早期帕金森病患者的临床与18F-FDG PET影像学特征研究

目的探讨早期帕金森病患者临床特征与18F-FDG正电子发射计算机断层显像的影像学特征及其在帕金森病早期诊断中的价值。方法选择我院神经内科门诊和住院收治的Hoehn-Yahr分级Ⅰ～Ⅱ级早期帕金森患者18例,另设正常对照组,与PD组年龄匹配的对照者20例。所有患者静脉注射18F-FDG后进行正电子发射计算机脑断层显像,获得双侧纹状体、丘脑等部位葡萄糖代谢图像,采用目测法对脑各部位的葡萄糖代谢进行判断,应用PET专用软件计算各ROI的18F-FDG放射性核素值,以枕叶为基准,计算脑部各ROI与枕叶的18F-FDG代谢放射性核素值的比值,在此基础上计算脑部各两两比较的18F-FDG代谢比值。结果早期帕金森组：脑各部结构显示清晰,部分患者大脑皮层显示轻度脑萎缩;大脑皮层示踪剂分布相对均匀,左右对称;皮层下各神经核团显示结构完整,清晰对称;18例早期帕金森病患者18F-FDG正电子计算机断层显像有16例可见脑内有不同程度的放射性分布异常,占88.89%,非对称性纹状体放射性减低14例（77.78%）,其中5例为双侧减低,患者的双侧纹状体放射性计数进行半定量比较,发现运动障碍肢体对侧（脑病侧）纹状体尾状核/小脑比值为1.12±0.31,另侧（脑健侧）1.38±0.28,病侧与健侧脑相应区域相比下降,差异显著（t=2.64,P〈0.05）;壳核/小脑比值分别为1.22±0.28和1.46±0.22（t=2.86,P〈0.01）。结论PET显像有助于早期发现亚临床期PD患者纹状体功能改变,可提高早期PD诊断的准确性。PD患者18F-FDGPET显像显示尾状核与壳核团的不对称性代谢减低改变,利用局部ROI的半定量分析方法,能反映出纹状体功能,有助于临床上早期诊断帕金森病并更为客观地评估病情和病程。     

氟代脱氧葡萄糖在PET／CT致痫灶定位显像中的应用

目的探讨正电子药物18F氟代脱氧葡萄糖（18F-FDG）在正电子发射计算机（断层PET／CT）脑显像致痫灶定位中的应用。方法对32例癫痫患者行18F-FDG脑三维PET／CT显像,将其定位结果与头皮脑电图（EEG）、颅脑CT或MRI结果进行比较。结果PET／CT阳性检出率为90．6％（29／32）,其中低代谢灶27例,高代谢灶2例,正常3例;EEG阳性检出率为65．6％（21／32）,常规脑部CT或MRI阳性检出率为31．0％（10／32）。结论18F-FDG在PETJCT脑显像中对癫痫的定位诊断有较高的灵敏性和准确性。     

正电子发射断层显象对胰腺癌的诊断及其价值

胰腺癌在临床早期诊断中尚属难点,正电子发射断层显像(positron emission computed tomography,简称PET)对胰腺癌的诊断已受到重视和关注.目前用于胰腺癌PET诊断的正电子放射性药物为氟化脱氧葡萄糖(18F-FDG).18F-FDG PET显像能显示组织中的葡萄糖摄取和代谢,恶性肿瘤组织的葡萄糖代谢的特点是糖酵解增强和葡萄糖摄取增加.基于这个机制,18F-FDG PET显像用于恶性肿瘤的诊断,包括胰腺癌的诊断.业已研究表明胰腺癌细胞表面葡萄糖转运体增多,其中Glut1基因过度表达,而此与癌细胞糖酵解增强相关联[1].     

光刺激对视觉功能区的^18F-FDG再分布的影响

目的研究光刺激和时间延迟因素对脑的视觉功能区^18F-FDG代谢影响。方法应用PET/CT对21例正常人脑行^18F-FDG PET显像,注射后1h按有无光刺激分成二组,并于注射后2h后分别再次采集脑部图像,分析光刺激和时间延迟因素是否会引起^18F-FDG在脑内的再分布。结果在给予光刺激后,大脑的布劳德曼（Brodmann）17、18、19分区、中枕回、楔叶及舌回区域对称性代谢增高,而在丘脑、前连合、胼胝体、尾状核及海马部位则对称性降低。在未受光线视觉刺激研究组,早期相和延迟相未见视觉传导通路上脑区代谢变化。结论^18F-FDG在引入体内后,如果未有光线刺激,其视觉功能区的代谢分布尚可保持相对稳定;反之,光线刺激可引起^18F-FDG在脑内的再分布及视觉功能区的代谢变化。     

18F-FDG PET/CT显像联合HRCT对孤立性肺结节的应用价值

目的 应用18 F-FDG PET/CT代谢显像联合HRCT对孤立性肺结节(SPN)的诊断价值.方法 回顾性分析2017年6月至2018年12月经术后病理证实及临床随访2年的孤立性肺结节患者50例,汇总其影像及临床检查等资料.结果 50例患者中,确诊肺癌43例,良性7例.单行18 F-FDG PET/CT显像检查的病例...     

~(18)F-脱氧葡萄糖与~(99)Tc~m-亚甲基二膦酸盐骨扫描显像探测恶性肿瘤全身骨转移病灶的对比分析

<正>99Tcm-亚甲基二膦酸盐(MDP)全身骨显像是检测恶性肿瘤骨转移的常规方法,而18F-脱氧葡萄糖(FDG)正电子发射型计算机断层显像(PET)显像可显示具有葡萄糖高代谢水平的骨骼转移病灶。本研究目的是比较18F-FDG hPET(hybird PET)/CT显像与99Tcm-MDP全身骨显像检测恶性肿瘤骨骼病灶的异同点,探讨18F-FDG hPET/CT显像诊断恶性肿瘤骨转移病灶的临床价值。1资料与方法1.1临床资料:选取本院2009年12月至2013年10月收治     

规范化整体护理对PET/CT肿瘤检查的显像质量和患者满意度的影响

<正>正电子发射计算机断层显像(PET/CT)在临床已得到广泛应用,且在肿瘤诊断、分期及疗效评估中具有明显优势,目前检查常用的显像剂为18F-氟代脱氧葡萄糖(18F-FDG),可被肿瘤摄取并滞留在胞内,可反映肿瘤的葡萄糖代谢率^[1];但18F-FDG为葡萄糖类似物,在体内与葡萄糖存在竞争性摄取关系,受血糖水平影响较大,且PET/CT检查涉及环节较多,体内遗留的钡剂、肌肉紧张、寒冷刺激等许多因素均可影响显像质量^[2]。     

自体干细胞移植前后18F-FDG PET显像评价非霍奇金淋巴瘤预后的价值

目的 探讨非霍奇金淋巴瘤(NHL)患者在自体干细胞移植(ASCT)前后18F-脱氧葡萄糖(FDG)正电子发射计算机断层扫描(PET)显像评价预测患者无进展生存期(PFS)的价值.方法 43例NHL患者在ASCT前后均行18F-FDG PET/CT检查,ASCT后随访时间均＞18个月.根据随访结果,将ASCT前8F-FDG PET显像阳性患者分为进展与无进展组,比较两者最大标准化摄取值(SUVmax)的平均值.采用Kaplan-Meier方法进行PFS分析,并对影响PFS与预后的一系列因素进行Cox回归分析.结果 ASCT前,20例18F-FDG PET显像阳性患者中13例出现疾病进展,其SUVmax平均值明显高于其余7例无进展者[(5.9±2.0)对(3.6±1.5),P=0.016].ASCT前后18F-FDG PET显像为阴性和显像为阳性的患者PFS差别均有统计学意义(P＜0.01).Cox回归分析发现ASCT前后18F-FDG PET显像评价是预测PFS的最重要因素(P＜0.05),且独立于其他变量.结论 ASCT前后18F-FDG PET显像评价对预测NHL预后可能有一定价值,值得更进一步研究.     

18F-FDG显像和血肿瘤标志物联合诊断结直肠癌术后复发价值研究

目的探讨18F-脱氧葡萄糖（18F-FDG）显像联合CEA、CA242检测诊断结直肠癌术后复发的价值。方法采用18F-FDG双探头符合线路显像,同机图像融合。CEA、CA242采用双抗体夹心法的化学发光检测。结果18F-FDG显像发现36例复发,联合检测发现全部复发病例。结论18F-FDG显像联合血肿瘤标志物检测能明显提高结直肠癌复发的检出率。     

肝癌肝移植术后18F-FDG PET/CT显像特点和预后判断

目的分析肝癌肝移植患者术后18F-FDG（18氟标记的脱氧葡萄糖）PET/CT的显像特点和预后判断。方法回顾分析2006年以来15例已行肝移植的肝癌患者的临床病历资料和18F-FDG PET/CT的影像学资料及随访结果,用Kaplan-Meier方法计算其生存率,COX回归进行预后因素分析。结果 15例肝移植患者PET/CT显像中,9例提示肿瘤复发和远处转移,6例为阴性显像。②15例显像分为阳性组（n=9）和阴性组（n=6）,中位生存时间为分别为18个月和67个月。③Log-rank单因素分析预后因素年龄、最大标准摄取值（SUVmax）和甲胎蛋白（AFP）水平是影响预后的独立因素。结论 18F-FDG PET/CT对肝癌肝移植患者的全面评估及预后判断具有较好的应用价值。     

Review. 18F-FDG PET in the diagnosis and follow-up of thyroid malignancy

The diagnosis of carcinoma of the thyroid is usually made in the process of investigating a thyroid nodule with clinical examination, Technetium-99m scan, ultrasonography and fine-needle aspiration (FNA) cytology. The follow-up is mainly based on 123-iodine and 131-iodine scans and serum thyroglogulin measurement. The aim of the present review was to establish the role of 18F-FDG PET in the differential diagnosis of doubtful thyroid nodules and in the follow-up of patients with increased serum thyroglobulin levels and negative iodine-scan. It remains to be defined if metabolic imaging with PET could be a useful routine procedure in the management of thyroid tumours since the majority of them are well-differentiated and therefore have less avidity to 18F-FDG. In the present work we collected the specific literature derived from MEDLINE over the last 10 years to clarify the potential clinical value of 18F-FDG PET in thyroid malignancies. An emerging role for 18F-FDG PET is in the assessment of incidental finding of a thyroid nodule which, when showing high FDG uptake should be regarded as a possible malignancy that needs further assessment. Another well-documented role for 18F-FDG PET is in the investigation of cases of established well-differentiated thyroid carcinomas presenting with high thyroglobulin and negative iodine imaging. An increase of the 18F-FDG uptake in these tumours indicates a shift towards lesser differentiation (with more aggression and poor prognosis) and may benefit from alternative management. 18F-FDG PET can be considered a routine functional imaging method in detecting iodine-negative recurrent disease in thyroid cancer patients with elevated serum thyroglobulin levels during follow-up. 18F-FDG PET seems to be useful also in differential diagnosis of suspected thyroid nodules, especially using the semi-quantitative SUV analysis.     

18F-FDG PET/CT in myeloma with presumed solitary plasmocytoma of bone

AIM: To evaluate the value of 18F-fluorodeoxy-glucose (FDG) positron emission tomography with computed tomography (PET/CT) in myeloma in patients presenting with a solitary plasmacytoma of bone (SPB). PATIENTS AND METHODS: Fourteen consecutive patients studied since 2006, all having a diagnosis of SPB before PET/CT imaging took part in this study. In 3 patients PET/CT was performed for staging while in the remaining 11 it was used to monitor therapy. PET/CT was performed using a dedicated tomograph 60-90 minutes after intravenous injection of 53 MBq/kg of 18F-FDG and the results were compared to other diagnostic procedures [radiographs and magnetic resonance imaging (MRI)], biopsy, and other available follow-up data. RESULTS: In 8/14 patients, PET/CT scans showed previously unsuspected sites of increased FDG accumulation. In 6/8 patients, FDG uptake was considered pathologic, depicting myeloma involvement in bone, while in the remaining cases, findings were considered incidental and not related to myeloma. PET findings attributed to myeloma were confirmed (i.e. true positives) in 6/6 cases (100%) and in all patients with findings reported as non-pathologic, myeloma was excluded (100% true negatives). CONCLUSION: Our preliminary data in a small number of cases suggests that there are a group of patients with SPB (local disease) in whom FDG PET/CT may detect other unsuspected sites of bone involvement, upstaging the extent of the disease. In these cases, SPB may be a local manifestation of multiple myeloma where other sites of involvement have eluded detection by other less sensitive imaging modalities (i.e. skeletal surveys) or anatomically restricted imaging (i.e., less than total body MR or CT). Finding other sites of involvement have significant implications for appropriate treatment of myeloma.     

Radioligand development for PET imaging of beta-amyloid (Abeta)--current status

Two of the main pathological hallmarks of Alzheimer's disease (AD) are neuritic plaques and neurofibrillary tangles. Significant evidence supports a critical and probable causative role of beta amyloid (Abeta) plaque formation. Since neuroprotective treatments are typically most effective at early stages of injury, the detection and measurement of Abeta load in living brain should be performed at early and perhaps even presymptomatic stages of AD. Two primary targets of molecular imaging research with positron emission tomography (PET) are to develop surrogate markers (radioligands) for assessing disease progression and for monitoring the efficacy of developmental therapeutics. Here, we review the current status of radioligand development for PET imaging of Abeta aggregates. General structure-activity relationships have emerged, including the identification of at least three different ligand binding sites in various Abeta aggregates and recognition of the general structural requirements for ligand binding at each site. Also a few radioligands applicable to imaging Abeta plaques in living human brain with positron emission tomography (PET) have emerged, including [(11)C]PIB, [(11)C]SB-13 and [(18)F]FDDNP.     

18F-FDG符合探测正电子显像在恶性淋巴瘤诊治评估中的应用

目的探讨18F-FDG符合探测正电子显像(SPECT/PET)在恶性淋巴瘤诊治中的应用。方法回顾性分析2006年1月~2010年9月在本院经病理确诊为恶性淋巴瘤67例患者共102次18F-FDGSPECT/PET显像结果。霍奇金淋巴瘤患者9例,1例治疗前行SPECT/PET显像,8例为治疗中、后行检查。非霍奇金淋巴瘤患者58例,16例治疗前SPECT/PCT显像,9例治疗前、后均进行SPECT/PET检查,33例治疗后显像。结果 9例霍奇金淋巴瘤患者中治疗前阳性显像1例,化疗中和(或)放疗后SPECT/PET显像共8例,其中5例完全缓解,1例未见明显缓解,1例部分缓解,1例进展。58例非霍奇金淋巴瘤患者中25例治疗前患者中的SPECT/PET显像24例为阳性(96.0%)。42例接受治疗的非霍奇金淋巴瘤患者(包括9例治疗前后均行检查患者),其中16例SPECT/PET显像为完全缓解(38.09%),10例部分缓解(23.81%),9例病灶有进展(21.43%),7例缓解后又复发(16.67%)。结论 18F-FDGSPECT/PET在淋巴瘤的临床诊断分期与疗效评估中具有重要的临床价值。     

探讨PET/MR/CT多模式融合显像在原因不明发热中寻找致热源的价值

目的：探讨18 F-FDG PET/MR/CT多模式融合显像在原因不明发热( fever of unknown origin, FUO)中的诊断价值。方法对在2009—2014年符合FUO诊断标准的57例病例,全部行PET/MR或PET/CT检查后通过手术探查或穿刺活检获得病理诊断,临床诊断而非手术治疗者随访半年以上,通过目测法和半定量分析方法对18 F-FDG PET/MR/CT的诊断结果进行评价。结果57例FUO患者,其中能明确致热源的有43例,包括感染性炎性反应16例,恶性肿瘤12例,非感染性炎性反应8例,其他类型7例,未能发现病因14例。而18 F-FDG PET/MR/CT显像诊断真阳性38例,假阳性5例,假阴性3例,真阴性11例。18 F-FDG PET/MR/CT的灵敏度92.7%,特异性68.8%;阳性预测值88.4%,阴性预测值78.6%。结论18 F-FDG PET/MR/CT显像在临床FUO的诊疗中具有独特价值。     

Synthesis and preliminary evaluation of 2‐arylhydroxyquinoline derivatives for tau imaging

Alzheimer's disease (AD) is the most common cause of dementia. Senile plaques, consisting of β‐amyloid, and neurofibrillary tangles (NFTs), composed of tau protein, are representative pathological hallmarks of AD. It is believed that the accumulation of NFTs precedes the onset of clinical symptoms of AD and correlates with the progression of memory dysfunction. Thus, the use of noninvasive detection techniques including radiolabeled probes and positron emission tomography (PET) will facilitate early diagnosis or staging of AD. In this study, we synthesized and evaluated novel hydroxylated 2‐arylquinoline derivatives as tau imaging PET probes. The binding affinities of compounds for tau were evaluated by fluorescent staining of the AD hippocampal section and a competitive binding assay using [¹⁸F]THK‐523. THK‐951 showed high binding affinity for tau pathology in an AD brain section and K18Δ280K fibrils (K_i = 20.7 nM); thus, we radiosynthesized a ¹¹C‐labeled THK‐951 and further studied its potential as a tau PET probe. The [¹¹C]THK‐951 demonstrated excellent kinetics in a normal mouse brain (3.23% ID/g at 2 min postinjection and 0.15% ID/g at 30 min postinjection) and showed the labeling of NFTs in an AD brain section by autoradiography assay. These findings indicate the availability of [¹¹C]THK‐951 for in vivo PET imaging of tau pathology in AD. Copyright © 2013 John Wiley & Sons, Ltd.     

The role of MRI and PET/SPECT in Alzheimer's disease

Alzheimer's disease (AD) is difficult to diagnose in its early stages, and even if detected early, there is no preventative treatment. Imaging modalities such as MRI, PET, and SPECT have the potential to contribute to both the diagnosis of Alzheimer's disease, as well as assist in the search for more effective treatments. A number of AD-related biomarkers have been proposed and evaluated. The use of PET imaging to detect alterations in regional brain metabolism using [(18)F]FDG has enabled more sensitive and accurate early diagnosis of AD, especially in conjunction with traditional medical evaluation. Additionally, magnetic resonance imaging and spectroscopy provide a wide range of biomarkers that have been shown to correlate with the progression of AD. Some of these markers have been pursued in clinical trials. Progress has been made toward the evaluation of other more AD-specific biomarkers. However, many questions remain concerning the validity and sensitivity of these imaging biomarkers to aid in the assessment of potential new treatments, especially those related to increased levels of amyloid peptides in the brain.     

In vivo type 1 cannabinoid receptor availability in Alzheimer's disease

The endocannabinoid system (ECS) is an important modulatory and potentially neuroprotective homeostatic system in the brain. In Alzheimer's disease (AD), the role of type 1 cannabinoid receptor (CB₁R) is unclear, with contradictory findings in post-mortem studies showing upregulation, downregulation or unchanged CB₁R status. We have investigated CB₁R availability in vivo in patients with AD, in relation to amyloid deposition, cognitive functioning and apolipoprotein E (ApoE) genotype. Eleven AD patients and 7 healthy volunteers (HV) underwent combined [¹⁸F]MK-9470 PET and [¹¹C]PIB PET scans to assess CB₁R availability and amyloid deposition, respectively, and T1 volumetric MRI for partial volume correction. We found no difference in CB₁R availability between AD and HV, VOI-based fractional uptake values (FUR) were 0.043±0.01 for AD and 0.045±0.01 for controls (p=0.9). CB₁R availability did not correlate with neuropsychological test scores and was not modulated by ApoE genotype. As expected, global [¹¹C]PIB SUVR (standardized uptake value ratio) was increased in AD (SUVR 1.9±0.3) compared to HV (1.2±0.1) with p<0.001, but no correlation was found between amyloid β (Aβ) deposition and CB₁R availability. In conclusion, we found no in vivo evidence for a difference in CB₁R availability in AD compared to age-matched controls. Taken together with recently reported in vivo CB₁R changes in Parkinson's and Huntington's disease, these data suggest that the CB₁R is differentially involved in neurodegenerative disorders.     

Current status of PET-imaging probes of β-amyloid plaques

Alzheimer’s disease (AD) is the most common form of dementia and is characterized by progressive cognitive decline and memory loss. One of pathological hallmarks of AD is the accumulation and deposition of β-amyloid (Aβ) plaques which is a potential target for the early diagnosis of AD. Positron emission tomography (PET), a sensitive radionuclide imaging technique, has provided opportunities to detect Aβ plaques of AD. PET-imaging probes of Aβ plaques have been extensively developed during the last decade. [¹⁸F]Florbetapir, the ¹⁸F-labeled PET-imaging probe of Aβ plaques, was recently approved by US Food and Drug Administration. A number of follow-on PET-imaging probes are currently being developed in academia and pharmaceutical companies. This article will discuss the recent development of PET-imaging probes from [¹¹C]PIB to [¹⁸F]Florbetapir, which are in clinic trials, and several follow-on probes in preclinical stage.