18F脱氧葡萄糖-正电子发射体层显像在贲门胃底恶性肿瘤患者中应用价值的探讨

目的探讨^18F脱氧葡萄糖（FDG）-正电子发射体层显像（PET）在贲门胃底恶性肿瘤患者诊断治疗中的应用价值。方法1999年4月—2005年4月间对57例贲门胃底恶性肿瘤患者行全身FDG—PET检查,其中29例在PET检查前未经任何治疗,另外28例为综合治疗后复查。采用目测法结合半定量分析判读PET结果,与病理及随访结果对照。结果29例FDG—PET检查前未经任何治疗的患者中,25例T2～T4期原发肿瘤显影,4例T1期原发肿瘤未显影,FDG—PET定性诊断灵敏度86％（25／29）;其中24例根治性手术治疗的患者切除胸、腹腔直径〉1．0cm的淋巴结40处,FDG—PET正确定性诊断28处为恶性及12处为良性淋巴结;5例患者FDG—PET发现有远隔脏器转移未行根治性手术。28例综合治疗后复查FDG—PET的患者中,FDG—PET发现22例存在复发或转移。结论FDG—PET检查对于贲门胃底恶性肿瘤的定性、TNM分期及判断治疗效果有帮助,但必须结合其他检查才能发挥优势。     

18F-脱氧葡萄糖正电子发射计算机断层显像CT检查在前列腺癌诊断和分期中的应用价值

目的 评价18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像CT检查(PET/CT)在前列腺癌诊断和分期中的应用价值.方法 经手术或穿刺活检病理证实为前列腺癌患者40例,年龄52 ～ 78岁,平均67岁.其中T24例,T316例,T420例.行18F-FDG PET/CT及99Tcm-MDPECT骨显像检查,统计PET/CT显像对前列腺癌原发灶、淋巴结转移及骨转移诊断的敏感性,对比分析PET/CT显像及99Tcm-MDPECT骨显像对骨转移的诊断效果.结果 40例患者中,18F-FDG PET/CT检查显示前列腺局部结节状放射性浓聚17例,对原发灶诊断敏感性为43％.17例淋巴结转移患者中CT检查发现8例,18F-FDG PET/CT检查发现15例,诊断敏感性为88％,其中5例患者因PET/CT检查改变了临床分期以及治疗方案.18F-FDG PET/CT对骨转移诊断的敏感性与99Tcm-MDP骨显像相近,但特异性(95％)和准确率(96％)均明显高于99Tcm-MDP骨显像,其中6例患者因PET/CT检查改变了临床分期,2例改变了治疗方案.结论 18F-FDG PET/CT对前列腺癌淋巴结转移和骨转移有较高诊断价值,对前列腺的分期具有特殊优势,可为临床医生制定治疗方案提供可靠依据.     

PET—CT在前列腺癌诊断与临床分期的应用

目的探讨PET—CT应用于前列腺癌诊断及分期的临床价值。方法2008年1月至2011年1月新疆自治区人民医院泌尿外科收治前列腺肿瘤病例中,病理类型最终确诊为前列腺癌者有47例接受了全身PET—CT检查。检查范围包括前列腺原发肿瘤、区域淋巴结及全身脏器,将PET—CT结果参照手术／病理结果进行评价分析。结果47例患者中1例未发现原发病灶,此外PET—CT与常规检查各有1例假阴性,准确性均高达95．7％,差异无统计学意义。35例I、Ⅱ期患者中18例髂血管淋巴结转移,PET-CT检查的敏感性59．6％、特异性81％、准确性70．3％,优于B超、磁共振检查;PET—CT发现4例患者合并远处转移并经穿刺证实,准确性100％。结论PET—CT对于发现前列腺癌原发肿瘤、区域淋巴结转移均优于B超、磁共振检查,且对于远处转移具有较精确的检测能力,对于前列腺癌术前诊断及分期有较好的临床价值。     

18F-FDG PET鉴别肾上腺良恶性肿瘤的临床价值

目的：评价^18F-氟代脱氧葡萄糖正电子发射计算机断层显像(^18F-FDG PET)在肾上腺病变定性诊断中的应用价值。方法：回顾性分析22例28个肾上腺肿瘤患者的临床资料，均采用^18F-FDG PET显像，以鉴别肾上腺肿瘤为原发性抑或继发性，同期均行CT检查。结果：CT检查28个肿瘤中22个为恶性肿瘤(其中6个经手术或活检证实，16个随访证实)，6个通过活检或随访证实为良性病变。CT发现的19个肾上腺肿瘤中。17个为恶性肿瘤，^18F—FDG PET显像均为阳性。^18F—FDG PET对肾上腺肿瘤的定性判断的灵敏度、特异度和准确度分别为100％、66．7％和92．9％。结论：^18F—FDG PET通过肿瘤的葡萄糖代谢程度来判定病变的性质，对肾上腺恶性病变的标准摄取率(SUV)相对较高，在肾上腺肿瘤良恶性鉴别中可以提供重要的依据。     

18F-FDG PET/CT显像在肾癌中的临床应用价值

目的:评价18F-脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)正电子发射计算机断层扫描(PET)/CT显像对肾癌诊断和治疗方案选择的临床应用价值.方法:回顾性分析56例临床诊断为肾癌患者的全身18F-FDG PET/CT和CT平扫加增强扫描的影像学资料.比较两者对肾癌的诊断价值.结果:56例患者中,经手术病理检查实为肾癌者47例.其余9例因18F-FDG PET/CT显像发现有转移病灶者放弃手术.18F-FDG;PET/CT 榆古敏感度为80.4%;CT平扫加增强扫描的敏感度为92.9%.9例转移病例中,3例为腹膜后淋巴结转移,3例两肺多发转移,2例骨转移并肝转移,1例伴有下腔静脉和肾静脉癌栓形成,而CT平扫加增强扫描仅发现1例肾静脉和下腔静脉痛栓形成.结论:18F-FDG PET/CT显像对诊断原发性肾癌的敏感性不如CT,但对淋巴结转移及远处转移的诊断优于CT,对肾癌的分期、治疗方案的选择及预后的判断有重要意义.     

18FDG PET/CT在术前检测食管癌淋巴结转移及分期中的应用

目的观察^18FDG PET/CT在术前检测食管癌淋巴结转移及分期的临床应用价值.方法随机选择拟行手术治疗的食管癌病人30例,术前1周内行^18FDG PET/CT检查,12例病人同期行CT增强扫描,术前均不接受放化疗,根据术后病理对比PET/CT与CT诊断食管癌淋巴结转移及确定淋巴结分期的价值.结果22例存在淋巴结转移,共切取并分离淋巴结243枚,转移淋巴结49枚.PET/CT诊断淋巴结转移的敏感性、特异性、准确性分别为93.9%、91.2%、91.8%,CT分别为40.8%、96.9%、85.6%;PET/CT阳性与阴性预测值分别为73.0%,98.3%,CT为76.9%,86.6%.PET/CT确定淋巴结分期的敏感性、特异性、准确性分别为95.5%、62.5%、86.7%,CT分别为72.7%、75.0%、73.3%.结论18FDG PET/CT图像融合技术诊断食管癌淋巴结转移及确定淋巴结分期临床应用价值优于CT.     

18F-FDG符合线路SPECT显像诊断胃癌

目的 探讨^18F-FDG符合线路SPECT显像在胃癌诊断中的应用价值。方法对18例经组织病理学证实的胃癌患者的^18F-FDG符合线路SPECT显像进行分析，并与近期CT结果比较。结果①符合线路SPECT检出原发性胃癌的敏感性、特异性和阳性预测值分别为88．9％、100％和88．9％。②18例手术患者中，胃局部淋巴结转移12例，符合线路SPECT显像检出7例，其敏感性、特异性和阳性预测值分别为58．3％、100％和58．3％。③符合线路显像检出远处转移6例，CT仅检出2例。④对6例同时行^18F-FDG符合线路SPECT显像与锝[^99Tc^m]-亚甲基二膦酸盐(^99Tc^m-MDP)骨显像的患者进行分析，发现两者所示骨病灶部位不尽一致。结论^18F-FDG符合线路SPECT显像诊断胃癌较为灵敏，检出胃癌局部淋巴结及远处转移可能优于CT。     

18F-FDG PET/CT结肠空气造影在结肠病变应用中的诊断价值

【摘要】 目的 探讨18F-FDG PET/CT结肠空气造影术对结肠病变的诊断效能。方法 临床连续纳入70例怀疑结肠息肉（肿瘤）的患者及常规PET/CT检查发现肠道局灶性浓聚患者。患者注射18F-FDG（0.1mCi/Kg）60分钟后进行第一次非造影扫描。扫描结束后,行结肠空气造影扫描。所有患者行电子纤维肠镜检查,非造影扫描及空气造影扫描图像影像诊断均分别与电子纤维肠镜作为金标准进行统计,分析18F-FDG PET/CT结肠空气造影检查对结肠息肉、结肠肿瘤的灵敏度、特异度。结果70例患者电子肠镜共发现23处恶性肿瘤病灶,15处息肉等良性病灶,其中常规PET/CT对恶性肿瘤的诊断灵敏度为86.96%,对息肉的诊断诊断灵敏度为46.67%。结肠空气造影PET/CT对恶性肿瘤的诊断灵敏度为95.65%（22/23）,对良性息肉的诊断灵敏度为86.67% （13/15）。11个息肉在造影后显示病灶形态更为清晰（73.33%）。1例患者造影后显示肠道内瘘清晰。23例患者在结肠空气造影PET/CT检查后对常规PET/CT检查报告做出了较大修改,占32.86%（23/70）。结论18F-FDG PET/CT结肠空气造影检查能提高结肠良性息肉的检出灵敏度,能较好的鉴别生理性浓聚,提高诊断特异度;18F-FDG PET/CT结肠造影空气检查对显示病灶的形态、大小及肿瘤侵犯转移情况优于非造影检查,18F-FDG PET/CT结肠造影空气检查可以作为常规PET/CT扫描检查的重要补充方法。     

结直肠癌术后癌胚抗原水平升高者行18F-FDG PET/CT显像的价值

结直肠癌术后复发转移率较高，明确诊断是确定治疗方案的关键，本组对24例结直肠癌术后血清癌胚抗原（carcinoembryonic antigen，CEA）升高，而常规检查未能明确诊断的患者行全身^18F-FDG（^18F-fluoro-2-deoxy—D—glucose，^18F-氟代脱氧葡萄糖）PET／CT检查，旨在探讨其临床应用价值。     

胃癌前哨淋巴结临床意义的研究

目的 观察胃癌前哨淋巴结的分布，探讨其临床意义。方法 回顾性分析288例胃癌前哨淋巴结术中染色后显影的范围及特征。术中向肿瘤边缘的正常胃壁浆膜下肌层、黏膜下层注射亚甲蓝，观察淋巴结显影的情况；切取各站淋巴结行病理检查。结果 288例胃癌术后病理诊断为T1期102例，T2期126例，T3期60例。术中成功显影270例，阳性率为93．8％。102例患者有淋巴结转移，其中前哨淋巴结（SNs）与非前哨淋巴结（non—SNs）均有转移者66例，仅前哨淋巴结有转移者18例，仅非前哨淋巴结有转移者18例。结论 通过前哨淋巴结，术中能准确预测胃癌淋巴结转移状况。在手术治疗淋巴结转移阴性的胃癌患者中，前哨淋巴结术中标识有望免除常规淋巴清扫。     

Scanning with 18F-FDG-PET/CT for Detection of Pelvic Nodal Involvement in Inguinal Node-Positive Penile Carcinoma

Background

Penile carcinoma patients with inguinal lymph node involvement (LNI) have an increased risk for pelvic nodal involvement with or without distant metastases.

Objective

To evaluate the diagnostic accuracy of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) with computed tomography (CT; 18F-FDG PET/CT) scanning in determining further metastatic spread in patients with tumour-positive inguinal nodes.

Design, setting, and participants

Eighteen patients with penile squamous cell carcinoma with unilateral or bilateral cytologically tumour-positive inguinal disease underwent whole-body 18F-FDG-PET/CT scanning for tumour staging.

Measurements

Images were blindly assessed by two nuclear medicine physicians. All scans were evaluated for pelvic nodal involvement per basin and for distant metastases. Histopathology (when available), radiologic imaging, and clinical follow-up (with a minimum of 1 yr) served as a reference standard. The diagnostic value of PET/CT scanning for predicting pelvic nodal involvement was evaluated using standard statistical methods.

Results and limitations

The reference was available in 28 of the 36 pelvic basins. Of the 11 tumour-positive pelvic basins, 10 were correctly predicted by PET/CT scan, as were all 17 tumour-negative pelvic basins. PET/CT scan showed a sensitivity of 91%, a specificity of 100%, a diagnostic accuracy of 96%, a positive predictive value of 100%, and a negative predictive value of 94% in detecting pelvic nodal involvement. Additionally, PET/CT scans showed distant metastases in five patients. In four patients, the presence of distant metastases could be confirmed, while in one patient, no radiologic confirmation was found for that particular lesion. A potential limitation is that the diagnostic accuracy of PET/CT scanning was calculated on 28 pelvic basins only. Furthermore, no comparison was made with conventional CT scans, as not all patients had undergone contrast-enhanced CT scans.

Conclusions

PET/CT scanning appears promising for detecting pelvic lymph node metastases with great accuracy, and it identifies distant metastases in penile carcinoma patients with inguinal LNI. In our practice, PET/CT scanning has become part of routine staging in such patients.     

Clinical value of 18FDG PET/MRI in muscle-invasive,locally advanced,and metastatic bladder cancer

ObjectiveMetastatic bladder cancer is an aggressive disease that can often be difficult to diagnose and stage with conventional cross-sectional imaging. The primary objective of this study was to determine the clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET/MRI for surveillance and restaging of patients with muscle-invasive, locally advanced, and metastatic bladder cancer compared to conventional imaging methods.Materials and MethodsThis retrospective study enrolled patients with muscle-invasive, locally advanced and metastatic bladder cancer in a single institute evaluated with ¹⁸F-FDG PET/MRI. All patients also underwent conventional imaging with CT. Additional imaging may also have included ¹⁸F-FDG PET/CT (¹⁸F-FDG PET), or sodium fluoride (NaF) PET/CT in some patients. Images were reviewed by a diagnostic radiologist/nuclear medicine physician. Number of lesions and sites of disease were captured and compared between ¹⁸F-FDG PET/MRI and conventional imaging. Lesions were confirmed by sequential imaging or lesion biopsy. All patients were followed for survival.ResultsFifteen patients (4 for surveillance; 11 for restaging) underwent 34 ¹⁸F-FDG PET/MRI scans. Each patient received a corresponding conventional CT around the time of the ¹⁸F-FDG PET/MRI (median 6 days). The 15 patients (11 male; 4 female) had a median age of 61.5 years (range 37–73) and histologies of urothelial carcinoma (n = 13) and small-cell carcinoma of the bladder (n = 2) diagnosed as stage 4 (n = 13), stage 3 (n = 1), or stage 2 (n = 1). ¹⁸F-FDG PET/MRI detected 82 metastatic malignant lesions involving lymph nodes (n = 22), liver (n = 10), lung (n = 34), soft tissue (n = 12), adrenal glands (n = 1), prostate (n = 1), and bone (n = 2) with a resultant advantage of 36% for lesion visibility in comparison with CT. Serial imaging or biopsy confirmed these lesions as malignant.Conclusion¹⁸F-FDG PET/MRI can detect metastatic lesions which cannot be identified on conventional CT, and this can allow for better treatment planning and improved disease monitoring during therapy.     

18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is accurate for high-grade prostate cancer bone staging when compared to bone scintigraphy

IntroductionIn this study, we compared ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG)-positron emission tomography/computed tomography (PET/CT) and bone scintigraphy accuracies for the detection of bone metastases for primary staging in high-grade prostate cancer (PCa) patients to determine if ¹⁸F-FDG-PET/CT could be used alone as a staging modality.MethodsMen with localized high-grade PCa (n=256, Gleason 8–10, International Society of Urological Pathology [ISUP] grades 4 or 5) were imaged with bone scintigraphy and ¹⁸F-FDG-PET/CT. We compared, on a per-patient basis, the accuracy of the two imaging modalities, taking inter-modality agreement as the standard of truth (SOT).Results¹⁸F-FDG-PET/CT detected at least one bone metastasis in 33 patients compared to only 26 with bone scan. Of the seven false-negative bone scintigraphies, four (57.1%) were solitary metastases (monometastatic), three (42.9%) were oligometastatic (2–4 lesions), and none were plurimetastatic (>4 lesions). Compared to SOT, ¹⁸F-FDG-PET/CT showed higher sensitivity and accuracy than bone scintigraphy (100% vs. 78.8%, and 98.7% vs. 98.2%) for the detection of skeletal lesions.Conclusions¹⁸F-FDG-PET/CT appears similar or better than conventional bone scans to assess for bone metastases in patients newly diagnosed with high-grade PCa. Since intraprostatic FDG uptake is also a biomarker for failure of radical prostatectomy and that FDG-PET/CT has been shown to be accurate in detecting PCa lymph node metastasis, FDG-PET/CT has the potential to be used as the sole preoperative staging modality in high-grade PCa.     

Preoperative lymph-node staging of invasive urothelial bladder cancer with 18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging: correlation with histopathology

OBJECTIVE: The treatment and prognosis of bladder cancer are based on the depth of primary tumour invasion and the presence of metastases. A highly accurate preoperative tumour, node, metastasis (TNM) staging is critical to proper patient management and treatment. This study retrospectively investigated the value of 1?F-fluorodeoxyglucose (FDG) positron emission tomography/computed axial tomography (1?F-FDG PET/CT) and magnetic resonance imaging (MRI) for preoperative N staging of bladder cancer. Material and methods. From June 2006 to January 2008, 48 consecutive patients diagnosed with bladder cancer were referred to preoperative staging including MRI and 1?F-FDG PET/CT. Eighteen out of 48 patients underwent radical cystoprostatectomy including removal of lymph nodes for histology, and were included in the study. Values of 1?F-FDG PET/CT and MRI for regional N staging were compared to histopathology findings, the gold standard. Results. 1?F-FDG PET/CT and MRI were performed in 18 patients. The specificities for detection of lymph-node metastases for MRI and 1?F-FDG PET/CT were 80% (n = 15) and 93.33% (n = 15), respectively. The negative predictive values were 80% (n = 15) and 87.5% (n = 16) for MRI and 1?F-FDG PET/CT, respectively. The differences in specificity and negative predictive values were not statistically significant. Conclusions. No significant statistical difference between 1?F-FDG PET/CT and MRI for preoperative N staging of urothelial bladder cancer was found in the study. However, the trend of the data indicates an advantage of 1?F-FDG PET/CT over MRI. Larger prospective studies are needed to elucidate the role of 1?F-FDG PET/CT in N staging of bladder cancer.     

18F-FAMT-PET Is Useful for the Diagnosis of Lymph Node Metastasis in Operable Esophageal Squamous Cell Carcinoma

Background

The role and potential usefulness of positron emission tomography (PET) scanning in certain tumors has been widely investigated in recent years. ¹⁸F-FAMT (L-[3-¹⁸F]-α-methyltyrosine) is an amino acid tracer for PET. This study investigated whether PET/CT with ¹⁸F-FAMT provides additional information for preoperative diagnostic workup of esophageal squamous cell carcinoma compared with that obtained by ¹⁸F-FDG (fluorodeoxyglucose) PET or CT.

Methods

PET/CT studies with ¹⁸F-FAMT and ¹⁸F-FDG were performed as a part of the preoperative workup in 21 patients with histologically confirmed esophageal squamous cell carcinoma.

Results

For the detection of primary esophageal cancer, ¹⁸F-FAMT-PET exhibited a sensitivity of 76.2%, whereas the sensitivity for ¹⁸F-FDG-PET was 90.5% (P = 0.214). ¹⁸F-FAMT uptake in primary tumors showed significant correlation with depth of invasion (P = 0.005), lymph node metastasis (P = 0.045), stage (P = 0.031), and lymphatic invasion (P = 0.029). In the evaluation of individual lymph node groups, ¹⁸F-FAMT-PET exhibited 18.2% sensitivity, 100% specificity, 71.9% accuracy, 100% positive predictive value, and 70.0% negative predictive value, compared with 24.2%, 93.7%, 69.8%, 66.6%, and 70.2%, respectively, for ¹⁸F FDG-PET. CT exhibited 39.4% sensitivity, 85.7% specificity, 69.8% accuracy, 59.1% positive predictive value, and 73.0% negative predictive value. The specificity of ¹⁸F-FAMT-PET is significantly higher than that of ¹⁸F-FDG-PET (P = 0.042) and CT (P = 0.002). ¹⁸F-FAMT-PET did not have any false-positive findings compared to those with ¹⁸F-FDG-PET.

Conclusions

Our findings suggest that the addition of ¹⁸F-FAMT-PET to ¹⁸F-FDG-PET and CT would permit more precise staging of esophageal cancer.     

Section III: endoscopic and other staging techniques

Accurate staging of esophageal cancer is important as disease survival closely correlates with TNM stage. The optimal management of patients with esophageal cancer utilizes stage-dependent algorithms. The primary diagnosis of esophageal cancer is established by upper endoscopy and biopsy. Computed tomography (CT) is typically the next test performed and is most valuable at detecting metastatic (M) distant disease, particularly in the liver, lungs, and bone. Positron emission tomography (PET) scanning with 18-fluorodeoxyglucose also is useful in detecting distant disease. Endoscopic ultrasound (EUS) combines endoscopy with high-frequency ultrasonography to obtain detailed images of the tumor and surrounding structures. EUS is the most accurate technique for the locoregional (T and N) staging of esophageal cancer. The recent availability of EUS-directed fine needle aspiration (FNA) has allowed a tissue diagnosis of lymph nodes both periesophageal and in the celiac axis. EUS-FNA can also sample liver metastases. Laparoscopic and thoracoscopic techniques can also be used to sample thoracic and celiac axis lymph nodes. Optimal staging strategies for esophageal cancer combine EUS FNA with either CT or PET scans.     

增强CT和PET/CT对胰腺癌诊断及分期中的价值

目的 探讨增强CT和PET/CT对胰腺癌诊断及分期中的价值.方法 回顾性分析安徽医科大学第一附属医院普外科2009年10月至2013年10月间收治47例手术治疗的胰腺占位患者资料.术前均行CA19-9检查、腹部增强CT扫描及全身PET/CT扫描,比较增强CT与PET/CT在胰腺癌诊断及分期中价值.结果 47例患者中,确诊胰腺癌41例,非胰腺癌6例.CA19-9、增强CT和PET/CT对胰腺癌诊断的灵敏度分别为78.0％、80.4％和95.1％,PET/CT灵敏度优于CA19-9和增强CT,差异有统计学意义（P值分别为0.023和0.043）;在胰周淋巴结转移判断方面,PET/CT和增强CT的灵敏度分别为75.0％和41.6％,二者差异有统计学意义（P=0.019）;在肝转移判断方面,PET/CT和增强CT诊断的灵敏度分别为80.0％和60.0％,二者差异无统计学意义（P=1.0）.结论 PET/CT对胰腺癌诊断有较高灵敏度,显著优于增强CT.当肿瘤SUV值升高,PET/CT诊断仍应注意结合CA19-9、增强CT甚至MRI综合判断;PET/CT有助于发现淋巴结和远处器官转移病灶,获得更加准确的术前分期,从而避免诊断性剖腹探查手术.