依据 PET／CT、CT 图像勾画非小细胞肺癌肿瘤大体靶区对比观察

目的：对比观察PET/CT图像、CT图像在Ⅲ期非小细胞肺癌（ NSCLC）肿瘤大体靶区（ GTV）的勾画。方法Ⅲ期NSCLC患者30例,采用PET/CT胸部放疗定位,将PET/CT图像传输至计划系统,由4位放射肿瘤医师分别先后依据CT图像和PET/CT图像目测勾画GTV,包括肺部原发灶和转移淋巴结,分别表示为GTVct和GTVpet/ct ,并进行比较。结果30例患者的GTVpet/ct为（147．4±7．1）cm3,GTVct为（192．0±22．0）cm3,两者比较P＝0．025。有8例GTVpet/ct大于GTVct ,其中2例体积变化＞25％;有22例GTVpet/ct小于GTVct ,其中13例体积变化＞25％。15例体积变化＞25％的患者均为中心型肺癌,6例周围型肺癌GTV体积变化在20％以内。不同勾画者勾画的GTV之间无统计学差异,但是依据PET/CT图像勾画的GTV体积变异较单纯依据CT图像勾画的体积变异减小。结论PET/CT图像较CT图像能更准确地确定伴有阻塞性肺不张肺癌的原发灶以及更准确地确定转移淋巴结范围,减小勾画者之间的主观差异,更好地指导Ⅲ期NSCLC患者靶区的勾画。     

~(99m)Tc-MIBI SPECT/CT显像联合超声对继发性甲状旁腺功能亢进症患者甲状腺内异位甲状旁腺的术前定位

目的探讨~(99m)Tc-甲氧基异丁基异腈(Tc-99m methoxyisobutylisonitrile,~(99m)Tc-MIBI)单光子发射计算机断层扫描/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)显像联合超声对继发性甲状旁腺功能亢进症(hyperparathyroidism,HPT)术前异位病灶的定位诊断价值。方法回顾2013年9月至2018年12月经东南大学医学院附属江阴医院手术及病理证实的67例继发性HPT患者的影像资料,由多学科团队分析甲状腺内异位甲状旁腺(ectopic intrathyroid parathyroid gland,ETPG)的~(99m)Tc-MIBI SPECT/CT显像及超声表现。结果 67例患者中,3例经术中探查和术后病理证实为ETPG,其中ETPG异位于右侧甲状腺内1枚,异位于左侧甲状腺内2枚。术前~(99m)Tc-MIBI SPECT/CT显像检出2枚;经多学科讨论后由经验丰富的超声医师二次检查后检出1枚; 1枚ETPG并发同侧结节性甲状腺肿~(99m)Tc-MIBI SPECT/CT显像及超声均漏诊,该例还并发甲状腺微小乳头状癌,术前由超声检出。结论联合应用~(99m)TcMIBI SPECT/CT显像及超声对ETPG有较好的术前定位诊断价值,建立长期密切协作的多学科合作模式有助于提高ETPG的定位准确性。     

Clinical usefulness of ^18F-FDG PET/CT in the restaging of esophageal cancer after surgical resection and radiotherapy

AIM： To evaluate the clinical usefulness of lSF-fluorodeoxyglucose positron emission and computed tomography QSF-FDG PET/CT） in restaging of esophageal cancer after surgical resection and radiotherapy. METHODS： Between January 2007 and Aug 2008, twenty histopathologically diagnosed esophageal cancer patients underwent 25 PET/CT scans （three patients had two scans and one patient had three scans） for restaging after surgical resection and radiotherapy. The standard reference for tumor recurrence was histopathologic confirmation or clinical follow-up for at least ten months after ^18F-FDG PET/CT examinations. RESULTS： Tumor recurrence was confirmed histopathologically in seven of the 20 patients （35%） and by clinical and radiological follow-up in 13 （65%）. ^18F-FDG PET/CT was positive in 14 patients （68.4%） and negative in six （31.6%）. ^18F-FDG PET/CT was true positive in 11 patients, false positive in three and true negative in six. Overall, the accuracy of ^18F-FDG PET/CT was 85%, negative predictive value （NPV） was 100%, and positive predictive value （PPV） was 78.6%.The three false positive PET/CT findings comprised chronic inflammation of mediastinal lymph nodes （n = 2） and anastomosis inflammation （n = 1）. PET/ CT demonstrated distant metastasis in 10 patients. ^18F-FDG PET/CT imaging-guided salvage treatment in nine patients was performed. Treatment regimens were changed in 12 （60%） patients after introducing ^18F-FDG PET/CT into their conventional post-treatment follow-up program. CONCLUSION： Whole body ^18F-FDG PET/CT is effective in detecting relapse of esophageal cancer after surgical resection and radiotherapy. It could also have important clinical impact on the management of esophageal cancer, influencing both clinical restaging and salvage treatment of patients.