Progress in SPECT/CT imaging of prostate cancer

Prostate cancer is the most common type of cancer (other than skin cancer) among men in the United States. Although prostate cancer is one of the few cancers that grow so slowly that it may never threaten the lives of some patients, it can be lethal once metastasized. Indium-111 capromab pendetide (ProstaScint, Cytogen Corporation, Princeton, NJ) imaging is indicated for staging and recurrence detection of the disease, and is particularly useful to determine whether or not the disease has spread to distant metastatic sites. However, the interpretation of 111In-capromab pendetide is challenging without correlated structural information mostly because the radiopharmaceutical demonstrates nonspecific uptake in the normal vasculature, bowel, bone marrow, and the prostate gland. We developed an improved method of imaging and localizing 111In-Capromab pendetide using a SPECT/CT imaging system. The specific goals included: i) development and application of a novel iterative SPECT reconstruction algorithm that utilizes a priori information from coregistered CT; and ii) assessment of clinical impact of adding SPECT/CT for prostate cancer imaging with capromab pendetide utilizing the standard and novel reconstruction techniques. Patient imaging studies with capromab pendetide were performed from 1999 to 2004 using two different SPECT/CT scanners, a prototype SPECT/CT system and a commercial SPECT/CT system (Discovery VH, GE Healthcare, Waukesha, WI). SPECT projection data from both systems were reconstructed using an experimental iterative algorithm that compensates for both photon attenuation and collimator blurring. In addition, the data obtained from the commercial system were reconstructed with attenuation correction using an OSEM reconstruction supplied by the camera manufacturer for routine clinical interpretation. For 12 sets of patient data, SPECT images reconstructed using the experimental algorithm were interpreted separately and compared with interpretation of images obtained using the standard reconstruction technique. The experimental reconstruction algorithm improved spatial resolution, reduced streak artifacts, and yielded a better correlation with anatomic details of CT in comparison to conventional reconstruction methods (e.g., filtered back-projection or OSEM with attenuation correction only). Images produced with the experimental algorithm produced a subjective improvement in the confidence of interpretation for 11 of 12 studies. There were also changes in interpretations for 4 of 12 studies although the changes were not sufficient to alter prognosis or the patient treatment plan.     

131I平面显像与SPECT/CT断层显像对分化型甲状腺癌转移灶诊断的对比分析

目的:探讨131I全身平面显像与131I- SPECT/CT同机融合显像对分化型甲状腺癌(DTC)病人术后残留甲状腺和转移灶的的诊断价值.方法: 对58例DTC术后病人,口服131I 74-185 MBq 48h后分别行全身平面显像和SPECT/CT同机融合显像,所得影像结果进行分析.结果: 临床证实133处病灶中 131I SPECT/CT同机融合影像发现131I异常摄取灶124处,阳性率为93.2%(124/133),有9处转移灶显示为阴性,假阴性率为6.8%(9/133),无假阳性病例.131I全身平面显像发现131I异常摄取灶105处,阳性率为80.2%(105/131),有26处转移灶显示为阴性,假阴性率为19.8%(26/131).有19处假阳性转移灶,假阳性率为14.5%(19/131),两组在阳性率,假阴性率比较均有显著差别. 结论: 131I- SPECT/CT同机融合显像与131I全身平面显像相比,能提高DTC转移灶检出率,明显降低假阳性率,有益于DCT术后病人转移灶的诊断和鉴别诊断.     

30例消化道肿瘤骨转移患者的定量SPECT/CT显像分析

目的:总结30例消化道肿瘤骨转移患者的临床资料及放射性骨显像的特点,并探讨定量SPECT/CT监测的SUVmax的影响因素.方法:回顾性分析2017年01月至2020年10月之间30例曾经来我院接受定量SPECT/CT检查的消化道肿瘤骨转移患者的临床资料,对消化道肿瘤骨转移的临床特点进行归纳总结,并分析定量SPECT/...     

18F-FDG符合线路SPECT/CT显像在诊断肺癌纵隔淋巴结转移中的价值

目的:探讨18氟-脱氧葡萄糖（18F-FDG）符合线路SPECT/CT显像在诊断肺癌纵隔淋巴结转移中价值。方法:回顾性研究我院2013年1月至2014年11月确诊为肺癌的100例患者,肿瘤分型鳞癌患者14例、腺癌患者70例、大细胞癌5例及其他类型的15例,运用18F-FDG符合线路对患者的纵隔淋巴结的诊断结果分类,包括阴性组70例、阳性组30例。参照肺癌术后的病理学诊断标准,评价18F-FDG符合线路SPECT/CT显像在肺癌中的诊断价值,分析假阴性和假阳性患者各项危险因素指标之间的差异性。结果:18F-FDG符合线路SPECT/CT显像在诊断肺癌纵隔淋巴结转移中具有较高的特异性、敏感性,其阳性预测值为78%,阴性预测值为83%,假阴性组的原发灶T/N比值(7.21±3.52)、淋巴结短径(6.58±2.12)mm,小于真阳性组［(9.58±4.53）、（10.02±2.89)mm］;假阳性组伴有局限性肺炎（n=8）、慢性支气管炎或肺气肿（n=13）的多于真阳性组（n=2、4）。结论:18F-FDG符合线路SPECT/CT显像是诊断肺癌纵隔淋巴结转移的重要手段,假阴性的发生与原发灶T/N 比值、淋巴结短径短小具有相关性,假阳性淋巴结与局限性肺炎、慢支炎肺气肿具有相关性。     

局部骨融合断层显像在乳腺癌患者肋骨病变中的诊断价值

目的:探讨局部骨融合断层显像在乳腺癌患者肋骨病变中的诊断价值。方法:选取21例进行全身骨扫描的乳腺癌患者,对肋骨放射性浓聚灶进行局部骨融合断层显像。结果:局部骨融合断层显像结果如下:21例患者共检出病灶39例次,结果依次为肿瘤骨转移:21例次;骨折:12例次;肋骨良性骨病:3例次;术后改变:2例次;胸膜所致反应性改变:1例次。结论:局部骨融合断层显像可敏感的发现病变,并可准确的对病变进行定性,对患者进一步治疗方案的制定有很高的临床价值。     

~(18)氟代脱氧葡萄糖符合线路SPECT/CT显像在肺癌患者术后随访中的价值

目的探讨18氟代脱氧葡萄糖(~(18)F-FDG)符合线路单光子发射计算机化断层显像(SPECT)CT显像在肺癌术后随访中的应用价值。方法选取2012年3月至2013年5月间德阳市人民医院收治的56例行肺癌根治术的肺癌患者,以术后病理结果为金标准,评估~(18)F-FDG符合线路SPECT/CT显像在肺癌患者术后随访中的应用价值。结果残端复发、残端复发合并转移、单个病灶、多发转移及胸部未见明显复发转移征象患者例数分别为14、9、4、13和12例。~(18)F-FDG符合线路SPECT/CT显像诊断肺癌术后复发灵敏度为93.2%(41/44),特异性为75.0%(9/12),准确性为83.9%(47/56),阳性预测值为93.2%(41/44),阴性预测值75.0%(9/12)。结论~(18)F-FDG符合线路SPECT/CT显像在肺癌患者术后随访诊断复发价值较高,为临床医师制定辅助化疗方案提供重要参考。     

单光子发射计算机断层显像/CT在乳腺癌前哨淋巴结探测中的应用

目的探讨用放射性硫胶体(SC)单光子发射计算机断层显像(SPECT)/CT探测乳腺癌前哨淋巴结(SLN)的应用价值。 方法按照入组和排除标准,收集2015年4～8月在青岛大学附属医院确诊的118例女性乳腺癌患者临床资料进行回顾性分析。患者术前行⁹⁹Tc^m-SC SPECT/CT联合术中蓝染法定位SLN,以联合法(SPECT/CT＋蓝染法)检出结果为标准,比较单纯平面显像、蓝染法、SPECT/CT 3种方法对SLN的检出率,并对所有检出的SLN送病理检查。组间SLN检出率(以病例数分析)的比较采用Fisher精确概率法,SLN检出率(以淋巴结数分析)的比较及SLN病理阳性率的比较采用配对χ²检验。 结果以联合法(SPECT/CT＋蓝染法)检出结果为标准,从病例数角度分析,平面显像、SPECT/CT及蓝染法的SLN检出率分别为91.53%(108/118)、97.46%(115/118)和97.46%(115/118),差异有统计学意义(P＝0.020),SPECT/CT及蓝染法的SLN检出率高于平面显像(χ²＝5.143、5.143,P＝0.023、0.023)。从淋巴结数的角度分析,平面显像、SPECT/CT及蓝染法的SLN检出率分别为61.72%(158/256)、96.88%(248/256)和95.70%(245/256),差异有统计学意义(χ²＝158.072,P<0.001),SPECT/CT与蓝染法的SLN检出率也高于平面显像(χ²＝90.000、87.000,P<0.001)。对于腋窝区SLN,平面显像、SPECT/CT及蓝染法的检出率分别为64.44%(154/239)、96.65%(231/239)和100.00%(239/239),差异有统计学意义(χ²＝163.312,P<0.001),SPECT/CT与蓝染法均高于平面显像(χ²＝77.000、85.000,P均<0.001),蓝染法高于SPECT/CT(χ²＝6.125,P＝0.013)。对于非腋窝区SLN,平面显像、SPECT/CT及蓝染法的检出率分别为4/17、17/17和6/17,差异有统计学意义(χ²＝23.139,P<0.001),SPECT/CT高于平面显像及蓝染法(χ²＝11.077、9.091,P＝0.001、0.003)。SPECT/CT与蓝染法检出的SLN病理阳性率分别为24.22%(62/256)和21.09%(54/256),差异无统计学意义(χ²＝3.500,P＝0.061)。对于腋窝区淋巴结,蓝染法比SPECT/CT多发现8枚,其中3枚SPECT/CT阴性的淋巴结经病理证实为淋巴结宏转移,另5枚均为非转移淋巴结。对于非腋窝区淋巴结,SPECT/CT比蓝染法多发现11枚(3枚内乳淋巴结,5枚胸肌间淋巴结,3枚乳腺内淋巴结),病理证实9枚微转移淋巴结,2枚宏转移淋巴结。 结论SPECT/CT的应用能够更精确地指导SLN活组织检查定位,而且在提高病理阳性SLN的检出率,尤其是探测非腋窝SLN方面,SPECT/CT较蓝染法有较大优势。     

牙龈癌侵犯下颌骨SPECT/CT融合显像和CT影像的对照研究

Objective  

The aim of the study was to evaluate the clinical value of ^99mTc-methylene diphosphonic acid (MDP) SPECT/CT fusion imaging and CT scanning in diagnosis of infiltrated mandible by gingival carcinoma.     

Molecular imaging of cancer—evaluating characters of individual cancer by PET/SPECT imaging

The present status of cancer molecular imaging (MI) with nuclear medicine techniques is reviewed, highlighting the Japanese activities in this field. With the progress in MI research, including significant contributions from Japanese studies, it has become possible to noninvasively evaluate various important characters of cancer in clinical patients, such as metabolism, cellular proliferation, tumor hypoxia, and receptor expression. Tumor metabolic information is used for tumor characterization, treatment response evaluation, and prognosis prediction. Hypoxia imaging is used for treatment planning and predicting treatment response. Receptor imaging can be used for the selection of the candidate for receptor-targeted treatment. Various novel probes that can target cancer-associated antigens, various cellular growth factor receptors, tumor angiogenesis, and so on, are under development, aiming for clinical evaluation. Application of radiolabeled ligands for treatment (targeted internal radiation therapy) is another important field in which MI technique can play a critical role. MI, which can deliver the outcome of basic oncological research to the bedside, is essential translational research for improved individualized patient management, and further advances in MI studies are eagerly awaited. ( Cancer Sci 2009; 100: 375–381)     

99mTc-HL91 SPECT/CT对鼻咽癌原发灶乏氧检测的可行性研究

目的:探讨99m Tc-HL91SPECT/CT用于鼻咽癌原发灶乏氧临床研究的可行性.方法:选择初治鼻咽癌患者22例,静脉注射99m TC-HL91 25 mCi(925MBq),对前5例患者分别于0.5、2、4、6 h进行断层显像,观察99m Tc-HI91在鼻咽的生物分布,分析各时间点的图像,确定最佳显像时间;再于所确定的最佳显像时段对另17例患者进行断层扫描,分析显像图像.目测分析以内眼可辨别的鼻咽病灶区放射性浓聚高于正常鼻咽本底为乏氧显像阳性;再对阳性病例进行半定量分析,通过核医学感兴趣区技术分别计算鼻咽病灶内放射性浓聚部位(T+)、病灶内非放射性浓è聚部位(T)及正常鼻咽组织(N)的放射性计数比(T+/N和T-/N).结果:5例鼻咽癌患者鼻咽病灶浓聚部位(T+)和正常鼻咽组织(N)对99mTc-HL91的摄取均在0.5h最高,然后逐渐下降,且随时间延迟,T+/N比值逐渐升高,至4 h时T+/N比值最高;22例惠者中,目测分析阳性20例(90.91%),阳性病例中T+/N为1.64±0.38,T-/N为1.09±0.17,两者差异有统计学意义,P＜0.05.结论:99m Tc-HL91SPECT/CT显像图像能够较好地辨别鼻咽病灶内浓聚和非浓聚区域,是临床上用于评价鼻咽癌乏氧状况的可行手段.     

99mTc-HL91 SPECT/CT对鼻咽癌原发灶乏氧检测的可行性研究

目的探讨99m Tc-HL91SPECT/CT用于鼻咽癌原发灶乏氧临床研究的可行性.方法选择初治鼻咽癌患者22例,静脉注射99m TC-HL91 25 mCi(925MBq),对前5例患者分别于0.5、2、4、6 h进行断层显像,观察99m Tc-HI91在鼻咽的生物分布,分析各时间点的图像,确定最佳显像时间;再于所确定的最佳显像时段对另17例患者进行断层扫描,分析显像图像.目测分析以内眼可辨别的鼻咽病灶区放射性浓聚高于正常鼻咽本底为乏氧显像阳性;再对阳性病例进行半定量分析,通过核医学感兴趣区技术分别计算鼻咽病灶内放射性浓聚部位(T+)、病灶内非放射性浓è聚部位(T)及正常鼻咽组织(N)的放射性计数比(T+/N和T-/N).结果5例鼻咽癌患者鼻咽病灶浓聚部位(T+)和正常鼻咽组织(N)对99mTc-HL91的摄取均在0.5h最高,然后逐渐下降,且随时间延迟,T+/N比值逐渐升高,至4 h时T+/N比值最高;22例惠者中,目测分析阳性20例(90.91%),阳性病例中T+/N为1.64±0.38,T-/N为1.09±0.17,两者差异有统计学意义,P＜0.05.结论99m Tc-HL91SPECT/CT显像图像能够较好地辨别鼻咽病灶内浓聚和非浓聚区域,是临床上用于评价鼻咽癌乏氧状况的可行手段.     

双时相18F-FDG符合线路SPECT/CT 显像在肺占位性病变鉴别诊断中的应用

背景与目的：葡萄糖肿瘤代谢显像已广泛应用于临床,而双时相显像技术能够更真实地反映肿瘤的葡萄糖代谢情况,更有助于良恶性的鉴别。探讨双时相18F-FDG符合线路SPECT/CT显像在肺占位性病变鉴别诊断中的应用价值。方法：胸部CT检查发现肺占位性病变患者28例。被检查者注射显像剂40~60 min后行胸部早期符合线路SPECT/CT显像,延迟显像于静脉注射显像剂后2~3 h进行。计算早期及延时两次显像病灶部位(T)与正常部位(N)的放射性计数比值T1/N1及T2/N2,并计算T/N的变化率ΔT/N。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)确定T1/N1、T2/N2及ΔT/N的诊断阈值,应用曲线下面积(area under the curve,AUC)分别评价早期显像和双时相显像的诊断效能。结果：早期显像T1/N1的诊断阈值为2.650,AUC为0.767,诊断肺癌的灵敏度为83.3%,特异度为30.0%,准确度为64.3%。延时显像T2/N2的诊断阈值为3.140, AUC为0.847,诊断肺癌的灵敏度为94.4%,特异度为60.0%,准确度为82.1%。ΔT/N的诊断阈值为16.9%, AUC为0.950,诊断肺癌的灵敏度为88.5%,特异度为71.4%,准确度为86.2%。结论：双时相18F-FDG符合线路SPECT/CT显像对肺占位性病变的鉴别诊断与常规一次显像相比有较高的准确度和特异度,但仍存在假阳性,应结合患者CT图像特征及临床病史综合分析。     

18F-FDG SPECT/CT与CT在肺结核合并肺癌患者诊断中的比较研究

目的:通过18F-FDG SPECT/CT与CT在肺结核合并肺癌患者诊断中的对比研究,评价18F-FDG SPECT/CT在诊断肺结核合并肺癌中的临床价值.方法:选取2013年3月-2016年3月我院收集确诊的100例肺结核合并肺癌患者,将肺癌病灶为周围型肺癌者分为I组,其中结核病灶为陈旧性结核者分为Ⅰa,活动性结核者分为Ⅰb;中心型肺癌者分为Ⅱ组,其中陈旧性结核者分为Ⅱa,活动性结核者分为Ⅱb,均行18F-FDG SPECT/CT扫描,并与CT对比研究.结果:100例患者中Ⅰa组47例,Ⅰb组24例,Ⅱa组17例,Ⅱb组12例.患者中肺结核病灶以双肺上叶尖后段及下叶背段分布为主(78.0%),与肺癌病灶分布有差异(P<0.001).Ⅰa组SPECT/CT、CT检出率分别为95.74%、80.85%,SPECT/CT检出率高于CT(P=0.001).Ⅰb组SPECT/CT、CT检出率分别为79.17%、75.00%,SPECT/CT检出率与CT检出率的差异无统计学意义(P=0.502).Ⅱa组SPECT/CT、CT检出率分别为94.12%、70.59%,SPECT/CT检出率高于CT(P<0.001).Ⅱb组SPECT/CT、CT检出率分别为75.00%、66.67%,SPECT/CT检出率与CT检出率的差异无统计学意义(P=0.213).结论:18F-FDG SPECT/CT在肺结核合并肺癌的诊断上,具有较高的临床价值,尤其对于非活动性肺结核合并肺癌的诊断上优于CT.     

SPECT/CT在乳腺癌前哨淋巴结定位中的应用价值

目的：研究功图像融合技术在乳腺前哨淋巴结定位中的价值.方法：回顾分析110例乳腺癌患者前哨淋巴结硫胶体显像的平面扫描和断层扫描图像资料.结果：110例乳腺癌患者平面采集前哨淋巴结检出率为88.2％ （97/110）,断层采集前哨淋巴结检出率为93.6％（103/110）.放射性核素平面扫描不能准确定位前哨淋巴结的位置,应用图像融合技术可显示前哨淋巴结的数量及准确定位前哨淋巴结,提供三维定位信息.结论：图像融合技术的应用可提高前哨淋巴结硫胶体显像的阳性检出率,并提供准确的三维定位信息.     

SPECT/CT在阴茎阴囊肿瘤淋巴显影中的初步临床应用

背景与目的:阴茎阴囊癌区域淋巴结转移情况是疾病预后的重要影响因素.近年来,国外对阴茎癌的研究重点集中在动态前哨淋巴结活检术.我院已经在阴茎阴囊癌患者中逐步开展SPECT/CT淋巴显影和动态前哨淋巴结活检术,现初步评价SPECT/CT在阴茎阴囊肿瘤淋巴显影中的临床应用价值.方法:通过多功能ECT对阴茎阴囊癌患者进行术前同机融合淋巴显影,分析我院7例行SPECT/CT淋巴显影的患者资料,并结合文献复习进行讨论.结果:7例患者中6例可见淋巴结显影.相比于平面显影,SPECT/CT能更精确的定位阴茎阴囊癌区域淋巴引流,不仅能检出平面显影不易或不能发现的淋巴结(7例患者中多发现3枚),同时还可以发现异位的淋巴引流.结论:SPECT/CT能够精确的定位阴茎阴囊肿瘤的引流淋巴结.对初诊的患者,可行SPECT/CT淋巴显影提高前哨淋巴结活检的成功率;对已行腹股沟淋巴结清扫的患者,可通过SPECT/CT淋巴显影的资料有针对性的进行淋巴结评估和随访.     

SPECT/CT断层骨显像对骨盆转移性病灶的诊断价值

目的:探讨单光子发射计算机断层显像(SPECT)/X线计算机断层显像(CT)在骨盆骨良恶性病变诊断中的价值。方法:对全身骨显像中骨盆骨出现异常放射性浓聚灶的53例患者行局部骨断层,获得局部骨断层图像、同机定位CT图像以及两者的融合图像。所有病例经病理、PET/CT、磁共振诊断或1年以上随诊为最终诊断结果。结果:53例患者73处病灶中,42处诊断为肿瘤骨盆骨转移,占总病灶数的57.5%;31处诊断为良性病变,占总病灶数的42.5%。SPECT/CT对于骨盆病灶恶性及良性病变的诊断准确度分别为95.3%和96.7%。结论:SPECT/CT可以提高骨盆病灶诊断的特异性和准确性,对鉴别骨盆良恶性病变有重要的临床诊断价值。     

乳腺癌SPECT分子显像靶点基础研究进展

近年来乳腺癌的分子显像水平逐渐进步,更多特异性的显像靶点被发现.本文对比了几组基础实验较为成熟的乳腺癌SPECT分子显像靶点:小鼠双微体扩增基因(Murine double minute2,MDM2)、磷酸化组蛋白(Phosphorylated H2AX,γH2AX)、膜联蛋白Ⅴ(Annexin Ⅴ)、表皮生长因子受体(Epidermal growth factor receptor,EGFR)、人表皮生长因子受体2(Human epidermal growth factor receptor-2,HER-2)等.并综述了这些靶点及显像技术的研究现状,为乳腺癌SPECT分子显像的发展奠定基础.     

肺黏液腺癌的CT及18F-FDG符合线路SPECT显像的影像表现

目的:探讨肺黏液腺癌的CT及18F-FDG符合线路SPECT显像的影像表现.方法:分析经病理证实的6例肺黏液腺癌患者的影像、病理及病例资料,6例患者均有18F-FDG符合线路显像及诊断CT资料,其中4例有增强CT.结果:2例为广泛分布型,最大病变位于下叶或以下叶分布为主,均可见支气管充气征.4例为局灶型病变,位于上叶1例,下叶3例,病灶最大径2.1 ～ 7.0cm,仅1例为磨玻璃与实性混合密度,其余均为实变影,1例形成肿块样,其余3例为不规则片状,2例平扫内部可见低密度区,2例有空泡征,1例有毛刺,2例病灶周围有小结节或微结节.4例增强扫描的病例中3例可见血管造影征,1例广泛分布病变患者有纵隔淋巴结肿大.18F-FDG符合线路SPECT显像结果为4例局灶型病变中,目测分级0级2例,1级1例,0-2级1例,2例广泛分布病变放射性摄取最高区目测分别为3级和4级.结论:肺黏液腺癌影像表现有一定的特征,好发于下叶,CT表现以实变、磨玻璃影为主,内可见支气管充气征、空泡征,增强扫描可见血管造影征,易发生肺内转移,表现为广泛播散性分布.局灶型黏液腺癌FDG摄取值低,容易误诊为良性病变,广泛分布型黏液腺癌表现为FDG高摄取,需要与感染性病变鉴别.     

PET/CT imaging in response evaluation of patients with small cell lung cancer

There is an increasing amount of evidence on the usability of PET in response evaluation of non-small cell lung cancer. However, data on SCLC is scarce and mainly retrospective. This prospective study assesses the use of PET (positron emission tomography) and PET/CT in response evaluation of patients with small cell lung cancer (SCLC). METHODS: Assignment of early and final response was compared between PET, PET/CT, and CT in 20 patients with SCLC. Final response as assigned by CT (RECIST) served as reference. RESULTS: At response evaluation after one cycle of chemotherapy major disagreement (responder versus non-responder) between PET and CT in predicting final response was seen in 1 of 12 patients. At final response evaluation major disagreement between PET, PET/CT and CT was seen in 2 of 19 patients (11%). All measurements of FDG-uptake were significantly correlated to size and changes in size as measured by CT. A significant difference in relative change in tumour FDG-uptake and volume was found between responding and non-responding patients. No significant difference was found between a visual and semi-quantitative analysis of PET. CONCLUSION: Response evaluation of SCLC by PET/CT is feasible, but it is uncertain whether it adds further information to evaluation by RECIST, thus further studies and standardization of methods are needed.