能量底物环境对^18F—FDG显像的影响

＾１８Ｆ－氟代脱氧葡萄糖显像时的体内能量底物环境显著影响肿瘤,心肌及脑等组织对＾１８Ｆ－ＦＤＧ的摄取,从而影响影像质量及临床对影像的分析判断。因此,根据不同的检查目的,合理控制＾１８Ｆ－ＦＤＧ显像时的能量底物环境,是提高影像质量及实现正确影像分析的基础。     

~(18)F-FDGPET显像在肿瘤学中的应用

从 (氟代脱氧葡萄糖 )在正常人体内的分布角度考虑 ,使用 PET进行 1 8F- FDG显像可应用于脑肿瘤、结直肠癌、淋巴瘤、黑色素瘤、肺癌以及头颈部肿瘤等。美国核医学会 (SNM)已报道 1 8F- FDG显像在原发性脑肿瘤、乳腺癌、骨肿瘤、肺癌、前列腺癌、黑色素瘤及淋巴瘤等中的应用。初步结果表明 ,葡萄糖代谢在坏死型及持续型生长肿瘤中有明显差别 ,当肿瘤局部 FDG利用减低 ,提示治疗后有明显效果。本文简要综述 1 8F- FDG PET显像在乳腺癌、胰腺癌、肝细胞癌、肌肉骨骼肿瘤、内分泌肿瘤、生殖泌尿道肿瘤和胃食道肿瘤中的应用。     

~(18)F-FDG PET显像检查结肠腺瘤

目的 :评估 1 8F- FDG (1 8F-氟代脱氧葡萄糖 ) PET显像对检查结肠腺瘤性息肉的价值。方法 :作为对癌症筛查的一部分 ,对 110名无症状者同时进行了 1 8F- FDG PET和结肠镜检查 ,其中男 71名 ,女 39名 ,36～ 84岁 ,平均 5 6 .5± 9.3岁。所有受检者在进行 1 8F-FDG PET检查前禁食 4h,注射 2 6 0 MBq1 8F- FDG后 45～ 6 0min进行无衰减校正的全身显像。所采集到的横断和冠状影像 ,由一名具有从事 1 8F- FDG PET显像研究肿瘤方面不少于5年的医生进行分析 ,并与结肠镜的结果进行对照。在 1 8F-FDG PET影像上 ,沿着大肠走行分布…     

~(18)F-FDG PET显像检出和分期恶性淋巴瘤

目的 :首次前瞻性研究 1 8F- FDG (1 8F-氟代脱氧葡萄糖 )PET显像检出和分期恶性淋巴瘤的临床价值。方法 :1996年 10月～ 1998年 7月 ,前瞻性检查了连续5 2例未治疗的恶性淋巴瘤 (均经组织学证实 )病人 ,其中霍奇金病 2 7例 ,非霍奇金淋巴瘤 2 5例。以 1 8F- FDG PET显像、CT和骨髓活检 (BMB)对每例的淋巴结、淋巴结以外组织和骨髓进行研究。通过活检 ,MRI或临床随访 (4～ 2 4个月 )对1 8F- FDG PET显像与 CT和 BMB间的分歧发现进行验证。1 8F- FDG平均剂量为 390 (2 30～ 5 5 0 ) MBq。 1 8F- FDG PET扫描范围包括 :上…     

乳腺癌患者手术前~(18)F-FDG PET显像分期与传统分期方法的比较

目的 :评价 1 8F-氟代脱氧葡萄糖 (1 8F- FDG) PET显像在良、恶性乳腺癌原发灶的诊断、多个肿块的测定、腋窝淋巴结转移和远端转移的准确性及与常规分期方法的比较。方法 :117例女性患者 (2 8～ 86岁 ,平均 5 6 .8岁 ,未绝经34例 ,更年期 2 3例 ,绝经 6 0例 ) ,其中 6例乳腺癌患者经过乳腺保留术治疗。所有患者手术前两周行 1 8F- FDG PET显像、X射线胸片、胸肝部超声、乳腺 X射线和骨扫描检查。1 8F- FDG PET阅片分别由 2名有经验的医生在不知患者其它影像结果及肿块位置情况下进行。传统乳腺癌分期 :乳腺和腋窝采用超声和触诊检…     

一种PET评估心肌存活的报告系统

临床上二维超声心动图用于评价心室局部室壁运动和1 8F-氟代脱氧葡萄糖 (1 8F- FDG) PET检测心肌存活的实用性及其临床价值已得到充分肯定 ,但二者检查所发现的心肌受累节段结果常有矛盾。本工作将 1 8F- FDG PET心肌代谢影像按照美国超声心动图协会二维超声心动图几何学划分左心室节段分析法 ,准确评价和定量检测室壁运动障碍节段中的存活心肌。方法 :受检者常规给予胰岛素调控血糖水平。用泵控制在 2 m in内静脉滴注 185 MBq1 8F- FDG,用 ECAT931- 0 8/ 12PET进行心肌葡萄糖代谢显像。给药后以 30 s/帧采集第 1帧 (作为本底对…     

~(18)F-FDG代谢显像预测胃食道结合部腺癌术前化疗反应

目的 :由于缺乏监测肿瘤化疗反应的可靠方法 ,胃食道结合部癌病人术前化疗与否尚存争议。现探讨 1 8F- FDG(1 8F-氟代脱氧葡萄糖 ) PET显像能否预测早期肿瘤化疗反应。方法 :研究对象是连续 40例胃食道结合部局部晚期腺癌病人 ,每例术前接受两个疗程 (每疗程 36 d)以顺铂为基础的联合化疗 ,化疗前与第一疗程后 14d分别行 1 8F- FDG PET显像 (每例每次静脉注射 1 8F- FDG2 5 0～ 370 MBq)。应用内镜和标准影像技术评估化疗临床反应 (肿瘤长度和厚度均减少5 0 %以上为有临床反应 )。完成化疗后 3～ 4周手术切除肿瘤 ,以组织病理学检…     

18F-FDG PET延迟显像能鉴别胰腺良恶性损害

目的 :因炎性病变 1 8F-氟代脱氧葡萄糖 (1 8F- FDG)的浓聚 ,使 1 8F- FDG PET对病变的良恶性难以准确鉴别。日本京都大学医院核医学科根据动物实验肿瘤与炎性损害 1 8F- FDG浓聚的动态差异 ,对以 1 8F- FDG PET延迟显像鉴别胰腺良恶性损害进行了前瞻性研究。方法 :47例疑为恶性胰腺肿瘤者通过手术 (n=31)和放射学或临床随访 (n=16 ) ,最后证实 2 7例为胰腺癌 ,2 0例为胰腺炎。所有病人均于静脉注射 1 8F- FDG370 MBq后 1h和2 h行 PET扫描 ,其中 19例注射后 3h再次重复扫描。根据1 8F- FDG的标准摄取值 (SUV )和滞留指数 (…     

~(18)F-FDGPET和~(99)Tc~m标记抗体片段免疫显像法探测结肠直肠癌复发

目的 :以 99Tcm直接标记抗 CEA(癌胚抗原 )单克隆抗体Fab′片段——一种新的单克隆抗体显像剂探测结肠直肠癌复发与 1 8F- FDG(1 8F-氟代脱氧葡萄糖 ) PET作比较。方法 :2 8例经治疗的结肠直肠癌患者 ,疑有复发而作1 8F- FDG PET和免疫显像法检查。最常见的指征为血清CEA升高 (13例 ) ,CT提示病灶 (9例 ) ,声像图检查 (4例 )和严重便秘 (2例 )。静脉注射新显像剂后 4～ 6 h作平面显像和SPECT显像。静脉注射 1 8F- FDG后 45～ 6 0 min作全身 PET显像。以常规诊断方式、手术和组织学证实其结果。结果 :2 8例患者中 9例组织学证…     

用~(99)Tc~m-tetrofosm in和~(18)F-FDG校正SPECT评价心肌灌注和存活能力

目的 :心肌灌注 -代谢不匹配主要由 PET检测。近来 ,将1 8F-氟代脱氧葡萄糖 (1 8F- FDG)与 99Tcm标记的灌注示踪剂相结合 ,用双同位素同时采集 (DISA) SPECT来检测灌注 -代谢不匹配心肌 ,便可提供与 PET等同的临床信息。此研究用99Tcm- tetrofosmin和 1 8F- FDG DISA SPECT显像评价心肌灌注和存活能力时交互校正的用途。方法 :选择 18例冠状动脉疾病病人 (14男 ,4女 ,平均 6 4岁 ) ,注入 740 MBq99Tcm - tetrofosmin后 ,用双探头、低能高分辨准直器进行 SPECT研究 ;采集完后 ,口服 75 g葡萄糖 ,再静脉注入 1 8F- FDG 370…     

Euglycemic hyperinsulinemic clamp and oral glucose load in stimulating myocardial glucose utilization during positron emission tomography.

To enable assessment of myocardial viability, myocardial glucose utilization has commonly been stimulated by oral glucose loading. To compare the effects of glucose loading and insulin and glucose infusion (insulin clamp) on PET fluorodeoxyglucose ([18F]FDG) myocardial scan image quality and regional myocardial glucose utilization rate (rMGU), eight patients with angiographically documented coronary artery disease and previous myocardial Q-wave infarction were studied twice, once during insulin clamp and once 1 hr after oral glucose loading. The rMGU rates were derived by graphic Patlak analysis in 33 normal, 10 scar and 6 "hot spot" myocardial segments. Infusion of insulin and glucose gave stable plasma-glucose and serum-insulin levels during imaging. In contrast, glucose loading caused marked changes in plasma-glucose and insulin concentrations. The image quality was clearly superior and the fractional utilization rates of [18F]FDG were twice as high during insulin clamp than after glucose loading (p less than 0.0001). Due to the higher plasma-glucose levels after glucose loading, the calculated rMGU in normal, scar and hot spot myocardial segments was comparable between the two protocols. The insulin clamp technique makes it possible to adjust and maintain a metabolic steady state during the PET study. It does not alter [18F]FDG uptake patterns in different myocardial areas when compared to the standard glucose loading protocol, but this technique results in superior image quality and permits the use of smaller [18F] FDG patient doses.     

Feasibility of dual-isotope coincidence/single-photon imaging of the myocardium.

Hybrid PET scanners offer the possibility of obtaining myocardial viability information from coincidence imaging of the positron emitter (18)F-FDG and perfusion measurements from a single-photon tracer-potentially simultaneously. This new approach is less costly and more readily available than dedicated PET and offers potential for improved FDG resolution and sensitivity compared with SPECT with 511-keV collimators. Simultaneous imaging of the coincidence and single-photon events offers the further advantages of automatic image registration and reduced imaging time. However, the feasibility of simultaneous coincidence/single-photon imaging or even immediately sequential imaging is unknown. In this study, the potential of using standard low-energy high-resolution (LEHR) collimators with hybrid PET to obtain coincidence and SPECT data was assessed. METHODS: Phantom and human studies were performed to investigate the effect of LEHR collimators on FDG coincidence imaging with a hybrid PET system, the effect of the presence of (99m)Tc during FDG coincidence imaging with LEHR collimators, and the effect of the presence of FDG during (99m)Tc SPECT imaging. RESULTS: FDG images were somewhat degraded (a measure of myocardial nonuniformity increased 10%) with LEHR collimators. With 148 MBq (4 mCi) (99m)Tc present during FDG imaging of a phantom, image quality was maintained and the number of detected coincidences changed by <5%. With (99m)Tc/(18)F whole-body ratios of 7:1, crosstalk from (18)F photons accounted for the majority of counts in the (99m)Tc SPECT images and resulted in severe artifacts. The artifacts were decreased with a simple crosstalk correction scheme but remained problematic. CONCLUSION: (99m)Tc/(18)F ratios of at least 9:1 and state-of-the-art reconstruction and crosstalk correction are likely to be required to perform immediately sequential coincidence/single-photon imaging of the myocardium with clinically useful results. Additional challenges remain before simultaneous imaging of coincidence events and single photons can be realized in practice.     

16例颅内胶质瘤术后并放射治疗后的18F-FDG PET显像

目的　探讨18F 脱氧葡萄糖 (FDG)PET在颅内胶质瘤术后并放射治疗后随诊中的临床价值。方法　对 16例颅内胶质瘤术后并放射治疗后的患者同期行18F FDGPET和CT、MRI检查 ,采用双盲法对结果进行比较。结果　 16例中 87 5 % (14例 )CT和 (或 )MRI表现不规则环形或结节状明显强化 ,不能准确作出手术后改变和 (或 )放射治疗后脑损伤、残存肿瘤或肿瘤复发的诊断 ;其中 9例残存肿瘤或肿瘤复发病灶18F FDGPET影像表现为葡萄糖代谢明显增高 ,有 5例得到手术病理证实 ;另 5例术后放射治疗后脑损伤患者和 2例术后软化灶18F FDGPET影像均显示局部病变区为放射性分布缺损或明显低下。结论　18F FDGPET在胶质瘤术后放射治疗后的脑损伤和肿瘤复发的定性诊断上具有明显的优势 ,结合CT和MRI更能提供病变解剖结构和功能改变的综合信息。     

Early diagnosis and follow-up of aortitis with [18F]FDG PET and MRI

The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) with magnetic resonance imaging (MRI) in patients with early aortitis, at the time of initial diagnosis and during immunosuppressive therapy. The study population consisted of 15 patients (nine females and six males; median age 62 years, range 26-76 years) who presented with fever of unknown origin or an elevated erythrocyte sedimentation rate or elevated C-reactive protein and who showed pathological aortic [(18)F]FDG uptake. Fourteen of these patients had features of early giant cell arteritis (GCA), while one had features of early Takayasu arteritis. During follow-up, seven PET scans were performed in six patients with GCA 4-30 months (median 19 months) after starting immunosuppressive medication. The results of [(18)F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [(18)F]FDG uptake was present in 59/104 (56%) of the vascular regions studied in 15 patients. Seven follow-up PET studies were performed in six patients. Of 30 regions with initial pathological uptake in these patients, 24 (80%) showed normalisation of uptake during follow-up. Normalisation of [(18)F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [(18)F]FDG uptake were investigated with MRI and MRA. Thirteen of these 14 patients showed inflammation in at least one vascular region. Of 76 vascular regions studied, 41 (53%) showed vasculitis on MRI. Of 76 vascular regions studied with both PET and MRI, 47 were concordantly positive or negative on both modalities, 11 were positive on MRI only and 18 were positive on PET only. MRI was performed during follow-up in six patients: of 17 regions with inflammatory changes, 15 regions remained unchanged and two showed improvement. Whole-body [(18)F]FDG PET is valuable in the primary diagnosis of early aortitis. The results of [(18)F]FDG PET and MRI in the diagnosis of aortitis in this study were comparable, but FDG imaging identified more vascular regions involved in the inflammatory process than did MRI. In a limited number of patients [(18)F]FDG PET was more reliable than MRI in monitoring disease activity during immunosuppressive therapy.     

Coincidence camera FDG imaging for the diagnosis of chronic orthopedic infections: a feasibility study

PURPOSE: Results of dedicated [(18)F]fluoro-2-deoxy-d-glucose (FDG) PET imaging in patients with suspected orthopedic infections are promising. This study evaluates the feasibility of dual-head gamma-camera coincidence (DHC) imaging in this population. METHOD: Twenty-four patients, referred for the confirmation or exclusion of orthopedic infection, were prospectively studied with consecutive FDG-dedicated PET and FDG DHC imaging. Images were read by two blinded readers experienced with FDG PET and compared with the final diagnosis, obtained by microbiologic proof in 11 patients and clinical follow-up of at least 9 months in 13 patients. RESULTS: Nine patients had osseous infection on final diagnosis. Sensitivity, specificity, and accuracy in this limited series were (Reader 1/Reader 2), respectively, 100/100, 86/86, and 92/92% for FDG-dedicated PET and 89/89, 100/93, and 96/92% for FDG DHC imaging. CONCLUSION: Despite lower image quality for FDG DHC imaging, results in this limited series were comparable with the results of FDG-dedicated PET. Further studies are needed to confirm the utility of FDG DHC imaging in suspected chronic orthopedic infections in larger patient groups.     

Evaluation of F-18-labeled amino acid derivatives and [18F]FDG as PET probes in a brain tumor-bearing animal model

2-Deoxy-2-[(18)F]fluoro-d-glucose ([(18)F]FDG) has been extensively used as positron emission tomography (PET) tracer in clinical tumor imaging. This study compared the pharmacokinetics of two (18)F-labeled amino acid derivatives, O-2-[(18)F]fluoroethyl-l-tyrosine (l-[(18)F]FET) and 4-borono-2-[(18)F]fluoro-l-phenylalanine-fructose (l-[(18)F]FBPA-Fr), to that of [(18)F]FDG in an animal brain tumor model. METHODS: A self-modified automated PET tracer synthesizer was used to produce no-carrier-added (nca) l-[(18)F]FET. The cellular uptake, biodistribution, autoradiography and microPET imaging of l-[(18)F]FET, l-[(18)F]FBPA-Fr and [(18)F]FDG were performed with F98 glioma cell culture and F98 glioma-bearing Fischer344 rats. RESULTS: The radiochemical purity of l-[(18)F]FET was >98% and the radiochemical yield was 50% in average of 16 runs. The uptake of l-[(18)F]FET and l-[(18)F]FBPA-Fr in the F98 glioma cells increased rapidly for the first 5 min and reached a steady-state level after 10 min of incubation, whereas the cellular uptake of [(18)F]FDG kept increasing during the study period. The biodistribution of l-[(18)F]FET, l-[(18)F]FBPA-Fr and [(18)F]FDG in the brain tumors was 1.26+/-0.22, 0.86+/-0.08 and 2.77+/-0.44 %ID/g at 60 min postinjection, respectively, while the tumor-to-normal brain ratios of l-[(18)F]FET (3.15) and l-[(18)F]FBPA-Fr (3.44) were higher than that of [(18)F]FDG (1.44). Both microPET images and autoradiograms of l-[(18)F]FET and l-[(18)F]FBPA-Fr exhibited remarkable uptake with high contrast in the brain tumor, whereas [(18)F]FDG showed high uptake in the normal brain and gave blurred brain tumor images. CONCLUSION: Both l-[(18)F]FET and l-[(18)F]FBPA-Fr are superior to [(18)F]FDG for the brain tumor imaging as shown in this study with microPET.     

Parametric images of myocardial metabolic rate of glucose generated from dynamic cardiac PET and 2-[18F]fluoro-2-deoxy-d-glucose studies

We describe a method for generating parametric images of the myocardial metabolic rate of glucose (MMRGlc) with positron emission tomography (PET). The method employs serially acquired images of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake and a Patlak graphical analysis of the image data. The arterial input function is derived from images of the left ventricular blood pool calibrated with 18F-plasma measurements. The approach is computationally fast enough to be used in a clinical environment. The MMRGlc parametric images improve myocardial contrast relative to non-parametric images, especially in studies with poor myocardial uptake of FDG. In addition, MMRGlc parametric images consolidate the large amount of data in a dynamic PET study into a clinically usable image set.     

Feasibility, safety and image quality of cardiac FDG studies during hyperinsulinaemic-euglycaemic clamping

Fluorine-18 fluorodeoxyglucose (FDG) imaging for the assessment of myocardial viability has become an integral part of the diagnostic and prognostic work-up of patients with ischaemic cardiomyopathy. To ensure good image quality, in particular in patients with diabetes mellitus, hyperinsulinaemic-euglycaemic clamping has been proposed. In this study we evaluated the safety and the image quality of cardiac FDG imaging during clamping in a large group of patients, including a subgroup with diabetes mellitus. The incidence of viability (on both a segment and a patient basis) was also determined for patients with and without diabetes mellitus. The safety and image quality of cardiac FDG studies during clamping were evaluated in 131 patients, including 19 with diabetes mellitus. Image quality was assessed visually and quantitatively using heart-to-lung (H/L), heart-to-liver (H/Li) and myocardium-to-background (M/B) ratios. Blood samples were drawn at baseline and at the time of FDG injection to determine levels of glucose, free fatty acids and insulin. The metabolic circumstances were optimal for FDG imaging: high insulin levels, low free fatty acid levels and glucose levels in the normal range (levels of substrates were comparable between patients with and patients without diabetes mellitus). No serious side-effects occurred in any patient. Image quality (assessed visually) was good in all patients. The quantitative parameters of image quality (H/L, H/Li and M/B) were comparable between patients with and patients without diabetes mellitus. The incidence of viability was high: 38% of patients without and 58% of patients with diabetes mellitus had substantial viability despite contractile dysfunction. It is concluded that cardiac FDG imaging during clamping is safe and provides excellent image quality, including in patients with diabetes mellitus. The incidence of viability is high, in particular in patients with diabetes mellitus.     

18F]fluorodeoxyglucose scintigraphy in diagnosis and follow up of treatment in advanced breast cancer

Seventeen patients with advanced breast cancer were imaged with a specially collimated gamma camera to study tumor uptake of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) before and during therapy. Fourteen patients (82%) showed increased FDG accumulation in metastatic tumors, 6/8 (75%) of axillary, supra or infraclavicular metastatic lymph nodes were detectable. In one of these cases, FDG imaging was the first method to identify axillary metastasis causing nerve compression. Also, pulmonary and liver metastases could be imaged with FDG; both in two patients. The intra individual variability in uptake was considerable in bone metastases, and some lesions remained FDG negative: 99mTc-DPD was superior in detecting bone disease. Bone metastases of the osteolytic or mixed type were better visualized than sclerotic ones. Ten patients were reimaged later to assess the effect of therapy on FDG uptake. Increased uptake was associated with clinical progression, while unchanged or diminished uptake did not predict the course of disease as reliably. This study indicates that FDG can be used to image breast cancer metastases. FDG may be valuable in monitoring treatment response, but positron emission tomography (PET) would probably be more appropriate than planar imaging for this purpose.