氟脱氧葡萄糖PET-CT常规及双时相显像检测食管癌术后复发转移的价值

目的 评价氟脱氧葡萄糖(FDG)PET-CT常规及双时相显像在监测食管癌术后复发转移中的应用价值.方法 回顾分析食管癌术后临床怀疑复发转移而行FDG PET-CT检查的48例患者临床资料,根据细胞学、病理或随访结果分析FDG PET-CT检查结果.两样本率比较采用Fisher's精确概率法检验.结果 48例患者中位随访21.5个月,34例出现复发转移,确定复发转移灶61处.FDG PET-CT常规显像对全部病灶诊断的敏感性、特异性和准确性分别为93.44%、74.29%和86.46%;对局部复发和区域淋巴结转移的敏感性、特异性、准确性分别为91.67%、57.14%、78.95%和90.48%、77.78%、84.62%.FDG PET-CT双时相显像诊断局部复发+区域淋巴结转移的敏感性、特异性、准确性均高于常规显像,分别为96.97%∶90.90%(P=0.613)、96.00%∶72.00%(P=0.049)、96.55%∶82.76%(P=0.029).结论 FDG PET-CT常规显像虽然检测食管癌术后局部复发及区域淋巴结转移的特异性和准确性较低,但仍是检测其术后复发转移的有效手段;双时相显像较常规显像更具优势,可有效提高检测的特异性及准确性.

Abstract：

Objective To evaluate the clinical value of regular and dual-time-point 18-fluorodeoxyglucose positron emission tomography-CT(FDG PET/CT)imaging for recurrence and metastasis in esophageal carcinoma(EC)after curative esophagectomy. Methods A retrospective study was done on 48 patients received curative esophagectomy, who underwent FDG PET/CT scans to detect doubtful recurrent or metastatic lesions. The diagnostic accuracy of FDG PET-CT was assessed with the help of pathological findings as well as clinical or follow-up data. Using Fisher's Exact Test from SPSS 11.5 to analyze the data.Results Of the 48 patients, after a median follow-up of 21.5 months, 61 sites of local and regional recurrence or metastasis were finally confirmed in 34 patients. The sensitivity, specificity and accuracy of regular FDG PET/CT imaging in detecting recurrence of all sites were 93.44%, 74.29% and 86.46%respectively. The specificity and accuracy of local recurrence and regional metastasis were 57.14% ,78.95% and 77.78% ,84.62%, respectively. The sensitivity, specificity and accuracy of dual-time-point FDG PET/ CT imaging in detecting local and regional recurrence(96.97% ,96.00% and 96.55%)were higher than those of regular FDG PET/CT(90.90%, 72.00% and 82.76%)and there were significant differences of specificity and accuracy(P = 0.049, P = 0.029). Conclusions Regular FDG PET/CT imaging is highly effective in detecting recurrence and metastasis in EC patients after curative esophagectomy despite the low specificity and accuracy. Dual-time-point FDG PET/CT imaging can elevate the specificity and accuracy.     

MRI和PET-CT对放疗后鼻咽癌颅底复发的诊断价值

[目的]比较磁共振成像(MRI)和18F-氟代脱氧葡萄糖—正电子发射计算机体层摄影(PET-CT)对放疗后鼻咽癌颅底复发的诊断价值.[方法]48例放疗后的鼻咽癌患者,均行鼻咽MRI和PET-CT显像.比较MRI和PET-CT诊断放疗后鼻咽癌颅底复发的灵敏度、特异性、准确率、阳性预测值及阴性预测值.[结果] PET-CT和MRI对颅底复发诊断的灵敏度、特异性、准确率、阳性预测值和阴性预测值分别为94.1％和88.2％、42.9％和35.7％、79.2％和72.9％、80.0％和76.9％、75.0％和55.6％.PET-CT和MRI联合时灵敏度、特异性、阳性预测值、阴性预测值和准确率分别为93.8％、31.3％、73.2％、71.4％和72.9％,与MRI和PET-CT比较,差异均无统计学意义(P＜＞0.05).颅底有软组织者复发组占85.3％,未复发组仅占28.6％,差异有统计学意义(P＜0.05).复发组标准化摄取值(SUV)平均为7.59(1.9～15.4),未复发组SUV为3.86(0.7～8.4),差异有统计学意义(P=0.000).[结论]PETCT和MRI在鼻咽癌放疗后疑似颅底复发诊断上无明显差异,两者联合亦未显示优势.     

应用18FDG PET评价食管癌新辅助治疗疗效的价值

背景与目的:食管癌患者采用新辅助治疗有望提高其预后,因此新辅助治疗的疗效评价非常关键.目前,18FDG PET被认为是评价食管癌新辅助治疗疗效最佳的检查方法.本研究采用Meta分析方法系统评价18FDG PET对食管癌新辅助治疗疗效的诊断价值.方法:通过MEDLINE及EMBASE数据库检索、收集公开发表的应用18FDG PET评价食管癌新辅助治疗疗效的所有英文文献.对收集到的文献参照QUADAS系统进行质量评估.对符合标准的入选文献数据进行统计处理,计算综合敏感度、特异度及诊断优势比;根据Moses'线性模型绘制SROC曲线,计算曲线下面积及Q*值.结果:入选的13篇文献均满足QUADAS质量评价系统所列评估项目.18FDG PET评价食管癌新辅助治疗疗效的综合敏感度为70.3%(95%CI:64.4%～75.8%),综合特异度为70.1%(95%CI:65.1%～74.8%),综合诊断优势比为9.389(95%CI:3.482～25.319);SROC曲线下面积为0.824 4,Q*值为0.757 5.结论:18FDG PET作为一种无创性分子影像诊断技术,在评价食管癌患者接受新辅助治疗疗效上具有较高的诊断价值.     

PET-CT和MRI在诊断鼻咽癌放疗后复发中的价值

目的:探讨PET-CT和MRI在诊断鼻咽癌放疗后复发中的价值.方法:21例鼻咽癌放疗后患者均行PET-CT和MRI检查.依据病理组织活检和临床随访分别评价PET-CT和MRI对鼻咽癌放疗后复发检出的灵敏度、特异性、漏诊率、误诊率和准确度,并对两者的准确度比较.结果:PET-CT诊断鼻咽癌放疗后复发的灵敏度、特异性、漏诊率、误诊率和准确度分别为92.3%、100.00%、7.7%、0.00%和95.2%,MRI分别为100.00%、87.5%、0.00%、12.5%和95.2%,两者间准确度的差异没有统计学意义(P﹥0.05).结论:PET-CT和MRI在诊断鼻咽癌放疗后复发中均有较高的价值,两者间没有明显差别,两种诊断方法有各自的优缺点,应将两者结合起来,以提高诊断鼻咽癌放疗后复发的准确度.     

18FDG PET-CT在鼻咽癌放疗后的应用价值

目的研究18FDG PET-CT在鼻咽癌放疗后的应用价值。方法27例鼻咽癌放疗后CT检查发现鼻咽黏膜增厚者在放疗后8-32周行全身18FDG PET-CT检查,并在检查后对全部病例随访12个月以上,所有患者均行纤维鼻咽镜活检。利用PET-CT评价鼻咽癌在放疗后转移及残留,并分析SuV值与预后相关性。结果27例中2例通过PET-CT检查发现远处转移,及时接受相应治疗。以SUV≥2.5作为阳性标准,PET-CT诊断鼻咽癌局部残留20例,其中经病理证实18例;诊断为局部低代谢性病灶7例,病理证实5例。18例被确诊为鼻咽癌局部残留者分别接受鼻咽腔内放疗或立体定向适形放疗。全组患者1年局部控制率为70%,1年总生存率为81%。SUV≥5者11例,1年局部控制率为55%,远处转移率为82%,1年生存率为64%。2.5≤SUV<5者9例,1年局部控制率为67%,远处转移率为22%,1年生存率为89%。两者1年局部控制率和生存率比较差异无统计学意义(P=0.670、0.319),远处转移率差异有统计学意义(P=0.022)。结论18FDG PET-CT对于鉴别鼻咽癌患者放疗后病灶残留具有诊断意义,放疗后局部残留病灶SUV值与远处转移率有关。     

18F-脱氧葡萄糖PET对判断脑胶质瘤手术并放疗后肿瘤残留的价值

背景与目的:恶性肿瘤治疗后残留的判断靠CT或MRI有时是很困难的,18F-脱氧葡萄糖(fluorodeoxyglucose,FDG)正电子发射型体层摄影术(positron emission tomography,PET)在这方面的应用是放射肿瘤学目前研究的热点之一.本研究旨在探讨18F-FDG PET在判断脑胶质瘤手术后并放疗后肿瘤残留的临床价值.方法:对23例脑胶质瘤手术后并放疗后临床疑肿瘤残留患者同期行18F-FDG PET和CT/MRI检查,最后诊断结合手术后病理检查和临床随访.结果:23例患者中18F-FDGPET显像阳性12例,阴性11例,其中3例为假阴性.9例CT/MRI未能确定肿瘤残留,PET显示其中7例FDG异常浓聚,2例FDG摄取缺损;8例CT/MRI诊断为肿瘤残留者PET显示FDG异常浓聚.18F-FDG PET显像检查的准确率为87.0%(20/23),而CT/MRI检查的准确率为60.9%(14/23),前者准确率明显高于后者(P＜0.05).结论:18F-FDG PET在判断脑胶质瘤手术后并放疗后的脑损伤和肿瘤残留方面具有明显的优势,结合CT和MRI能更好的提供解剖结构和功能改变的综合信息.     

PET-CT和MRI诊断兔鼻咽肿瘤颈淋巴结转移的比较研究

目的 探讨18FDG PET-CT在诊断兔鼻咽肿瘤颈部淋巴结性质上的作用.方法 建立兔鼻咽VX2肿瘤模型,对颈部淋巴结行PET-CT诊断并用病理诊断证实,同时与MRI诊断相比较.结果 30只鼻咽VX2肿瘤兔解剖检出颈部淋巴结共53个,病理证实转移淋巴结42个,且淋巴结是否转移与淋巴结体积、最短径显著相关(r=9.18,P=0.007;r=2.77,P:0.008).体积>0.5 cm3(25个)、≤0.5 cm3(17个)淋巴结的PET-T诊断敏感性分别为96%(24个)、29%(5个),最短径≥0.5cm(30个)、<0.5 cm(12个)淋巴结的PET-CT诊断敏感性分别为83%(25个)、33%(4个),PET-CT诊断的总敏感性为69%(29/42),特异性为100%(11/11),准确性为95%(40/42).MRI诊断敏感性为60%(25/42),特异性为9l%(10/11),准确性为83%(35/42).PET-CT图像所测淋巴结体积与实测体积相当(t=-1.23,P=0.233),MRI的则大于实测体积(t=-3.99,P=0.001).结论 18FDGPET-CT诊断颈部淋巴结转移的敏感性、特异性均高于MRI,特别对体积>0.5 cm3或最短径≥0.5 cm的颈部淋巴结转移的敏感性更高,对更小淋巴结的诊断仍有参考价值,仉假阴性较高.     

18FDG PET/PET-CT诊断局部复发性结直肠癌价值的系统评价

 目的
系统评价¹⁸FDG PET/PET-CT 诊断局部复发性结直肠癌的临床价值。
方法
计算机检索Pubmed、Embase、SCI、CBM和Medion数据库，检索时间截至2011年7月，搜集¹⁸FDG PET/PET-CT诊断局部复发性结直肠癌的文献。由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价质量后，采用Stata10.1软件deeks法绘制漏斗图，MetaDiSc1.4软件进行Meta分析，计算合并敏感度，特异性，阳性似然比，阴性似然比及诊断比。绘制SROC曲线，计算曲线下面积（AUC）与Q值。
结果
最终纳入22个研究。汇总SROC曲线下面积及Q值分别为0.978，0.933。Meta分析结果显示敏感度0.944 (95% CI：0.918~0.964, I²=0)、诊断比208.670 (95% CI：109.56~397.44, I²=23.5%) 和阴性似然比0.084 (95% CI：0.060~0.119, I²=0) 同质性较好，特异性和阳性似然比存在异质性。根据森林图直接合并同质研究和Meta回归分析后再行同质研究合并分别得到特异性和阳性似然比0.986 (95% CI：0.975~0.993,I²=15%)，34.903 (95% CI：21.321~57.126,I²=0)；0.981 (95% CI：0.968~0.989,I²=55.5%)，27.937 (95%CI：15.953~48.926,I²=25.5%)。
结论
¹⁸FDG PET/PET-CT可作为敏感度及特异性均较高的影像工具用于局部复发性结直肠癌的诊断。     

胰腺癌平扫或强化氟脱氧葡萄糖PET-CT图像靶区勾画研究

目的 探讨平扫或强化氟脱氧葡萄糖(FDG) PET-CT图像在胰腺癌靶区勾画中的作用。方法 回顾分析本院 2008—2009年间 21例局部晚期不可切除及术后复发胰腺癌患者资料,以相同固定体位分别行平扫CT、PET,其中 11例之后行强化CT。将扫描数据输入治疗计划系统,行平扫或强化CT、PET图像融合,分别依据强化CT、平扫CT、平扫PET及平扫或强化PET-CT融合图像勾画大体肿瘤体积(GTV),并用配对或成组t检验比较不同图像GTV大小。结果 21例患者平扫 GTV_CT、平扫 GTV_PET、平扫或强化 GTV_PET-CT平均值分别为76.9、47.0、44.5 cm³,平扫 GTV_PET-CT平均体积明显小于平扫GTV_CT (z=－3.91,P=0.000)。11例强化 GTV_CT、强化 GTV_PET、强化 GTV_PET-CT平均体积分别为64.1、45.1、49.3 cm³,强化 GTV_PET-CT平均体积明显小于强化GTV_CT (z=－2.13,P=0.033),强化 GTV_PET-CT平均体积与平扫 GTV_PET-CT相似(z=－0.80,P=0.424)。结论 PET和强化或平扫CT的融合图像能提高不可切除胰腺癌靶区勾画准确性,有望降低放疗不良反应。     

动态增强磁共振对前列腺癌术后复发或残留诊断的Meta分析

  目的  评价动态增强磁共振（dynamic contrast-enhanced MRI,DCE -MRI）对前列腺癌（PCa）手术治疗后局部复发或残留的诊断效能。   方法  检索PubMed、EMBASE、Cochrane Library、SCI、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）、万方数字化期刊群等数据库,再根据已发表文献中的参考文献追溯进行手工检索。检索时间截止到2013年6月6日。依据纳入排除标准筛选文献,参照QUADAS评价纳入研究的质量并提取数据,利用Meta-Disc 1.4软件进行统计分析,计算总敏感度、特异度、诊断比值比（dOR）及其95%可信区间（95% CI）和SROC曲线下面积（AUC）。   结果  检索得到118篇文献,有7篇文献（12项研究）符合纳入标准。对12项研究进行Meta分析,总敏感性为0.88（95%CI:0.84~0.91）,总特异性为0.87（95%CI:0.81~0.92）,dOR为50.4（95%CI:26.0~97.6）。DCE-MRI对PCa术后复发或残留诊断的SROC AUC为0.9391,Q*指数为0.8764。   结论  动态增强磁共振对诊断前列腺癌治疗后局限性复发或残留具有较高的敏感性与特异性,其中DCE与磁共振波谱（magnetic resonance spectroscopy,MRS）联合诊断效能更高。      

FDG-PET, CT, MRI for diagnosis of local residual or recurrent nasopharyngeal carcinoma, which one is the best? A systematic review.

PURPOSE: To perform a systematic review to compare FDG-PET, CT, and MRI imaging for diagnosis of local residual or recurrent nasopharyngeal carcinoma. MATERIALS AND METHODS: MEDLINE, EMBASE, the CBMdisc databases and some other databases were searched for relevant original articles published from January 1990 to June 2007. Inclusion criteria were as follows: Articles were reported in English or Chinese; FDG-PET, CT, or MRI was used to detect local residual or recurrent nasopharyngeal carcinoma; histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months were the reference standard. Two reviewers independently extracted data. A software called "Meta-DiSc" was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the Q* index. RESULTS: Twenty-one articles fulfilled all inclusion criteria. The pooled sensitivity estimates for PET (95%) were significantly higher than CT (76%) (P<0.001) and MRI (78%) (P<0.001). The pooled specificity estimates for PET (90%) were significantly higher than CT (59%) (P<0.001) and MRI (76%) (P<0.001). The pooled DOR estimates for PET (96.51) were significantly higher than CT (7.01) (P<0.001) and MRI (8.68) (P<0.001). SROC curve for FDG-PET showed better diagnostic accuracy than CT and MRI. The Q* index for PET (0.92) was significantly higher than CT (0.72) (P<0.001) and MRI (0.76) (P<0.01). For PET, the sensitivity and diagnostic OR for using qualitative analysis were significantly higher than using both qualitative and quantitative analyses (P<0.01). For CT, the sensitivity, specificity, diagnostic OR, and the Q* index for dual-section helical and multi-section helical were all significantly higher than nonhelical and single-section helical (P<0.01). And the sensitivity for 'section thickness <5 mm' was significantly lower than ' =5 mm' (P<0.01), while the specificity was significantly higher (P<0.01). For MRI, there were no significant differences found between magnetic field strength <1.5 and > or =1.5 T (P>0.05). CONCLUSION: FDG-PET was the best modality for diagnosis of local residual or recurrent nasopharyngeal carcinoma. The type of analysis for PET imaging and the section thickness for CT would affect the diagnostic results. Dual-section helical and multi-section helical CT were better than nonhelical and single-section helical CT.     

Diagnostic value of FDG-PET in recurrent colorectal carcinoma: a meta-analysis

Accurate detection of recurrent colorectal carcinoma remains a diagnostic challenge. The purposes of this study were to evaluate the diagnostic value of Positron emission tomography (PET) using fluor-18-deoxyglucose (FDG) in recurrent colorectal carcinoma with a meta-analysis. All the published studies in English relating the diagnostic value of FDG-PET in the detection of recurrent colorectal carcinoma were collected. Methodological quality of the included studies was evaluated. Pooled sensitivity, specificity and diagnostic odds ratio and SROC (summary receiver operating characteristic curves) were obtained by the statistical software. Twenty-seven studies were included in the meta-analysis. The pooled sensitivity and specificity for FDG-PET detecting distant metastasis or whole body involvement in recurrent colorectal carcinoma were 0.91 (95% CI 0.88-0.92) and 0.83 (95% CI 0.79-0.87), respectively. The pooled sensitivity and specificity for FDG-PET detecting hepatic metastasis were 0.97 (95% CI 0.95-0.98) and 0.98 (95% CI 0.97-0.99). The pooled sensitivity and specificity for pelvic metastasis or local regional recurrence were 0.94 (95% CI 0.91-0.97) and 0.94 (95% CI 0.92-0.96). FDG-PET is valuable for the assessment of recurrent colorectal carcinoma.     

Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis

Objective: Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is a new techniquefor identifying different malignant tumors using different uptake values between tumor cells and normal tissues.Here we assessed the diagnostic accuracy of 18F-FDG-PET in patients with testicular cancer by pooling data ofexisting trials in a meta-analysis. Methods: PubMed/MEDLINE, Embase and Cochrane Central Trials databaseswere searched and studies published in English relating to the diagnostic value of FDG-PET for testicularcancer were collected. The summary receiver operating characteristic (SROC) curve was used to examine theFDG-PET accuracy. Results: A total of 16 studies which included 957 examinations in 807 patients (median age,31.1 years) were analyzed. A meta-analysis was performed to combine the sensitivity and specificity and their95% confidence intervals (CIs), from diagnostic odds ratio (DOR), positive likelihood ratios (PLR), negativelikelihood ratio (NLR). SROC were derived to demonstrate the diagnostic accuracy of FDG-PET for testicularcancer. The pooled sensitivity and specificity were 0.75 (95% confidence interval (CI), 0.70-0.80) and 0.87 (95%CI, 0.84-0.89), respectively. The pooled DOR was 35.6 (95% CI, 12.9-98.3). The area under the curve (AUC) was0.88. The pooled PLR and pooled NLR were 7.80 (95% CI, 3.73-16.3) and 0.31 (95% CI, 0.23-0.43), respectively.Conclusion: In patients with testicular cancer, 18F-FDG-PET demonstrated a high SROC area, and could be apotentially useful tool if combined with other imaging methods such as MRI and CT. Nevertheless, the literaturefocusing on the use of 18F-FDG-PET in this setting still remains limited.     

Fluorine-18 deoxyglucose positron emission tomography, magnetic resonance imaging and bone scintigraphy for the diagnosis of bone metastases in patients with lung cancer: which one is the best?--a meta-analysis

Aims

To carry out a meta-analysis to compare fluorine-18 deoxyglucose (¹⁸FDG) positron emission tomography (PET), magnetic resonance imaging (MRI) and bone scintigraphy imaging for the diagnosis of bone metastases in patients with lung cancer.

Materials and methods

MEDLINE, EMBASE, Scopus and other databases were searched for relevant original articles published between January 1995 and January 2010. Inclusion criteria were as follows: ¹⁸FDG PET, MRI or ^99mTc-MDP bone scintigraphy was carried out to detect bone metastases in patients with lung cancer; sufficient data were presented to construct a 2 × 2 contingency table; histopathological analysis and/or close clinical and imaging follow-up and/or radiographic confirmation by multiple imaging modalities were used as the reference standard. Two reviewers independently extracted data. META-DiSc was used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves and the *Q index.

Results

In total, 14 articles that consisted of 34 studies fulfilled all inclusion criteria. On a per-patient basis, the pooled sensitivity estimates for PET, MRI and bone scintigraphy were 91.9, 80.0 and 91.8%, respectively. The sensitivity for PET and bone scintigraphy were significantly higher than for MRI (P < 0.05). There was no significant difference between PET and bone scintigraphy (P > 0.05). The pooled specificity estimates for PET, MRI and bone scintigraphy were 96.8, 90.6 and 68.8%, respectively. The specificity for PET was significantly higher than for MRI and bone scintigraphy (P < 0.05), and the specificity for MRI was significantly higher than for bone scintigraphy (P < 0.05). The pooled DOR estimates for PET, MRI and bone scintigraphy were 365.5, 53.8 and 34.4, respectively. The DOR for PET was significantly higher than for MRI and bone scintigraphy (P < 0.05). There was no significant difference between MRI and bone scintigraphy (P > 0.05). The SROC curve for PET showed better diagnostic accuracy than for MRI and bone scintigraphy. The SROC curve for MRI was better than for bone scintigraphy. The *Q index estimates for PET, MRI and bone scintigraphy were 0.933, 0.903 and 0.857, respectively. The *Q index for PET and MRI were significantly higher than for bone scintigraphy (P < 0.05). There was no significant difference between PET and MRI (P > 0.05). On a per-lesion basis, the pooled sensitivity estimates for PET, MRI and bone scintigraphy were 95.0, 83.8 and 71.5%, respectively. The sensitivity for PET was significantly higher than for MRI and bone scintigraphy (P < 0.05), and the sensitivity for MRI was significantly higher than for bone scintigraphy (P < 0.05). The pooled specificity estimates for PET, MRI and bone scintigraphy were 94.6, 96.3 and 91.0%, respectively. The specificity for MRI was significantly higher than for PET and bone scintigraphy (P < 0.05), and the specificity for PET was significantly higher than for bone scintigraphy (P < 0.05). The pooled DOR estimates for PET, MRI and bone scintigraphy were 431.9, 158.1 and 9.0, respectively. The DOR for PET was significantly higher than for MRI and bone scintigraphy (P < 0.05) and the DOR for MRI was significantly higher than for bone scintigraphy (P < 0.05). The SROC curve for PET and MRI showed better diagnostic accuracy than for bone scintigraphy. There was no significant difference between PET and MRI. The *Q index estimates for PET, MRI and bone scintigraphy were 0.953, 0.962 and 0.778, respectively. The *Q index for PET and MRI were significantly higher than for bone scintigraphy (P < 0.05). There was no significant difference between PET and MRI (P > 0.05).

Conclusion

¹⁸FDG PET was found to be the best modality to detect bone metastasis in patients with lung cancer, both on a per-patient basis and a per-lesion basis; MRI had the highest specificity on a per-lesion basis. For the subgroup analysis of ¹⁸FDG PET, PET/computed tomography was shown to be better than PET and there were no significant differences between using ⁶⁸Ge and computed tomography for attenuation correction on a per-patient basis.     

MRI、CT和PET-CT检查对鼻咽癌咽后淋巴结转移的诊断价值

背景与目的:三维适形调强放射治疗已成为鼻咽癌放射治疗发展的方向,靶区勾画的精确性显得尤为重要.本研究的目的是探讨MRI、CT以及18F-FDG PET-CT对鼻咽癌咽后淋巴结转移诊断的临床价值,为设计放射治疗计划提供参考.方法:收集2003年1月至2005年4月间中山大学肿瘤防治中心放疗科收治、经病理证实的初诊鼻咽癌87例,所有病例同时具有治疗前鼻咽和颈部的MRI、增强CT及PET.CT检查资料.在MRI、CT及PET-CT上分别评价鼻咽癌咽后淋巴结转移的检出率,比较采用χ2检验.结果:174侧(87例患者)咽旁间隙中,MRI、CT和PET-CT对鼻咽癌咽后淋巴结转移的检出率分别为44.8%、33.9%和24.1%.MRI对鼻咽癌咽后淋巴结转移的检出优于CT(P=0.037).MRI及CT对鼻咽癌咽后淋巴结转移的检出率高于.PET-CT,其差异均有统计学意义(P＜0.001,P=0.002).咽后淋巴结的最小径与PET-CT的标准摄取值呈正相关(r=0.832,P＜0.001).结论:MRI对咽后淋巴结转移的检出率高于CT及PET-CT.在鼻咽癌的三维适形调强放射治疗中,三者的结合应用将有利于提高靶区勾画的精确度.     

Meta-analysis of 18FDG PET-CT for nodal staging in patients with esophageal cancer

BackgroundWe aimed to evaluate the value of ¹⁸FDG PET-CT for detection of regional nodal metastasis in patients with esophageal cancer before surgery.MethodsA computer search about PET-CT original articles was conducted from January 2000 to December 2012. The reference standard was histopathologic analysis. Two reviewers independently searched articles and extracted data. Sensitivity, specificity, diagnostic odds ratio, and likelihood ratio were pooled for PET-CT using bivariate models. Summary receiver operating characteristic (SROC) curves were also used to summarize overall test performance.ResultsAcross all seven studies on a per-station analysis (2232 stations), the pooled sensitivity and speci?city with 95% confidence interval for PET-CT were 0.62 (0.40–0.79) and 0.96 (0.93–0.98). Across all 6 studies on a per-patient analysis (245 patients), corresponding values for PET-CT were 0.55 (0.34–0.74) and 0.76 (0.66–0.83).Conclusions¹⁸FDG PET-CT had lower sensitivity and accuracy for detection of regional nodal metastasis in patients with esophageal cancer before surgery.     

鼻咽癌放射治疗后FDG PET显像的临床价值

目的 探讨核医学影像诊断技术--FDG PET在鼻咽癌放射治疗后随诊中的临床价值。方法 12例鼻咽癌患者放射治疗后12～18个月同期行FDG PET和CT、MRI检查,并采用双盲法将PDG PET与CT和MRI结果进行比较,其中6例经活检病理证实,余6例经CT动态观察10个月后确诊。结果 9例CT和MRI未见肿瘤复发,PET显示其中3例有局灶性FDG代谢明显增高病变,2例CT和MRI提示肿瘤复发,FDG PET均显示局部病变有放射性摄取浓聚;该5例FDG摄取浓聚的病变处均经活检病理证实为肿瘤复发。另1例MRI提示鼻咽癌颅内转移,而FDG PET诊断为放射治疗后脑损伤,后经CT随访证实。结论 与CT和MRI检查相比,FDG PET在鼻咽癌放射治疗后肿瘤复发的早期定性诊断上具有明显的优势,若结合CT和MRI多种影像结果分析,更能提供局部病变结构与代谢改变的复合信息,尤其对局部复发病灶精确的适形放射治疗非常重要。     

Diagnostic Performance of PET/MRI in Breast Cancer: A Systematic Review and Bayesian Bivariate Meta-analysis

IntroductionBy performing a systematic review and meta-analysis, the diagnostic value of ¹⁸F-FDG PET/MRI in breast lesions, lymph nodes, and distant metastases was assessed, and the merits and demerits of PET/MRI in the application of breast cancer were comprehensively reviewed.MethodsBreast cancer-related studies using ¹⁸F-FDG PET/MRI as a diagnostic tool published before September 12, 2022 were included. The pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the curve (AUC) were calculated using Bayesian bivariate meta-analysis in a lesion-based and patient-based manner.ResultsWe ultimately included 24 studies (including 1723 patients). Whether on a lesion-based or patient-based analysis, PET/MRI showed superior overall pooled sensitivity (0.95 [95% CI: 0.92-0.98] & 0.93 [95% CI: 0.88-0.98]), specificity (0.94 [95% CI: 0.90-0.97] & 0.94 [95% CI: 0.92-0.97]), LDOR (5.79 [95% CI: 4.95-6.86] & 5.64 [95% CI: 4.58-7.03]) and AUC (0.98 [95% CI: 0.94-0.99] & 0.98[95% CI: 0.92-0.99]) for diagnostic applications in breast cancer. In the specific subgroup analysis, PET/MRI had high pooled sensitivity and specificity for the diagnosis of breast lesions and distant metastatic lesions and was especially excellent for bone lesions. PET/MRI performed poorly for diagnosing axillary lymph nodes but was better than for lymph nodes at other sites (pooled sensitivity, specificity, LDOR, AUC: 0.86 vs. 0.58, 0.90 vs. 0.82, 4.09 vs. 1.98, 0.89 vs. 0.84).Conclusion¹⁸F-FDG PET/MRI performed excellently in diagnosing breast lesions and distant metastases. It can be applied to the initial diagnosis of suspicious breast lesions, accurate staging of breast cancer patients, and accurate restaging of patients with suspected recurrence.