Detection of thyroid malignancy in a hot nodule by fluorine-18-fluorodeoxyglucose positron emission tomography

Carcinoma of the thyroid arising in an autonomously functioning or "hot" nodule is uncommon. The majority of thyroid carcinomas present as a "cold" nodule on radionuclide scintigraphy. We report a poorly-differentiated thyroid carcinoma developing in a long-standing "hot" nodule in a 51-year-old Chinese woman. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG PET) showed focal FDG uptake in the thyroid nodule, as well as in the cervical and pulmonary hilar lymph nodes. This case illustrates that the incidence of thyroid carcinoma in a "hot" nodule is not negligible. The role of FDG PET in the differentiation of benign from malignant thyroid nodules is still unclear. In contrast, FDG PET has been shown to have a role in the follow-up of thyroid cancer patients after thyroidectomy and subsequent radioactive iodine-131 (I-131) ablation. It may be useful in the identification and localisation of recurrent cancer foci in patients with elevated thyroglobulin levels but a negative I-131 whole body scan.     

18氟脱氧葡萄糖-正电子发射体层显像在小细胞肺癌患者中的应用价值

目的 探讨^18氟脱氧葡萄糖(FDG)-正电子发射体层显像(PET)在小细胞肺癌(SCLC)患者中的应用价值。方法 2000年2月～2003年7月,对17例小细胞肺癌患者行全身FDG-PET检查,采用目测法判读结果并将其与病理及随访结果对照。结果 15例患者肺内原发病变均在FDG-PET检查中显影;准确判断了15例63处淋巴结转移;比常规检查发现了更多例远处转移。FDG-PET将5例常规检查定为局限性疾病的患者正确判断为进展性疾病。结论 FDG-PET在SCLC患者TNM分期、治疗方案的制定和治疗效果的判断中有很大的优越性。     

18F-FDG正电子显像在分化型甲状腺癌术后诊断及判定预后上的价值

目的 评估18F-FDG正电子显像对分化型甲状腺癌（DTC）患者术后诊断及预后判定上的价值。方法 52例已确诊为DTC并经手术治疗的患者,进行诊断性剂量的全身扫描（DxWBS）及FDG正电子显像;对其中48例再行131I治疗的患者进行治疗剂量的全身扫描（TxWBS）。将FDG正电子扫描结果与DxWBS及TxWBS结果进行对比,并将FDG扫描结果与DTC的分级及预后联系起来进行对照。结果 48例已行131I治疗的患者,TxWBS结果所显示的病灶数量与DxWBS类似。FDG显像主要显示甲状腺以外的病灶,DxWBS与TxWBS主要显示甲状腺内的病灶。FDG正电子显像结果阴性的患者大多处于疾病1期,同时,所有高于1期的患者均为阳线结果。平均30个月的随访中,FDG正电子结果为阳性的患者肿瘤持续存在或恶化、转移,阴性患者中的极大多数病情逐渐缓解。结论 与DxWBS、TxWBS对比,在对DTC术后诊断方面,FDG正电子显像更容易发现甲状腺外的转移灶,而且,其结果与肿瘤分级及预后有着相关性。     

FDG-PET AS A ROUTINE SURVEILLANCE TOOL IN HEAD AND NECK CARCINOMA SIX MONTHS AFTER TREATMENT

Objective To evaluate prospectively the impact of fluorodeoxyglucose-fluorine-18 positron emission tomography (FDG-PET) in the detection of recurrence, second primary cancers, and distant metastases in head and neck squamous cell carcinoma (HNSCC) 6 months after treatment. Methods A total of 41 patients without any clinical element for recurrence, second primary cancer, or distant metastases received a whole-body FDG-PET as a routine surveillance tool 6 months after initial combined curative therapy for HNSCC. Results There were 35 negative PET results and 6 positive. One patient with abnormal FDG-PET did not have recurrent HNSCC (false positive). Five had true positive results: proven recurrence in 2 patients, second primary cancer in 2, and distant metastasis in 1. The sensitivity and specificity of FDG-PET for the diagnosis of HNSCC recurrence, second tumor, and distant metastases were 100% (5/5) and 97.2% (35/36), respectively. The positive predictive value was 83.3% (5/6). The negative predictive value was 100% (35/35). The overall accuracy was 97.6% (40/41). FDG-PET had a therapeutic impact in 5 of 41 patients (12.2%). There was no impact of FDG-PET on management in other 36 patients. Conclusion FDG-PET is useful as primary method for detecting nodal recurrence and distant metastases in HNSCC as well as second cancer in subclinical patients as it had a high effectiveness. But systematic FDG-PET performed at 6 months in patients without any clinical suspicion of local recurrence was scarcely useful.     

18氟-脱氧葡萄糖正电子发射计算机断层显像在探测乳腺癌复发和转移中的应用

目的 对30例乳腺癌术后患者进行^18氟－脱氧葡萄糖（^18F－DG）正电子发射计算机断层显像（PET）检查，评价其在探测乳腺癌复发和转移中的应用价值。方法 30例经治疗后临床疑有肿瘤复发或转移的乳腺癌患者均进行FDG PET全身显像，应用目测法和半定量分析法判断结果（标准摄取值，SUV）。分别对每例患者及其病灶进行分析，比较FDG PET与常规影像学检查对病灶检出率的不同。结果 30例患者中，12例PET检查未见异常，18例可见局部复发和／或转移。1例骨转移患者PET为阳性。FDG PET检测灵敏度为97.4%，仙影像学检查灵敏度为73.7%。在122个肿瘤转移灶中，PET检出116个（95％），常规影像学检查检出84个（69％），FDG PET对病灶的检出率明显高于常规影像学检查（P＜0.001）。结论 FDG PET全身显像有助于早期诊断乳腺癌治疗后的肿瘤复发和／或转移。     

PET与PET/CT在头颈部肿瘤放射治疗中的应用

正电子发射型计算机断层显像(PET)是一种功能性影像技术,而PET/CT图像融合技术则将CT解剖结构信息与PET功能代谢信息结合在一起,更为准确地显示肿瘤与周围正常组织的关系。PET与PET/CT在头颈部肿瘤放疗前分期,明确原发不明颈淋巴结转移癌原发灶,预测头颈部肿瘤放射敏感性及预后;在头颈部肿瘤放疗计划(RTP)中尤其是调强放射治疗(IMRT)中的应用;放疗后评估放疗的疗效,以及监测肿瘤复发等各个方面都受到了广泛关注。但由于其应用在很多方面存在争议,尚无大量临床证据,因此有待进一步实践和证实。     

PET在胃癌诊断中的价值与CT对照研究

目的：评价术前应用正电子发射型断层扫描(PET)、CT对胃癌的诊断价值。方法：28例胃癌患者术前行PET全身显像，23例行CT检查，将以上结果和病理分期对照。结果：PET和CT对胃癌局部病灶的显示率分别为92.9％和82.6％，PET对淋巴结的检测准确性(87．5％)高于CT(61．9％)。PET检测出8例远处转移患者，CT漏诊3例。结论：PET相对于CT能更准确检测原发和复发胃癌淋巴结及远处转移灶，对胃癌的临床诊断有较高的应用价值。     

PET in lung cancer

Accurate tumor staging is essential for choosing the appropriate treatment strategy in patients with lung cancer. It has already been shown that FDG-PET is highly accurate in classifying lung nodules as benign or malignant. Integrated PET-CT enables the exact matching of focal abnormalities on PET to anatomic structures on CT. PET-CT is superior in diagnostic accuracy for T staging and differentiation between tumor and peritumoral atelectasis. PET has also proved to be a very effective staging modality for mediastinal nodal staging. It has been demonstrated to assist mediastinoscopy to reveal additional mediastinal disease in 6% of patients. PET detects unexpected extrathoracic metastases in 10-20% of patients and changes therapeutic management in about 20% of patients. A very high accuracy of FDG-PET in distinguishing recurrent disease from benign treatment effects has been shown. Patients should be evaluated after a minimum of 2 months after completion of therapy. FDG-PET can be clinically used for selecting biopsy sites. At our institution PET-CT has become the standard imaging modality for staging patients with lung cancer. Although not all tumors take up FDG, other radiotracers are being studied to expand the utility of PET-CT. PET-CT offers many opportunities for the patients, the clinicians, and the researchers. PET-CT has the potential to become the most efficient oncologic examination in the near future.     

A case of papillary thyroid cancer recurring as an esophageal submucosal tumor

A 75-year-old woman who underwent a total thyroidectomy for papillary thyroid cancer 7 years previously presented with a palpable neck mass. Computed tomography (CT) showed two metastatic masses on the thyroid bed and another mass that looked benign originating from the esophageal wall. Endoscopic ultrasonography (EUS) showed a hypoechoic mass in the esophageal wall that looked similar to a gastrointestinal stromal tumor. The mass on the esophagus had intense fluorodeoxyglucose (FDG) uptake in positron emission tomography-computed tomography (PET-CT), which suggested the possibility of malignancy. Subsequently, after surgery, the mass in the esophagus was confirmed as a metastasis from the thyroid papillary carcinoma. Here we report this unusual case of papillary thyroid cancer that recurred as an esophageal submucosal tumor.     

Clinical applications of FDG PET/CT in carcinoma of unknown primary

Background Carcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP, including detecting the occult primary tumor and effecting on disease therapy. Methods One hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350-425 MBq of 18F-FDG. Results In 24.8% of patients, FDG PET/CT detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86%, 87.7%, and 87.2%, respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%, 47 of 149) patients underwent a change in therapeutic management. Conclusions FDG PET/CT is a valuable tool in patients with carcinoma of unknown primary, because it assistsed in detecting unknown primary tumors and previously unrecognized distant metastases, and optimized the mangement of these patient.     

Clinical applications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of unknown primary

Background  Carcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP, including detecting the occult primary tumor and effecting on disease therapy.

Methods  One hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350–425 MBq of ¹⁸F-FDG.

Results  In 24.8% of patients, FDG PET/CT detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86.0%, 87.7%, and 87.2%, respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%, 47 of 149) patients underwent a change in therapeutic management.

Conclusions  FDG PET/CT is a valuable tool in patients with CUP, because it assisted in detecting unknown primary tumors and previously unrecognized distant metastases, and optimized the mangement of these patients.

     

桥本病合并甲状腺癌12例治疗观察

目的探讨桥本病合并甲状腺癌的诊断和治疗。方法回顾性分析我院1994年￣2005年收治的12例桥本病合并甲状腺癌患者的临床资料。结果桥本病合并甲状腺癌的发病率占慢性淋巴性甲状腺炎的10.1%,占甲状腺癌的8.5%,所有病人均以颈部结节就诊;并存甲状腺癌中乳头状癌8例,滤泡状癌2例,混合性癌1例,髓样癌1例。其中6例行Ⅰ期根治性手术,2例行Ⅱ期根治性手术;4例行一侧或双侧甲状腺全切或次全切术。随访3个月至10年不等,1例复发,无死亡。结论桥本病与甲状腺癌并存率高,诊断困难,因此掌握桥本病的手术探查指征十分必要,对桥本病合并甲状腺癌手术应采取根治性治疗原则。     

原发性甲状腺功能亢进症合并甲状腺癌18例分析

目的：探讨原发性甲状腺功能亢进症（甲亢）合并甲状腺癌（甲癌）的诊断和治疗。方法：回顾分析1990年1月于2000年1月手术治疗18例甲亢合并甲癌患者的临床资料，结果：微小癌占83％（15／18）。术前彩超检查15例，14例发现可疑结节；13例行癌侧叶全切除和对侧叶次全切除术，5例行双侧叶次全切除术，其中3例同时行颈淋巴结清扫术，1例二次行颈淋巴结清扫术。随访16例，平均随访7年，1例死于癌肺转移，余者仍存活，结论：术前常规彩超检查发现可疑结节有助于术中冰冻切片病理检查，手术治疗应兼顾甲亢和甲癌。     

颈胸交界部转移性肿瘤的手术治疗

目的 探讨颈胸交界部转移性肿瘤的手术方法和疗效。方法 回顾14例颈胸交界部转移性肿瘤的诊治经过。其中分化型甲状腺癌淋巴结转移11例(乳头状癌8例,滤泡癌3例),恶性嗜铬细胞瘤淋巴结转移1例,下咽和食管癌淋巴结转移各1例。手术步骤为离断胸锁关节后,掀起或部分切除同侧锁骨(必要时去除部分胸骨柄),解剖和保护喉返神经、膈神经及甲状腺下动脉,如肿瘤位于静脉深面,可切断和结扎颈内静脉和／或无名静脉后切除肿瘤。结果 10例分化型淋巴结转移性甲状腺癌2～5年内无复发,1例淋巴结转移性嗜铬细胞瘤2年内症状无复发,淋巴结转移性下咽癌和食道癌患者均于末次术后11个月内死于肺和肝转移。无手术区局部复发和手术死亡者。结论 分化型甲状腺癌等颈胸交界部淋巴结转移性肿瘤手术切除有效并相对安全。     

Gallium-67-citrate scintiscanning in the search for occult primary malignant tumours.

Fifty consecutive patients in whom occult primary malignant disease was suspected underwent scintiscanning of the head, neck and trunk with gallium-67-citrate. In 17 patients a carcinoma was correctly identified as to presence and approximate location. In another seven patients the site of the primary tumour was identified from the scan and confirmed by radiologic study but no histopathological diagnosis, except for metastatic anaplastic carcinoma, was made. In another five patients the many abnormalities on the scan did not permit identification of a possible site of the primary tumour. Eleven patients had normal scintiscans and no evidence of malignant disease on follow-up. In seven patients with proven carcinoma false-negative results were obtained: no uptake of the radioisotope was detected, even at the sites of known disease. In three patients false-positive uptake of the radiotracer was observed; two had benign disease and one had a malignant tumour remote from the scan abnormality.     

F-18 FDG-PET对肾细胞癌诊治临床作用初步研究

目的评价F-18 FDG-PET对肾细胞癌诊断和治疗方案选择的临床作用.方法对怀疑或诊断为原发性肾细胞癌的40例病人进行全身PET检查,确诊依靠病理或随访,比较PET与CT诊断价值并分析PET检查结果对治疗方案选择的影响.结果 40例中39例最后诊断为原发性肾细胞癌,PET检查结果真阳性30例,假阴性9例,假阳性1例(为局部肾间质纤维化),而CT真阳性36例;35例常规检查后拟行手术治疗,PET改变治疗方案5例(5/35):1例行肾部切除术;1例因发现双肺多发转移,放弃手术;确诊3例,直接行肾癌根治手术.结论 PET对原发性肾细胞癌诊断敏感性不如CT,但对CT等常规影像检查不能确诊的肾细胞癌患者有帮助,能改变约14%术前治疗方案.     

18F-FDG PET/CT在肝癌肝移植术后复发监测中的临床应用价值

目的评价18F-脱氧葡萄糖正电子发射体层摄影术(FDG PET)/CT在肝癌肝移植术后复发监测中的临床应用价值。方法选择41例肝癌肝移植术后患者行18F-FDG PET/CT显像,分析比较PET、PET/CT和甲胎蛋白(AFP)对复发、转移病灶的检测效能,并分析病灶18F-FDG摄取高低和PET检测阳性率与肿瘤分化、个体荷瘤数量及AFP水平的关系。结果 41例肝癌肝移植术后患者中经临床证实肿瘤复发转移者38例,18F-FDG PET/CT诊断肿瘤复发转移的灵敏度、特异性分别为94.7%、66.7%。肝内复发者17例,PET和PET/CT的阳性检出率分别为58.8%和82.4%。肝外转移者36例,最常见部位为淋巴结(23例),其次为肺(17例)和骨(11例)。PET对肺转移灶及腹膜转移灶的检出率为70.6%、0.0%,而PET/CT均为100%;PET和PET/CT对其他部位肝外转移灶的阳性检出率相同(均为100%)。AFP检测对肝细胞癌(HCC)移植术后复发的诊断灵敏度为73.0%,低于18F-FDG PET/CT(94.6%),二者比较差异有统计学意义(χ2=6.366,P<0.05)。PET对单发病灶复发的阳性检出率低于多发病灶者(P<0.05),而PET的阳性检出率与HCC的分化及AFP水平的高低无明显相关(P>0.05)。病灶最大标准摄取值(SUVmax)与个体荷瘤数量密切相关(P<0.05),但与肿瘤的分化及AFP水平无关(P>0.05)。结论 18F-FDG PET/CT能灵敏地检测肝癌肝移植术后肿瘤复发及转移病灶,具有较好的临床应用价值。     

18F-FDG PET/CT显像在原发性中枢神经系统淋巴瘤诊断中的应用

目的:探讨¹⁸F-FDG PET/CT在原发性中枢神经系统淋巴瘤(PCNSL)的诊断和鉴别诊断中的价值,阐明其影像学表现特点,为临床选择治疗方法提供参考和依据。方法:回顾性分析经病理证实的8例PCNSL、19例胶质瘤和28例脑转移瘤患者的 ¹⁸F-FDG PET/CT 影像资料及免疫组织化学结果;对3种疾病的半定量最大标准摄取值(SUV_max)进行比较。结果:PCNSL ¹⁸F-FDG PET/CT显像表现为结节状、团块状、束带状异常放射性摄取浓聚,病灶内示踪剂摄取均匀,与周围组织分界不清,但水肿少见。胶质瘤¹⁸F-FDG PET/CT显像的放射性摄取程度取决于其病理类型,一般低级别胶质瘤脱氧葡萄糖(FDG)摄取减低,SUV_max为2.2~4.3;高级别胶质瘤FDG摄取增高,SUV_max为9.3~17.2;病灶内示踪剂摄取欠均匀,且瘤周水肿范围较严重。典型脑转移瘤¹⁸F-FDG PET/CT显像表现为病灶放射性摄取增高,灶周伴大片状水肿。PCNSL患者的SUV_max高于脑转移瘤患者(P<0.05),PCNSL与胶质瘤患者SUV_max比较差异无统计学意义(P>0.05)。结论:PCNSL 患者¹⁸F-FDG PET/CT 显像具有一定的影像学特征,可与其他中枢神经系统肿瘤进行鉴别诊断。     

胸部螺旋CT图像后处理技术的临床应用

目的 评价胸部螺旋CT后处理技术的临床应用价值。方法 对167例胸部螺旋CT扫描资料进行MPR、MIP、SSD、VR、STS及VE等图像后处理,结合轴扫资料评价后处理图像的诊断和临床应用价值。结果 与轴扫资料对比,采用后处理图像明确诊断15例;提供病变细节,增加诊断信息57例;复杂部位病变准确定位9例;直观显示病变范围及其与周围组织关系75例;无明显增加诊断信息11例。结论 胸部螺旋CT后处理技术可有效增加和提高轴扫CT诊断信息及临床应用价值。     

~(18)F-FDG与~(131)I显像在甲状腺癌诊断中的应用

目的评价~(18)F-FDG与~(131)I显像在诊断甲状腺癌复发和转移中的价值。方法53例手术病理确诊的甲状腺癌患者,进行甲状腺全切和大剂量~(131)I去除甲状腺治疗,并进行~(18)F-FDG SPECT/CT全身显像和~(131)I全身扫描。结果在39例血清hTg高于正常的患者中,11例患者~(18)F-FDG SPECT/CT全身显像与~(131)I全身扫描均为阳性;2例均为阴性;12例~(18)F-FDG SPECT/CT全身显像阳性,而~(131)I全身扫描阴性;14例~(18)F-FDG SPECT/CT全身显像阴性,而~(131)I全身扫描阳性。在14例血清hTg正常的患者中,~(18)F-FDG SPECT/CT全身显像与~(131)I全身扫描均为阴性。结论~(18)F-FDG SPECT/CT全身显像和~(131)I全身扫描联合显像,在探测甲状腺癌复发和转移病灶中具有重要价值;甲状腺癌细胞对~(18)F-FDG和~(131)I的摄取与肿瘤细胞的分化程度密切相关。