~(18)F-FDG PET/CT和PET/MRI在前列腺癌诊断及分期中的效能研究

目的对比前列腺癌2-氟-2脱氧-D-葡萄糖(~(18)F-FDG)正电子发射断层扫描/计算机断层成像(PET/CT)和正电子发射断层扫描/核磁共振成像(PET/MRI)影像学特征,探讨两种方法在前列腺癌筛查、诊断及分期中的价值。方法回顾性分析20例组织学证实为前列腺癌患者的~(18)F-FDG PET/CT和PET/MRI图像资料,比较两种方法影像学结果,并采用配对t检验和卡方检验进行统计学分析。结果 ~(18)F-FDG PET/CT和PET/MRI对病灶定量的最大标准摄取值(SUVmax)(2.9±0.25 vs.3.2±0.26)有统计学差异(P0.05),PET/CT和PET/MRI探查原发性前列腺癌阳性结果(11例vs.18例)有统计学差异(P0.05),探查周围组织(1例vs.4例)、盆腔淋巴结(4例vs.4例)及骨盆(6例vs.5例)的转移效能无统计学差异(P0.05)。结论 ~(18)F-FDG PET/MRI诊断原发性前列腺具有优势,在探查周围侵犯、盆腔淋巴或骨盆转移时和PET/CT无明显差异。临床工作中合理选择或联合应用有助于前列腺癌筛查、诊断及分期的全面评估。     

MRI联合MRCP在胆道梗阻性疾病诊断中的应用价值

目的 探究MRI及MRCP在胆道梗阻性疾病定位和定性诊断的应用价值。方法 回顾性分析2017年11月至2019年11月在上海中医药大学附属岳阳中西医结合医院经手术病理或临床证实的72例胆道梗阻性疾病患者的临床资料,所有患者均行MRI及MRCP检查,其中42例加行CT检查,对不同影像学检查结果进行对比分析。结果 MRI联合MRCP、MRI、CT检查的定位诊断准确率分别为100%(72/72)、94.4%(68/72)、78.6%(33/42),定性诊断准确率分别为95.8%(69/72)、86.1%(62/72)、66.7%(28/42)。上述3种影像学检查均做的42例中,MRI联合MRCP检查较CT检查的定位诊断[100%(42/42) vs 78.6%(33/42),χ²=10.080,P<0.05]和定性诊断[90.5%(38/42) vs 66.7%(28/42),χ²=7.071,P<0.05]的准确率差异均有统计学意义,MRI联合MRCP与MRI、MRI与CT检查比较,定位诊断和定性诊断的准确率差异均无统计学意义(P&g...     

CT与MRI在早期股骨头坏死诊断中的临床应用价值

目的探讨CT,MRI影像学检查在早期股骨头坏死诊断中的应用价值。方法选取2016年1月-2017年5月收治的早期股骨头坏死56例(共98髋),均进行多层螺旋CT及MRI检查,比较两种方法对各临床分期股骨头坏死的检出率及早期征象的检出率。结果 MRI对股骨头坏死总检出率高于CT,且MRI对Ⅰ～Ⅱ期股骨头坏死检出率高于CT,存在统计学差异(P0.05);在Ⅰ～Ⅱ期股骨头坏死患者中,MRI对线样征、骨髓水肿、骨小梁模糊的检出率高于CT,存在统计学差异(P0.05);两种检查方法对局部囊变检出率比较无统计学意义(P0.05)。结论 MRI在早期股骨头坏死诊断中要优于CT,尤其是骨髓水肿、线样征、骨小梁模糊等典型征象,具有良好的临床诊断价值。     

腹部超声、CT、MRI对肝脏局灶性结节增生的诊断价值

目的探讨肝脏局灶性结节增生(Focal nodular hyperplasia,FNH)采用腹部超声、CT、MRI诊断的影像学特点,为临床诊断FNH提供依据。方法回顾性分析2015年6月至2018年6月经医院手术病理检查或肝穿刺活检确诊为FNH的70例患者的临床资料,所有患者均行腹部超声、CT、MRI检查,分别对其影像学特征进行分析,并对诊断符合率进行评价。结果腹部超声FNH诊断符合率为62.86%,CT FNH诊断符合率为65.71%,MRI FNH诊断符合率为97.14%,MRI诊断符合率显著高于超声和CT,误诊率、漏诊率均低于CT,差异有统计学意义(P0.05);超声的漏诊率、诊断符合率与CT相比差异无统计学意义(P0.05),CT误诊率低于超声,差异有统计学意义(P0.05)。结论腹部超声、CT、MRI检查均可作为FNH的初筛手段,MRI增强扫描三期信号与CT扫描特点具有相似性,但MRI更适合微小病灶的诊断,因此MRI对FNH的诊断更具有临床价值。     

CT与MRI诊断乙肝肝硬化继发小肝癌的临床比较

探讨乙肝肝硬化继发小肝癌应用磁共振成像和多排螺旋计算机断层扫描检查的诊断价值。2017年5月—2018年3月,乙肝肝硬化背景小肝癌患者80例,病灶104个,均经病理检查确诊。按照病灶直径大小分为小肝癌组(1～3 cm)和微小肝癌组(1 cm)。其中小肝癌组病灶70个,微小肝癌组病灶34个,均予以核磁共振成像检查和多排螺旋计算机断层扫描,比较2种检查方法的检出准确性,通过绘制ROC曲线,分析小肝癌病灶应用2种检查方法的诊断效能。观察小肝癌/微小肝癌的多排螺旋CT及MRI的表观特征。结果显示,小肝癌病灶70个,CT扫描检出病灶53个(75.7%),MRI检出病灶67个(95.7%),MRI的小肝癌病灶检出率显著高于CT(P0.05);微小肝癌病灶34个,CT检出病灶22个(64.7%),MRI检出病灶32个(94.1%),MRI的微小肝癌病灶检出率显著高于CT,差异有统计学意义(P0.05)。CT扫描小肝癌组时,检出率最低为CT平扫(60.0%),检出率最高为CT动脉期(72.9%);MRI检查时,检出率最高者为LAVA动脉期(88.6%);微小肝癌组MRI病灶检出率最低为LAVA平衡期(52.9%),检出率最高为LAVA动脉期(85.3%),CT检查微小肝癌组检出率最低为CT平扫(38.2%),差异有统计学意义(P0.05)。CT平扫主要为低密度病灶,其中小肝癌21个,微小肝癌8个,二者均未见高密度病灶;CT动脉期主要为高密度病灶,其中小肝癌44个,微小肝癌10个;门静脉期主要为低密度病灶,其中小肝癌40个,微小肝癌10个;平衡期主要为低密度病灶,其中小肝癌43个,微小肝癌13个;MRI T2WI序列主要为高信号病灶,其中小肝癌56个,微小肝癌27个,未见低信号病灶;DWI序列主要为高信号病灶,其中小肝癌56个,微小肝癌26个;IN-PHASE序列主要为低信号病灶,其中小肝癌49个,微小肝癌16个;OUT-PHASE序列主要为低信号病灶,其中小肝癌46个,微小肝癌15个;LAVA平扫主要为低信号病灶,其中小肝癌49个,微小肝癌16个;动脉期主要为高信号病灶,其中小肝癌50个,微小肝癌25个;门静脉期主要为低信号病灶,其中小肝癌47个,微小肝癌20个;平衡期主要为低信号病灶,其中小肝癌51个,微小肝癌14个。结果表明,微小肝癌及小肝癌进行MRI检查的检出准确性更高,其中MRI容积快速三维成像动脉期对小肝癌的检查准确性最高。     

CT与MRI检查用于诊断强直性脊柱炎骶髂关节病变的临床效果对比分析

目的探讨CT与MRI检查用于诊断强直性脊柱炎骶髂关节病变的临床效果。方法选取2011年1月至2015年1月本院收治的经临床确诊为强直性脊柱炎骶髂关节病变患者68例,回顾性分析所有患者CT与MRI等影像学表现,比较MRI、CT检出率。结果68例患者共61例患者CT表现异常,CT检出率为89.70%;68例患者中所有患者MRI检查均异常,MRI检出率为100%。MRI检出率高于CT检出率,组间差异有统计学意义(P0.05)。结论 MRI检查相比于CT用于诊断强直性脊柱炎骶髂关节病变,可以提高病变早期检出率,对疾病的病情评估提供重要影像学信息,具有重要的临床意义。     

磁共振技术与CT在膝关节损伤诊断中的价值对比

目的对比膝关节损伤诊断中应用磁共振成像(Magnetic Resnane Iamge,MRI)与电子计算机断层扫描(Computed Tomography,CT)的价值。方法回顾性分析2016年3月至2019年3月医院收治的40例膝关节损伤患者的临床资料,40例患者均给予CT、MRI检查,将关节镜检查及手术病理结果作为金标准,比较CT、MRI检查的诊断结果,并对影像学特征进行分析。结果 CT检测的检出率为77.50%,MRI检测的检出率为100.00%,MRI检出率显著高于CT,两种检测方式检出率差异有统计学意义(P0.05);经关节镜探查及手术结果显示,40例膝关节损伤患者半月板损伤11例、韧带损伤9例、骨质损伤6例、关节腔积液14例,CT、MRI对不同类型膝关节损伤诊断准确率分别为75.00%、100.00%,MRI诊断准确率显著高于CT组,两组差异有统计学意义(P0.05)。结论 MRI对膝关节损伤检出率及不同类型膝关节损伤诊断准确率均高于CT,可为临床诊断、治疗及评估预后提供依据。     

MRI和CT诊断早期股骨头坏死的价值

目的比较MRI和CT诊断早期股骨头坏死的价值。方法选择2015-01—2017-01间收治的110例早期股骨头坏死患者,均采用MRI和CT进行双侧股骨头扫描,并经手术及骨穿病理证实,比较分析2种不同影像学的诊断结果。结果 MRI的阳性检出率(95.98%)显著高于CT(89.08%),差异有统计学意义(P0.05)。结论与CT检查比较,MRI诊断股骨头坏死的敏感性和准确性更高,能较好呈现病灶的形态和病理,利于股骨头坏死的早期诊断,且安全性高。     

双排螺旋CT成像技术在结肠癌诊断中的临床价值

目的探讨双排螺旋CT成像技术在结肠癌诊断中的临床价值。方法对我院2011年3月至2014年3月收治的经手术治疗及病理证实为结肠癌患者进行抽样,选取84例患者随机分成两组,其中实验组患者治疗前予以CT检查,对照组予以常规腹部B型超声检查,比较结肠癌阳性检出率、病灶检出率及淋巴结转移检出率,同时评价双排螺旋CT对结肠癌分期的诊断准确率。结果实验组癌检出率(50.00%)稍低于对照组(52.38%),但对比差异无统计学意义(P0.05);而实验组病灶检出率(88.10%)明显高于对照组(59.52%),且淋巴结转移检出率(80.95%)显著优于对照组(54.76%),差异具有统计学意义(P0.05)。双排螺旋CT对结肠癌T分期诊断准确性为88.1%(37/42),对结肠癌TNM分期诊断准确性为83.3%(35/42),经一致性检验均无统计学意义。结论双排螺旋CT成像技术在结肠癌诊断中具有至关重要的临床应用价值,属于结肠癌术前分期的关键依据,值得临床大力推广与应用。     

5种影像学检查方法对胰腺癌诊断价值的比较

目的 评价BUS、MRI、CT、ERCP、EUS五种影像学检查方法对胰腺癌诊断的价值.方法 376例胰腺癌患者进行了BUS、MRI、CT、ERCP和EUS的一项或多项检查,均经手术及病理证实为胰腺癌.对检查结果进行分析.结果 结果显示BUS、MRI、CT、ERCP、EUS对胰腺癌的准确性分别为85.1%、88.9%、89.4%、90.2%和93.8%:EUS对胰腺癌有较高的准确性.而BUS的准确性最差;CT、MRI、ERCP三者的准确性没有显著差异.结论 EUS对胰腺癌是目前准确性最高的影像学检查方法:MRI、CT对于术前判断胰腺癌的可切除性具有极其重要意义:ERCP对胰腺癌的诊断是一种较好的方法.但不作为首选的方法.     

胰腺神经内分泌肿瘤的CT和MRI表现

目的探讨胰腺神经内分泌肿瘤的影像特征。方法分析43例经手术后病理证实的胰腺神经内分泌肿瘤的CT和MRI资料,并与手术病理结果对照。结果 43个病灶平均大小为(25.00±1.82)mm,23个病灶出现坏死囊变;CT平扫15个病灶呈等密度,28个病灶呈稍低密度;43个病灶T1WI均呈低/稍低信号,27个病灶T2WI呈高/稍高信号,16个病灶T2WI呈等信号;26个病灶见包膜;30个病灶显示清晰轮廓;24个病灶增强扫描动脉期病灶即明显强化,8个呈延迟强化,5个呈向心性强化,6个呈轻度强化。结论胰腺神经内分泌肿瘤形态及CT和MRI动态增强扫描具有特征性表现,影像学检查对诊断其具有重要价值。     

Prospective Analysis of Accuracy of Positron Emission Tomography,Computed Tomography,and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

Background: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities.Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS).Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients.Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.     

Clinical value of 18FDG PET/MRI in muscle-invasive,locally advanced,and metastatic bladder cancer

ObjectiveMetastatic bladder cancer is an aggressive disease that can often be difficult to diagnose and stage with conventional cross-sectional imaging. The primary objective of this study was to determine the clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET/MRI for surveillance and restaging of patients with muscle-invasive, locally advanced, and metastatic bladder cancer compared to conventional imaging methods.Materials and MethodsThis retrospective study enrolled patients with muscle-invasive, locally advanced and metastatic bladder cancer in a single institute evaluated with ¹⁸F-FDG PET/MRI. All patients also underwent conventional imaging with CT. Additional imaging may also have included ¹⁸F-FDG PET/CT (¹⁸F-FDG PET), or sodium fluoride (NaF) PET/CT in some patients. Images were reviewed by a diagnostic radiologist/nuclear medicine physician. Number of lesions and sites of disease were captured and compared between ¹⁸F-FDG PET/MRI and conventional imaging. Lesions were confirmed by sequential imaging or lesion biopsy. All patients were followed for survival.ResultsFifteen patients (4 for surveillance; 11 for restaging) underwent 34 ¹⁸F-FDG PET/MRI scans. Each patient received a corresponding conventional CT around the time of the ¹⁸F-FDG PET/MRI (median 6 days). The 15 patients (11 male; 4 female) had a median age of 61.5 years (range 37–73) and histologies of urothelial carcinoma (n = 13) and small-cell carcinoma of the bladder (n = 2) diagnosed as stage 4 (n = 13), stage 3 (n = 1), or stage 2 (n = 1). ¹⁸F-FDG PET/MRI detected 82 metastatic malignant lesions involving lymph nodes (n = 22), liver (n = 10), lung (n = 34), soft tissue (n = 12), adrenal glands (n = 1), prostate (n = 1), and bone (n = 2) with a resultant advantage of 36% for lesion visibility in comparison with CT. Serial imaging or biopsy confirmed these lesions as malignant.Conclusion¹⁸F-FDG PET/MRI can detect metastatic lesions which cannot be identified on conventional CT, and this can allow for better treatment planning and improved disease monitoring during therapy.     

Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective?

BACKGROUND: Multimodality staging is recommended in patients with periampullary tumors to optimize preoperative determination of resectability. We investigated the potency of currently used diagnostic procedures in order to determine resectability. METHODS: Ninety-five consecutive patients with periampullary tumors prehospitally staged resectable underwent preoperative diagnostic tests: helical-computed tomography (CT) with maximum intensity projection of arterial vessels (MIP), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreaticography (ERCP), digital subtraction angiography (DSA), and positron emission tomography (PET). Diagnoses were verified by surgery and histopathology. RESULTS: In 45 patients with benign and 50 patients with malignant periampullary tumors sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET. Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy. Arterial vessel infiltration was best predicted by CT/MIP with an accuracy of 85%. For venous vessel infiltration MRI reached 85% accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92% (MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases were identified by CT and PET, respectively. The correct diagnosis of malignancy and determination of resectability was made by CT in 71% and by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was the single most useful test, providing correct diagnosis in 88% and resectability in 71% of patients. If no tumor is depicted in CT, EUS should be added. Uncertain venous vessel infiltration can be verified by MRI or EUS. Angiography should no longer be a routine diagnostic procedure. Equivocal tumors or possible metastasis may be further examined with PET.     

影像学检查对壶腹周围癌诊断价值的临床研究

目的评价各种检查手段对壶腹周围癌的诊断价值,帮助临床医师合理地选择检查方法。方法对胰头及壶腹周围癌患者３４例施行二维超声（Ｂｕｓ）、彩色多普勒超声（ＣＤＩ）、内镜超声（ＥＵＳ）、逆行性胆胰管造影（ＥＲＣＰ）、电子计算机断层扫描（ＣＴ）、核磁共振显像（ＭＲＩ）、血管造影（Ａｎｇｉｏ）及术中超声（ＯＵＳ）检查,比较它们的诊断效能。结果除Ａｎｇｉｏ的诊断符合率不足５０％外,Ｂｕｓ与ＣＤＩ,ＣＴ,ＭＲＩ的诊断符合率相当,约８０％（２７／３４）,ＥＵＳ,ＯＵＳ,ＥＲＣＰ的诊断率均达９０％（３２／３４）以上,检出全部直径大于和等于２ｃｍ的癌灶。直径小于２ｃｍ的癌灶１０例,ＥＵＳ及ＯＵＳ均检出８／１０例,ＥＲＣＰ在加用活体组织检查后全部检出,Ｂｕｓ、ＣＤＩ、ＣＴ、ＭＲＩ分别检出３例、３例、２例、４例,Ａｎｇｉｏ则无检出病例。结论ＥＵＳ和ＥＲＣＰ是目前检测微小癌灶最有效的方法,Ｂｕｓ因方便经济可做为首选的检查手段,ＣＤＩ从检测癌灶内血流信号有助判断癌灶来源     

Adenocarcinoma of the Esophagus and the Esophagogastric Junction: Positron Emission Tomography Improves Staging and Prediction of Survival in Distant but Not in Locoregional Disease

In adenocarcinoma of the esophagus and esophagogastric junction for prognostication and treatment allocation, one prerequisite is accurate pretreatment staging. This staging, we hypothesized, would be improved by the use of positron emission tomography (PET). After 55 patients suitable for radical esophageal resection were staged with PET, spiral computed tomography (CT), and endoscopic ultrasonography (EUS), results were compared with histopathology and with survival. Accuracy in detecting locoregional lymph node metastasis did not differ significantly between EUS (72%), PET (60%), and CT (58%). Adding PET to standard staging failed to improve the accuracy of N staging (P = 0.250). In M staging, accuracy between CT (75%) and PET (76%) did not differ. The accuracy of combined studies of CT and PET and of EUS, CT, and PET were 87% (P = 0.016 versus CT) and 91% (P = 0.031 versus EUS and CT), respectively. Of the 55 patients, 19 (35%) had metastatic lesions. By combined use of CT and EUS and by combined use of CT, EUS, and PET, 8 and 14 (P = 0.031), respectively, could be detected. In nodal disease without distant metastases, PET did not improve the prediction of survival. However, positive PET for distant metastasis by either positive EUS or CT predicts well the poor survival of these patients. The staging value of PET by itself in adenocarcinoma of the esophagus is limited because of low accuracy for nodal and the lack of specificity for distant disease prognosis. Adding PET to standard staging does, however, improve detection of stage IV disease and its associated poor survival. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (poster presentation).     

MRI and PET/CT for evaluation of the pathological response to neoadjuvant chemotherapy in breast cancer: A systematic review and meta-analysis

BackgroundNeoadjuvant chemotherapy (NAC) has become an essential treatment for breast cancer. However, there is still no consensus on the best tool to evaluate pathological response to NAC.MethodsTwo reviewers systematically searched Cochrane, PubMed, EMBASE, Web of Science, and CBM (last updated in February 2017) for eligible articles. We independently screened and selected studies that conformed to the inclusion criteria and extracted the requisite data. Pooled sensitivity, specificity, and the area under the SROC curve were calculated to estimate the diagnostic accuracy of magnetic resonance imaging (MRI) and positron emission computed tomography (PET/CT). And the relative DOR (RDOR) was used to compare accuracy for levels of the covariable.ResultsThirteen studies involving 575 patients who underwent MRI and 618 who underwent PET/CT were included in our analysis. The pooled sensitivity and specificity of MRI were 0.88 (95% CI: 0.78–0.94) and 0.69 (95% CI: 0.51–0.83), respectively. The corresponding values for PET/CT were 0.77 (95% CI: 0.58–0.90) and 0.78 (95% CI: 0.63–0.88), respectively. The area under the SROC curve for MRI and PET/CT were 0.88 and 0.84, respectively. And the RDOR = 1.44 (95% CI, 0.46–4.47 P = 0.83).ConclusionMRI had a higher sensitivity and PET/CT had a higher specificity in predicting the pathologic response after NAC in patients with breast cancer. According to the area under the SROC curve and anatomic discriminative resolution, MRI is the more suitable recommendation for predicting the pathologic response after NAC.     

18F-FDG PET/CT在胆道系统恶性肿瘤中的应用

目的探讨~(18)F-FDG PET/CT诊断胆道系统恶性肿瘤的价值。方法回顾性分析34例临床疑似胆道恶性肿瘤患者的PET/CT影像资料,均获得术后病理结果,其中12例经手术切除淋巴结或淋巴结穿刺活检对18枚淋巴结获得病理诊断;与病理结果对照,计算PET/CT对胆道恶性病变原发灶、淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率。结果 34例中,31例为恶性病变,3例为良性病变。PET/CT诊断胆道恶性肿瘤原发灶的灵敏度100%(31/31),特异度66.67%(2/3),阳性预测值96.88%(31/32),阴性预测值100%(2/2),准确率97.06%(33/34)。胆道恶性病变原发灶最大标准摄取值(SUV_(max))为8.42±4.27;3例胆道良性疾病SUV_(max)分别为12.90、2.00及1.90。共18枚淋巴结获得病理结果,包括转移性淋巴结13枚,良性增生5枚。PET/CT诊断淋巴结转移的灵敏度76.92%(10/13),特异度60.00%(3/5),阳性预测值83.33%(10/12),阴性预测值50.00%(3/6),准确率72.22%(13/18)。结论 PET/CT对胆道系统恶性肿瘤的诊断具有重要价值。     

18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism

PurposeThe purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (^99mTc-MIBI scintigraphy, cervical ultrasonography [CUS]) and ¹⁸F-fluorocholine PET/CT (FCH PET/CT) in the detection of hyperfunctioning parathyroid gland in patients with primary hyperparathyroidism (PHPT) used alone or as a single imaging set.Materials and methodsA total of 51 consecutive patients (6 men, 45 women; mean age, 62 ± 11.6 [SD] years; age range: 28–86 years) with biochemically confirmed PHPT who underwent CUS, single-tracer dual phase ^99mTc-MIBI scintigraphy and FCH PET/CT were retrospectively included. ^99mTc-MIBI scintigraphy were performed immediately after CUS and interpreted by the same operators. FCH PET/CT examinations were interpreted independently by two nuclear medicine physicians. An additional reading session integrating the three imaging modalities read in consensus as a combined imaging set was performed.ResultsAt surgery, 74 lesions were removed (32 parathyroid adenomas, 38 parathyroid hyperplasia and 4 subnormal glands). Thirty-six patients (71%) had single-gland disease and 15 patients (29%) had multiglandular disease at histopathological analysis. On a patient basis, sensitivity and accuracy of FCH PET/CT, CUS and ^99mTc-MIBI scintigraphy for the detection of abnormal parathyroid glands were 76% (95% CI: 63–87%) and 76% (95% CI: 63–87%), 71% (95% CI: 56–83%) and 71% (95% CI: 56–83%), 33% (95% CI: 21–48%) and 33% (95% CI: 21–48%), respectively. The sensitivity of the combined imaging set was 94% (95% CI: 84–99%) and greater than the sensitivity of each individual imaging technique (P ≤ 0.001 for all).ConclusionOur results suggest that CUS, ^99mTc-MIBI scintigraphy and FCH PET/CT interpreted as a single imaging set could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT before surgery.     

Comparison of Linear Array Endoscopic Ultrasound and Helical Computed Tomography for the Staging of Periampullary Malignancies

Background: The purpose of this study was to compare linear array endoscopic ultrasound (EUS) and helical computed tomography (CT) scan in the preoperative local staging evaluation of patients with periampullary tumors.Methods: Patients evaluated with EUS and CT for suspected periampullary malignancies from 1996 to 2000 were analyzed. Surgical/pathology staging results were the reference standard.Results: Forty-eight patients (28 men and 20 women; mean age, 62 ± 4.9 years; range, 18–90 years) were identified. Malignancy was histologically confirmed in 44 patients. Parameters evaluated included tumor size, lymph node metastases, and major vascular invasion. EUS was significantly more sensitive (100%), specific (75%), and accurate (98%) than helical CT (68%, 50%, and 67%, respectively) for evaluation of the periampullary mass (P < .05). In addition, EUS detected regional lymph node metastases in more patients than helical CT. Sensitivity, specificity, and accuracy of EUS were 61%, 100%, and 84%, in comparison to 33%, 92%, and 68%, respectively, with CT. Major vascular involvement was noted in 9 of 44 patients. EUS correctly identified vascular involvement in 100% compared with 45% with CT (P < .05).Conclusions: Linear array EUS was consistently superior to helical CT in the preoperative local staging of periampullary malignancies.Presented in part at the Society of Surgical Oncology Parallel Session, Washington, DC, March 2001.