PET-CT in thoracic disease

PET-CT imaging merges metabolic data obtained after injection of a tracer labelled with a positron emitter, with CT anatomical data. This whole-body technique provides (i) an improved spatial resolution and (ii) when the tracer is 1?FDG, quantification of tissue glucose metabolism. In thoracic oncology, 1?FDG PET-CT imaging allows diagnosis, staging, follow-up of treatment efficiency, and detection of recurrence. Furthermore, its potential usefulness in inflammatory and infectious diseases should be emphasized. Its main contra-indication is pregnancy, and a good knowledge of its technical procedure is mandatory. The most currently used quantification index is the standardized uptake value (SUV), whose interpretation requires caution.     

Stellenwert der PET-CT in der thorakalen Diagnostik

In thoracic diseases the best prognosis and the most effective treatment can only by achieved with an accurate diagnostic staging. Especially in non-small cell lung cancer (NSCLC), the decision for a therapeutic regime like surgical resection of the tumour either alone or in combination with chemo- or radiotherapy changes the chances of cure immensely. However, many patients present metastatic disease at the time of diagnosis. Both computed tomography (CT) and positron emission tomography (PET) using fluorodeoxyglucose (FDG) play an important role in the diagnosis and staging of lung cancer. CT provides excellent morphologic information but has limitations in differentiating between benign and malignant lesions especially in mediastinal lymph nodes. FDG-PET is highly accurate in the detection of mediastinal lymph node metastases as well as extrathoracic metastases. However, additional morphologic examination is needed to properly locate a lesion due to the poor anatomic information provided by PET. Thus, imaging with integrated PET-CT hybrid scanners offers essential advantages in comparison to PET or CT alone and visual correlation of separate imaging data. A combined PET-CT system provides a synergism of both techniques so that lesions can be more easily detected and exactly localized. With such a diagnostic tool, therapeutic decisions are improved, hopefully leading to a prognostic improvement of diseases like lung cancer.     

空洞型肺癌的PET-CT影像特点分析

目的分析空洞型肺癌的PET-CT影像特点。方法回顾性分析35例经病理证实空洞型肺癌患者的PET-CT表现,分析不同病理类型空洞型肺癌间的差异及病理类型、空洞壁厚度最大径、肿瘤最大径对最大标准摄取值(maximum standardized uptake value,SUV max)的影响。结果35例患者中,鳞癌15例,腺癌20例,鳞癌组SUV max为13.51±4.73,显著大于腺癌组(8.50±4.27),P<0.05;而鳞癌组空洞壁厚度最大径及肿瘤最大径均显著大于腺癌组(P值分别为0.001、0.043),两者之间空洞最大径差异无统计学意义(P>0.05)。在空洞壁厚度最大径分组(<0.5 cm,0.5~1.5 cm,>1.5 cm)及肿瘤最大径分组(<3 cm、3~5 cm,>5 cm)中,SUV max差异有统计学意义(F=10.735,P<0.001;F=6.568,P=0.004)。结论18 F-脱氧葡萄糖(18 F-FDG)PET-CT对空洞型肺癌有较好的诊断价值,且SUV max与病理类型、空洞壁厚度最大径以及肿瘤最大径存在一定的关联。     

PET-CT imaging of combined brachial and lumbosacral neurolymphomatosis

Neurolymphomatosis is a rare manifestation of progressive non-Hodgkin's lymphoma. A 44-yr-old man with diffuse large B-cell lymphoma presented with unilateral progressive peripheral sensorimotor neuropathy after the 7th cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. No pathology in the nervous system was evident by computerized tomography (CT), magnetic resonance imaging (MRI) of the head, spinal axis and plexuses and by repeated analysis of cerebrospinal fluid. However, the hybrid modality of positron emission tomography (PET) of fluorinated deoxyglucose (FDG) combined with CT scan (PET-CT) showed unilateral involvement of both the brachial and lumbosacral nervous plexuses. A complete recovery of neurological manifestations and normalization of PET-CT followed intensive chemotherapy with autologous stem cell transplantation. The diagnosis and localization of neurolymphomatosis may be supported by PET-CT imaging.     

PET-CT在肺癌诊断中的应用价值

肺癌是严重危害人类生命与健康较为常见的恶性肿瘤之一,其发生率和病死率均占恶性肿瘤的首位,亦是肿瘤致死的首要原因。如何对肺癌进行早期诊断、准确分期、合理治疗,以及改善患者预后,是多年来医学工作的重点,而影像学检查是诊断肺癌的主要手段。随着影像学进展,CT、CT造影、MRI、PET及PET-CT等先进技术的应用,对早期发现肺癌早期诊断起着越来越大的作用,对影像学的肿瘤分期也越来越接近病理。近年来的研究证明,PET是评价肺癌患者有效的非侵入性检查方法之一,但PET对病灶的精确定位有一定限制。PET-CT实现了CT解剖结构与PET功能信息的同机图像融合,可以对病灶进行精确定位。本文主要综述PET-CT对肺癌诊断的应用价值。     

PET-CT显像在肺癌治疗中的临床应用

目的探讨PET-CT显像在肺癌治疗中的临床应用价值.方法对56例肺癌患者治疗前显像,并对其中15例经手术治疗、13例化学治疗、10例放射治疗肺癌进行疗效随访观察.结果 56例患者中,治疗前有13例发现不同程度的转移,治疗方案发生变化.6例患者明确区分肿块内肿瘤大小,为肿瘤放射治疗提供准确的照射野.15例手术治疗后有4例患者在原发肿瘤病灶区域发现复发,同期的CT检查未能发现.13例化学治疗及10例放射治疗患者中有6例PET-CT显示肿瘤细胞活性无明显降低而改变治疗方案.结论 PET-CT显像在肺癌治疗前对治疗方案的选择及病灶复发的监测有较大的临床应用价值.     

Cardiac Denervation and Cardiac Function

With respect to neural control of the heart, intrathoracic ganglia and their interconnections form the final common pathway for autonomic modulation of regional cardiac function. In this review, data are presented indicating that such ganglia that include those distributed on the heart contain afferent (sensory) and efferent (motor) neurons that intercommunicate via local circuit neurons. The intrathoracic reflexes involving these neurons function in a coordinated fashion with central neurons located in the spinal cord, brain stem, and supraspinal central neuronal regions to regulate cardiac output on a beat-to-beat basis. The focus of this review is the putative role that these various populations of intrathoracic neurons play in regulating normal cardiac function and, in particular, how their interactions can become altered following their decentralization or in the presence of altered regional cardiac function. It is proposed that a thorough understanding of the interactions that occur among the hierarchy of neurons within intrinsic cardiac and intrathoracic extracardiac ganglia is required in order to assess cardiac regulation in normal as well as diseased states.     

正电子发射计算机断层显像-CT在肺结核活动性评价中的价值

影像学一直是结核病活动性评价的重要方法之一,¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像(PET)-CT能反映细胞的葡萄糖代谢程度,可以从代谢角度结合形态学层面综合评价结核病的活动性。¹⁸F-FDG PET-CT有可能识别出结核分枝杆菌潜伏感染者中处于亚临床状态的患者。陈旧性结核病灶无¹⁸F-FDG摄取的患者复发风险低。¹⁸F-FDG PET-CT能早期评估抗结核治疗效果,标准化摄取值(standard uptake value,SUV)降低表明治疗效果好,无¹⁸F-FDG摄取可能提示治疗达到了杀灭结核分枝杆菌的效果,¹⁸F-FDG PET-CT有望作为抗结核新药疗效评价及确定治疗时间截点的检查方法。本文中,笔者即对¹⁸F-FDG PET-CT识别结核分枝杆菌潜伏感染者,以及评价结核病患者抗结核治疗疗效、预后等方面的应用与价值进行综述。     

Critical review of PET-CT for radiotherapy planning in lung cancer

In the last decade, FDG-PET scans have had a major impact on the treatment of patients with NSCLC. The benefits of staging PET scans are well established, with improved selection of patients for curative radiotherapy or aggressive chemo-radiotherapy. The large body of literature correlating FDG-PET with nodal pathology in NSCLC makes it rational to use PET for designing mediastinal radiation fields. However, suboptimal image-fusion and a low spatial resolution for PET scans, makes use of PET for defining target volumes for primary tumours questionable. Data on the role of PET scans for radiotherapy planning for limited stage small-cell lung cancer is limited, although the incorporation of FDG-PET positive regions would appear to be reasonable.     

Critical review of PET-CT for radiotherapy planning in lung cancer

In the last decade, FDG-PET scans have had a major impact on the treatment of patients with NSCLC. The benefits of staging PET scans are well established, with improved selection of patients for curative radiotherapy or aggressive chemo-radiotherapy. The large body of literature correlating FDG-PET with nodal pathology in NSCLC makes it rational to use PET for designing mediastinal radiation fields. However, suboptimal image-fusion and a low spatial resolution for PET scans, makes use of PET for defining target volumes for primary tumours questionable. Data on the role of PET scans for radiotherapy planning for limited stage small-cell lung cancer is limited, although the incorporation of FDG-PET positive regions would appear to be reasonable.     

^18F-FDG PET-CT对非小细胞肺癌TNM分期的价值

目的探讨PET-CT显像对非小细胞肺癌（NSCLC）患者分期的价值。方法43例非小细胞肺癌患者行全身PET-CT显像,且于检查前一周内行胸部16层螺旋CT扫描。按照国际通用的AJCC（美国癌症联合委员会）肺癌TNM分期标准对病变分别行CT、PET-CT分期,并将组织病理结果作为参照标准。结果①对照病理结果,PET-CT对NSCLC的T分期比CT准确性更高（P〈0.05）。43例肺癌T分期中,PET-CT正确分期41例,cT正确分期34例。②43例术前诊断分期的患者中,与病理符合的肺癌N分期,PET-CT 40例,CT 33例。PET-CT对肺癌的N分期与CT相比具有显著性差异（P〈0.05）。③CT发现了8例患者的13处转移,PET-CT发现了14例患者的32处转移,改变了6例患者治疗计划。结论PET-CT显像用于NSCLC的分期是一可靠的非创伤性方法,对指导肺癌的临床治疗具有重要意义。     

The role of PET-CT in patients with incidental gallbladder cancer

Introduction:

After a cholecystectomy, incidental gallbladder cancer (IGC) requires accurate imaging studies to determine the actual extent of the disease to properly tailor subsequent treatment. The aim of this study was to evaluate the utility of ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸FDG PET-CT) to provide optimal pre-treatment staging in patients with IGC.

Material and Methods:

Between January 2006 and August 2008, all patients with IGC and at least muscular layer invasion were studied with ¹⁸FDG PET-CT. The examination was considered positive when the standardized uptake values (SUV) were ≥2.5. In all instances patients were offered to undergo definitive exploration and possible radical resection.

Results:

The series included 32 patients, 26 women and 6 men, with a median age of 57 years (range 30–81 years). The examination was performed at a median time of 6 weeks after cholecystectomy (range 2–52 weeks). ¹⁸FDG PET-CT was negative in 13 patients and positive in 19 patients: 9 with localized potentially resectable disease (PRD) and in 10 with disseminated disease. Of the 13 patients with negative PET-CT, 9 refused surgery and 4 underwent formal exploration: 3 patients were resected with no disease identified in the final pathology report (FPR) and 1 was not resected as a result of peritoneal carcinomatosis. Of the 9 with PRD, 4 patients refused reoperation and 5 underwent exploration: 3 were resected with residual disease noted in the FPR and 2 did not undergo resection because of dissemination. Two patients with disseminated disease were reoperated and in both instances disseminated disease was confirmed. The median survival for the entire group was 20.3 months (range 1.6–32.9 months). The median survival for those patients with negative PET-CT was 13.5 months (range 5.6–32.9 months), 6.2 months (range 1.6–18.7 months) for localized potentially resectable disease and 4.9 months (range 2–14.1 months) for disseminated disease (P < 0.003).

Conclusions:

For patients presenting with stage T1b or greater IGC, the use of ¹⁸FDG PET-CT will help reduce the number of patients undergoing non-therapeutic re-exploration and may help to determine the likely prognosis. ¹⁸FDG PET-CT might be a useful tool for the selection of patients for potentially curative treatment.     

PET-CT显像判断肺癌转移的临床价值

目的探讨PET—CT显像判断肺癌转移的临床价值。方法回顾性分析124例肺癌患者治疗前PET—CT显像结果,并与常规CT扫描结果、病理结果对比。结果PET—CT判断肺癌转移的准确率、灵敏度、特异性、阳性预测值、阴性预测值分别为95．2％、96．7％、94．9％、98．3％、94．9％,常规CT的准确率为73．6％;两者准确率比较,P＜0．01。结论PET—CT显像判断肺癌转移的准确率高,可为临床制定治疗方案提供依据。     

Primary Cardiac Angiosarcoma Accompanying Cardiac Tamponade

A de novo cardiac malignant tumor is rare and sometimes challenging to diagnose. We encountered a 67-year-old man without any medical history complaining of dyspnea on effort. On admission, his hemodynamics were deteriorated due to cardiac tamponade, which was improved by percutaneous drainage of 1,200 mL pericardial effusion, showing 11.0 g/dL of hemoglobin. We suspected primary cardiac malignancy following multidisciplinary tests, and a cardiac biopsy via sternotomy demonstrated the definitive diagnosis of primary malignant tumor (angiosarcoma) infiltrating the right atrial myocardium. We initiated weekly paclitaxel therapy. Further studies are warranted to establish the optimal diagnostic and therapeutic strategy for de novo cardiac malignancy.     

The current role of PET-CT in the characterization of hepatobiliary malignancies

Background

Surgery has become heavily dependent on accurate imaging in the assessment and treatment of suspected or confirmed intra-abdominal malignancy. Positron emission tomography-computed tomography (PET-CT) fuses uptake of a radiotracer combined with CT images to assess both functional tissue activity and anatomical detail. Since its introduction it has offered new ways of treating gastrointestinal cancers.

Methods

The review analyses the present literature regarding the use of PET-CT in the assessment, diagnosis, staging and treatment of hepatobiliary malignancies.

Results

PET-CT is widely used in pre-operative tumours staging for colorectal liver metastases. There is convincing data that it may also be applicable for neuroendocrine tumours, assessment of indeterminate pancreas lesions and clinical drug trials. PET-CT is of limited value in hepatocellular cancers, although new techniques in dual-tracer PET-CT may change this.

Conclusion

Knowledge of the strengths and limitations of PET-CT is important for all surgeons managing cancer of the hepatobiliary system. More clinical data are required on PET-CT, particularly its effect on long-term survival in PET-CT-staged patients undergoing resection.     

PET-CT选择肺内多发病灶再穿刺病灶的价值

目的评价PET-CT引导下精准选择病灶并进行穿刺活检诊断的价值。方法 52例肺内多发病灶直接使用胸部CT定位穿刺活检后,对首次诊断不明确需要第二次活检病例,根据PET-CT定位来选择穿刺病灶,并对诊断结果进行分析。结果 52例多发肺部病变患者,51例有明确的病理诊断,其中恶性肿瘤36例,良性病变15例;1例因不能耐受第二次穿刺最终未取得病理结果。首次穿刺活检诊断准确度为73.1%(38/52),敏感度75.7%(28/37),特异度66.7%(10/15),假阳性率33.3%,假阴性率24.3%;结合PET-CT定位的第二次活检诊断准确度98.1%(51/52)、敏感度97.3%(36/37)、特异度达100%,无假阳性,假阴性率2.7%(P0.01)。全部病例未发生严重并发症。结论根据PET-CT表现,该方法诊断准确度、特异度及灵敏性均较高,安全性好,在肺内多发病灶患者二次穿刺诊断的定位上有重要价值。