18F-氟代脱氧葡萄糖PET对鼻咽癌放疗的临床应用价值

[目的]探讨^18F氟代脱氧葡萄糖正电子成像术（^18F-FDG PET）评价鼻咽癌放疗疗效的价值。[方法]21例经病理证实的鼻咽癌患者在实施适形放射治疗前、后进行PET/CT或PET检查，将PET的结果与同期的CT检查结果比较，分析PET的检查结果与临床疗效的关系。[结果]放射治疗前PET检查改变了4例病人的N分期；放疗后PET检查原发灶SUV≥4.0者证实为肿瘤残留；CT显示肿瘤残留而最大SUV≤2.5者证实为肿瘤纤维化。[结论]PET与CT相比较在对原发肿瘤的检测方面没有差别；但是PET在检测淋巴结方面比CT的敏感性高，而且PET对检测鼻咽癌放疗后疗效的准确性高于CT。     

18F-FDG PET/CT显像在胃癌诊断中的应用

[目的]评价18F-FDG PET/CT显像在胃癌诊断中的应用.[方法]49例经胃镜和病理确诊的胃癌患者进行18F-FDG PET/CT显像,其诊断结果与病理学检查、其他影像学检查及临床随访比较.[结果] 49例患者18F-FDG PET/CT阳性44例,阳性率89.8％;39例有淋巴结转移患者中18F-FDGPET/CT显像发现32例,灵敏度为82.1％(32/39); 12例有远处转移患者中18F-FDG PET/CT显像发现11例,灵敏度91.6％(11/12).[结论]18F-FDG PET/CT显像对胃癌原发灶、淋巴结转移和远处转移具有较高的灵敏度,18F-FDG PET/CT显像在胃癌诊断中具有较高的临床价值.     

Rh-Apo2L联合长春瑞滨杀伤人肺腺癌A549细胞的作用研究

[目的]对比PET／CT与MRI诊断鼻咽癌颅底、颅内侵犯的效能．评估PET／CT对以MRI为基础的鼻咽癌T分期影响。[方法]2005年1月至2009年12月,60例患者均行PET／CT和MRI检查,对比PET／CT和MRI的诊断效能及T分期结果。[结果]PET／CT和MRI对鼻咽癌颅底侵犯的敏感性、特异性、准确率分别为96．7％、60．0％和78-3％;76．7％、93.3％和85．0％。PET／CT使28.3％病例T分期提高,8．3％病例T分期下降。[结论]虽然PET／CT对鼻咽癌原发灶侵犯范围的评估效能与MRI相仿,但如以PET／CT作为鼻咽癌分期基础,可能使T分期提高,临床需予以重视。     

PET/CT和MRI在鼻咽癌早期诊断中的价值对比分析

[目的]探讨PET/CT和MRI在鼻咽癌早期诊断中的价值.[方法]回顾性分析2010年1月至2012年5月经确诊的21例早期鼻咽癌和11例鼻咽部炎性肿块患者的临床资料,所有患者均行鼻咽部PET/CT、MRI检查及鼻内镜下取材病理检查确诊.依据病理组织活检和临床随访分别评价PET/CT和MRI对鼻咽癌早期诊断的灵敏度、特异性、准确率,并对两者的结果比较.[结果] MRI和PET/CT诊断鼻咽癌灵敏度分别为84.09％和97.67％;特异性分别为69.23％和57.14％;准确率分别为80.70％和87.72％;PET/CT在灵敏度方面较MRI有明显优势(P＜0.05).[结论]PET/CT和MRI在鼻咽癌诊断中均有较高的价值,两种诊断方法有各自的优缺点,应将两者结合起来,以提高早期诊断鼻咽癌的准确率.     

PET/CT与MRI在鼻咽癌淋巴结转移诊断和N分期中的比较研究

目的 比较PET／CT与MRI在鼻咽癌淋巴结转移诊断和N分期中的作用。方法116例鼻咽癌患者于治疗前行PET／CT和MRI检查。依据随访结果比较PET／CT和MRI在淋巴结转移诊断和N分期中的作用。结果116例患者的614个淋巴结的随访结果显示,阳性340个,阴性274个。PET／CT诊断转移淋巴结的敏感性、特异性及准确性分别为93．2％、98．2％和95．4％,而MRI分别为88．8％、91．2％和89．9％,两者各指标比较,差异有统计学意义（P〈0．05）。按1992年福州分期,109例（94．0％）的PET／CT分期正确,103例（88．8％）的MRI分期正确;按UICC分期,108例（93．1％）的PET／CT分期正确,100例（86．2％）的MRI分期正确。结论PET／CT判断鼻咽癌淋巴结转移和N分期较MRI准确,但对炎性增生、大面积坏死淋巴结,或直径小于PET空间分辨率的转移淋巴结应警惕其假阳性和假阴性判断。     

6例原发性脑淋巴瘤^18F-FDG PET／CT表现

[目的]探讨^18F-FDG PET／CT显像对原发性脑淋巴瘤的诊断价值。[方法]6例经病理学证实的脑原发性淋巴瘤患者（男性4例,女性2例）行^18F-FDG PET／CT检查．其中5例为初诊患者,1例为可疑复发的复诊患者。[结果]6例患者共8个病灶,其中基底节区5个,丘脑1个,额叶2个。肿瘤为单发或多发病灶,多位于脑组织深部,边界清楚,大小不等,圆形或卵圆形．周围水肿较轻。18F—FDGPET／CT显像病灶多表现为稍高密度灶,对18F—FDG摄取明显增高。『结论]原发性脑淋巴瘤的18F—FDGPET／CT表现有一定特征性,熟悉其影像特点有助于作出正确的诊断。     

PET/CT对鼻咽癌颅底颅内侵犯的诊断价值及T分期影响

[目的]对比PET/CT与MRI诊断鼻咽癌颅底、颅内侵犯的效能,评估PET/CT对以MRI为基础的鼻咽癌T分期影响.[方法]2005年1月至2009年12月,60例患者均行PET/CT和MRI检查,对比PET/CT和MRI的诊断效能及T分期结果.[结果]PET/CT和MRI对鼻咽癌颅底侵犯的敏感性、特异性、准确率分别为96.7％、60.0％和78.3％;76.7％、93.3％和85.0％.PET/CT使28.3％病例T分期提高,8.3％病例T分期下降.[结论]虽然PET/CT对鼻咽癌原发灶侵犯范围的评估效能与MRI相仿,但如以PET/CT作为鼻咽癌分期基础,可能使T分期提高,临床需予以重视.     

胃癌孤立淋巴结转移的影像研究

[目的]评价CT在胃癌孤立淋巴结转移中的诊断作用。[方法]回顾性分析胃癌孤立淋巴结转移患者75例临床资料。[结果]75例患者中,68例淋巴结转移位于胃周（N1）。另有7例患者淋巴结跳跃转移至N2～N3站,CT对孤立淋巴结转移胃癌患者T分期、N分期及M分期的准确率分别为73-3％、78．7％和90％。[结论]并非每个前哨淋巴结都位于胃周原发病灶附近。CT在孤立淋巴结转移胃癌患者TNM分期上的准确性较高。     

N2~3期鼻咽癌EGFR、VEGF、EBER表达与放化疗敏感性的关系

[目的]探讨N期鼻咽癌EGFR、VEGF、EBER表达与放化疗敏感性间的关系。[方法]采用免疫组织化学疗法研究143例经病理确诊的鼻咽癌患者组织EBER、EGFR和VEGF表达：定量PCR和酶联免疫吸附法（ELISA）检测92例N。期鼻咽癌患者血浆EB病毒游离DNA（EBV／DNA）、EGFR、VEGF的表达水平,并对92例NH期鼻咽癌随访2年。[结果]N期鼻咽癌EBER、EGFR及VEGF表达阳性牢分别为97．8％（90／92）、95．7％（88／92）和35．9％（33／92）。EBER表达与远处转移、复发及临床缓解相关,VEGF和EGFR表达强度与远处转移均呈正相关。期鼻嘲癌患者血浆EBV／DNA、EGFR、VEGF治疗前与同步放化疗后比较差异均有统计学意义（P均〈0．05）。血浆中EGFR和VEGF表达水平与远处转移相关。[结论]血浆和组织中EGFR和VEGF表达水平均可能与鼻咽癌远处转移相关。     

咽后淋巴结对鼻咽癌预后影响的研究

[目的]分析咽后淋巴结转移对鼻咽癌预后的影响.[方法]收集1999年1月至1999年12月间中山大学肿瘤防治中心放疗科收治、经病理证实的初诊鼻咽癌749例并进行分析.[结果]咽后淋巴结的发生率51.5%.单因素分析显示咽后淋巴结对鼻咽癌总生存率及无远处转移生存率的影响有统计学意义(P＜0.001).多因素分析显示咽后淋巴结转移并不是影响鼻咽癌生存率的独立预后因素,但对无远处转移生存率的影响接近有统计学意义(P=0.053).对于N0患者,咽后淋巴结转移对鼻咽癌总生存率、无远处转移生存率及无局部区域复发生存率的影响均有统计学意义(P值分别为0.007、0.023和0.008).[结论]基于鼻咽癌增强CT资料,咽后淋巴结转移对鼻咽癌无远处转移生存率可能有影响,是影响无颈部淋巴结转移的鼻咽癌患者的独立预后因素.     

FDG PET imaging in hereditary thyroid cancer

AIM: To report the role of different imaging methods in staging individuals with multiple endocrine neoplasia 2A (MEN2A) or familial medullary thyroid carcinoma (FMTC). MATERIAL AND METHODS: Fourteen newly diagnosed gene carriers underwent cervical ultrasound scanning (US), cervical and mediastinal CT, MRI and whole-body meta-[131I]iodobenzylguanidine (MIBG) scintigraphy and [18F]fluorodeoxyglucose (FDG) PET scanning. RESULTS: US identified seven true primary cancer. CT and MRI located only tumors > or =5 mm in diameter. MIBG scintigraphy and FDG PET could not identify MTC foci within the thyroid. Whole-body FDG PET identified two true-positive and one false-positive lymph node metastases. MIBG scintigraphy did not identify lymph node metastases. Total thyroidectomy was performed in 12 cases, and subtotal thyroidectomy in two subjects. CONCLUSIONS: Whole-body FDG PET and cervical US help stage individuals carrying mutant genes verifying MEN2A or FMTC.     

Detection of occult bone metastases of lung cancer with Fluorine‐18 fluorodeoxyglucose positron emission tomography

Accurate staging of cancer has a critical role in optimal patient management. Fluorine‐18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with non‐small cell lung cancer. Although Tc‐99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X‐rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans.     

Role of FDG-PET in the assessment of survival prognosis in melanoma

Positron-emission tomography (PET) employing fluorodeoxyglucose (FDG) has proven to be a highly sensitive and specific diagnostic method in the staging and restaging of various neoplasms, including melanoma, complementing morphologic imaging. FDG uptake has been correlated with proliferation rate, and thus, the degree of malignancy of a given tumor (i.e., grading). Consecutively, a relationship of survival prognosis and the extent of tumor burden as well as degree of FDG accumulation--determined by FDG-PET--has been suggested in various tumors. The aim of this study was to assess the potential of fluor-18-FDG-PET in order to evaluate the survival prognosis in melanoma. Patient data (n=95) were retrospectively analyzed, and the results of functional FDG-PET staging was correlated with survival data. Time of staging (diagnosis of primary versus recurrence) had no statistically significant effect on survival prognosis when patients were matched for pertaining node metastasis (NM) stages. Differences in survival were owing to the presence of metastatic disease rather than time of staging. Tumor (T)-stage (T1-T4) alone had no effect on survival prognosis when patients were matched for NM stages. Differences in survival were also due to higher rates of lymph node (LN) and organ metastases in higher T-stages. Detection of LN metastases (N1M0) had a statistically significant and predominant impact on 5-year survival (N0M0 80% versus N1M0 45%; p<0.01). Additional presence of distant metastases in LN-positive patients (N1M1) had only a statistically insignificant further impact on survival (5-year survival in N1M0 45% versus N1M1 29%; p>0.05). Exclusive presence of organ metastases (N0M1) showed a statistically significant drop of survival with a 5-year survival of 61% in N0M1 versus 80% in N0M0, respectively (p<0.03). Further, the combined presence of LN and distant metastases had the worst prognosis (5-year survival in N1M1 29% versus N0M1 61%; p<0.02). Based on a qualitative 4-point scoring system, patients with malignancy-typical FDG uptake showed an overall 5-year survival of 38%, as compared to patients with malignancy-suspicious lesions (71%; p 相似文献   

The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma

BACKGROUND: The purpose of the current study was to assess whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) provides incremental value (e.g., additional information on lymph node involvement or the presence of distant metastases) compared with computed tomography (CT) in patients with esophageal carcinoma. METHODS: The authors examined 149 consecutive patients with thoracic esophageal carcinoma. Eighty-one patients underwent radical esophagectomy without pretreatment, 17 received chemoradiotherapy followed by surgery, 3 underwent endoscopic mucosal resection, and the remaining 48 patients received definitive radiotherapy and chemotherapy. The diagnostic accuracy of FDG-PET and CT was evaluated at the time of diagnosis. RESULTS: The primary tumor was visualized using FDG-PET in 119 (80%) of 149 patients. Regarding lymph node metastases, FDG-PET had 32% sensitivity, 99% specificity, and 93% accuracy for individual lymph node group evaluation and 55% sensitivity, 90% specificity, and 72% accuracy for lymph node staging evaluation. PET exhibited incremental value over CT with regard to lymph node status in 14 of 98 patients who received surgery: 6 patients with negative CT findings were eventually shown to have lymph node metastases (i.e., they had positive PET findings and a positive reference standard [RS]); 6 patients with positive CT findings were shown not to have lymph node metastases (i.e., they had negative PET findings and a negative RS); and 2 patients were shown to have cervical lymph node metastases in addition to mediastinal or abdominal lymph node metastases. Among the remaining patients, PET showed incremental value over CT with regard to distant organ metastases in six patients. The overall incremental value of PET compared with CT with regard to staging accuracy was 14% (20 of 149 patients). CONCLUSIONS: FDG-PET provided incremental value over CT in the initial staging of esophageal carcinoma. At present, combined PET-CT may be the most effective method available for the preoperative staging of esophageal tumors.     

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophagealcancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distantlymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT andcontrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophagealcancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCTscan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. Theprimary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed withinone week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the goldstandard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCTwas conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT indetecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05).The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, ascompared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with orwithout metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distantlymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity ofFDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitivethan MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophagealcancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detectingboth regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value indistinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CTwith MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.     

Improved detection of second primary cancer using integrated [18F] fluorodeoxyglucose positron emission tomography and computed tomography for initial tumor staging.

PURPOSE: This study evaluated prospectively the value of integrated whole-body positron emission tomography and computed tomography (PET/CT) using [18F] fluorodeoxyglucose (FDG) in detecting a second primary cancer at the time of the initial staging in comparison with a conventional staging work-up (CSW). METHODS: The participants were 547 patients diagnosed with cancer who underwent FDG PET/CT imaging for the initial staging. An additional diagnostic evaluation was performed when there were abnormal findings indicative of a second primary cancer on either PET/CT or CSW considering the site and the biologic behavior of the alleged primary tumor. RESULTS: A total of 27 second primary malignant tumors were identified in 26 of the 547 patients (4.8%). FDG PET/CT found 45 lesions indicative of a second primary cancer, of which 24 lesions were proved to be a second primary cancer, seven were clinically unexpected metastases, and 14 lesions were benign. Therefore, sensitivity and positive predictive value of FDG PET/CT in detecting a second primary cancer or an unexpected metastasis were 91% (31 of 34) and 69% (31 of 45), respectively. In contrast, CSW could not identify 16 second primary cancers and one metastatic lesion. CONCLUSION: FDG PET/CT at the time of the initial staging is useful for screening a second primary cancer with a high sensitivity. An additional diagnostic work-up is essential when abnormal findings, which are indicative of a second primary cancer, are obtained on PET/CT images to rule out the presence of either a second primary cancer or an unexpected metastasis.     

Staging and Response Evaluation to Neo-Adjuvant Chemoradiation in Esophageal Cancers Using 18FDG PET/ CT with Standardized Protocol

Background: Precise staging of esophageal cancer (EC) is important for selection of optimal treatment optionand prognostication. Aim of this study was to assess the role of 18FDG PET/CT in staging and response evaluationto neoadjuvant chemoradiation (nCR) in EC patients using standardized imaging protocol. Material and methods:This prospective study was conducted at PET/CT Section of Department of Radiology, Aga Khan University HospitalKarachi, Pakistan from July 2017 till February 2018. We included 34 biopsy proven EC patients who had 18FDGPET/CT and CT of neck, chest and abdomen as part of initial staging. Eleven patients had post-nCR 18FDG PET/CTusing standardized imaging protocol as per EANM guidelines. CT and PET/CT based staging was compared. Basedon PERCIST criteria, response evaluation was assessed using change in highest SUVmax (%ΔSUVmax) in baselineand follow-up scans (primary lesion, node or extra-nodal metastases). Results: Mean age of cohort was 57 ± 14 years(23 males and 11 females) having adenocarcinoma (AC) in 23 and squamous cell cancer (SCC) in 11 patients. Mean18FDG dose, uptake time and hepatic SUVmean for baseline scans were 169 ±54 MBq, 65 ±10 minute and 1.91 ± 0.49which were within ± 10%, ± 15% and ± 20% for follow-up scans in 11 patients respectively. Mean size (craniocaudaldimension in mm) and SUVmax of primary tumor was 56 ±27 mm and 13.4 ± 4.7. Based on 18FDG PET/CT findings,patients were categorized into N0 (10/34), N1 (09/34), N2 (11/34) and N3 (04/34) while 11/32 had stage IV disease.No significant difference was seen in AC and SCC groups. CT found stage IV disease in 3/34 (09%) while PET/CTfound in 11/34 (32%; p value: 0.019) cases. PET/CT showed concordance with CT in 41% while discordance (allwith upstaging) seen in 59%. On follow-up PET/CT, complete metabolic response was seen in 5/11 (45%) and partialmetabolic response was noted in 6/11 (55% - p value non-significant) patients. Median %ΔSUVmax over primarylesions was 49.84% (-32.69 -100%) while over nodal sites it was 41.18% (-82.60 -100%). Conclusion: We concludethat 18FDG PET/CT was found a sensitive tool in initial staging of EC. Compared with CT, it had higher diagnosticaccuracy for distant nodal and extra-nodal metastasis. %ΔSUVmax between baseline and post-nCR studies acquiredwith standardized protocol had changed management in more than half of our patients. For response evaluation in ECmore studies with standardized 18FDG PET/CT imaging protocols are warranted.     

Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non–small‐cell lung cancer patients

In the recent years, fluorine 18 fluorodeoxyglucose (¹⁸F‐FDG) positron emission tomography (PET)/computed tomography (CT) has emerged as a new modality for staging non–small‐cell lung cancer (NSCLC) patients. The aim of this meta‐analysis was to assess the diagnostic value of ¹⁸F‐FDG PET/CT in detecting metastatic lesions in NSCLC patients. Meta‐analysis methods were used to pool sensitivity, specificity, positive and negative likehood ratios, diagnostic odd ratios and to construct a summary receiver‐operating characteristic curve. Data from included studies were pooled to compare the diagnostic accuracy between PET/CT and PET or CT alone in nodal staging. Totally, 56 studies involving 8,699 patients met the inclusion criteria. The pooled sensitivities and specificities of ¹⁸F‐FDG PET/CT were 0.72 [95% confidence interval (CI): 0.65–0.78] and 0.91 (95% CI: 0.86–0.94) in determining mediastinal nodal staging; 0.71 (95% CI: 0.60–0.80) and 0.83 (95% CI: 0.77–0.88) in intrathoracic staging; 0.78 (95% CI: 0.64–0.87) and 0.90 (95% CI: 0.84–0.94) in intrathoracic staging on a per‐node basis. For detecting extrathoracic metastases, the pooled sensitivities and specificities of ¹⁸F‐FDG PET/CT were 0.77 (95% CI: 0.47–0.93) and 0.95 (95% CI: 0.92–0.97) for all extrathoracic metastases; 0.91 (95% CI: 0.80–0.97) and 0.98 (95% CI: 0.94–0.99) for bone metastases. ¹⁸F‐FDG PET/CT is beneficial in detecting lymph node metastases and extrathoracic metastases although PET/CT showed low sensitivity in detecting brain metastases. ¹⁸F‐FDG PET/CT confers significantly higher sensitivity and specificity than contrast‐enhanced CT (both p < 0.01) and higher sensitivity than ¹⁸F‐FDG PET in staging NSCLC (p < 0.05).     

Positron emission tomography for staging of oesophageal and gastroesophageal malignancy.

Positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose (FDG) was prospectively investigated as a means of detecting metastatic disease in patients with oesophageal tumours and compared with computerized tomography (CT), with the surgical findings as a gold standard. Twenty-six patients with a malignant tumour of the oesophagus or gastroesophageal junction underwent CT and PET of the chest and the abdomen. Seven patients underwent laparoscopy to establish resectability. Fifteen patients underwent laparotomy without prior laparoscopy. Four patients did not undergo surgery. The primary tumour was visualized in 81% of patients with CT and in 96% with PET. Neither CT nor PET were suited to assess the extent of wall invasion. Surgically assessed nodal status corresponded in 62% with CT and in 90% with PET. Distant metastases were found in five patients with CT and in eight with PET. The diagnostic accuracy of CT in determining resectability was 65% and for PET 88%. For CT and PET together this was 92%. The present study indicates that FDG-PET can be of importance for staging patients with oesophageal tumours. PET has a higher sensitivity for nodal and distant metastases and a higher accuracy for determining respectability than CT. PET and CT together would have decreased ill-advised surgery by 90%.