~(18)F-FDG PET/CT在食管癌的应用进展

食管癌恶性程度高、预后差,严重威胁了人类健康,18F-FDG PET/CT集功能和解剖信息于一身,这种医学影像技术在食管癌的应用优势日益受到广大医务工作者的关注。本文综述了18F-FDG PET/CT在食管癌的诊断、分期、复发、疗效和预后评估、放射治疗计划制定等方面的研究进展。     

MRI and PET/CT of patients with bone metastases from breast carcinoma

3.0Tesla magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was compared with combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) in patients with suspected bone metastases from breast cancer. A prospective clinical study was performed in 13 female breast cancer patients (mean age 61years; range 45-85 years). The spine was imaged in the sagittal plane with T1-weighted (T1), short tau inversion recovery (STIR), and T2-weighted fat-saturated (T2) sequences. The pelvis was imaged similarly in the coronal plane. Axial DWI was performed from the skull base to the mid-thigh. MRI and PET/CT were performed in all patients at a maximum interval of 10 working days and at least 14 days after chemotherapy. MRI was reviewed by two radiologists, and their consensus on potential metastases in 27 predefined locations was recorded. The predefined locations were the vertebral bodies (24), the left (1) and right (1) pelvic bones, and the sacral bone (1). The PET/CT was reviewed by a radiologists and a nuclear medicine physician. MRI detected 59 of the 60 active metastases found with our gold standard modality PET/CT. T1 had the highest sensitivity (98%) but rather low specificity (77%), but with the addition of STIR and DWI, the specificity increased to 95%. The additional metastases detected with MRI most likely represented postherapeutic residual scars without active tumour. In conclusion, 3.0Tesla MRI with T1, STIR, and DWI is useful for the clinical evaluation of bone metastases from breast cancer and compares well to PET/CT.     

Diagnosis of prostatic neuroendocrine carcinoma: Two cases report and literature review

Two cases of prostatic neuroendocrine carcinoma (PNEC) imaged by computed tomography (CT) and magnetic resonance imaging (MRI), and literature review are presented. Early enhanced CT, MRI, especially diffusion-weighted image were emphasized, the complementary roles of ultrasound, CT, MRI, clinical and laboratory characteristic’s features in achieving accurate diagnosis were valued in the preoperative diagnosis of PNEC.     

CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck

The purpose of this retrospective study was to compare the diagnostic value of four different imaging methods—computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT—and their combined use for preoperative detection of cervical nodal metastases in head and neck squamous cell carcinoma (SCC). Sixty-seven patients (58 men and 9 women; mean age, 60.1 years) with head and neck SCCs underwent CT, MR, US, and PET/CT before surgery. First, each study was reviewed separately for the presence of nodal metastases. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified, on a level-by-level basis, with histopathologic findings. Histopathologic examination revealed nodal metastases in 74 of 402 nodal levels. The sensitivity, specificity, and accuracy were 77.0%, 99.4%, and 95.3% for CT and MR; 78.4%, 98.5%, and 94.8% for US; and 81.1%, 98.2%, and 95.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (p > 0.05). The combination of CT, MR, US, and PET/CT improved sensitivity (86.5%), without loss of specificity (99.4%) and accuracy (97.0%), although the difference failed to reach statistical significance.     

Nasopharyngeal carcinoma: MRI and CT assessment

Precise assessment of the extent of nasopharyngeal carcinoma (NPC) represents the basic step towards optimal treatment. We compared the capacity of CT and MRI in assessing the extent of NPC in 67 patients. MRI was superior to CT in demonstrating lesions in the retropharyngeal node, skull base, intracranial area, carotid space, longus colli muscle and levator palatini muscle. Of 25 cases in which retropharyngeal adenopathy was recognised only on MRI, seven had been reported as showing oropharyngeal involvement and 18 as primary extension to the carotid space on CT. MRI showed skull-base involvement in 40 patients compared with 27 on CT and intracranial involvement in 38 patients versus 24 on CT. There was not a single case in which skull base invasion was seen on CT but not on MRI. MRI enabled improved recognition of tumour infiltration of longus colli muscles (34 cases compared with 15 on CT). It allowed us to clarify 12 questionable sinonasal opacities on CT. Overall, T-staging was changed in 18 of 67 patients (26.9 %), including upstaging in 15 cases and downstaging in 3 cases, after comparing CT with MRI. The nodel status was changed from negative on CT to positive on MRI in 4 of 67 patients (6 %). We believe that MRI allows more accurate evaluation of the extent of NPC than CT and should be the primary mode of investigation. Received: 18 November 1996 Accepted: 22 January 1997     

^18F-FDG PET/CT显像与心脏磁共振成像对Beagle犬局部辐射后心脏损伤的诊断

目的探讨^18F-脱氧葡萄糖(FDG)PET/CT显像与心脏磁共振成像(CMR)对Beagle犬局部放射性心脏损伤(RIHD)的诊断价值。方法将24只1岁龄健康雄性Beagle犬按照随机数字表法分为对照组及照射后3、6和12个月组,每组各6只;其中各照射组左心室前壁行单次20 Gy调强放疗。对全部犬行^18F-FDG PET/CT心肌代谢显像和CMR检查,计算^18F-FDG摄取增高区平均标准摄取值(SUVmean)及面积。全部检查结束后1周处死实验犬,取心脏进行Masson染色及电子显微镜检查。采用单因素方差分析比较组间差异。结果对照组心肌^18F-FDG几乎不摄取,照射后3个月即可见犬心肌^18F-FDG摄取增加,照射后3、6和12个月组的心肌SUVmean分别为5.90±1.31、4.66±2.21和3.21±0.82,与对照组(1.13±0.21)的差异有统计学意义(F=11.81,P<0.05);照射组^18F-FDG摄取增高面积随着照射后时间延长逐渐下降(F=195.74,P<0.01)。CMR示照射后6和12个月组的心肌灌注降低、进行性纤维化加重;与对照组相比,照射后6和12个月组的舒张末期容积(EDV)和收缩末期容积(ESV)增加(F=15.479和16.908,均P<0.01),而左心室射血分数(LVEF)下降(F=63.715,P<0.01)。Masson染色发现照射后心肌纤维化进行性加重;电子显微镜检查示照射后心肌线粒体变性肿胀,线粒体数量进行性减少。结论照射后局部心肌^18F-FDG摄取增高对于RIHD的危险性有预测价值,^18F-FDG PET/CT显像能早于CMR发现RIHD。     

肺癌脊椎骨转移（18）F-FDG PET/CT与MRI的对比分析

目的：比较分析18 F-FDG PET/CT与MRI在肺癌脊椎骨转移诊断方面的敏感性、特异性。方法：28例肺癌PET/CT疑脊椎转移患者行MRI检查,比较两种方法对脊椎转移的显示征象。统计学方法采用配对四格表资料2检验,P〈0.05被认为差异有显著性。结果：经病理或随访确诊脊椎骨转移22例。以受累椎体病灶个数为统计单位,脊椎范围内共700个椎体,153个为真阳性,574个为真阴性。PET/CT诊断正确143个病灶,假阴性10个,假阳性24个,其敏感性93.4%,特异性95.6%。MRI诊断正确145个病灶,假阴性8个,无假阳性,其敏感性94.7%,特异性100%。结论：在显示脊椎骨转移方面,MRI较PET/CT具有更高的敏感性、特异性。     

Follicular thyroid carcinoma presenting with multiple skull metastases on CT and MRI: A case report and literature review

Although the incidence of thyroid carcinoma has increased in recent years, follicular thyroid carcinoma with bone metastasis as the first symptom remains rare. Here, we report a case of occult follicular thyroid carcinoma in a 65-year-old female patient admitted to hospital with cerebrovascular disease. Computed tomography findings suggested a diagnosis of meningioma; however, magnetic resonance imaging results showed multiple skull bone destruction with soft tissue masses on the left side of the skull. After surgical resection, the pathology results revealed skull metastasis of follicular thyroid carcinoma. We present this case not only because of the diagnostic challenge it posed, but also because the patient had multiple skull metastases from follicular thyroid carcinoma.     

PET/CT和MRI在多发性骨髓瘤中的应用与进展

多发性骨髓瘤（MM）是一种恶性B细胞肿瘤,其主要累及骨髓,部分也可出现髓外浸润。影像学检查是全面评估MM不可或缺的手段,X射线与CT对病灶的检出率低、定量能力差。PET/CT与MRI对MM的评估具有较大的价值,特别是18F-FDG及其他新型分子探针,全身扩散加权成像、动态增强MRI及水脂分离等MRI新技术。笔者就PET/CT及MRI在MM中的应用与进展进行综述。     

18F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值：Meta分析

目的 系统评价¹⁸F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值。方法 检索PubMed、EMbase、Cochrane Library、中国知网、万方数据、维普数据库从2010年1月—2020年5月公开发表的关于¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的中英文文献,根据纳入、排除标准筛选并提取数据,采用诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入文献质量,应用Meta-Disc 1.4软件进行分析。采用不一致指数(I2)和Cochran-Q检验进行异质性分析,并计算合并敏感度、特异度、阳性似然比、阴性似然比及相应95%CI,绘制汇总受试者操作特征(SROC)曲线并计算曲线下面积(AUC)。采用阈值效应和亚组分析探讨异质性的来源。亚组分析根据研究类型、原发肿瘤类型、是否合并有增强MRI进行分组分析。结果 共纳入25篇文献,包括1 347例肿瘤病人,¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的合并敏感度、特异度、阳性似然比、阴性似然比、AUC值分别为0.85(95%CI:0.8...     

PET/CT和PET/MR在黑色素瘤中的临床应用及新进展

黑色素瘤易转移、复发率高,已经成为严重危及人民健康的恶性肿瘤之一,早期诊断和准确分期对预后及远期生存十分关键。18F-FDG PET/CT作为一项集PET与CT于一体的成像模式,被广泛地应用于包括黑色素瘤等在内的恶性肿瘤的诊断、分期及疗效的评估。随着一体化PET/MR成像系统研发的成功,多模态成像技术向前迈进了一大步,实现了真正意义上的数据同步采集。笔者就18F-FDG PET/CT及PET/MR在黑色素瘤分期、复发和疗效评价中的研究现状进行综述,介绍了多模态成像技术在黑色素瘤中的新进展。     

PET/MRI融合显像在脑胶质瘤诊断和治疗中的研究进展

脑胶质瘤发病率较高,是颅内最常见的原发肿瘤。MRI技术在脑胶质瘤分级、手术定位和术后放疗靶区勾画中有着重要的作用。但是,越来越多的研究发现,MRI在肿瘤显像方面仍存在局限性,如准确确定肿瘤边界。PET利用组织代谢原理进行功能显像,有利于发现增殖活跃的肿瘤组织。PET与MRI图像的融合,实现了解剖与功能共同显像,为提高脑胶质瘤诊断的准确性提供了一条新途径。     

Periodontoid pseudotumor: CT and MRI imaging

Periodontoid pseudotumor (PP) can be a severe and disabling disease. This disease process typically presents in elderly patients with a longstanding history of myelopathy. We reviewed four cases of PP in order to summarize the clinical and imaging features.     

Additional Value of Integrated 18F-FDG PET/MRI for Evaluating Biliary Tract Cancer: Comparison with Contrast-Enhanced CT

ObjectiveTo evaluate the value of ¹⁸F-fluorodeoxyglucose PET/MRI added to contrast-enhanced CT (CECT) in initial staging, assessment of resectability, and postoperative follow-up of biliary tract cancer.Materials and MethodsThis retrospective study included 100 patients (initial workup [n = 65] and postoperative follow-up [n = 35]) who had undergone PET/MRI and CECT for bile duct or gallbladder lesions between January 2013 and March 2020. Two radiologists independently reviewed the CECT imaging set and CECT plus PET/MRI set to determine the likelihood of malignancy, local and overall resectability, and distant metastasis in the initial workup group, and local recurrence and distant metastasis in the follow-up group. Diagnostic performances of the two imaging sets were compared using clinical-surgical-pathologic findings as standards of reference.ResultsThe diagnostic performance of CECT significantly improved after the addition of PET/MRI for liver metastasis (area under the receiver operating characteristic curve [A_z]: 0.77 vs. 0.91 [p = 0.027] for reviewer 1; 0.76 vs. 0.92 [p = 0.021] for reviewer 2), lymph node metastasis (0.73 vs. 0.92 [p = 0.004]; 0.81 vs. 0.92 [p = 0.023]), and overall resectability (0.79 vs. 0.92 [p = 0.007]; 0.82 vs. 0.94 [p = 0.021]) in the initial workup group. In the follow-up group, the diagnostic performance of CECT plus PET/MRI was significantly higher than that of CECT imaging for local recurrence (0.81 vs. 1.00 [p = 0.029]; 0.82 vs. 0.94 [p = 0.045]).ConclusionPET/MRI may add value to CECT in patients with biliary tract cancer both in the initial workup for staging and determination of overall resectability and in follow-up for local recurrence.     

Role of 18F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma

Head and neck cancer (HNC) ranks as the 6^th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma (HNSCC). The majority of patients present with complicated locally advanced disease (typically stage III and IV) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Some patients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography (CT) or magnetic resonance imaging (MRI). ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography/CT (¹⁸F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.     

18F-FDGPET／CT在腺样囊性癌术后中的应用价值

目的：探讨18F-FDGPET/CT在腺样囊性癌术后中的应用价值。方法回顾性分析2007年8月-2014年3月13例腺样囊性癌术后18F-FDGPET/CT检查图像资料,分析其特点,以提高对该病局部复发或远处转移的认识,所有病例确诊肿瘤复发、转移的依据为再次手术或穿刺病理及临床随访证实。结果13例腺样囊腺癌中,其中位于右颌下腺3例,左颌下腺2例,而位于左上唇、左侧鼻腔、右侧鼻腔、右侧蝶窦及筛窦、右上颌窦、气管下段、口底、右侧硬颚各1例。经手术病理或随访证实,局部复发2例,未见局部复发11例,PET/CT诊断复发5例,未见局部复发8例,PET/CT对术区局部复发诊断敏感性为100％,特异性为78．6％;远处转移9例,PET诊断转移7例,转移性病变诊断敏感性为77.8％,特异性为100％,其中4例改变了临床分期。其中颈部淋巴结转移3例,双肺转移4例,肝脏及骨骼多发转移1例,双肺、骨骼转移1例,同时并双肺、肝脏、骨骼多发转移1例。肿瘤局部复发病例中,SUVmax最大值为15．3,SUVmax最小值为7．4;转移性病变中,其中SUVmax最大值为15．8,SUVmax最小值为0．8。结论腺样囊性癌是一种高度侵袭性恶性肿瘤,具有生长速度慢、手术治疗后易局部复发和长期随访易发生远处转移等特点。因此,18F-FDGPET/CT一次显影全身显像,不仅对腺样囊性癌术后局部有无复发有重要诊断价值,而且对远处转移也有很好的参考意义。     

Evaluation of Dixon Sequence on Hybrid PET/MR Compared with Contrast-Enhanced PET/CT for PET-Positive Lesions

Purpose

Hybrid positron emission tomography and magnetic resonance (PET/MR) imaging performs a two-point Dixon MR sequence for attenuation correction. However, MR data in hybrid PET/MR should provide anatomic and morphologic information as well as an attenuation map. We evaluated the Dixon sequence of hybrid PET/MR for anatomic correlation of PET-positive lesions compared with contrast-enhanced PET/computed tomography (CT) in patients with oncologic diseases.

Methods

Twelve patients underwent a single injection, dual imaging protocol. PET/CT was performed with an intravenous contrast agent (85 ± 13 min after ¹⁸F-FDG injection of 403 ± 45 MBq) and then (125 ± 19 min after injection) PET/MR was performed. Attenuation correction and anatomic allocation of PET were performed using contrast-enhanced CT for PET/CT and Dixon MR sequence for hybrid PET/MR. The Dixon MR sequence and contrast-enhanced CT were compared for anatomic correlation of PET-positive lesions (scoring scale ranging from 0 to 3 for visual ratings). Additionally, standardized uptake values (SUVs) for the detected lesions were assessed for quantitative comparison.

Results

Both hybrid PET/MR and contrast-enhanced PET/CT identified 55 lesions with increased FDG uptake in ten patients. In total, 28 lymph nodes, 11 bone lesions, 3 dermal nodules, 3 pleural thickening lesions, 2 thyroid nodules, 1 pancreas, 1 liver, 1 ovary, 1 uterus, 1 breast, 1 soft tissue and 2 lung lesions were present. The best performance was observed for anatomic correlation of PET findings by the contrast-enhanced CT scans (contrast-enhanced CT, 2.64 ± 0.70; in-phase, 1.29 ± 1.01; opposed-phase, 1.29 ± 1.15; water-weighted, 1.71 ± 1.07; fat weighted, 0.56 ± 1.03). A significant difference was observed between the scores obtained from the contrast-enhanced CT and all four coregistered Dixon MR images. Quantitative evaluation revealed a high correlation between the SUVs measured with hybrid PET/MR (SUVmean, 2.63 ± 1.62; SUVmax, 4.30 ± 2.88) and contrast-enhanced PET/CT (SUVmean, 3.88 ± 2.30; SUVmax, 6.53 ± 4.04) in PET-positive lesions (SUVmean, ρ = 0.93; SUVmax, ρ = 0.95), although hybrid PET/MR presented a decrease of SUVs compared with contrast-enhanced PET/CT (mean reduction; SUVmean, 32.44 ± 15.64 %; SUVmax, 35.16 ± 12.59 %).

Conclusions

Despite different attenuation correction approaches, the SUV of PET-positive lesions correlated well between hybrid PET/MR and contrast-enhanced PET/CT. However Dixon MR images acquired for attenuation correction were insufficient to provide anatomic information of PET images because of low spatial resolution. Thus, additional MR sequence with fast and higher resolution may be necessary for anatomic information.     

基于CT/MRI/PET-CT进行鼻咽癌大体肿瘤区及淋巴结勾画的对照研究

目的:比较基于计算机体层成像(CT)、磁共振成像(MRI)、 18氟-脱氧葡萄糖正电子发射计算机断层显像( 18F-FDG PET-CT)3种图像勾画鼻咽癌(NPC)大体肿瘤靶区(GTV)及淋巴结的差异,并以MRI为参考研究基于PET自动勾画NPC GTV的最佳标准摄取值(SUV)。 ...     

CT,MRI, and FDG-PET imaging findings of low-grade extrauterine endometrial stromal sarcoma arising from the mesentery: A case report

Endometrial stromal sarcoma is a rare uterine mesenchymal neoplasm, and extrauterine endometrial stromal sarcoma is even rarer, with a limited number of case reports. In the present report, we present a case of low-grade extrauterine endometrial stromal sarcoma originating from the mesentery in a 49-year-old woman, without endometrial stromal sarcoma in the uterus or evidence of endometriosis. The tumor was diagnosed using recombination of the JAZF1 gene by fluorescence in situ hybridization. Computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed a 13 cm, primarily polycystic, mass containing a contrast-enhancing solid component with restricted diffusion and mild 18F-fluorodeoxyglucose uptake. A large cystic component may be a characteristic feature of extrauterine endometrial stromal sarcoma, given the low pressure from the surrounding tissues.