Increased Utilization of Positron Emission Tomography/Computed Tomography (PET/CT) Imaging and Its Economic Impact for Patients Diagnosed With Bladder Cancer

Background

The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer.

FDG PET/CT在精确放疗中应用的初步研究

目的：研究FDG PET/CT在肿瘤病例中的成像特点和对精确放疗的影响.方法：2009年8月至2011年5月,72例肿瘤患者在放疗前接受GE Discovery PET/CT定位扫描.图像资料传至Varian Eclipse 8.6治疗计划系统.将FDG在各组织器官及肿瘤病灶中的聚积水平分为四个等级（＋-＋＋＋＋）,分析PET成像特点并探讨PET/CT图像融合对放疗的影响.结果：通常情况下,肿瘤病灶和正常脑组织、膀胱肾盏肾盂FDG聚积水平最高（＋＋＋＋）;肝脏、脾脏、椎体次之（＋＋＋）;大部分肌肉和胃肠道、胰腺FDG稍低（＋＋）;肺和皮肤最低（＋）.非肿瘤性FDG高聚积多见于左心室、咽喉周围、局部肠道内以及创伤或炎症病变等部位.PET/CT图像融合使肿瘤病灶更易被发现,因此约22％病例病灶数增加.此外,约62.5％放疗靶区受PET/CT融合图像影响发生了较明显改变.结论：FDG PET/CT在放疗的应用有利于复杂解剖部位肿瘤的边界确定及早期肿瘤病灶的发现和治疗,而非肿瘤性FDG高聚积是最主要的不良影响因素.     

Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases

Aims

Patients with chemotherapy-refractory colorectal cancer liver metastases have limited therapeutic options. Selective internal radiation therapy (SIRT) delivers yttrium 90 microspheres as a minimally invasive procedure. This prospective, single-arm, observational, service-evaluation study was part of National Health Service England Commissioning through Evaluation.

18F-FDG PET/CT与血清CEA测定联合应用对结直肠癌术后复发与转移的临床诊断价值

[目的]探讨18F-FDGPET／CT在结直肠癌术后血清CEA升高患者探测复发及转移灶中的应用。[方法]64例结直肠癌术后血清CEA升高患者均进行了18F-FDGPET／CT显像,并与病理及临床随访结果进行比较。[结果]PET／CT诊断阳性56例,1例假阳性;阴性8例,2例假阴性。PET／CT诊断灵敏度为96．5％,特异性为85．7％,阳性预测值为98.2％,阴性预测值为75．0％,准确率为93．8％。[结论]应用18F-FDGPET／CT检查对于结直肠癌术后血清CEA升高患者复发及转移灶的探测具有较高的灵敏度及特异性,血清CEA升高可以作为18F-FDGPET／CT检查前初筛的良好指标。     

18F-FDG PET/CT相关参数与胃癌患者HER2表达状态的相关性研究

目的:探讨18F-FDG PET/CT相关参数对预测胃癌患者HER2表达状态的价值.方法:回顾性分析2000年1月至2020年3月河北医科大学第四医院115例经手术病理证实的胃癌患者临床资料,且术前均行PET/CT检查,分析胃癌原发病灶的最大标准化摄取值(maximum standard uptake value,SU...     

Value of ~（18）F-FDG PET/CT and MRI in diagnosing primary endometrial small cell carcinoma

Primary small cell carcinoma（SCC） is a group of aggressive neoplasms that mainly arise from the lung and digestive tract. Endometrial small cell carcinoma（ESCC） is extremely rare. To our knowledge, less than 90 cases have been reported, and most of these reports were dedicated to describing the clinicopathologic or immunochemical features of ESCC. Herein, we present a new case of ESCC involving a 51-year-old woman and mainly focus on the magnetic resonance imaging（MRI） and positron emission tomography/computed tomography（PET/CT） findings. MRI showed that the uterus was significantly enlarged（11.6 cm × 11.1 cm × 14.4 cm）, and a giant irregular mass（7.5 cm × 8.4 cm × 8.5 cm） was observed in the uterine cavity. The lesion demonstrated an extremely low apparent diffusion coefficient（ADC） value [（0.553±0.088）×10^–3 mm^2/s] and a high FDG uptake value（22.7）. Multiple metastatic lymph nodes（LNs） were identified at different positions, with diameters ranging from 0.3 to 2.8 cm and a maximum standardized uptake value（SUV max） ranging from 6.9 to 19.3.     

18F-FDG PET/CT在子宫颈癌放疗靶区勾画中的价值

目的 探讨18F-FDG PET/CT在子宫颈癌放疗靶区勾画中的价值.方法 收集2015年3月至2016年10月经病理学检查证实为子宫颈鳞癌Ⅲb期患者33例,由3名放疗医师分别基于单纯CT和PET/CT融合图像勾画原发病灶大体肿瘤靶区体积(gross target volume,GTV),比较不同医师所勾画靶区的差异.结果 3名医师在单纯CT和PET/CT融合图像下定义的GTV比较差异均有统计学意义(P＜0.001).不同医师定义GTVCr差异有统计学意义(F=4.28,P＜0.001),但GTVPERT-CT差异无统计学意义(F=0.21,P=0.81).3位医师应用PET/CT图像勾画的肿瘤靶区体积变异减小(7.75 cm3 vs 24.50 cm3).结论 PET/CT融合图像可以提高靶区勾画的准确性.     

Comparison Between 64Cu-PSMA-617 PET/CT and 18F-Choline PET/CT Imaging in Early Diagnosis of Prostate Cancer Biochemical Recurrence

Purpose

To evaluate the diagnostic performance of ⁶⁴Cu-PSMA-617 positron emission tomography (PET) with computed tomography (CT) for restaging prostate cancer after biochemical recurrence (BCR) and to compare it with ¹⁸F-choline PET/CT in a per-patient analysis.

18F-FDG PET/CT显像在胰腺癌诊断中的应用价值

[目的]评价18F-脱氧葡萄糖(148F-FDG)PET/CT显像在胰腺癌诊断中的应用价值.[方法]回顾性分析46例疑似胰腺癌患者的全身18F-FDG PET/CT及CT平扫加增强的影像学资料,比较两者对胰腺癌的诊断价值.[结果] 46例疑似胰腺癌患者中,44例经手术、腹腔镜取病理确诊,其中胰腺癌38例,慢性胰腺炎6例,另2例PET/CT发现多处肝转移或肺转移,因而放弃手术,经临床随访1年后确诊为胰腺癌.18F-FDG PET/CT检查阳性37例,灵敏度92.5％,特异性83.3％,准确率为91.3％;CT平扫加增强检查,灵敏度75.0％,特异性66.7％,准确率为73.9％.PET/CT对胰腺癌诊断的灵敏度、特异性、准确率均明显高于CT,两者差异有统计学意义(P＜0.05).[结论] 18F-FDG PET/CT对胰腺癌的诊断与分期有较高的临床应用价值.     

The role of F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma

Objectives

To evaluate the efficacy of ¹⁸F-FDG PET/CT in depicting metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma (LSCC) or lung adenocarcinoma (LAC) in a tuberculosis-endemic country.

Methods

This study retrospectively reviewed patients with LSCC or LAC, who underwent preoperative ¹⁸F-FDG PET/CT to assess mediastinal lymph node metastasis. Patients with the short-axis of mediastinal lymph node ≤ 15 mm were included. PET/CT interpretation was analyzed in two ways. Firstly, with CT for anatomical localization, lymph nodes showing greater ¹⁸F-FDG uptake than vessel pool on PET were regarded malignant. Secondly, lymph nodes with positive uptake on PET were considered malignant, only when nodes had neither calcification nor higher attenuation than vessel pool on CT.

Results

One hundred and sixteen LSCCs and 234 LACs were evaluated. With CT for anatomical localization, the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET were 78.6%, 45.5%, 53.4%, 31.4% and 87.0% in LSCC group, and 61.8%, 66.3%, 65.0%, 42.9% and 80.9% in LAC group. PET showed higher specificity and accuracy in LAC group compared with LSCC group (p = 0.001 and p = 0.038, respectively). Considering calcification or high attenuation on CT, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 71.4%, 67.0%, 68.1%, 40.8% and 88.1% in LSCC group, and 54.4%, 86.1%, 76.9%, 61.7% and 82.2% in LAC group. Compared with PET, PET/CT possessed higher specificity and accuracy in LSCC group (p = 0.000 and p = 0.000, respectively), and higher specificity, accuracy and PPV in LAC group (p = 0.000, p = 0.000 and p = 0.022, respectively).

Conclusions

¹⁸F-FDG PET displays limited efficacy in assessing mediastinal lymph node metastasis with the short-axis diameter <15 mm in LSCC and LAC groups and higher false-positivity in LSCC group. The specificity and accuracy in LSCC and LAC groups are enhanced by interpreting attenuation characteristic on CT.     

18F-FDG PET/CT显像在肾上腺肿瘤诊断中的应用

目的:评价18F-脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)PET/CT显像在肾上腺肿瘤诊断中的应用价值。方法:回顾性分析42例肾上腺肿瘤患者的全身18F-FDG PET/CT及CT平扫加增强的影像学资料,比较两者对肾上腺肿瘤的诊断价值。结果:42例中,原发性肾上腺肿瘤30例,均经手术病理证实。其余12例为转移性肾上腺肿瘤,肾癌转移4例,肺癌转移7例,肝癌转移1例。18F-FDG PET/CT检查阳性42例,敏感度100%,良性病变的SUV值为1.1-2.6,平均1.8,恶性病变的SUV值为2.5-12.3,平均6.0。良恶性病变的SUV值差异有统计学意义(P<0.01)。CT平扫加增强检查阳性38例,敏感度90.5%。PET/CT对肾上腺肿瘤的敏感度明显高于CT,两者差异有统计学意义(P<0.05)。结论:18F-FDG PET/CT在肾上腺肿瘤诊断中具有重要价值,敏感度高于CT。     

Comparison of PET/CT and MRI for the detection of bone marrow invasion in patients with squamous cell carcinoma of the oral cavity

Our aim was to retrospectively assess the diagnostic performance from combined positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) for the detection of bone marrow invasion of the mandible or maxilla in patients with oral cavity squamous cell carcinoma (OCSCC). A total of 114 patients with OCSCC, arising from or abutting the upper or lower alveolar ridge, underwent staging PET/CT and MRI studies before surgery. The possibility of bone marrow invasion on PET/CT and MRI was graded retrospectively on a 5-point score. Histopathology was taken as the reference standard. Sensitivity, specificity, predictive values and likelihood ratios were calculated. Clinical factors affecting the performance, like tumor origin and dentate status were also explored. PET/CT was found to be more specific than MRI (83% vs. 61%, respectively, p=0.0015) but less sensitive (78% vs. 97%, respectively, p=0.0391). Dentate status and tumor origin affected the diagnostic performance of PET/CT. In patients with positive MRI, sensitivity and specificity of PET/CT were 78% and 100% in dentate patients with alveolar ridge tumors, 75% and 80% in dentate patient with buccal tumors, 90% and 33% in edentulous patients with alveolar ridge tumors and 0% and 63% for edentulous patients with buccal tumors, respectively. PET/CT is more specific than MRI and can be used to complement the role of MRI. A negative MRI result can confidently exclude the presence of bone marrow invasion, while in patients with positive MRI findings, a negative PET/CT may be useful to rule out bone marrow invasion in dentate patients.     

肺癌的PET／CT检查方法与价值

目的评价18F-FDGPET／CT对肺癌诊断及临床分期的意义。方法对来本院就诊的周围型肺部肿块患者78例,其中经病理证实的肺癌62例。18F-FDGPET／CT显像后,目测和标准摄取值（SUV）相结合判断病灶良恶性,并与病理结果对照分析。结果18F-FDGPET／CT显像对肺癌诊断的敏感性和特异性分别为88．7％和75．0％;PET／CT显像发现62例肺癌患者恶性病灶共227处;PET和CT均有肯定诊断的恶性病灶178个。结论18F-FDGPET／CT对肺癌诊断及分期有较高临床价值。结合年龄、病史及其它影像学检查进行综合判断十分重要。     

西妥昔单抗联合FOLFIRI方案治疗大肠癌肝转移的近期疗效观察

[目的]评价西妥昔单抗联合化疗治疗大肠癌肝转移的近期疗效和不良反应.[方法]35例大肠癌肝转移患者采用西妥昔单抗、伊立替康、亚叶酸钙、氟尿嘧啶联合化疗,2周重复1次.4周期化疗后评价疗效及不良反应.[结果]全组35例均可评价疗效,完全缓解(CR)2例,部分缓解(PR)9例,疾病稳定(SD)18例,疾病进展(PD)6例,有效率(RR)为31.43％,疾病控制率(DCR)为82.86％;中位无进展生存时间(PFS)为15.2个月,中位总生存时间(OS)为50.9个月.不良反应主要表现为痤疮样皮疹、腹泻和血液学毒性.[结论]西妥昔单抗联合FOLFIRI方案治疗大肠癌肝转移疗效肯定,其不良反应可以耐受.     

PET/CT在卵巢癌术后监测复发/转移上的优势:与血清CA125及增强CT比较

目的:探讨18F-脱氧葡萄糖(18F-FDG)PET/CT在早期发现卵巢癌术后复发/转移方面的价值,并与血清CA125检测及增强CT进行比较。方法:回顾性分析过去5年内在我院行卵巢癌二次手术,并在术前均行血清CA125、增强CT、PET/CT检查的患者36例（99个病灶）。分别计算出以患者个体为研究单位时血清CA125及PET/CT检查的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,并比较二者在监测卵巢癌术后个体复发/转移方面的效能。采用卡方检验或Fisher确切概率法来比较增强CT、PET/CT两种方法诊断卵巢癌术后转移/复发病灶的差异性,并分别计算出以病灶为研究单位时的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,比较二者在诊断卵巢癌术后复发/转移病灶方面的效能。结果:PET/CT诊断出34/36例复发/转移的患者,而血清CA125以0~35 U/ml为基准时仅诊断出11/36例复发/转移的患者。前者诊断卵巢癌术后复发/转移患者的阳性预测值、灵敏度、准确度明显高于后者（97%、100%、97% vs 91%、32%、33%）。PET/CT与增强CT在诊断卵巢癌术后复发/转移病灶效能方面差异具有统计学意义（P=0.037）。PET/CT能够诊断出78/99个卵巢癌术后复发/转移的真阳性病灶,而增强CT仅能够诊断出70/99个。PET/CT以病灶为研究单位的阳性预测值、阴性预测值、灵敏度、特异度、准确度均比增强CT高（94% vs 89%、62.5% vs 30%、93% vs 83%、67% vs 40%、89% vs 77%）。结论:对于符合二次手术条件的患者,PET/CT诊断卵巢癌术后复发/转移方面的价值要优于血清CA125及增强CT。