^18F—FDGPET在食管癌诊断与治疗中的应用价值

早期诊断和准确分期是提高食管癌生存率的关键，传统的影像学检查对食管癌的诊断、分期、疗效评价及预后评估存在一定的局限性，作为生物影像，^18F-FDGPET现已广泛应用于临床，现综述其在食管癌诊断与治疗中的应用价值。     

^18F-FDG PET显像在食管癌诊断中的临床意义

目的：探讨正电子发射型电子计算机断层(positron emission computed tomography，PET)显像在食管癌早期诊断以及临床分期中的临床应用价值。方法：23例食管癌患者，进行全身^18F-脱氧葡萄糖(^18F-fluorodeoxy-glucose，^18F-FDG)PET显像，并与外科手术或内镜活检病理结果和CT检查结果对照。结果：46倒患者中PET显像食管部位均有异常放射性浓聚灶，经病理确诊，46处食管浓聚灶均为食管癌原发病灶。其中28例为单发病灶，2例为食管多发灶，其余16例除食管原发病灶外，还有其他部位32个病灶，经临床和病理证实为远处转移病灶。与46例PET显像前CT结果相比较，PET共检出食管部位恶性病灶46例，检出率为100．0％，而CT仪检出34例，检出率为73．9％。46例中确诊有其他部位转移者18例，PET检出18例，检出率为100．0％，而PET显像前CT仅检出6例，检出率为33．3％。27例手术治疗者PET分期与临床病理分期一致，而常规检查对食管癌临床分期高估5例，低估12例，PET显像改变了这17例患者的临床治疗方案。结论：^18F-FDG-PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值。     

18F-FDG PET显像在食管癌诊断中的临床意义

目的探讨正电子发射型电子计算机断层(positron emission computed tomography,PET)显像在食管癌早期诊断以及临床分期中的临床应用价值.方法23例食管癌患者,进行全身18F-脱氧葡萄糖(18F-fluoro-deoxy-glucose,18F-FDG ) PET显像,并与外科手术或内镜活检病理结果和CT检查结果对照.结果46例患者中PET显像食管部位均有异常放射性浓聚灶,经病理确诊,46处食管浓聚灶均为食管癌原发病灶.其中28例为单发病灶,2例为食管多发灶,其余16例除食管原发病灶外,还有其他部位32个病灶,经临床和病理证实为远处转移病灶.与46例PET显像前CT结果相比较,PET共检出食管部位恶性病灶46例,检出率为100.0%,而CT仅检出34例,检出率为73.9%.46例中确诊有其他部位转移者18例,PET检出18例,检出率为100.0%,而PET显像前CT仅检出6例,检出率为33.3%.27例手术治疗者PET分期与临床病理分期一致,而常规检查对食管癌临床分期高估5例,低估12例,PET显像改变了这17例患者的临床治疗方案.结论18F-FDG PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值.     

18F-FDG PET及PET/CT在食管癌诊断中的应用

食管癌是常见的消化道肿瘤,预后差,是当今严重危害人类健康的主要疾病之一。目前手术切除仍是其治疗的主要手段。早期诊断和准确的临床分期是食管癌治疗成功的关键。以往食管癌影像学检查主要依赖消化道造影、CT扫描、超声及食管内窥镜超声检查(transesophageal endoscopic ult     

18F-FDG SPECT/CT显像在食管癌治疗前分期诊断中的应用价值

[目的]探讨氟(18F)-氟代脱氧葡萄糖(18F-FDG)双探头符合线路断层融合显像(SPECT/CT)在食管癌诊断中的价值.[方法]149例临床疑诊食管癌患者行18F-FDG双探头符合线路SPECT检查,诊断结果与病理检查结果对照.[结果]149例原发肿块定性诊断的灵敏度、特异性、准确率分别为98.6％( 139/141)、75.0％( 6/8)、96.6％(139/149);253枚可疑转移淋巴结诊断的灵敏度、特异性、准确率分别为94.4％(201/213)、55.0％ (22/40)、84.2％ (223/253);56例患者的78个远处病灶中,最终67个病灶被确诊为转移,其灵敏度、特异性、准确率分别为97.0％(65/67)、90.9％(10/11)、96.2％(75/78).[结论]18F-FDG双探头符合线路SPECT/CT在食管癌治疗前诊断分期上具有较高的准确率和灵敏度,为食管癌术前较好的无创性检查方法.     

功能影像在食管癌精确放疗中的应用价值研究

目的 探讨PET-CT在食管癌临床分期诊断和三维适形放疗靶区勾画及治疗计划制定中的应用价值.方法 2007-2008年经病理证实的食管癌患者20例人组,其中2例接受手术治疗,18例行三维适形放疗.患者疗前行PET-CT模拟定位,比较食管镜、食管钡餐造影、CT、PET-CT_(SUV2.5)、PET-CT_(40%SUVmax)图像上的病变长度及最大横径,观察CT与PET-CT对临床分期诊断的差异.依据CT、PET-CT_(SUV2.5)和PET-CT<40%SUVmax>勾画靶区并制定治疗计划,评价3套计划受量情况.结果 食管镜、食管钡餐造影、CT、PET-CTS_(SUV2.5、PET-CT_(40%SUVmax))所示病变长度分别为4.93、5.06、6.67、5.89、4.84 cm,CT、PET-CT_(SUV2.5)、PET-CT_(40%SUV)所示病变最大横径分别为4.05、3.38、2.95 cm.CT图像诊断31个淋巴结转移,PET-CT图像诊断21个淋巴结转移,共同诊断14个,17个淋巴结CT诊断阳性而PET-CT为阴性,7个淋巴结CT诊断阴性而PET-CT为高代谢.5例患者经PET-CT模拟定位后M分期由Mn期改为_1期,1例经PET-CT模拟定位后由M_0期改为M_1期,1例CT和PET-CT M分期一致.依据CT和PET-CT_(SUV2.5)勾画的GTV基本相等2例,CTV_(CT)GT_(SUV2.5)者13例,GTV_(SUV2.5),相似文献   

18F-脱氧葡萄糖PET/CT诊断复发性食管癌的价值

背景与目的：PET／CT实现了功能和解剖影像的同机融合，在癌症患者的诊断和分期中的地位日益重要。本研究的目的是探讨^18F-脱氧葡萄糖（FDG）PET／CT诊断复发性食管癌的临床价值。方法：临床疑复发的24例食管癌患者行PET／CT显像，经迭代法处理和重建，获得衰减校正后的PET图像、CT图像和PET／CT融合图像，以目测双盲阅片法进行帧对帧诊断分析。最后诊断依靠病理检查和临床随访。比较PET、CT和PET／CT的灵敏度、特异性、准确度、阳性预测值、阴性预测值和定位准确性。结果：24例患者PET／CT显像的灵敏度、特异性、准确度、阳性预测值和阴性预测值分别为94．7％，80．0％，91．7％，94．7％和80．0％；PET分别为81．2％，75．0％，79．1％，86．7％，66．7％；CT分别为62．3％，66．7％，62．5％，69．2％，54．5％。PET／CT的定位准确性为89．5％，PET和CT分别为33．3％和84．6％。PET／CT的诊断准确性高于CT，定位准确性高于PET。结论：评价复发性食管癌，PET／CT的灵敏度、特异性和准确度较高。PET／CT对复发性食管癌放射治疗靶区的确定有较高价值。     

18F-脱氧葡萄糖PET-CT检测食管癌病变长度的临床价值

目的 评价18F-脱氧葡萄糖(FDG)PET-CT诊断食管癌病变长度的临床价值,并和其他检测方法比较.方法 选择食管癌患者32例,其中胸上段食管癌1例,胸中段22例,胸下段9例.术前分别行食管镜、食管钡餐、CT和FDG PET-CT检查,并检测食管癌原发灶病变位置和长度.1周内行食管癌手术,手术大体标本与检查结果比较.结果 食管钡餐、CT、FDG PET-CT分段与大体标本全部符合,而食管镜检查有2例分段与大体标本不符合.食管镜、食管钡餐、CT、PET-CT所示食管癌病变长度与大体标本的相关系数分别是0.741、0.746、0.870、0.876(P值均为0.000);所示食管癌原发灶长度分别为(3.8±1.4)、(4.1±1.5)、(4.4±1.6)、(5.3±1.9)和(4.7±1.7)cm,4种检查结果与大体标本差异均有统计学意义(P=0.000、0.007、0.025、0.001),病变长度从小到大依次为食管镜、食管钡餐、CT、大体标本、PET-CT.但考虑到标本离体后有一定程度的回缩,实际病变长度与PET-CT最接近.结论 PET-CT较准确的显示食管癌病变实际长度,有一定临床价值.对手术病例,PET-CT可用于指导术者选择食管癌切除的剖胸径路及食管切除长度;对放疗病例,PET-CT有助于指导放疗靶区的精确确定.     

18F-脱氧葡萄糖PET-CT检测食管癌治疗后复发与转移的应用价值

目的 评价^18F-脱氧葡萄糖（^18FDG）PET—CT对食管癌治疗后复发及转移的临床应用价值。方法 治疗后怀疑肿瘤残留、复发或转移而行PET—CT扫描的食管癌37例，回顾性分析其临床资料，根据细胞学、病理或随访结果分析PET—CT的检测结果。结果 31例患者最终确定复发转移灶46处，PET—CT对全部病灶的诊断敏感性、特异性和准确性分别为93．5％（43／46）、76．9％（20／26）和87．5％（63／72），在术后吻合口和肺门淋巴结的检测中各出现2例假阳性，使总体特异性降低，特别是局部复发仅50％（3／6）。复发转移（31例）及随访期内死亡的病例（26例）SUV高于对照组（t=2．40、3．04，P=0．022、0．004）。结论 尽管对局部复发的诊断特异性较低，但^18FDG PET—CT仍不失为探测食管癌治疗后复发转移的有效工具，SUV可为预后评估提供重要参考价值。     

18FDG PET-CT检测进展期食管癌淋巴结转移的临床价值

目的评价^18FDG PET-CT对进展期食管癌淋巴结转移的诊断价值及临床意义.方法随机选择拟行手术治疗的进展期食管癌患者30例,术前1周内行^18EDG PET-CT检查及CT增强扫描.根据术后病理结果,对比CT与PET-CT诊断食管癌淋巴结转移的敏感性、特异性、阴性预测值、阳性预测值与准确性的差异.结果术后病理原发灶均为鳞状细胞癌,22例存在淋巴结转移.共切取淋巴结243个,病理确定的转移淋巴结49个,平均直径1.4 cm（0.3～2.8 cm）.CT确定的转移淋巴结26个,平均直径1.7 cm（1.1～2.8 cm）;敏感性和特异性分别为40.8%和96.9%,阳性预测值76.9%,阴性预测值86.6%,准确性85.6%.18FDG PET-CT确定淋巴结转移63个,平均直径1.5cm（0.8～2.8 cm）;敏感性和特异性分别为93.9%和91.2%,阳性预测值73.0%,阴性预测值98.3%,准确性91.9%.18FDG PET-CT的敏感性、阴性预测值、准确性均高于CT（P＜0.001、0.001、0.05）.结论18FDGPET-CT是检测进展期食管癌淋巴结转移的有用工具,可指导手术剖胸径路的选择、优化适形放疗计划,临床应用价值优于CT.     

Nasopharyngeal carcinoma staging by (18)F-fluorodeoxyglucose positron emission tomography

PURPOSE: Nasopharyngeal carcinoma (NPC) has a high rate of neck lymph node and/or distant metastasis. We evaluated the value of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in staging NPC, especially in the detection of distant metastasis. METHODS AND MATERIALS: A total of 95 patients, including 85 with primary and 10 with recurrent, NPC were enrolled. Dual-phase FDG-PET was used, in addition to the conventional workup. Eighty-one patients without distant metastases underwent repeat studies 3-4 months after initial radical treatment. RESULTS: Of 14 patients with distant metastases, all had lesions detected by FDG-PET, and the conventional workup detected the metastases in only 4. Two patients had false-positive MRI findings for neck node metastasis, but the FDG-PET findings were accurate. Four patients without distant metastases on their initial workup were found to have new lesions on FDG-PET 3-4 months after initial treatment. Patients with advanced node disease had a significantly greater incidence of distant metastases on FDG-PET, especially for N3 disease. Of the 95 patients, the FDG-PET results for distant metastasis were true positive in 14 patients, false positive in 8, and true negative in 73. None of our patients had a false-negative result. For a patient base, the sensitivity and specificity of FDG-PET for distant metastasis was 100% and 90.1% (95% confidence interval 81.5-95.6%), respectively, in this study. The accuracy was 91.6% (95% confidence interval 84.1-96.3%), the positive predictive value was 63.6 (95% confidence interval 40.7-82.8%), and the negative predictive value was 100%. CONCLUSION: FDG-PET stages N and M disease of NPC more accurately and sensitively than does the conventional workup. Patients with advanced node disease, particularly N3 disease, would benefit the most from FDG-PET.     

Evolving role of (18)F-fluorodeoxyglucose positron emission tomography in the management of esophageal carcinoma

Positron emission tomography (PTE) and PET/CT imaging with (18)F-fluorodeoxyglucose are metabolic imaging modalities that depict tissues based on their level of glucose uptake. PET provides useful information in the primary staging of disease. PET performance in detecting locoregional nodal metastases is limited; however, it is the most accurate single noninvasive modality for detecting distant metastases. It is the imaging modality of choice for whole-body scanning in high-risk patients or patients who have clinically suspected recurrence, and is particularly helpful in determining which patients are the best candidates for surgical cure.     

Prognostic significance of 18F-fluorodeoxyglucose positron emission tomography in lymphoma

Today, many patients with lymphoma are cured by polychemotherapy and irradiation. However, residual masses are frequently observed after treatment and discrimination between vital tumor and inactive fibrotic tissue by computed tomography or magnetic resonance tomography is often not possible. 18 F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) is a metabolic imaging modality that is able to detect active lymphoma lesions. The application of PET may play a crucial role in identifying patients with residual disease and contribute valuable prognostic information. To assess the prognostic implications of PET in the post-therapeutic setting, we performed a MedLine Search and reviewed the current available studies on this important issue together with our own data.     

Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer.

PURPOSE: Despite the increasing number of publications concerning (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) for staging of esophageal cancer and the increasing availability of this novel diagnostic modality, its exact role in preoperative staging of these tumors is still unknown. The aim of this study was to systematically review the literature regarding the diagnostic performance of FDG-PET in preoperative staging of patients with esophageal cancer, and to calculate summary estimates of its sensitivity and specificity. METHODS: The databases of PubMed, Embase, and Cochrane were searched for relevant studies. Two reviewers independently assessed the methodological quality of each study. A meta-analysis of the reported sensitivity and specificity of each study was performed. RESULTS: Twelve studies met the inclusion criteria. The studies had several design deficiencies. Pooled sensitivity and specificity for the detection of locoregional metastases were 0.51 (95% CI, 0.34 to 0.69) and 0.84 (95% CI, 0.76 to 0.91), respectively. For distant metastases, pooled sensitivity and specificity were 0.67 (95% CI, 0.58 to 0.76) and 0.97 (95% CI, 0.90 to 1.0), respectively. CONCLUSION: FDG-PET showed moderate sensitivity and specificity for the detection of locoregional metastases, and reasonable sensitivity and specificity in detection of distant lymphatic and hematogenous metastases.     

The role of 18F-fluorodeoxyglucose positron emission tomography in thyroid neoplasms

(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has established itself as an important imaging modality in many oncological and nononcological specialties and, as a consequence, it is increasingly being used in clinical practice. Since the first report of FDG being taken up by metastatic differentiated thyroid carcinoma (DTC) cells >20 years ago, various groups of investigators have explored the potential role of FDG-PET scanning in patients with benign and malignant thyroid neoplasms. With the increasing demand for FDG-PET scanning, clinicians are faced with the challenge of managing an increasing number of FDG-PET-detected thyroid incidentalomas because their significance remains unclear. The aims of this review are to address some of these issues, specifically, the clinical significance of FDG-PET-detected thyroid incidentalomas, the ability of FDG-PET to characterize thyroid nodules, especially those with indeterminate fine needle aspiration cytology results, and the role of FDG-PET in patients with confirmed primary DTC and with suspected recurrent DTC, by reviewing the current literature.     

18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) for staging and follow-up of marginal zone B-cell lymphoma

OBJECTIVE: According to recent reports, nodal marginal zone lymphoma (MZL) appears to be a distinctive lymphoma entity rather than a more advanced stage of extranodal MZL of mucosa-associated lymphoid tissue (MALT). We have therefore retrospectively evaluated all patients diagnosed with nodal or extranodal MZL who have been referred to our unit for imaging using (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET). PATIENTS AND METHODS: A total of 21 patients with a diagnosis of MZL upon referral for imaging with (18)F-FDG-PET were identified. Histological reassessment of biopsy specimens confirmed the diagnosis of extranodal MZL of MALT in 14 patients, while a diagnosis of nodal MZL was verified in 6 patients. Lymphoma cell proliferation was assessed immunohistochemically using a Ki-67 antibody. Whole-body (18)F-FDG-PET scans were performed on a GE advanced PET scanner 40 min after intravenous injection of 300-380 MBq (18)F-FDG. RESULTS: None of the patients with extranodal MZL showed focal tracer uptake within verified tumor sites. In contrast, 5 of the 6 patients with nodal MZL showed significant FDG uptake within the affected lymph nodes. These results did not simply reflect the different growth fractions of the two lymphoma entities since the proliferation indices of the two groups did not differ significantly. CONCLUSION:(18)F-FDG-PET visualizes nodal MZL in a high proportion of patients whereas FDG uptake is undetectable in extranodal MZL. Although limited by the small number of patients, this study suggests that imaging with (18)F-FDG-PET might play a potential role in the diagnostic workup of patients with nodal MZL involvement.     

The utility of 18F-fluorodeoxyglucose positron emission tomography for early diagnosis of radiation-induced myocardial damage

PURPOSE: We evaluated the clinical significance of focal increased uptake in the basal myocardium on F-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with esophageal cancer after radiotherapy. METHODS AND MATERIALS: Between August 2004 and July 2005, a total of 64 patients who had been irradiated for thoracic esophageal cancer underwent FDG-PET at least three months after the completion of chemoradiotherapy. Some patients showed increased FDG uptake in the basal portion of the myocardium. To clarify the clinical significance of these findings, further examinations of hearts were performed. The dose distribution in the myocardium with high FDG uptake was also analyzed retrospectively. RESULTS: Thirteen (20.3%) of the 64 patients showed high FDG uptake in the basal myocardium corresponding to the irradiated fields compared with FDG uptake in the myocardium outside the irradiated fields. Eight of the 13 patients consented to undergo examinations of the heart. Five of those eight patients showed low 123I-BMIPP uptake and four showed low 201TlCl uptake in the myocardium corresponding with high FDG uptake regions. In two patients, delayed enhancement was found in some parts of the area with high FDG uptake on Gd-DTPA magnetic resonance imaging (MRI), and the delay-enhanced lesion showed hypokinesia on cine-MRI in one patient. CONCLUSIONS: FDG-PET often shows focal increased uptake in the basal myocardium after radiotherapy for esophageal cancer. This finding indicates the possibility of radiation-induced cardiac damage, and cardiac function and symptoms of such patients should be followed carefully.