~(18)F-FDG符合线路PET/CT联合增强CT在老年胰腺癌临床诊治中的应用价值

目的研究~(18)F-FDG符合线路正电子发射计算机及扫描(PET)/计算机断层扫描(CT)联合增强CT在老年胰腺癌临床诊治中的应用价值。方法选取40例疑似胰腺癌老年患者作为研究对象,最后经手术病理确诊。回顾性分析所有入选对象的~(18)F-FDG符合线路PET/CT、增强CT检测相关资料,观察并比较各种检测方法在老年胰腺癌诊断方面的灵敏度与特异度、准确率。结果 ~(18)F-FDG PET/CT检测显示,胰腺癌假阴性率为21.4%(3/14),假阳性率为11.5%(3/26);增强CT检测显示,胰腺癌假阴性率为43.7%(7/16),假阳性率为20.8%(5/24);联合检测显示,胰腺癌假阴性率为0.0%(0/13),假阳性率为3.7%(1/27)。~(18)F-FDG符合线路PET/CT单独检测的灵敏度与特异度、准确率依次分别为88.5%、78.6%、85.0%;增强CT单独检测的灵敏度与特异度、准确率依次分别为73.1%、64.3%、70.0%;~(18)F-FDG符合线路PET/CT联合增强CT检测的灵敏度与特异度、准确率依次分别为100.0%、92.9%、97.5%。结论 ~(18)F-FDG符合线路PET/CT、增强CT单独检测对临床医学诊治老年胰腺癌均具有一定参考意义;但两者联合检测能明显提高老年胰腺癌诊治灵敏度与特异度、准确率,临床应用与参考价值高。     

PET和PET／CT在食管癌中的临床应用价值

PET和PET／CT作为一种以显示器官功能和代谢状态为特征的技术,在鉴别肿瘤性质、发现隐匿病灶等方面具有无创性、高敏感性、高准确性等优点,现将其在食管癌诊治中的应用综述如下。     

PET／CT在胰腺癌诊断、分期及预后中的价值

时至今日,胰腺癌仍是预后最差的？肖化道恶性肿瘤之一,5年生存率约为6％。由于胰腺癌发病早期临床症状多不典型,患者就诊时多为晚期而丧失手术机会。根治性切除术（R0切除）是唯一可能治愈胰腺癌的方式,但只有15％～20％患者可行手术治疗,根治术后5年生存率仅为15％～27％]。     

PET/CT在结直肠癌术前应用的现状和进展

结直肠癌是我国最常见的恶性肿瘤之一,早期诊断和准确的分期分级有助于明确治疗方案,改善患者的预后和生命质量。随着PET/CT的快速发展,其在结直肠癌术前诊断、分期分级、预后评估等方面发挥重要的作用。本文就PET/CT在结直肠癌术前应用的现状和进展作一综述。     

PET/CT在肺癌中的应用价值

肺癌在许多国家是首位的癌症致死原因，因此早期诊断并及时手术切除显得尤为重要。随着CT(computed tomography)技术的进步与发展．扫描方法的改进，使得大部分肺癌都能得到及时准确的诊断。但对一部分表现为孤立性肺结节(solitary pulmonary nodule，SPN)的肺癌仅依据其形态学特征仍然难以确定；对纵隔淋巴结的术前分期，CT仅依据淋巴结的大小来判     

PET／CT 在恶性淋巴瘤疗效评估中的应用

恶性淋巴瘤是全球增长最迅速的恶性肿瘤之一,发病率每年以4％～5％的速度增长。北京市卫生局2012年发布的白皮书显示,北京市淋巴瘤发病率从2001年的4．37例／10万人上升至2010年的9．13例／10万人,增幅超过1倍。最新的全国调查数据显示,中国淋巴瘤发病率女性上升至第11位,2011年全国淋巴瘤发病率已达到6．43例／10万。淋巴瘤分型复杂,按照《WHO淋巴系统肿瘤病理分类标准》,目前已知淋巴瘤有近70种病理类型,大体可分为霍奇金淋巴瘤（HL,约占10％）和非霍奇金淋巴瘤（NHL,约占90％）两类。     

老年肺不张病人18F-FDG PET/CT显像特点

<正>肺不张是指由于肺部阻塞而引起一侧性肺叶或肺小叶的肺泡内空气消失、体积缩小,从而导致肺萎陷的症状〔1〕。本文分析我中心行PET/CT显像的肺不张病人的资料,旨在评估PET/CT显像在肺不张病人中的诊断价值。1材料与方法1.1一般材料对在PET/CT中心2010年4月至2014年2月的159例CT或X线胸片示肺不张的病人行PET/CT显像,男123例,女36例,年龄62⁸3〔平均(69.2±10.8)〕岁。所有病人均行PET/CT扫描后行气管镜检查或超声引导下经气道     

18 F-FDG PET/CT在肺孤立性磨玻璃结节中的临床诊断价值

磨玻璃结节(ground glass nodules,GGNs)是肺部结节中的一种特殊类型,指肺内局灶性、结节状、淡薄密度增高影,结节内部原有结构如血管、气道及小叶间隔仍可见。GGNs可分为两大类,其中不含实性成分的为单纯性GGNs(pure GGNs,pGGNs);伴有实性成分、掩盖部分肺纹理的为混合性GGNs(mixed GGNs,m GGNs)或部分实性GGNs(part-solid GGNs)。     

PET/CT诊断恶性胸膜间皮瘤的研究进展

［摘要］　近年来随着PET/CT成像技术的广泛应用,目前已成为临床医师诊断恶性胸膜间皮瘤和评估治疗预后的重要手段。现就PET/CT诊断恶性胸膜间皮瘤的研究进展作一综述。     

PET/CT联合多项检查在肺癌诊断中的价值

目的探讨PET/CT联合肿瘤标志物与电子支气管镜检查在肺癌诊断中的应用价值,并进行对比分析。方法收集2011年5月~2012年5月在我院PET/CT中心检查发现肺部病变患者68例,对纳入患者均进行了肿瘤标志物、电子支气管镜检查或经皮肺穿或手术取组织行病理学检查。结果 68例患者中,电子支气管镜、PET/CT、PET/CT联合肿瘤标志物检测对肺癌诊断的灵敏度、特异度及准确度分别为62.2%、93.5%及76.4%;81.8%、74.9%及77.9%;91.9%、77.4%及85.3%。结论电子支气管镜检查的特异度较PET/CT显像检查高,而灵敏度较PET/CT显像检查低,二者的准确度基本相近,PET/CT与血清肿瘤标志物检测联合应用后可使灵敏度、特异度、准确度均有提高,可减少误诊或漏诊的发生。     

The Impact of 18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography on the Staging and Management of Primary Rectal Cancer

Purpose  18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) has a role in recurrent colorectal cancer. This study was designed to assess the impact of PET-CT on management of primary rectal cancer. Methods  Eighty-three patients with rectal cancer underwent PET-CT scan between 2002 and 2005. Referring physicians prospectively recorded stage and management plan after conventional imaging before PET-CT scan, which were compared to subsequent stage and management after PET-CT. Results  Staging PET-CT caused a change in stage from conventional imaging in 26 patients (31 percent). Twelve (14 percent) were upstaged (7 change in N stage; 4 change in M stage; 1 change in N and M stage), and 14 (17 percent) were downstaged (10 change in N stage; 3 change in M stage; 1 change in N and M stage). PET-CT scan altered management intent in seven patients (8 percent) (curative to palliative 6 patients; palliative to curative 1 patient). Management was altered in ten patients (12 percent). There was no difference in impact with respect to tumor height. Conclusions  PET-CT scan impacts the management of patients with primary rectal cancer and influences staging/therapy in a third of patients and should be a component of rectal cancer workup. Read at the meeting of The American Society of Colon and Rectal Surgeons, St Louis, Missouri, June 2 to 6, 2007.     

Diagnosis and management of pancreatic cancer in adults: A summary of guidelines from the UK National Institute for Health and Care Excellence

To enable standardisation of care of pancreatic cancer patients and facilitate improvement in outcome, the United Kingdom's National Institute for Health and Care Excellence (NICE) developed a clinical guideline for the diagnosis and management of pancreatic cancer in adults. Systematic literature searches, systematic review and meta-analyses were undertaken. Recommendations were drafted on the basis of the group's interpretation of the best available evidence of clinical and cost effectiveness. There was patient involvement and public consultation. Recommendations were made on: diagnosis; staging; monitoring of inherited high risk; psychological support; pain; nutrition management; and the specific management of people with resectable-, borderline-resectable- and unresectable-pancreatic cancer. The guideline committee also made recommendations for future research into neoadjuvant therapy, cachexia interventions, minimally invasive pancreatectomy, pain management and psychological support needs. These NICE guidelines aim to promote best current practice and support and stimulate research and innovation in pancreatic cancer.     

Utility of fusion CT-PET in the diagnosis of small pancreatic carcinoma

Pancreatic carcinoma has a poor prognosis and early detection is essential for potentially curative resection. Despite the wide array of diagnostic tools, preoperative detection of small pancreatic carcinomas remains difficult. We report a case of small pancreatic carcinoma of the head of pancreas with indeterminate findings on US, ERCP, MRI and EUS which was successfully diagnosed via fusion CT-PET. This case illustrates the utility of CT-PET in the diagnosis of patients with small pancreatic carcinoma with equivocal findings on conventional diagnostic modalities.     

Mediastinal node staging by positron emission tomography-computed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer: Results from a regional centre

AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.     

The role of 18fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer

BackgroundThe role of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.Methods¹⁸Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.ResultsOverall, 21% of patients had a maximum standardized uptake value ≤3, and 60% of those had undergone neoadjuvant treatment (P = 0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P = 0.112).ConclusionsThe widespread application of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9 > 200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.     

Surgical management of patients with bowel obstructions secondary to gastric cancer

AIM: To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment strategies. METHODS: The medical records of all of the patients who were admitted for an intestinal obstruction after curative resection for gastric cancer were retrospectively reviewed. PET/CT was performed before a clinical treatment strategy was established for each patient. The patients were divided into 2 groups: patients with no evidence of a tumor recurrence and patients with evidence of a tumor recurrence. Tumor recurrences included a local recurrence, peritoneal carcinomatosis or distant metastases. The primary endpoint was the 1-year survival rate, and other variables included patient demographics, the length of hospital stay, complications, and mortality. RESULTS: The median time between a diagnosis of gastric cancer and the detection of a SBO was 1.4 years. Overall, 31 of 65 patients (47.7%) had evidence of a tumor recurrence on the PET/CT scan, which was the only factor that was associated with poor survival. Open and close surgery was the main type of surgical procedure reported for the patients with tumor recurrences. R0 resections were performed in 2 patients, including 1 who underwent combined adjacent organ resection. In the group with no evidence of a tumor recurrence on PET/CT, bowel resections were performed in 7 patients, adhesiolysis was performed in 7 patients, and a bypass was performed in 1 patient. The 1-year survival curves according to PET/CT evidence of a tumor recurrence vs no PET/CT evidence of a tumor recurrence were significantly different, and the 1-year survival rates were 8.8% vs 93.5%, respectively. There were no significant differences (P = 0.71) in the 1-year survival rates based on surgical vs nonsurgical management (0% with nonoperative treatment vs 20% after exploratory laparotomy). CONCLUSION: 18 F-FDG PET/CT can be used to identify the causes of bowel obst     

~（18）F-fluorodeoxyglucose positron emission tomography in the diagnosis of small pancreatic cancer

AIM:To investigate the role of 18 F-fluorodeoxyglucose positron emission tomography(FDG-PET) in the diagnosis of small pancreatic cancer. METHODS:This study involved 31 patients with proven invasive ductal cancer of the pancreas.The patients were divided into 3 groups according to the maximum diameter of the tumor:TS1(maximum tumor size≤2.0 cm) ,TS2(>2.0 cm and≤4.0 cm) or TS3-4(>4.0 cm) .The relationships between the TS and various diagnostic tools,including FDG-PET with dual time point evaluation,were anal...     

SUVmax after (18)fluoro-deoxyglucose positron emission tomography/computed tomography: A tool to define treatment strategies in pancreatic cancer

Background(18)fluoro-deoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) might be a useful tool in the management of pancreatic ductal adenocarcinoma (PDAC).AimsThe aim of this study was to analyze maximum standard uptake value (SUVmax) after 18FDG-PET/CT as predictor of survival outcomes and method to determine treatment strategies.MethodsA consecutive series of patients who underwent preoperative 18FDG-PET/CT and subsequent resection for PDAC were retrospectively reviewed. Patients who underwent neoadjuvant chemotherapy were excluded.Results46 patients were included in the analysis. Median follow-up was 27 months (4–67). Patients who recurred within 12 months showed a significantly higher preoperative median SUVmax (8.1 vs 6.1, p = 0.039). Receiver operating characteristics (ROC) curves for disease-free survival (DFS) and disease-specific survival (DSS) identified SUVmax of 6.0 as optimal cut-off. Multivariate analysis showed that SUVmax ≥ 6.0 was an independent predictor of poor DFS (HR 2.288, p = 0.024) and DSS (HR 4.875, p < 0.001). The combination of SUVmax ≥6.0 with CA19.9 ≥200 U/ml was significantly associated with survival outcomes in comparison to patients without concordantly elevated values.ConclusionSUVmax ≥6.0 is an independent predictor of DFS and DSS in resected PDAC. 18FDG-PET/CT might be considered in the preoperative evaluation of patients with pancreatic cancer.     

Difficulty in differentiating two cases of sigmoid stenosis by diverticulitis from cancer

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging. The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%. However, few cases of stenosis due to diverticulitis have been reported. These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult. This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer. Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS). CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon. Barium enema revealed a marked, hourglass-shaped, 2-cm circumferential stenosis in the sigmoid colon. Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon. Sigmoid colon cancer was suspected, and laparoscopic sigmoidectomy was performed. Pathological examination demonstrated active inflammation with no evidence of malignancy. Case 2 was a 50-year-old man who presented to a nearby clinic with reduced stool output despite the urge to defecate. CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line. Contrast-enhanced abdominal CT revealed multiple diverticula, wall thickening, and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery. A partial sigmoidectomy was performed. Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface, but a marked infiltration of inflammatory cells was observed.     

Histone methylation in pancreatic cancer and its clinical implications

Pancreatic cancer (PC) is an aggressive human cancer. Appropriate methods for the diagnosis and treatment of PC have not been found at the genetic level, thus making epigenetics a promising research path in studies of PC. Histone methylation is one of the most complicated types of epigenetic modifications and has proved crucial in the development of PC. Histone methylation is a reversible process regulated by readers, writers, and erasers. Some writers and erasers can be recognized as potential biomarkers and candidate therapeutic targets in PC because of their unusual expression in PC cells compared with normal pancreatic cells. Based on the impact that writers have on the development of PC, some inhibitors of writers have been developed. However, few inhibitors of erasers have been developed and put to clinical use. Meanwhile, there is not enough research on the reader domains. Therefore, the study of erasers and readers is still a promising area. This review focuses on the regulatory mechanism of histone methylation, and the diagnosis and chemotherapy of PC based on it. The future of epigenetic modification in PC research is also discussed.