PET/CT显像在诊断结直肠癌术后复发和转移中的价值.方法 选取我院2012年10月至2014年12月期间的42例结直肠癌术后患者,对所有患者进行全身18F-FDG PET/CT检查与CT强化检查,依据PET/CT与强化CT图像对患者的术后吻合口是否复发及是否存在转移进行分析.最终以再次手术或活检病理学进行确诊,对比18F-FDG PET/CT检查与CT强化检查的灵敏度、特异性、准确性、阳性预测值及阴性预测值.结果 42例结直肠癌术后患者中,最终诊断2例有复发无转移,19例有转移无复发,11例既有复发又有转移,10例既无复发也无转移.PET/CT对诊断的准确率、特异性及阳性预测值虽高于强化CT检查,但差异无统计学意义(P＞0.05).PET/CT对诊断的准确率、灵敏度、特异性、阳性预测值及阴性预测值显著高于强化CT检查,差异有统计学意义(P＜0.05).结论 18F-FDG PET/CT显像在诊断结直肠癌术后复发和转移中的临床应用价值高于传统强化CT,有条件的医院可以推广应用.     

SPECT/CT符合线路18F-FDG检查与同机CT融合在妇科肿瘤诊断中的作用分析

目的研究妇科肿瘤^18F-FDG符合线路SPECT／CT显像中同机CT融合的作用。方法27例各类妇科肿瘤术后患者共进行28次^18F—FDG符合线路SPECT／CT检查，将其结果与未经过同机CT融合的单纯^18F-FDG图像（AC）读图结果比较，并结合患者2周CT内诊断结果及随访检查进行分析。结果以病例分析，单纯^18F-FDG图像（AC）和CT融合对妇科肿瘤复发和转移的灵敏度、准确率和阳性预测值分别为91．7％、92．9％和100％，二者无统计学意义，但与CT的准确率和阳性预测值比较有统计学意义（P〈0．01）。以病灶分析，^18F-FDG符合线路SPECT／CT检查的灵敏度、准确率和阳性预测值分别为97．4％、97．7％和100％，单纯FDG图像（AC）的相应指标为97．4％、84．1％和86．0％。二者比较准确率和阳性预测值有统计学意义（P〈0．05）。单纯^18F-FDG图像（AC）显像共发现86个病灶，同机CT融合后减少为74个病灶，共11例次检查（39．3％）的单纯^18F-FDG图像（AC）在与同机CT图像融合后其读图结果发生改变，其中6例中的12个病灶因同机CT图像发现其为非恶性病灶摄取而确定为假阳性病灶予以排除。共8例患者（28．6％）的分期和治疗方案在SPECT／CT符合线路FDG检查后发生改变，其中2例患者（7．1％）的分期和诊断与同机CT融合前的单纯^18F-FDG图像（AC）结果不同。结论同机CT融合显著提高了^18F-FDG符合线路SPECT／CT显像对妇科肿瘤检查中病灶诊断的准确率和阳性预测值，并能进一步明确患者诊断、分期，提高^18F-FDG符合线路SPECT／CT显像对患者诊断分期和治疗的影响。     

^18F—FDG SPECT／CT同种融合显像在肿瘤诊断中的应用

目的：初步评价FDG SPECT／CT符合线路同机图像融合在肿瘤诊断及复发监测中的应用价值。方法：经临床确诊的恶性肿瘤及恶性肿瘤治疗后怀疑复发或残留的患者53例（治疗前诊断8例、治疗后疑复发45例）。经SPECT／CT同机联合扫描行FDG显像检查，用二次迭代法加衰减校正进行影像重建，与同期CT或（和）MR检查相比较。结果：在治疗前诊断组中，8例恶性肿瘤患者FDG显像均呈阳性，CT（MR）亦全部发现病灶，但不能对病灶进行有效定性；在治疗（手术、放疗、化疗)后疑复发的45例患者中FDG与CT（MR）的假阳性、假阴性、真阳性、真阴性分别为0，4，32，9和3，7，29，6；FDG灵敏度、特异性、阳性预测值、阴性预测值分别为8．89％、100％、100％、69．2％；而CT或（和）MR分别为80．6％、66．7％、90．6％、46．2％。同机融合由CT提供的详细解剖资料能准确定位恶性病灶。结论：带有X线CT的符合线路的SPECT／CT同机融合PDG显像是一种新的有效的核医学显像方法，尤其是对治疗后残余或复发的肿瘤，较CT（MR）及其它功能性检查图像等更具有较特异的定性和准确性定位诊断价值，值得临床推广应用。     

血清肿瘤标志物测定联合应用对结直肠癌术后复发与转移探测的临床诊断价值

目的 评价部分肿瘤标志物测定联合应用探测结直肠癌术后复发、转移灶的效能.方法 研究对象为资料完整的90例结直肠癌患者.所有患者均检测血清CEA,部分患者2周内进行了CA19-9及CA242的监测.根据病理及临床随访结果,分别计算各项肿瘤标志物(单个指标、串联指标、并联指标)诊断结直肠癌术后复发及转移的灵敏度、特异性、阳性预测值、阴性预测值及准确度.结果 CEA提示结直肠癌复发及转移灶的灵敏度为74.03％、特异性为46.15％、阳性预测值为89.06％、阴性预测值为23.08％.CA19-9的灵敏度为31.88％、特异性为72.73％、阳性预测值为88.00％、阴性预测值为14.55％.CA242的灵敏度为37.50％、特异性为63.34％、阳性预测值为85.71％、阴性预测值为14.89％.肿瘤标志物指标串联结果:CEA与CA19-9,诊断效能灵敏度为26.09％、特异性为72.73％、阳性预测值为85.71％、阴性预测值为13.56％;CEA与CA242,诊断效能为灵敏度为32.81％、特异性为72.73％、阳性预测值为87.50％、阴性预测值为15.69％;CA19-9与CA242,灵敏度为25.00％、特异性为72.73％、阳性预测值为84.21％、阴性预测值为14.29％;CEA、CA19-9、CA242,灵敏度为23.44％、特异性为72.73％、阳性预测值为83.33％、阴性预测值为14.04％.指标并联结果:CEA与CA19-9并联,灵敏度为76.81％、特异性为45.45％、阳性预测值为89.83％、阴性预测值为23.81％;CEA与CA242并联,灵敏度为73.44％、特异性为36.36％、阳性预测值为87.04％、阴性预测值为19.05％;CA19-9与CA242并联,灵敏度为42.19％、特异性为63.64％、阳性预测值为87.10％、阴性预测值为15.91％;CEA、CA19-9、CA242并联后,灵敏度为78.13％、特异性为36.36％、阳性预测值为87.72％、阴性预测值为22.22％.结论 肿瘤标志物的联合应用可提升结直肠癌术后复发及转移灶的探测效能.     

18 F-FDG PET/CT显像联合血清肿瘤标志物检测在肺单发结节诊断中的价值

目的 探讨18F-FDG PET/CT显像和血清肿瘤标志物(CEA、NSE、CFRA21-1)检测联合在肺单发结节诊断中的价值.方法 91例经病理确诊的肺单发结节患者进行18F-FDG PET/CT显像,同时取静脉血4mL分离取血清在低温冰箱保存,用放免法集中测量血肿瘤标志物CEA、NSE、CFRA21-1.结果 18 F-FDG PET/CT检查对肺单发结节恶性肿瘤检出的灵敏度为84.8%(56/66),对肺单发结节诊断的准确率为86.8%(79/91);18 F-FDG PET/CT显像联合血肿瘤标志物(CEA+NSE+CFRA21-1)检测对肺单发结节恶性肿瘤检出的灵敏度为93.9%(62/66),对肺单发结节诊断的准确率为95.6%(87/91),和18F-FDG PET/CT检查相比,灵敏度和准确率差异具有统计学意义(P均﹤0.05).结论 18 F-FDG PET/CT显像和血肿瘤标志物(CEA、NSE、CFRA21-1)检测联合能提高对肺单发结节诊断的灵敏度和准确性,有较高的临床应用价值.     

25例肝癌术后患者18F-FDG SPECT/CT同机融合显像分析

目的:探讨^18F-FDG SPECT／CT同机融合显像在探测原发性肝癌术后疑复发中的价值。方法:对25例肝癌术后疑复发患者进行^18F-FDGSPECT／CT符合线路显像，经迭代法处理和重建，获得经衰减校正后的断层图像和融合图像，以目测双盲进行诊断分析，并与CT(MR)及手术病理检查、临床随访作出的最后诊断结果进行对比。结果:同机融合显像和CT(MR)对肝癌术后复发诊断的灵敏度、特异性及准确性分别为94．7％、100％、96％和78．9％、66．7％、76％。结论:FDG显像对肝癌术后复发及转移的定性诊断具有较高的灵敏度和准确性；SPECT／CT同机融合显像能准确定位复发病灶的解剖和功能信息。     

PET/CT在肿瘤疾病中的初步应用

目的回顾性探讨PET／CT对肿瘤的诊断价值。方法肿瘤病人200例，其中未治疗病人71例，已治疗病人129例。经静脉注射^18F-FDG 45min后，进行PET／CT扫描。结果未治疗病人71例中，PET／CT准确诊断有68例（95．7％），阴性3例，发现肿瘤转移54例，其中广泛转移30例。已治疗组129例中，提示肿瘤复发或／伴转移96例，其余33例在手术／放疗／化疗等治疗后未见肿瘤复发。结论PET／CT具有对病变部位进行精确定位和定性的优势，大大提高了诊断的准确率。对于肿瘤的早期诊断和分期、指导制定治疗方案、判断肿瘤有无复发与坏死及预后的估计均有重要的临床意义。     

CEA、CA15-3和CA125对乳腺癌的诊断价值以及影响因素探讨

研究肿瘤标志物CEA、CA15—3和CA125对乳腺癌的诊断价值,并对影响肿瘤标志物阳性率的相关因素进行分析。采用CLIA法测定血清CEA、CA15—3和CA125水平,以CEA〉4．8μg/mL、CA15-3〉25U／mL、CA125〉35U／mL作为诊断阳性标准。乳腺癌组患者59例,乳腺良性组患者69例,对照组65名。结果表明：乳腺癌CEA,CA15—3和CA125水平较对照组和乳腺良性组明显升高（P〈0．05）。CA15-3的灵敏度（42．4％）最高,CA125的特异度（89．6％）最高。采用平行联检法,可提高乳腺癌诊断的灵敏度（67．8％）和阴性预测值（85．0％）。而采用系列联检法,可提高特异度（91．0％）和阳性预测值（58．6％）。与乳腺癌肿瘤标志物阳性率显著相关的因素有：肿瘤分期、皮肤改变、淋巴转移、远处转移和P53（P〈0．05）。     

18F-FDG PET/CT对非小细胞肺癌淋巴结转移的诊断价值

目的探讨18氟-脱氧葡萄糖正电子发射计算机断层显像/计算机体层成像(18F-FDG PET/CT)对非小细胞肺癌淋巴结转移的诊断价值。方法回顾性分析2012年3月至2015年3月我院167例患者的临床资料,所有病例术前10 d内行18FFDG PET/CT及胸部增强CT检查并经术后病理诊断为非小细胞肺癌。根据PET/CT、增强CT及术后病理结果,计算PET/CT、增强CT判断淋巴结转移的灵敏度、特异性、准确度、阳性预测值、阴性预测值及约登指数并相互比较。结果 167例患者中共清扫出731组淋巴结,以术后病理结果为依据,PET/CT诊断出真阳性、假阳性、假阴性、真阴性淋巴结各有143组、26组、61组、501组,进而得出其灵敏度、特异度、准确度、阳性预测值、阴性预测值、约登指数分别为70.10%、95.07%、88.10%、84.62%、89.15%、0.65,增强CT分别为54.19%、92.23%、81.67%、72.85%、83.97%、0.4,二者差异有统计学意义(P0.05)。结论 PET/CT对非小细胞肺癌淋巴结转移的诊断效能高于增强CT,可以更好地为肺癌术前诊断、分期和后续治疗方式的选择提供依据。     

CT联合CA19-9,CEA诊断胰腺癌的价值分析

目的:分析计算机断层扫描(CT)联合癌胚抗原(CEA)以及癌抗原19-9(CA19-9)诊断胰腺癌的价值.方法:选择我院2018年1月至2021年4月期间收治的胰腺癌患者121例作为病例组,选择同期接受健康体检的120例作为健康组,均接受CT以及CA19-9、CEA检查.观察CA19-9,CEA在胰腺癌中的表达水平、CT对胰腺癌的诊断以及两种方式单独以及联合检测对该疾病的诊断价值.结果:2组CA19-9,CEA水平对比差异具有统计学意义(P<0.05),病例组上述水平高于健康组(P<0.05);病例组CA19-9,CEA以及CT阳性率高于健康组(P<0.05);联合检测诊断符合率94.61％、敏感度95.04％、特异度94.17％均较单一CA19-9诊断符合率63.48％、敏感度64.46％、特异度62.50％;CEA诊断符合率64.73％、敏感度66.94％、特异度62.50％;CT诊断符合率70.98％、敏感度71.90％、特异度70.00％高(P<0.05);联合检测和金标准一致性好,Kappa值为0.892.结论:血清CA19-9,CEA在胰腺患者中存在高表达,且联合检测可提高诊断效能.     

Detecting the recurrence of gastric cancer after curative resection: comparison of FDG PET/CT and contrast-enhanced abdominal CT

The purpose of this study was to evaluate the value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for detecting the recurrence of gastric cancer. We performed a retrospective review of 139 consecutive patients who underwent PET/CT and contrast-enhanced abdominal CT (CECT) for surveillance of gastric cancer after curative resection. Recurrence of gastric cancer was validated by histopathologic examination for local recurrence or serial imaging study follow-up with at least 1 yr interval for recurrence of distant metastasis form. Twenty-eight patients (20.1%) were confirmed as recurrence. On the patient based analysis, there was no statistically significant difference in the sensitivity, specificity and accuracy of PET/CT (53.6%, 84.7%, and 78.4%, respectively) and those of CECT (64.3%, 86.5%, and 82.0%, respectively) for detecting tumor recurrence except in detection of peritoneal carcinomatosis. Among 36 recurrent lesions, 8 lesions (22.2%) were detected only on PET/CT, and 10 lesions (27.8%) only on CECT. PET/CT had detected secondary malignancy in 8 patients. PET/CT is as accurate as CECT in detection of gastric cancer recurrence after curative resection, excepting detection of peritoneal carcinomatosis. Moreover, additional PET/CT on CECT could improve detection rate of tumor recurrence and provide other critical information such as unexpected secondary malignancy.     

The Role of Whole-Body FDG PET/CT, Tc 99m MDP Bone Scintigraphy, and Serum Alkaline Phosphatase in Detecting Bone Metastasis in Patients with Newly Diagnosed Lung Cancer

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients'' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.     

Gastrointestinal tract cancer screening using fecal carcinoembryonic antigen

There is a great need to detect gastrointestinal tract cancer at an early stage. It is well known that most carcinoma tissues of the gastrointestinal tract contain carcinoembryonic antigen (CEA). Stools are a rich source of cells derived from the gastrointestinal tract. We analyzed total fecal CEA in 60 gastrointestinal tract cancer patients, 20 benign gastrointestinal tract disorder patients, and 240 normal controls, using a simple, reliable method. We compared the sensitivity and specificity of fecal CEA with those of serum CEA and fecal occult blood test (FOBT). The level of fecal CEA in gastrointestinal tract cancer was much higher than controls (44.1 +/- 70.1 ng/mg stool vs 3.7 +/- 3.5 ng/mg stool, p < 0.001) and was not increased in benign gastrointestinal disorders (4.5 +/- 8.2 ng/mg stool). Fecal CEA level was > 10 ng/mg stool in 22 of 32 samples (69%)from stomach cancer patients and 24 of 28 samples (86%)from colorectal cancer patients. The sensitivity of serum CEA (> 5 ng/ml) was 19% in stomach cancer and 39% in colorectal cancer, whereas the sensitivity of FOBT was 13% in stomach cancer and 21% in colorectal cancer. The specificity of fecal CEA was 90% in benign gastrointestinal tract disorders and 93% in normal controls. This specificity was similar to those of serum CEA and FOBT. In conclusion, fecal CEA measurement is superior to serum CEA or FOBT for detection of gastrointestinal tract cancer. Fecal CEA may become the screening test of choice for gastrointestinal tract cancer.     

Carcinoembryonic Antigen as a Monitor in Breast Cancer

ABSTRACT: Carcinoembryonic antigen (CEA) levels were serially determined in 125 patients with breast cancer in order to study the diagnostic and prognostic use of serum CEA levels before and/or after surgery and during treatment with hormonal and chemotherapy. Serum CEA levels were elevated in 15.5% of nonmetastatic patients. Carcinoembryonic antigen increased according to stage (TNM classification); and a direct relationship between positive CEA levels and subsequent recurrence was found. After a three-year postoperative interval a 50% survival rate was exhibited in CEA-positive patients vs an 88% survival rate in those patients found to be CEA negative. There is a definite correlation between the trend of serial CEA values and the response to therapy and the development of metastases despite the fact that metastases occurred in CEA-negative patients. Therefore CEA assay is a useful and simple adjuvant test of monitoring metastatic and nonmetastatic breast cancer.     

直肠癌患者手术治疗前后血清IGF-I、CEA和TSGF检测的临床意义

目的:探讨了直肠癌患者手术治疗前后的血清IGF-I、CEA和TSGF水平的变化及临床意义.方法:分别应用放免法和化学法对36例直肠癌患者进行了血清IGF-I、CEA和TSGF水平的检测,并与35名正常健康人作比较.结果:手术前直肠癌患者血清IGF-I、CEA和TSGF水平非常显著地高于正常人 (P＜0.01),手术治疗一年后复发组明显地高于未复发组(P＜0.01).结论:检测直肠癌患者血清IGF-I、CEA和TSGF水平的变化与直肠癌患者的病情和预后密切相关,具有重要的临床价值.     

结肠癌患者手术治疗前后血清CEA、CA72-4、HCY和CysC检测的临床评估

目的 探讨结肠癌患者手术治疗前后血清CEA、CA72-4、HCY和CysC水平的变化及其临床意义.方法 应用放免法、免疫法和胶乳增强免疫法对35例结肠癌患者进行手术治疗前后血清CEA、CA724、HCY和CysC检测,并与35名正常人作比较.结果 结肠癌组在手术治疗前血清CEA、CA72-4、HCY和CysC水平均非常显著地高于正常人组（P＜0.01）,手术后6个月未复发的28例中明显下降,接近于正常人组水平,而复发的7例,其数值又回升至手术前水平（P＜0.01）.结论 检测结肠癌患者血清CEA、CA72-4、HCY和CysC的变化可作为诊断和疗效观察的指标.     

食管癌患者手术治疗前后血清Hcy、CEA和VEGF检测的临床意义

目的:探讨了食管癌患者手术治疗前后血清Hcy、CEA和VEGF水平的变化及临床意义.方法:应用免疫法、放免法和酶联法对31例食管癌患者进行了手术治疗前后血清Hcy、CEA和VEGF检测,并与35名正常健康人作比较.结果:食管癌患者在治疗前血清Hcy、CEA和VEGF水平非常显著地高于正常人组(P<0.01),术后6个月...     

FDG uptake in PET by bladder hernia simulating inguinal metastasis

A 70-year-old man with past history of hemicolectomy due to colon cancer underwent a follow-up abdominal/pelvic CT scan. CT revealed a right adrenal metastasis and then he underwent FDG-PET/CT study to search for other possible tumor recurrence. In PET images, other than right adrenal gland, there was an unexpected intense FDG uptake at right inguinal region and at first, it was considered to be an inguinal metastasis. However, correlation of PET images to concurrent CT data revealed it to be a bladder herniation. This case provides an example that analysis of PET images without corresponding CT images can lead to an insufficient interpretation or false positive diagnosis. Hence, radiologists should be aware of the importance of a combined analysis of PET and CT data in the interpretation of integrated PET/CT and rare but intriguing conditions, such as bladder herniation, during the evaluation of PET scans in colon cancer patients.