18F-FDG PET-CT在肿瘤临床中的应用

18F-FDC PET-CT实现了对PET和CT两种技术的互补，比单纯用PET或CT提高了对恶性肿瘤诊断的特异性与准确性。现从PET-CT在肿瘤诊治中的应用、PET-CT的局限性以及成本一效益三方面来探讨其临床价值。     

PET／CT联合HRCT对肺孤立结节的鉴别诊断价值

目的评价PET／CT联合HRCT对肺孤立结节（SPN）的鉴别诊断价值。方法60例SPN经常规PET-CT扫描加肺结节局部薄层高分辨CT扫描（以下简称为HRCT）,所有结节均经病理证实。PET／CT根据结节PET的代谢特点和同时平静呼吸低剂量CT的形态学特点综合判定;PET／CT联合HRCT则在PET／CT诊断的基础上综合HRCT的CT征象判定。结果PET／CT和PET／CT联合HRCT诊断SPN的敏感性、特异性、准确性分别为89．5％、77．3％、85．0％和97．4％、81．8％和91．7％。结论PET／CT联合HRCT可以提高PET／CT诊断孤立肺结节的敏感性、特异性和准确性。     

PET/CT融合显像分析恶性肿瘤

目的研究PET与CT相结合,检测恶性肿瘤及其转移灶的优势。方法对已病理确诊恶性肿瘤患者98例行PET-CT显像,图像经融合工作站处理后行18F-FDGPET-CT融合图像、PET图像和CT图像帧对帧对比分析。结果初诊者88例,具有恶性病灶396个。396个病灶中,PET与平扫CT病灶皆显示清楚,阅片医师均有肯定诊断结论者192个(48.5%);396个病灶中,PET示病灶浓聚程度高、显示清楚、有肯定诊断结论,但平扫CT所示病灶欠清楚或病灶小、易漏诊、难以有肯定诊断结论者166个(41.9%);396个病灶中,病灶处未见明显浓聚影或仅有轻度浓聚,PET显像为阴性或难定确定,而平扫CT病灶显示清楚、有肯定诊断结论者17例38个病灶,占病灶数9.6%,占病例数的19.3%。PET-CT的总体检出率高于单纯性PET和平扫CT,对病灶的显示、定位,PET-CT也明显优于单纯性PET和平扫CT。10例治疗后患者,平扫CT难以确定肿瘤残余和坏死区域,而PET-CT清楚区分残余和坏死区。结论PET-CT中平扫CT的作用不仅限于对病灶的定位,PET与平扫CT对肿瘤病灶的检出具有相互印证及互补价值,PET-CT在恶性病灶的检出、病灶的清楚显示和准确定位方面优于单纯型PET和CT,可进一步提高恶性肿瘤诊断及分期的准确性。     

18F-FDG PET-CT在非小细胞肺癌术前区域淋巴结分期中的价值

目的 探讨18F-FDG PET-CT在非小细胞肺癌(NSCLC)患者术前区域淋巴结(N)分期方面的价值,以及CT密度和双时相扫描在淋巴结性质判定方面的作用.方法 43例手术病理证实的NSCLC患者均于术前行18F-FDG PET-CT扫描,对常规扫描图像采用PET法(单纯根据18F-FDG摄取水平判断淋巴结性质)和PET+CT密度法(结合CT密度和摄取水平判断淋巴结性质)分析.摄取水平通过目测法和半定量分析法结合判定.双时相扫描的储留指数(RI)>10%为摄取升高.以病理检查作为金标准对所得结果进行分析.结果 以区域淋巴结组为单位,PET法的诊断敏感度、特异度、准确度、阳性预测值和阴性预测值分别为88.0%、88.4%、88.3%、59.5%和97.4%,PET+CT密度法的相应值分别为84.0%、94.6%、92.9%、75.0%和96.8%,其中2种方法的特异度和准确度之间差异有统计学意义(P<0.05).28组淋巴结行双时相扫描,良恶性组摄取变化值(△SUVmax)之间和砒之间差异无统计学意义(P>0.05);在23组延迟相摄取升高的淋巴结中,11组为转移;在5组无摄取升高的淋巴结中,1组为转移.结论 18F-FDG PET-CT在肺癌患者术前N分期方面有较高的诊断价值,结合淋巴结CT密度和18F-FDG摄取水平可进一步提高诊断的特异度和准确度.对于常规相摄取增高的淋巴结,延迟相摄取升高对判断淋巴结性质的价值有限,但无摄取升高则更支持良性诊断.     

Ⅲ期非小细胞肺癌FDG PET-CT定位三维适形放疗的预后分析

目的 观察Ⅲ期非小细胞肺癌(NSCLC)经氟标记脱氧葡萄糖(18FDG)PET-CT定位后行三维适形放疗的疗效、副反应及失败原因.方法 64例Ⅲ期NSCLC(临床Ⅲa、Ⅲb期)患者用信封法随机分为PET-CT定位三维适形放疗(3DCRT)组(PET-CT组)和普通CT定位3DCRT组(普通CT组).PET-CT组将PET和CT图像融合后进行靶区和重要脏器勾画,制定治疗计划后进行常规分割3DCRT 40 Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量65 Gy左右.普通CT组用普通CT定位设野,3DCRT至相同剂最.所有病例均用TP方案(紫杉醇175 mg/m2第1天,顺铂40 mg第2～4天)辅助化疗6个周期.结果 随访率100%.随访满1、2、3年者分别为40、20、11例,PET-CT组和CT组分别为23和17例、11和9例、7和4例.PET-CT组中13例靶区有改变.PET-CT组和普通CT组完全缓解、部分缓解率分别为13%、66%和19%、53%(x2=0.33,P=0.564),1、2、3年局部控制率分别为84%、66%、53%和72%、59%、44%(x2=2.36,P=0.124),1、2、3年生存率分别为72%、34%、22%和53%、28%、13%(x2=2.46,P=0.117).PET-CT组1、2级肺晚期放射损伤发生率低于普通CT组,分别为28%、53%(x2=4.14,P=0.042).PET-CT组肺门、纵隔淋巴结复发率低于普通CT组,分别为3%和25%(P=0.026)、6%和28%(P=0.043);治疗失败主要原因相似均为远处转移,分别为56%和47%(x2=0.56,P=0.453).结论 PET-CT定位可以优化Ⅲ期NSCLC放疗设野计划,减少肺门和纵隔复发率,但远期生存率无明显提高,远处转移为主要失败原因.

Abstract：

Objective To analyse the long-term result and prognosis of 18 FDG PET/CT positioning three - dimensional conformal radiotherapy ( 3 DCRT ) for stage Ⅲ non - small cell lung cancer. Methods Sixty-four cases with stage Ⅲ non-small cell lung cancer (clinical stage Ⅲa- Ⅲb ) were randomly divided into two groups: PET/CT positioning three-dimensional conformal radiotherapy group (PET/CT group) and the conventional CT positioning three-dimensional conformal radiotherapy group (conventional CT group). In the PET/CT group, the target volume and critical organs were sketched according to PET/CT after fusion of the PET and the CT images; the treatment plan was worked out, then conventional fractionated 3DCRT ( total dosage around 40 Gy) followed by field-shrinked radiotherapy to a total dose of 65 Gy or sowas performed ;in the conventional CT group, the target volume and critical organs were sketched according to CT and 3DCRT were performed to the same total dose; All cases were treated with the TP scheme (paclitaxel 175 mg/m2,d1 ,cisplatin 40 mg,d2-4) adjuvant chemotherapy for 6 cycles after the radiotherapy. Results The followup rate was 100%. The number of patients who completed the 1-,2-and 5-year follow-up were 40,20 and 11 respectively ;The number of patients of the PET/CT group and conventional CT group were 23 and 17,11 and 9,7 and 4 respectively. Target volumes of 13 cases in the PET/CT group were changed. The complete remission and partial remission rates of the two groups were 13% 、66% and 19% 、53% (x2 = 0. 33, P =0. 564), respectively. The 1-,2-and 3-year local control rates of the PET/CT group and conventional CT group were84 % 、66% 、53 % an d72% 、59% 、44% ( x2 = 2.36, P = 0. 124 ) respectively. The1 -, 2-and 3-year survival rates were 72% 、34% 、22% and 53% 、28% 、13% (x2 =2. 46,P =0. 117) respectively. The level-1 and level-2 lungs' and trachea's late radiation injury of the PET/CT group and the conventional CT group were 28% and 53% ( x2 = 4. 14, P = 0. 042 ), respectively. The hilar and mediastinal lymph node recurrence rates of the PET/CT group were lower than those of the conventional CT group, were 3% ,25%(P = 0. 026) and 6%, 28% ( P = 0. 042 ), respectively. The main reason for treatment failure was distant metastasis both in the PET/CT group and conventional CT group,56% and 47% (x2 = 0. 56,P = 0. 453 ),respectively. Conclusions PET/CT, as a method of sketching the target of stage Ⅲ non-small cell lung cancer, can improve the radiation treatment plan, reduce the recurrence rate of hilar and mediastinal lymph nodes, meanwhile it can not improve the long-term survival rate; Distant metastasis was the main reason of failure.     

18F-FDG PET/CT利尿延迟显像在膀胱恶性肿瘤诊断中的应用价值

目的:探讨18F-FDG PET/CT利尿延迟显像在膀胱癌诊断中的临床价值。方法:选择2011年5月-2014年2月在我院行PET/CT检查并经手术或膀胱镜检病理证实的膀胱癌患者33例。所有患者均行增强CT检查,且在18F-FDG PET/CT常规全身显像后,静脉注射呋塞米40mg,嘱患者多饮水,多次排尿（4-5次）后,憋尿充盈膀胱,再进行盆腔PET/CT利尿延迟显像。评价患者的膀胱放射性清除效果及PET/CT利尿延迟显像在膀胱癌中的应用价值。结果:33例患者膀胱促排良好率为93.9%（31/33）。PET-CT显像灵敏度为63.6％(21/33例),利尿延迟显像为90.9％(30/33例),两者间有显著性差异(P=0.008)。 CT增强显像诊断灵敏度84.8％（28/33）与单次PET-CT显像间有显著性差异（P=0.049）;与利尿延迟显像间无显著性差异(P>0.05）。但是,在PET/CT显像中较CT增强扫描改变了10例患者的临床分期。结论:利尿延迟显像在膀胱恶性肿瘤的诊断中具有重要的临床价值,尤其是其独特的全身显像模式在肿瘤临床分期上具有显著优势。     

氟脱氧葡萄糖PET-CT常规及双时相显像检测食管癌术后复发转移的价值

目的 评价氟脱氧葡萄糖(FDG)PET-CT常规及双时相显像在监测食管癌术后复发转移中的应用价值.方法 回顾分析食管癌术后临床怀疑复发转移而行FDG PET-CT检查的48例患者临床资料,根据细胞学、病理或随访结果分析FDG PET-CT检查结果.两样本率比较采用Fisher's精确概率法检验.结果 48例患者中位随访21.5个月,34例出现复发转移,确定复发转移灶61处.FDG PET-CT常规显像对全部病灶诊断的敏感性、特异性和准确性分别为93.44%、74.29%和86.46%;对局部复发和区域淋巴结转移的敏感性、特异性、准确性分别为91.67%、57.14%、78.95%和90.48%、77.78%、84.62%.FDG PET-CT双时相显像诊断局部复发+区域淋巴结转移的敏感性、特异性、准确性均高于常规显像,分别为96.97%∶90.90%(P=0.613)、96.00%∶72.00%(P=0.049)、96.55%∶82.76%(P=0.029).结论 FDG PET-CT常规显像虽然检测食管癌术后局部复发及区域淋巴结转移的特异性和准确性较低,但仍是检测其术后复发转移的有效手段;双时相显像较常规显像更具优势,可有效提高检测的特异性及准确性.

Abstract：

Objective To evaluate the clinical value of regular and dual-time-point 18-fluorodeoxyglucose positron emission tomography-CT(FDG PET/CT)imaging for recurrence and metastasis in esophageal carcinoma(EC)after curative esophagectomy. Methods A retrospective study was done on 48 patients received curative esophagectomy, who underwent FDG PET/CT scans to detect doubtful recurrent or metastatic lesions. The diagnostic accuracy of FDG PET-CT was assessed with the help of pathological findings as well as clinical or follow-up data. Using Fisher's Exact Test from SPSS 11.5 to analyze the data.Results Of the 48 patients, after a median follow-up of 21.5 months, 61 sites of local and regional recurrence or metastasis were finally confirmed in 34 patients. The sensitivity, specificity and accuracy of regular FDG PET/CT imaging in detecting recurrence of all sites were 93.44%, 74.29% and 86.46%respectively. The specificity and accuracy of local recurrence and regional metastasis were 57.14% ,78.95% and 77.78% ,84.62%, respectively. The sensitivity, specificity and accuracy of dual-time-point FDG PET/ CT imaging in detecting local and regional recurrence(96.97% ,96.00% and 96.55%)were higher than those of regular FDG PET/CT(90.90%, 72.00% and 82.76%)and there were significant differences of specificity and accuracy(P = 0.049, P = 0.029). Conclusions Regular FDG PET/CT imaging is highly effective in detecting recurrence and metastasis in EC patients after curative esophagectomy despite the low specificity and accuracy. Dual-time-point FDG PET/CT imaging can elevate the specificity and accuracy.     

PET-CT在恶性肿瘤治疗后评价中的作用与局限性

PET-CT即正电子发射断层与计算机断层显像,它将PET的功能代谢显像和CT的解剖显像融合在一起,明显提高了单独使用PET或CT诊断疾病的准确性。PET-CT在恶性肿瘤治疗早期可以评估治疗疗效,对下一步临床处理有指导意义;治疗结束后,作为一种随访方法,可用于早期检测肿瘤的复发及转移。但是,PET-CT评价指标众多,目前尚无一个公认的标准,致使其在临床运用中结果不一致。另外,有许多因素能引起PET-CT诊断的假阳性与假阴性限制了PET-CT的临床运用。本文就PET-CT在恶性肿瘤治疗后评价中的作用与局限性做一综述。     

~(18)F-FDG PET-CT与强化CT对非小细胞肺癌区域淋巴结诊断价值的评价

目的 探讨~(18)F-脱氧葡萄糖(FDG)PET-CT与强化CT对非小细胞肺癌(NSCLC)区域淋巴结的诊断价值.方法 随机选择手术治疗的NSCLC患者122例,术前2周内行PET-CT检查,同期行CT强化扫描,根据术后病理检查结果,评价PET-CT和CT诊断NSCLC区域淋巴结的价值.结果 PET-CT能对80.3%NSCLC患者的区域淋巴结正确分期,13.1%的患者分期过度,6.6%的患者分期过低,而CT分别为55.8%、26.2%和18.0%.PET-CT对NSCLC区域淋巴结诊断的敏感度、特异度和准确率分别为86.3%、85.0%和85.3%,CT分别为68.6%、71.0%和70.4%,二者差异有统计学意义(P<0.01).PET-CT能纠正CT出现的81.3%的假阴性和71.6%的假阳性淋巴结,CT能纠正PET-CT出现的57.1%的假阴性和45.2%的假阳性淋巴结.5.9%的病理阳性淋巴结内存在微小的癌灶且短径<10 mm,被PET-CT和CT均诊断为假阴性;8.2%的病理阴性淋巴结短径>10 mm(隆突下淋巴结>15 mm),存在炎症及高的FDG摄取,被PET-CT和CT均诊断为假阳性,这些淋巴结是二者共同的盲点.结论 与强化CT相比,PET-CT能提高NSCLC区域淋巴结诊断的准确率,并能纠正CT出现的假阳性和假阴性错误.CT对PET-CT也是一个有益的补充,二者联合应用能相互弥补在NSCLC区域淋巴结诊断中的不足.     

PET—C畛断乳腺癌及其腋窝淋巴结转移的价值

目的探讨PET—CT对诊断乳腺癌及腋窝淋巴结转移情况的临床价值。方法选取行PET—CT检查的乳腺肿瘤患者40例，根据术后病理检查结果评价PET—CT对原发病灶定性和判断腋窝淋巴结转移情况的准确性并与腋窝淋巴结清扫情况进行比较；检验原发肿瘤病灶病理直径大小与超声、PET—CT诊断的一致性及其与标准化摄取值（SUV）值的相关性。结果PET—CT对乳腺癌的定性诊断准确率95％、灵敏度94％、特异度100％；根据腋窝淋巴结清扫术情况，PET—CT诊断腋窝淋巴结转移准确率88．2％、灵敏度89．2％、特异度83．3％；肿瘤病灶病理直径大小与PET-CT诊断相关性最高（P〈0．05），与SUV则无相关性（P〉0．05）。结论PET—CT对乳腺癌及腋窝淋巴结转移的诊断与病理诊断基本相符，灵敏度、特异度较高，两者诊断原发病灶大小的一致性最佳，可为取舍腋窝淋巴结清扫术和选择合理治疗方案提供有益参考。