18F-氟脱氧葡萄糖PET-CT与99mc-亚甲基二膦酸盐骨显像诊断转移性骨肿瘤的对比研究

目的 探讨18F-氟脱氧葡萄糖(18F-FDG)PET-CT与唧99mTc-亚甲基二膦酸盐(99mTc-MDP)全身骨显像对转移性骨肿瘤的诊断价值.方法 93例经病理证实为恶性肿瘤的患者同时接受18F-FDG PET-CT和99mTc-MDP全身骨显像(时间间隔在1周之内),对比分析两种显像结果,骨转移的诊断通过随访2年,由病理、X射线片、CT或MRI检查结果综合决定.结果 93例恶性肿瘤患者中,经过2年随访或病理证实骨转移44例,其中18F-FDG PET-CT灵敏度、特异度和准确率分别为95.4%、91.8%和93.5%,99mTc-MDP全身骨显像分别为90.9%、63.3%和76.3%.18F-FDG PET-CT对转移性骨肿瘤诊断的灵敏度与99mTc-MDP全身骨显像相近,但特异度(t=2.53,P＜0.05)和准确率t=2.47,P＜0.05)均明显高于99mTc-MDP全身骨显像.结论 PET-CT对转移性骨肿瘤有较高的诊断价值.     

18F-氟脱氧葡萄糖正电子发射断层显像在妇科恶性肿瘤治疗后的随访价值

 目的 探讨18F-氟脱氧葡萄糖正电子发射断层显像(18F-FDG PET)在妇科恶性肿瘤治疗随访中的作用.方法 21例均经病理证实的妇科恶性肿瘤患者治疗后行18F-FDG PET检查.结果 21例中17例发现有残余或转移病灶,占80.9%,无假阳性病例;4例阴性显像患者中,3例提示未见明确复发和转移,1例为假阴性,为近期行化疗所致.FDG-PET对本组妇科肿瘤治疗后的复发或转移诊断的灵敏度、特异性和准确性分别为94.4%、100%和95.2%.结论 18F-FDG PET 对妇科恶性肿瘤治疗随访中有重要作用.     

^18F-FLT和^18F-FDG诊断孤立性肺结节误诊原因分析

目的:比较18F-FLT、18F-FDG PET显像诊断SPNs的敏感性和特异性,分析误诊原因.材料和方法:55例胸部SPNs患者行18F-FLT、18F-FDG PET显像,以术后病理或随访一年为最后诊断标准,证实肺癌16例、肺结核16例、肺炎13例、良性增生10例.根据对照最后诊断,选择假阳性和假阴性的病例进行分析.结果18F-FDG显像:16例肿瘤患者中假阴性2例.16例结核患者中,9例假阳性(SUVmax>2.56).13例炎性患者中,大部分轻度摄取18F-FDG,2例假阳性SUVmax>10.10例良性结节不同程度摄取18F-FDG.18F-FLT显像:16例肿瘤患者中,5例假阴性.16例结核患者中,3例假阳性(SUVmax>2.0).13例炎症,2例假阳性.10例良性结节3例假阳性.结论:18F-FDG和18F-FLT均非肿瘤特异性示踪剂,假阴性见于低活动度或小病灶;而假阳性原因为炎症活动期和肉芽肿形成期.18F-FLT的特异度高于18F-FDG.     

^99mTc（V）—DMSA骨显像诊断骨转移瘤的临床价值

目的：评价99mTc（V）－DMSA显像在骨转移瘤诊断中的意义。材料和方法：对91例疑骨转移瘤患者行99mTc（V）DMSA全身显像，并与99mTc-MDP全身骨显像及其它检查对比。结果：74例证实存在骨转移瘤者，99mTc．MDP骨显像均显示异常放射性浓聚，99mTc（V）-DMSA显像72例显示了与99mTc-MDP显像某些相同部位的放射性浓聚，2例99mTc（V）DMSA显像阴性。17例骨良性病变，99mTc－MDP骨显像显示轻度异常放射性浓聚，而99mTc（V）-DMSA显像却未见异常的放射性浓聚。结论：99mTc（V）－DMSA诊断骨转移瘤的特异性比99mTc-MDP骨显像高，在骨良恶性肿瘤鉴别诊断中具有重要的临床价值。     

^18FDG—PET在诊断头颈部鳞状细胞癌复发中的价值

目的了解18FDG-PET在诊断头颈部鳞状细胞癌复发中的价值,确定标准吸收值(SUV)来鉴别放疗后的炎症与肿瘤复发.材料和方法头颈部鳞状细胞癌患者43例,在放疗后至少4个月(平均11个月)进行18FDG-PET检查.计算感兴趣区的SUV值.肿瘤复发诊断依赖组织病理学检查或6个月以上的临床随访.结果43例患者中,FDG-PET阳性23例,其中3例为假阳性;20例为阴性,其中假阴性2例.FDG-PET的诊断准确性是88%(38/43),而CT/MRI的诊断准确性则为66%(25/38).肿瘤复发病灶和炎症病灶的SUV有部分重叠,无统计学上差异(p=0.31).结论18FDG-PET检测头颈部鳞状细胞癌复发中肉眼分析更有价值;18FDG-PET较CT/MRI更为准确.     

恶性肿瘤术后复发18F-FDG-PET评价

 目的 评价18F-FDG-PET(氟代脱氧葡萄糖正电子发射断层扫描)对恶性肿瘤术后复发的探测能力。方法 10例恶性肿瘤术后患者均经18F-FDG-PET成像,分析所得图像。(1)目视法：将所得结果定为阳性、阴性;(2)半定量方法：选定ROI(感兴趣区)进行SUV(标准摄取值)测定,以SUV＞2.5为阳性;(3)复习同期(2周内)CT／MRI资料。所有结果均与手术病理及临床随访(5～6月)结果对照。结果10例患者中,FDG-PET准确探测4／4例恶性肿瘤术后复发,5／6例阴性,假阳性1例。敏感性、特异性和准确性分别为100％,83.3％和90％。5／10例患者改变了治疗方案。而临床表现评估中其敏感性、特异性和准确性分别为75％,83.3％和80％,CT／MRI评估中其敏感性、特异性和准确性分别为25％,50％和40％。结论 FDG-PET对恶性肿瘤术后复发具有很好的探测能力。     

18F-FDG PET与99Tcm-MDP骨扫描诊断肿瘤骨转移的比较分析

目的:探讨18F-FDG PET显像对于肿瘤骨转移的诊断价值,并与99Tcm-MDP骨显像进行对比分析。方法:97例肿瘤及疑诊为肿瘤的患者在30天内先后行18F-FDG PET-CT及99Tcm-MDP骨扫描,对比分析两者的显像结果。结果:97例中经临床和病理确诊基于病例分析,为骨转移63例,62例18F-FDG PET显像阳性,1例假阴性;99Tcm-MDP骨显像阳性49例,假阴性14例,两者敏感度分别为98.4%和77.8%,差异有显著性意义(P<0.05);34例为阴性患者,其中PET显像阴性29例、假阳性5例,骨显像阴性21例、假阳性13例,两者的特异度为85.3%和61.8%(P>0.05),符合率为93.8%和72.2%(P<0.05)。基于病灶分析,97例中共分析1261个骨骼区,骨转移存在于226个骨骼区,剔除不能定性的14个区,18F-FDG PET显像阳性222个区,假阴性4个区;而骨扫描显像阳性154个区,假阴性72个区;两者的敏感度分别为98.7%和68.1%,差异有显著性意义(P<0.05)。1021个阴性区,其中18F-FDGPET显像为阴性1010个区,假阳性11个区;骨扫描显像阴性1001个区,假阳性20个区;两者特异度分别为98.9%和98.0%,差异无统计学意义(P>0.05)。18F-FDG PET的诊断符合率为98.8%,骨显像为92.6%,两者差异有显著性意义(P<0.05)。以CT表现分组,溶骨性病灶和CT上无明显异常改变病灶的FDG PET和骨扫描的检出率分别为99.4%和72.6%及81.5%和40.7%,差异有显著性意义(P<0.05)。结论:18F-FDG PET诊断敏感度及准确性均高于骨扫描对溶骨病灶和CT上无明显改变病灶的检出优于骨扫描。     

PET/CT显像在宫颈癌原发灶诊断及盆腔淋巴结分期的价值

目的:评价18F-FDG PET/CT显像在诊断宫颈癌原发灶及盆腔淋巴结分期中的临床应用价值.方法:回顾性分析58例患者在手术前PET/CT显像结果,所有恶性肿瘤患者均经手术治疗并行盆腔淋巴结清扫,良性患者经病理及组织学证实,将PET/CT显像结果与病理结果进行对比分析.结果:58例患者中,有28例为宫颈癌,PET/CT显像真阳性24例,真阴性28例,假阴性4例,假阳性2例,与病理结果对比,PET/CT诊断宫颈癌准确率、灵敏度、特异性、阳性预测值和阴性预测值分别为87.9%、85.7%、90%、92.3%、84.3%.28例恶性肿瘤患者,手术共取出盆腔大小不同淋巴结162枚,其中转移淋巴结35枚,与病理和随访结果对比,PET/CT诊断真阳性29枚,假阳性10枚,其诊断的准确率、灵敏度、特异性、阳性预测值和阴性预测值分别为90.1%、82.9%、92.1%;74.4%、95.1%.结论:PET/CT显像对诊断宫颈癌原发灶与盆腔淋巴结转移的准确率高.     

99Tcm-HL91显像鉴别乳腺肿瘤良恶性的初步临床研究

目的评价99Tcm-HL91在乳腺良恶性肿瘤鉴别诊断中的价值.方法临床疑乳腺肿瘤35例,静脉注射99Tcm-HL91925MBq后分别于1、3、6 h行乳腺显像,观察影像特点并进行半定量分析.所有病例于显像后1周内手术并行病理检查.结果经病理证实,24例阳性病例中有23例为恶性肿瘤,假阳性1例,11例阴性病例均为良性肿瘤,灵敏度100%,特异性91.7%,符合率97.1%.病灶与对侧相应部位放射性计数对比,恶性肿瘤比值为1.37±0.21;良性肿瘤为0.99±0.05,有显著性差异.恶性肿瘤中1 h计数比为1.31±0.02,3 h为1.34±0.16,6 h为1.45±0.29,三者之间无显著性差异.结论乳腺肿瘤99Tcm-HL91显像在乳腺肿瘤良恶性鉴别诊断中具有较高的临床应用价值.     

18F-FDG PET-CT与99Tcm-MDP骨显像对骨转移瘤诊断价值的对比研究

目的比较18F-FDG PET-CT和99Tcm-MDP全身骨显像对骨转移瘤的诊断价值。方法经病理学证实为恶性肿瘤且临床怀疑合并骨转移的患者32例,均行全身18F-FDG PET-CT扫描和99Tcm-MDP全身骨显像(检查间隔时间在2周之内)。比较相同扫描野内两者对骨转移病灶检出的敏感性、特异性及准确性。结果PET-CT对骨转移瘤诊断的敏感性、特异性及准确性分别为94.9%、91.7%和94.1%,骨显像分别为96.2%、54.2%和86.3%。18F-FDGPET-CT对骨转移瘤的诊断特异性高于99Tcm-MDP骨显像,敏感性和准确性二者无显著差异。结论18F-FDG PET-CT与99Tcm-MDP骨显像相比,对骨转移瘤的诊断特异性较高,对肿瘤良恶性的鉴别优于骨显像。     

Tc-99m PMT hepatobiliary scintigraphy in the differential diagnosis of extrahepatic metastases and hepatocellular carcinoma

PURPOSE: The authors evaluated the utility of hepatobiliary scintigraphy for tissue characterization of extrahepatic metastases from hepatocellular carcinoma (HCC) using Tc-99m N-pyrydoxyl-5-methyltriptophane (Tc-99m PMT). METHODS: We examined 13 patients with HCC (29 extrahepatic metastases and 3 benign bone lesions) and 5 patients with other cancers (15 extrahepatic metastases). Thirty minutes to 6 hours after intravenous administration of Tc-99m PMT, planar (all 47 lesions) and SPECT (42 lesions) images were obtained. Accumulation of Tc-99m PMT in the lesion was evaluated visually by comparing bone scintigraphy, computed tomography, magnetic resonance imaging, or all of these. RESULTS: Findings were positive in 12 of 13 patients with HCC and extrahepatic metastases (16 of 29 on planar imaging and 21 of 26 on SPECT). Findings in all three benign bone lesions and 15 metastatic lesions from non-HCC primary lesions were negative (0 of 18 on planar imaging, 0 of 16 on SPECT). There were no false-positive findings in these lesions. Lesion-by-lesion sensitivity, specificity, accuracy, and positive and negative predictive values were 55%, 100%, 72%, 100%, and 58% by planar imaging and 81%, 100%, 88%, 100%, and 76% by SPECT, respectively. CONCLUSIONS: Because of the high specificity and reasonable sensitivity, Tc-99m PMT appears to be useful for the differential diagnosis of extrahepatic metastases from HCC. SPECT improves the detectability of small or faint accumulation in metastases from HCC.     

18F-FDG SPECT/CT诊断肺癌骨转移的价值:与全身骨显像比较

目的：探讨^18F—FDG SPECT／CT肿瘤代谢显像在诊断肺癌骨转移方面的应用价值。材料和方法：对32例肺癌患者分别进行^18F—FDGSPECT／CT显像和^99Tc^m-MDP全身骨显像，间隔时间不超过2周。其他影像学和临床随访结果为确诊依据，比较两种方法诊断骨转移的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果：11个病人共48个病灶最终诊断为骨转移。^18F—FDG SPECT／CT诊断11个病人有骨转移^99T^m-MDP全身骨显像诊断10个病人。按病灶分析，FDG和MDP的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为94％、71％、89％、92％、77％和83％、64％、79％、89％、53％。”F—FDGSPECT／CT的敏感性和准确性优于^99Tc^m-MDP全身骨显像（P〈0.05）。结论：^18F—FDG SPECT／CT显像在诊断肺癌骨转移方面的敏感性和准确性高于^99Tc^m—MDP全身骨显像。     

18F-FDG hPET/CT显像与99Tcm-MDP骨显像探测骨转移瘤的价值

目的　探讨1 8F 脱氧葡萄糖 (FDG)hPET CT与99Tcm 亚甲基二膦酸盐 (MDP)骨显像探测骨转移瘤的临床价值。方法　临床拟诊恶性肿瘤或肿瘤术后复发合并骨病变患者 34例 ,均于 2周内分别行FDG和MDP骨显像 ,其中 31例经手术或活组织病理检查证实为原发肿瘤患者 ,余 3例为原发灶不明但广泛骨转移者。结果　 34例患者中 2 6例有骨转移 ,共探测到 75个骨病灶 ,其中骨转移灶 6 3个 ,良性病灶 12个 (其中骨退行性变 8个 ,肋骨骨折 2个 ,结核和慢性炎症各 1个 )。1 8F FDGhPET CT显像探测骨转移瘤灵敏度为 90 5 % ,特异性为 83 3% ,准确性为 89 3% ;99Tcm MDP骨显像分别为 79 4 % ,75 0 %和 78 7% (P均 >0 0 5 )。结论　99Tcm MDP骨显像仍为诊断骨转移瘤的首选方法 ,1 8F FDGhPET CT显像对鉴别诊断骨转移瘤具有一定临床价值。     

Diagnostic efficacy of technetium-99m pentavalent-dimercapto succinic acid versus gallium-67 citrate, imaging in patients with highly suspected acute bone and joint infections

The purpose of this study was to evaluate and compare the diagnostic efficacy of (99m)Tc(V) dimercaptosuccinic acid ((99m)Tc(V)DMSA) with the (67)Ga-citrare ((67)Ga-C) scintigraphy in patients with suspected bone and joint infection. Thirty one patients, 19 men and 12 women, aged 18-78 y with median age 56 y, with suspected acute bone infection, were enrolled in this study. Besides (67)Ga-C and (99m)Tc(V)DMSA scintigraphy, all patients underwent X-ray radiography and technetium-99m methylene disphosphonate ((99m)Tc-MDP) bone scan for supporting the initial diagnosis. The (99m)Tc-MDP bone scan was considered positive for acute bone and joint infection when all its four scintigraphic phases were positive. Final diagnosis was based on needle aspiration and/or biopsy findings. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) were calculated. Our results have shown the following: Seventeen patients (17/31) had histologically confirmed acute bone and joint infections, while the remaining patients had no infection. (99m)Tc(V)DMSA diagnosed bone and joint infections in all positive (17/31) patients while (67)Ga-C in 16/31 patients. Discordant scintigraphic results were observed by (67)Ga-C in 2/31 cases: in one positive case of femur postoperative infection (false negative for (67)Ga-C) and in one case of clinicaly suspected infection in the femur while the patient had a preexisting fracture (false positive with (67)Ga-C). No false negative results were observed with (99m)Tc(V)DMSA. Sensitivity, specificity, PPV, NPV and accuracy were maximum for (99m)Tc(V)DMSA, while for (67)Ga-C were: 94.1%, 93%, 94.1%, 93%, and 93.5% respectively. It is concluded that considering the high sensitivity and specificity of (99m)Tc(V)DMSA in the detection of acute bone and joint infections, the lower radiation dose, the cost and the shorter time spent for the imaging procedure, as compared to (67)Ga-C, (99m)Tc(V)DMSA should be preferred to (67)Ga-C as a bone scan agent for the detection of acute bone and joint infections.     

Comparison of18FDG-PET with99mTc-HMDP scntigraphy for the detection of bone metastases in patients with breast cancer

OBJECTIVE: Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients. METHODS: Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards. RESULTS: On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%). CONCLUSIONS: This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.     

^18F-FDG符合线路显像与^99Tc^m—MDP骨显像对恶性肿瘤探测效率的对比分析

目的比较^18F—FDG符合线路显像和^99Tc^m-MDP骨显像对恶性肿瘤及其转移灶的诊断效能。方法临床明确的恶性肿瘤患者71例,3周内先后行^18F—FDG和^99Tc^m-MDP显像,以手术或穿刺病理、其他影像学方法和随访等结果为标准,对比2种显像方法在成骨性、溶骨性和混合性骨转移灶的诊断差异（χ^2检验）,计算其诊断灵敏度、特异性、准确性、假阳性率、假阴性率、阳性和阴性预测值。结果（1）71例患者共发现包括原发、转移和良性病灶350个,其中恶性病灶286个（81．7％）。^18F—FDG发现141个（40．3％）,^99Tc^m-MDP发现209个（59．7％）,χ^2=25．65,P〈0．01;两者共同发现恶性病灶（全为转移）65个（18．6％）^99Tc^m-MDP单独发现恶性病灶144个,^18F-FDG单独发现76个（χ^2=29．76,P〈0．01）。（2）^18F—FDG对65个和^99Tc^m-MDP对88个（144个中可区分类型的骨转移灶）骨转移病灶探查,成骨性、溶骨性和混合性病灶数前者分别为11（16．9％）、12（18．5％）和42（64．6％）,后者为48（54．5％）、7（8．0％）和33（37．5％）,χ^2=20．78,2．89,9．94,P均〈0．05。（3）^18F—FDG和^99Tc^m-MDP诊断27例有随访最终诊断者骨转移灶的灵敏度、特异性、准确性、假阳性率、假阴性率、阳性预测值、阴性预测值分别为11．72％（15／128）、91．67％（22／24）、24．34％（37／152）、8．33％（2／24）、88．28％（113／128）、88．24％（15／17）、16．30％（22／135）和53．91％（69／128）、75．00％（18／24）、57．24％（87／152）、25．00％（6／24）、46．09％（59／128）、92．00％（69／75）、23．38％（18／77）,其中灵敏度、准确性、假阴性率、阳性预测值差异有统计学意义（χ^2=32．70～46．21,P均〈0．01）;两法合计的诊断指标分别为60．94％（78／128）、70．83％（17／24）、62．50％（95／152）、29．17％（7／24）、39．06％（50／128）、91．76％（78／85）、25．37％（17／67）,与^18F—FDG法相比,除特异性、假阳性率和阴性预测值外,余诊断指标差异均有统计学意义（χ^2=43．50—59．55,P均〈0.01）。与^99Tc^m-MDP法相比,均无统计学意义（χ^2=0～0．92,P均〉0．05）。结论对软组织和骨恶性病灶的发现能力、骨转移灶类型的诊断差异,各种诊断指标上^99Tc^m-MDP和^18F—FDG各有优势,但两者结合可相互补充,提高诊断效能。     

False negative of the scintigraphy with 99mTc-sestamibi in parathyroid carcinoma with associated brown tumors. Contributions of the 18F-FDG-PET/CT

Parathyroid carcinoma (PTC) is a rare malignant disease that is usually hyperfunctioning, which produces an excess of parathyroid hormone. Hyperparathyroidism causes bone metabolism disorders, as osteopenia and sometimes brown tumors. Brown tumors are benign but locally aggressive bone lesions, whose differential diagnosis with metastases or other primary malignancies may be complicated. (99m)Tc-Sestamibi scan is the usual procedure for the detection of parathyroid pathology, with a sensitivity of 85-100% and specificity close to 100% in parathyroid adenomas, it having similar percentages in the detection of PTC. We present the case of a patient diagnosed of a malignant hyperparathyroidism associated with bone lesions in which the (99m)Tc-Sestamibi scan showed a false negative result in the detection of parathyroid condition. However, (18)F-FDG-PET/CT detected the PTC and helped in the differential diagnosis of associated bone lesions, which were finally confirmed as brown tumors.     

18F-FDG PET与99Tcm- MDP显像诊断肿瘤骨转移的比较

目的　研究1 8F 脱氧葡萄糖 (FDG)PET显像对肿瘤骨转移的诊断价值 ,并与99Tcm 亚甲基二膦酸盐 (MDP)骨显像比较。方法　 4 3例确诊的肿瘤患者在 1个月内先后行1 8F FDGPET及99Tcm MDP骨显像 ,其中 2 4例经其他检查及随访证实为骨转移。对比分析 2种显像结果。结果　 2 4例骨转移患者FDGPET显像均为阳性 ,骨显像阳性 2 2例 ,灵敏度分别为 10 0 %和 91.7% ,差异无显著性 (P >0 0 5 )。19例无骨转移患者中FDGPET显像阴性 18例 ,骨显像阴性 11例 ,特异性分别为 94 .7%和5 7 9% ,差异有显著性 (P <0 0 5 )。 2种方法检测骨转移的准确性分别为 97.7%和 76 .7% ,差异有显著性 (P <0 0 5 )。结论　1 8F FDGPET显像诊断肿瘤骨转移的灵敏度与99Tcm MDP骨显像无明显差别 ,但有更高的特异性和准确性。