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.     

Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT.

This study was performed to compare (18)F-FDG PET with CT for the evaluation of primary tumors and lymph node metastases in gastric cancer. METHODS: Eighty-one patients (28 women and 53 men; mean age, 56.6 y; age range; 32-82 y) who had undergone radical (n = 74) or palliative (n = 7) gastrectomy and lymph node dissection for the management of gastric cancer were included. Preoperative (18)F-FDG PET and CT were reviewed retrospectively for primary tumors of the stomach and lymph node metastases. Any increased (18)F-FDG uptake exceeding that of the adjacent normal gastric wall was considered positive for the primary tumor. Lymph nodes were classified into 3 groups based on their anatomic sites. Because perigastric lymph nodes (N1) were often not clearly differentiated from primary tumors, N1 lymph node metastases were determined when possible. Lymph nodes were considered positive or negative on the basis of the group as a whole. Final conclusions for primary tumors and lymph node metastases were based on histopathologic specimens in all patients. RESULTS: There were 17 patients with early gastric cancer (EGC) and 64 patients with advanced gastric cancer (AGC). For primary tumors, both PET and CT showed a sensitivity of 47% (8/17) for EGC and 98% (63/64) for AGC. The sensitivity of CT for N1 disease was significantly higher than that of PET. (18)F-FDG PET had a sensitivity, specificity, and accuracy of 34% (11/32), 96% (47/49), and 72% (58/81), respectively, for N2 metastases, whereas the corresponding CT values were 44% (14/32), 86% (42/49), and 69% (56/81). For N3 metastases, PET and CT had the same sensitivity, specificity, and accuracy: 50% (3/6), 99% (74/75), and 95% (77/81), respectively. Overall, the sensitivity, specificity, and accuracy of (18)F-FDG PET were not significantly different from those of CT for primary tumors or for N2 and N3 metastases. CONCLUSION: (18)F-FDG PET is as accurate as CT for the detection of primary tumors of either EGC or AGC. The low sensitivities of PET and CT were insufficient to allow decision making on the extent of lymphadenectomy. In contrast, the high specificity of PET for N disease appeared valuable, and the presence of N disease on PET may have a clinically significant impact on the choice of initial therapy.     

18F-FDG PET/CT显像在胃癌分期及治疗方案制定中的应用价值

目的探讨18F-FDG PET/CT显像在胃癌分期及治疗方案制定中的应用价值。方法回顾性分析46例临床疑诊胃癌患者的18F-FDG PET/CT图像,采用目测法和半定量法对患者PET/CT图像进行分析,即测定SUV_max与最大胃壁厚度（T_max）,以胃镜或手术后取得的病理结果作为“金标准”,评估18F-FDG PET/CT显像对病灶的诊断效能,并采用Pearson相关分析法分析SUV_max与T_max的相关性。结果18F-FDG PET/CT诊断原发病灶的灵敏度、特异度和准确率分别为94.4%、40.0%和82.6%;原发灶SUV_max与T_max呈正相关（r=0.922,P=0.001）;18F-FDG PET/CT诊断淋巴结转移及远处转移的灵敏度、特异度和准确率分别为76.9%、90.0%、82.6%和92.9%、96.9%、95.7%。结论18F-FDG PET/CT在检测胃癌的原发病灶、淋巴结转移灶和远处转移灶时有较高的特异度和灵敏度,在评估临床分期、指导临床制定正确的治疗方案中具有重要的应用价值。     

18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI.

(18)F-FDG PET has a high accuracy in staging head and neck cancer, but its role in patients with clinically and radiographically negative necks (N0) is less clear. In particular, the value of combined PET/CT has not been determined in this group of patients. METHODS: In a prospective study, 31 patients with oral cancer and no evidence of lymph node metastases by clinical examination or CT/MRI underwent (18)F-FDG PET/CT before elective neck dissection. PET/CT findings were recorded by neck side (left or right) and lymph node level. PET/CT findings were compared with histopathology of dissected nodes, which was the standard of reference. RESULTS: Elective neck dissections (26 unilateral, 5 bilateral; a total of 36 neck sides), involving 142 nodal levels, were performed. Only 13 of 765 dissected lymph nodes harbored metastases. Histopathology revealed nodal metastases in 9 of 36 neck sides and 9 of 142 nodal levels. PET was TP in 6 nodal levels (6 neck sides), false-negative in 3 levels (3 neck sides), true-negative in 127 levels (23 neck sides), and false-positive in 6 levels (4 neck sides). The 3 false-negative findings occurred in metastases smaller than 3 mm or because of inability to distinguish between primary tumor and adjacent metastasis. TP and false-positive nodes exhibited similar standardized uptakes (4.8 +/- 1.1 vs. 4.2 +/- 1.0; P = not significant). Sensitivity and specificity were 67% and 85% on the basis of neck sides and 67% and 95% on the basis of number of nodal levels, respectively. If a decision regarding the need for neck dissection had been based solely on PET/CT, 3 false-negative necks would have been undertreated, and 4 false-positive necks would have been overtreated. CONCLUSION: (18)F-FDG PET/CT can identify lymph node metastases in a segment of patients with oral cancer and N0 neck. A negative test can exclude metastatic deposits with high specificity. Despite reasonably high overall accuracy, however, the clinical application of PET/CT in the N0 neck may be limited by the combination of limited sensitivity for small metastatic deposits and a relatively high number of false-positive findings. The surgical management of the N0 neck should therefore not be based on PET/CT findings alone.     

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.     

Added value of dedicated axillary hybrid 18F-FDG PET/MRI for improved axillary nodal staging in clinically node-positive breast cancer patients: a feasibility study

Purpose

To investigate the feasibility and potential added value of dedicated axillary 18F-FDG hybrid PET/MRI, compared to standard imaging modalities (i.e. ultrasound [US], MRI and PET/CT), for axillary nodal staging in clinically node-positive breast cancer.

Methods

Twelve patients with clinically node-positive breast cancer underwent axillary US and dedicated axillary hybrid 18F-FDG PET/MRI. Nine of the 12 patients also underwent whole-body PET/CT. Maximum standardized uptake values (SUVmax) were measured for the primary breast tumor and the most FDG-avid axillary lymph node. A positive axillary lymph node on dedicated axillary hybrid PET/MRI was defined as a moderate to very intense FDG-avid lymph node. The diagnostic performance of dedicated axillary hybrid PET/MRI was calculated by comparing quantitative and its qualitative measurements to results of axillary US, MRI and PET/CT. The number of suspicious axillary lymph nodes was subdivided as follows: N0 (0 nodes), N1 (1–3 nodes), N2 (4–9 nodes) and N3 (≥ 10 nodes).

Results

According to dedicated axillary hybrid PET/MRI findings, seven patients were diagnosed with N1, four with N2 and one with N3. With regard to mean SUVmax, there was no significant difference in the primary tumor (9.0 [±5.0] vs. 8.6 [±5.7], p = 0.678) or the most FDG-avid axillary lymph node (7.8 [±5.3] vs. 7.7 [±4.3], p = 0.767) between dedicated axillary PET/MRI and PET/CT. Compared to standard imaging modalities, dedicated axillary hybrid PET/MRI resulted in changes in nodal status as follows: 40% compared to US, 75% compared to T2-weighted MRI, 40% compared to contrast-enhanced MRI, and 22% compared to PET/CT.

Conclusions

Adding dedicated axillary 18F-FDG hybrid PET/MRI to diagnostic work-up may improve the diagnostic performance of axillary nodal staging in clinically node-positive breast cancer patients.

     

The Clinical Usefulness of 18F-FDG PET/CT for the Evaluation of Lymph Node Metastasis in Periorbital Malignancies

Objective

The aim of this study was to assess the clinical role of ¹⁸F-FDG PET/CT for the evaluation of lymph node metastasis in periorbital malignancies, compared with CT alone.

Materials and Methods

We analyzed eighteen PET/CT and CT scans in 15 patients with biopsy-proven periorbital malignancies. We compared the diagnostic capabilities of PET/CT and CT with regard to nodal metastasis by level-by-level analysis and by N staging prediction. The reference standards were surgical pathology (n = 7) from dissected lymph node specimens and the results from radiological follow-up (n = 11, mean 20.5 months; range 10-52 months). Moreover, any changes in patient care as prompted by PET/CT were recorded and compared with treatment planning for CT alone.

Results

PET/CT had a sensitivity of 100%, while CT had a sensitivity of 57% (p = 0.03) for nodal metastasis by level-by-level analysis. PET/CT had a specificity of 97%, positive predictive value of 93%, negative predictive value of 100%, and diagnostic accuracy of 98%, while the CT values for these same parameters were 97%, 89%, 82%, and 84%, respectively. PET/CT correctly predicted N staging with an accuracy of 100%, while CT was only 83% accurate (p = 0.01). Regarding the impact on patient care, the extent of surgery for regional lymph nodes and the treatment decision were modified by PET/CT in 39% of patients.

Conclusion

PET/CT could provide useful information in the management of regional lymph node metastases in patients with periorbital malignancies.     

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.     

The value of 18F-FDG PET in the detection of stage M0 carcinoma of the nasopharynx.

Distant metastasis is an important issue for nasopharyngeal carcinoma (NPC). The potential value of PET using 18F-FDG has not been well defined. This prospective study investigated the impact of 18F-FDG PET in NPC patients with stage M0 disease. METHODS: From April 2001 to June 2003, 140 NPC patients (118 primary and 22 primary recurrent) with stage M0 (negative results from chest radiography, liver sonography, and whole-body bone scanning) underwent 18F-FDG PET to check for distant metastases. Confirmatory MRI or CT was performed if any abnormal 18F-FDG uptake was found at distant sites. The distant lesion was confirmed pathologically, if feasible, and was followed up clinically and with imaging for at least 6 mo. RESULTS: 18F-FDG PET detected 26 true-positive metastatic sites in 18 (12.9%) of the 140 patients, among whom 14 had primary and 4 had recurrent tumors. The patient-based sensitivity and specificity of 18F-FDG PET for distant metastases were 100% and 86.9%, respectively. Mediastinal lymph nodes (n = 8) were the most common sites, followed by lung, liver, and bone (n = 5 each) and by other lymph nodes (n = 3). In patients with primary tumors, advanced nodal status (N2-3) was a statistically significant variable associated with development of distant metastases (P = 0.044). For recurrent NPC, neither age, sex, initial tumor stage, grade of differentiation, nor nodal stage showed a statistically significant difference between patients with and patients without distant metastases. CONCLUSION: 18F-FDG PET is valuable in avoiding aggressive locoregional radiotherapy in some NPC patients by the revelation of occult distant metastases, especially in patients with primary disease at a nodal stage of N2-3.     

Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer

The aims of this study were to investigate the detection of cervical lymph node metastases of head and neck cancer by positron emission tomographic (PET) imaging with fluorine-18 fluorodeoxyglucose (FDG) and to perform a prospective comparison with computed tomography (CT), magnetic resonance imaging (MRI), sonographic and histopathological findings. Sixty patients with histologically proven squamous cell carcinoma were studied by PET imaging before surgery. Preoperative endoscopy (including biopsy), CT, MRI and sonography of the cervical region were performed in all patients within 2 weeks preceding ¹⁸F-FDG whole-body PET. FDG PET images were analysed visually and quantitatively for objective assessment of regional tracer uptake. Histopathology of the resected neck specimens revealed a total of 1284 lymph nodes, 117 of which showed metastatic involvement. Based on histopathological findings, FDG PET correctly identified lymph node metastases with a sensitivity of 90% and a specificity of 94% (P<10^–6). CT and MRI visualized histologically proven lymph node metastases with a sensitivity of 82% (specificity 85%) and 80% (specificity 79%), respectively (P<10^–6). Sonography revealed a sensitivity of 72% (P<10^–6). The comparison of ¹⁸F-FDG PET with conventional imaging modalities demonstrated statistically significant correlations (PET vs CT, P = 0.017; PET vs MRI, P = 0.012; PET vs sonography, P = 0.0001). Quantitative analysis of FDG uptake in lymph node metastases using body weight-based standardized uptake values (SUV_BW) showed no significant correlation between FDG uptake (3.7±2.0) and histological grading of tumour-involved lymph nodes (P = 0.9). Interestingly, benign lymph nodes had increased FDG uptake as a result of inflammatory reactions (SUV_BW-range: 2–15.8). This prospective, histopathologically controlled study confirms FDG PET as the procedure with the highest sensitivity and specificity for detecting lymph node metastases of head and neck cancer and has become a routine method in our University Medical Center. Furthermore, the optimal diagnostic modality may be a fusion image showing the increased metabolism of the tumour and the anatomical localization. Received 17 February and in revised form 12 June 1998     

肺大细胞神经内分泌癌的18F-FDG PET/CT表现

目的探讨肺大细胞神经内分泌癌（LCNEC）的18F-氟脱氧葡萄糖（FDG）PET/CT的影像学表现。方法回顾性分析2009年10月至2017年5月经病理证实的37例肺LCNEC患者的18F-FDG PET/CT影像学表现,包括病灶位置、形态特征、代谢和淋巴结转移情况,以及最大标准化摄取值（SUV_max）预测淋巴结转移的价值。SUV_max与肿瘤最大径的相关性采用Pearson相关性分析。结果37例肺LCNEC患者均为单发,其中周围型28例（28/37,75.7%）、中央型9例（9/37,24.3%）。30例病灶（30/37,81.1%）可见分叶征,多为浅分叶;10例病灶（10/37,27.0%）可见毛刺征。29例病灶（29/37,78.4%）边界清晰,9例病灶（9/37,24.3%）可见胸膜凹陷征,2例病灶可见液化坏死,1例病灶可见空洞形成,1例病灶内见点状钙化,1例病灶内见充气支气管征。37例病灶18F-FDG代谢程度均高于肝脏,SUV_max为11.7±5.2（3.3~25.3）,肿瘤最大径为（3.2±1.5）cm,SUV_max与肿瘤最大径呈正相关（r=0.569,P=0.000）。15例病灶伴有肺门和（或）纵隔淋巴结转移,8例可见远处转移,包括骨转移4例、肾上腺转移1例、肝脏及骨转移2例、肾上腺及骨转移1例。约登指数最大为0.573,所对应的SUV_max为11.9,诊断效率最高,灵敏度为80.0%,特异度为77.3%。结论肺LCNEC的18F-FDG PET/CT多表现为周围型类圆形软组织结节或肿块,边缘清晰,充气支气管征少见,18F-FDG摄取较高。原发肿瘤SUV_max是判断淋巴结转移的重要半定量指标。     

Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology.

This prospective, nonrandomized, case-control study evaluated the impact of (18)F-FDG PET in staging untreated squamous cell carcinoma of the buccal mucosa (BSCC) and compared the results with CT/MRI and histopathology. METHODS: Between January 2002 and April 2004, 102 untreated BSCC patients with cM0 (no evidence of distant metastatic focus on chest radiograph, liver ultrasonograph, and bone scan) were enrolled with either conventional work-up (CWU, n = 51) or PET (CWU+PET, n = 51). All were monitored for at least 6 mo. The comparative diagnostic efficacies of PET and CT/MRI were evaluated using the area under the receiver-operating-characteristic curve (AUC). The primary endpoint was the percentage reduction in futile surgery (preoperative detection of distant metastatic lesions). The secondary endpoint was the 2-y cumulative recurrence rate among study participants (with PET) compared with that of comparable control subjects (without PET). RESULTS: Significant benefits of PET compared with those of CT/MRI for BSCC patients were in the detection of locoregional (AUC, 0.973 vs. 0.928; P = 0.026), regional (AUC, 0.939 vs. 0.837; P = 0.026), and level II (AUC, 0.974 vs. 0.717; P = 0.02) lymph nodes. Two percent (1/51) of the patients experienced a reduction in futile surgery in the CWU+PET group compared with 0% (0/51) in the CWU group. However, no statistical difference was found in the 2-y locoregional control rate between the CWU and the CWU+PET groups. CONCLUSION: The role of (18)F-FDG PET for BSCC with cM0 is limited. Although PET is superior to CT/MRI in identifying cervical nodal metastases, it does not improve locoregional recurrence.     

18F-FDG PET/CT for staging of penile cancer.

The value of PET or PET/CT with (18)F-FDG for the staging of penile cancer has yet to be determined. The objective of this study was to investigate the pattern of (18)F-FDG uptake in the primary malignancy and its metastases and to determine the diagnostic value of (18)F-FDG PET/CT in the staging and restaging of penile cancer. METHODS: Thirteen patients (mean +/- SD age, 64 +/- 14.0 y) with suspected penile cancer or suspected recurrent disease were examined with a Gemini PET/CT system (200 MBq of (18)F-FDG). The reference standard was based on histopathologic findings obtained at biopsy or during surgery. RESULTS: Both the primary tumor and regional lymph node metastases exhibited a pattern of (18)F-FDG uptake typical for malignancy. Sensitivity in the detection of primary lesions was 75% (6/8), and specificity was 75% (3/4). On a per-patient basis, sensitivity in the detection of lymph node metastases was 80% (4/5), and specificity was 100% (8/8). On a nodal-group basis, PET/CT showed a sensitivity of 89% (8/9) in the detection of metastases in the superficial inguinal lymph node basins and a sensitivity of 100% (7/7) in the deep inguinal and obturator lymph node basins. The mean +/- SD maximum standardized uptake value for the 8 primary lesions was 5.3 +/- 3.7, and that for the 16 lymph node metastases was 4.6 +/- 2.0. CONCLUSION: According to our results, the main indication for (18)F-FDG PET in the primary staging or follow-up of penile cancer patients may be the prognostically crucial search for lymph node metastases. With the use of a PET/CT unit, the additional information provided by CT may be especially useful for planning surgery. Implementing (18)F-FDG PET and PET/CT in future staging algorithms may lead to a more precise and stage-appropriate therapeutic strategy. Furthermore, invasive procedures with a high morbidity rate, such as general bilateral lymphadenectomy, may be avoided.     

18F-FDG PET/CT在寻找不明原发灶肿瘤患者原发灶中的价值

目的 探讨18F-FDG PET/CT在诊断不明原发灶肿瘤(CUP)患者原发灶中的价值.资料与方法 36例CUP患者行PET/CT检查拟寻找原发灶,根据转移灶部位分为淋巴结转移组(8例)、肝转移组(9例)、骨转移组(12例)及恶性胸腹水组(7例),比较18F-FDG PET/CT诊断淋巴结转移组与非淋巴结转移组CUP患者原发灶的灵敏度.结果 18F-FDG PET/CT寻找CUP原发灶的灵敏度为63.9％ (23/36),PET/CT诊断淋巴结转移组、肝转移组、骨转移组及恶性胸腹水组患者原发灶的灵敏度分别为87.5％ (7/8)、55.6％ (5/9)、58.3％(7/12)、57.1％ (4/7).18F-FDG PET/CT对淋巴结转移组原发灶的确诊率[87.5％(7/8)]显著高于非淋巴结转移组[57.1％( 16/28)],差异有统计学意义(P＜0.05).结论 18F-FDG PET/CT诊断CUP患者原发灶灵敏度较高,尤其适用于发生淋巴结转移的CUP患者.     

PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像与螺旋CT增强扫描检测乳腺癌及其腋淋巴结转移的临床价值。方法27例乳腺肿块患者于同日行^18F—FDG PET／CT显像与CT增强扫描。患者俯卧于乳腺专用泡沫垫上接受检查，前者图像由3位核医学科医师采用目测法结合半定量法进行诊断，后者图像由3位影像科医师分析诊断；最后与病理检查结果对照。结果27例患者PET／CT与增强CT均发现31个乳腺肿块，病理检查证实其中21个为乳腺癌，10个为良性病变；发现腋淋巴结91个，共有66个转移（1例有双侧腋淋巴结转移）；PET／CT显像检测乳腺癌原发灶的灵敏度为80．95％，特异性为90％，阳性预测值为94．44％；检测淋巴结转移的灵敏度为89．39％，特异性为88％，阳性预测值为95．16％。增强CT检测乳腺癌原发灶的灵敏度为90．48％，特异性为60％，阳性预测值为82．61％；检测淋巴结转移的灵敏度为86．36％，特异性为52％，阳性预测值为82．61％。^18F—FDG PET／CT和增强CT对腋淋巴结状态的诊断与病理检查结果的列联系数分别为0．64和0．37；两者对乳腺癌及其腋淋巴结转移的诊断特异性差异有显著性（P〈0．05）；对直径〈2cm的病灶，^18F—FDG PET／CT诊断准确性明显高于增强CT（P〈0．05）。结论^18F—FDG PET／CT对诊断乳腺癌及其腋淋巴结转移的特异性均高于增强CT。     

18F-FLT PET/CT与18F-FDG PET/CT在鼻咽癌诊断和分期中的应用比较

目的 通过与18F-FDG PET/CT显像对比,探讨18 F-FLT PET/CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性.方法 12例初治且经病理确诊的鼻咽癌患者(年龄22～62岁)自愿进入该前瞻性临床研究.每位患者先行18F-FDG PET/CT检查,次日行18F-FLF PET/CT检查.至少有2位核医学科和放射科医师阅片,比较18F-FDG PET/CT和18F-FLT PET/CT图像,采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对18F-FDG、18F-FLT的SUVmax、SUVmean和MTV.采用非参数Wilcoxon秩和检验比较组间摄取和MTV差异.结果 12例鼻咽癌患者病灶均明显摄取18F-FLT.18F-FLT PET/CT和18F-FDG PET/CT均可准确诊断该组病例,二者对原发灶和淋巴结转移灶的检测结果无明显差别.鼻咽癌病灶的18F-FDG和18F-FLT SUVmax分别为10.7±5.8和6.0±2.4,SUVmean分别为5.8±3.0和3.6±1.5;SUVmax和SUVmean组间差异均有统计学意义(Z=-2.589和-2.353,P均＜0.05),而 MTV在18F-FDG和8F-FLT PET/CT 2种显像方法之问的差异无统计学意义(15.9±9.2和18.1±11.1;Z=-0.786,P＞0.05).6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义(8.5±6.2比6.4±2.5、5.3±4.2比3.8±1.4、6.5 ±4.8比6.0±4.4;Z=-0.734、-0.734和-0.674,P均＞0.05).18F-FLT在颞叶摄取(SUVmax 0.7±0.3)明显低于18F-FDG(SUVmax 8.3±2.7;Z=-3.062,P＜0.01),其对于原发灶颅内浸润显示较18F-FDG更清晰.结论 18F-FLT PET/CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与18F-FDG PET/CT相当,对于显示原发灶的颅底附近侵犯更有利,其临床应用值得进一步研究.     

Unsuspected Active Sarcoidosis Diagnosed by 18F-FDG PET/CT During the Search for a Primary Tumour in a Patient with Bone Lesions

Sarcoidosis is a systemic chronic inflammatory disease of unknown aetiology, characterised by granulomatous lesions with heterogeneous clinical manifestations affecting multiple organs and tissues. Although the respiratory system is most commonly affected, the disease may also present with bone lesions. We report the case of a 31-year-old woman who presented with low back pain and no history of cancer and who was found to have suspicious lesions involving the entire spine on magnetic resonance imaging (MRI). The patient underwent 18F-fluorodeoxyglucose (FDG) PET/CT to search for a primary tumour and for staging purposes. 18F-FDG PET/CT revealed a pattern of hypermetabolic activity in widespread skeletal lesions and in a single left cervical lymph node. The primary tumour was not found, thus suggesting a haematologic disorder. Subsequent biopsies of a cervical lymph node and of bone tissue from L4 revealed active sarcoidosis with no evidence of cancer. This underlines the importance of considering all alternatives when hypermetabolic lesions are found on 18F-FDG PET/CT. Furthermore, 18F-FDG PET can be very useful to indicate accessible sites for guiding fine-needle aspiration cytology (FNAC).     

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.     

Detection of distant metastases in esophageal cancer with (18)F-FDG PET.

Standard staging of esophageal and gastroesophageal junction (GEJ) tumors substantially lacks accuracy. The aim of this study was to investigate whether the addition of PET with (18)F-FDG is a valuable gain in the initial staging. METHODS: Between January 1996 and January 2002, (18)F-FDG PET was performed in 74 patients. Conventional staging included CT in all patients and well-performed endoscopic ultrasonography (EUS) in 52 patients. They were compared with (18)F-FDG PET with pathology and follow-up of suspicious lesions as the gold standard. RESULTS: PET identified 70 primary tumors (sensitivity, 95%). Sensitivity to identify locoregional metastases was highest for EUS (69%) but was not different for CT and PET (44% and 55%, respectively). PET was able to identify distant nodal disease in 71% (17/24 patients) compared with 29% (7/24 patients) after combined CT/EUS alone (P = 0.021). Sensitivity to detect distant nodal and systemic (M1) disease increased with PET (78% vs. 37%; P = 0.012). PET upstaged 15 patients (15/74; 20%) correctly as M1 disease, missed by CT/EUS, and correctly downstaged 4 patients (5%) from M1 to M0 disease. However, false upstaging and downstaging was encountered in 5 (7%) and 3 (4%) patients, respectively. CONCLUSION: PET improves the currently applied staging of esophageal and GEJ tumors, particularly by ameliorating the detection of M1 disease.     

超声检查和PET/CT检查诊断甲状腺乳头状癌中央区淋巴结转移的对比研究

目的比较超声检查和18F-FDG PET/CT检查对甲状腺乳头状癌中央区淋巴结转移的诊断价值。方法回顾性分析93例经病理证实的甲状腺乳头状癌患者中央区淋巴结转移情况,与术前超声检查和PET/CT检查对比,评价其诊断甲状腺乳头状癌中央区淋巴结转移的价值。结果超声检查诊断中央区淋巴结转移的敏感度、特异度、准确度、阳性预测值、阴性预测值分别是78.8%、61.0%、71.0%、71.9%、69.4%(χ^2=4.742,P=0.029);PET/CT检查诊断中央区淋巴结转移的敏感度、特异度、准确性、阳性预测值、阴性预测值分别是53.8%、78.0%、64.5%、75.7%、57.1%(χ^2=3.882,P=0.049)。超声检查和PET/CT检查诊断中央区淋巴结转移的ROC曲线下面积(AUC)分别为0.699、0.659。结论超声检查诊断甲状腺乳头状癌中央区淋巴结转移具有较高敏感度和准确性,且因其简便、分辨率高、无辐射等优势,较18F-FDG PET/CT检查更具有显著意义。