Dual PET/CT with F-DOPA and F-FDG in metastatic medullary thyroid carcinoma and rapidly increasing calcitonin levels: Comparison with conventional imaging

Background

To evaluate the role of a multi-imaging PET with ¹⁸F-DOPA and ¹⁸F-FDG in comparison with conventional imaging (CI) in recurrent medullary thyroid carcinoma (MTC).

Methods

18 MTC patients who had thyroidectomy were included; they presented with elevated and rapidly increasing calcitonin levels during follow up. CI had revealed metastatic deposits in 9 patients. Patients were referred to us for a PET/CT with ¹⁸F-DOPA and ¹⁸F-FDG. Histologic/cytologic confirmation of recurrent MTC was obtained in at least one PET-positive lesion in all patients.

Results

Foci of abnormal uptake were observed in 15 patients at ¹⁸F-DOPA and in 11 at ¹⁸F-FDG; 8 patients showed the same number of positive lesions with both tracers, 2 showed more lesions on ¹⁸F-FDG, 1 was positive at ¹⁸F-FDG alone and 5 at ¹⁸F-DOPA alone. In 3 patients with a DOPA-positive loco-regional relapse a re-operation with curative intent was offered. SUV_max values were higher for ¹⁸F-FDG compared to ¹⁸F-DOPA (mean 12.7 ± 4.1 vs. 5.5 ± 2.1, p < 0.05). Calcitonin was higher in PET-positive patients compared to PET negative ones, while no significant differences were observed between ¹⁸F-DOPA and ¹⁸F-FDG positive patients.

Conclusions

In MTC patients with rapidly increasing calcitonin levels during follow up, ¹⁸F-DOPA has a good sensitivity and a complementary role with ¹⁸F-FDG PET/CT in detecting metastatic deposits. In our experience, the sensitivity of a multi-imaging ¹⁸F-DOPA & ¹⁸F-FDG PET/CT approach is greater than that obtained with CI. The higher SUV_max values found with ¹⁸F-FDG in some patients may reflect more aggressive tumors.     

促甲状腺激素水平对18F-FDG PET／CT诊断分化型甲状腺癌失分化后复发及转移灶的影响

目的探讨促甲状腺激素（thyroid stimulating hormone,TSH）水平对18F-氟代脱氧葡萄糖（18F—fluorodeoxyglucose,18F—FDG）正电子发射计算机断层显影术（positron emission tomography／eomputed tomograpby,PET／CT）诊断甲状腺球蛋白（thyroglobalin,TG）阳性而131I-诊断剂量全身显像（131I-diagnos—ticwhole—body scanning,131I-dWBS）阴性的分化型甲状腺癌（differentiated thyroid carcinoma,DTC）失分化后复发和转移灶的影响。方法征得患者同意后,将60例欲行18F-FDG PET／CT检测的分化型甲状腺癌术后患者（TG阳性而131I-dWBS阴性）随机分为低TSH组（30例）和高TSH组（30例）。以术后组织病理学或至少6个月的临床和影像学随访结果为诊断病灶性质的标准,得出其阳性预测值（positive predictive value,PPV）,比较TSH水平高低对18F—FDG PET／CT检测结果的影响;分析TG水平与放射性浓聚病灶的标准摄取值（standardized uptake Value,SUV）间的关系。结果高TSH水平及低TSH水平下18F—FDG PET／CT诊断DTC复发和转移灶的阳性预测值分别为96．7％和80．0％（P〈0．05）;患者TG水平与SUV呈正相关。结论18F—FDG PET／CT对于TG阳性而131I-dWBS阴性DTC患者复发和转移灶的诊断,在高TSH水平下较低TSH水平有更高的敏感性与特异性,此可能与TSH刺激肿瘤组织对18F—FDG的摄取相关。     

Impact of combined (18)F-FDG PET/CT in head and neck tumours

To compare the interobserver agreement and degree of confidence in anatomical localisation of lesions using 2-[fluorine-18]fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET)/computed tomography (CT) and (18)F-FDG PET alone in patients with head and neck tumours. A prospective study of 24 patients (16 male, eight female, median age 59 years) with head and neck tumours was undertaken. (18)F-FDG PET/CT was performed for staging purposes. 2D images were acquired over the head and neck area using a GE Discovery LS PET/CT scanner. (18)F-FDG PET images were interpreted by three independent observers. The observers were asked to localise abnormal (18)F-FDG activity to an anatomical territory and score the degree of confidence in localisation on a scale from 1 to 3 (1=exact region unknown; 2=probable; 3=definite). For all (18)F-FDG-avid lesions, standardised uptake values (SUVs) were also calculated. After 3 weeks, the same exercise was carried out using (18)F-FDG PET/CT images, where CT and fused volume data were made available to observers. The degree of interobserver agreement was measured in both instances. A total of six primary lesions with abnormal (18)F-FDG uptake (SUV range 7.2-22) were identified on (18)F-FDG PET alone and on (18)F-FDG PET/CT. In all, 15 nonprimary tumour sites were identified with (18)F-FDG PET only (SUV range 4.5-11.7), while 17 were identified on (18)F-FDG PET/CT. Using (18)F-FDG PET only, correct localisation was documented in three of six primary lesions, while (18)F-FDG PET/CT correctly identified all primary sites. In nonprimary tumour sites, (18)F-FDG PET/CT improved the degree of confidence in anatomical localisation by 51%. Interobserver agreement in assigning primary and nonprimary lesions to anatomical territories was moderate using (18)F-FDG PET alone (kappa coefficients of 0.45 and 0.54, respectively), but almost perfect with (18)F-FDG PET/CT (kappa coefficients of 0.90 and 0.93, respectively). We conclude that (18)F-FDG PET/CT significantly increases interobserver agreement and confidence in disease localisation of (18)F-FDG-avid lesions in patients with head and neck cancers.     

18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值及优势

  目的   探讨18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值, 并与增强CT、B超及MRI进行比较。   方法   收集2006年3月至2011年12月期间38例临床疑似胆囊癌而在本院行PET/CT检查的患者, 其中男26例, 女12例; 年龄46~82岁, 中位年龄69岁。患者均行PET/CT、增强CT、B超及MRI检查。全部病例均经手术病理及临床随访证实, 其中35例为原发胆囊癌, 3例为胆囊炎。分别统计4种影像诊断方法的真阳性率、假阳性率、真阴性率、假阴性率及诊断正确率。   结果   PET/CT、增强CT、B超及MRI检查的真阳性率分别为100.0%、74.3%、60.0%、71.4%;假阴性率分别为0、25.7%、40.0%、28.6%;增强CT、B超及MRI检查真阴性率分别为66.7%、33.3%、66.7%;假阳性率分别为33.3%、66.7%、33.3%。诊断正确率分别为92.1%、71.1%、60.5%、68.4%。PET/CT与增强CT、B超及MRI结果比较, P值分别为0.036、0.002、0.019, 均P < 0.05。   结论   在原发性胆囊癌诊断中, PET/CT较其他3种传统影像诊断方法准确率高。如将PET/CT结合增强CT检查, 可使诊断正确率提高2.6%。故18F-FDG PET/CT显像对原发性胆囊癌的诊断具有重要的临床应用价值。      

18F-FDG PET/CT在鼻咽癌诊断及分期中的临床价值

背景与目的:PET/CT能够通过准确显示肿瘤形态、大小及相邻关系从而对鼻咽癌(NPC)进行诊断及分期研究.本研究结合PET/CT、MRI结果及部分颈部小淋巴结病理结果,探讨18SF-FDG PET/CT在鼻咽癌TNM分期中的价值.方法:从2005年9月至2007年3月.选取行PET/CT和MRI检查的鼻咽癌患者68例.PET数据采用2D采集模式,CT扫描电压140 kV,采用自动毫安量跟踪扫描加血管增强的扫描方案,18F-FDG按3.7～5.5 MBq/kg剂量静脉注射.MRI检查采用T1W和T2W成像及T1W增强扫描成像.并对其中10例患者颈部小淋巴结切除和穿刺组织病理检查,进行图像与病理对照.结果:68例鼻咽癌患者所有鼻咽区域的病灶PET/CT均可以清晰显示,MRI和PET/CT显示病灶一致:对于直径≤1 cm的138枚PET/CT示阳性小淋巴结,MRI仅有约28%可作不肯定提示.10例鼻咽癌患者颈部16枚PET/CT显示阳性小淋巴结与病理结果相符14枚,符合率达87.5%.对于颈部肿大淋巴结PET/CT.和MRI均能显示,对部分放疗过程PET/CT示增殖活性明显受抑制的肿大淋巴结,MRI和PET/CT增强扫描可见强化.对于其中8例Ⅳb期鼻咽癌患者肺、骨、肝脏等转移灶,PET/CT全身扫描可清晰显示病灶,而MRI具有较多限制.由于18F-FDG PET/CT检查使其中24例的分期进行调整.结论:18F-FDG-PET/CT扫描采用自动毫安量跟踪扫描加血管增强的扫描方案,充分利用PET/CT信息进行鼻咽癌的临床分期,其结果较MRI全面、可靠.     

肝细胞癌TACE术后病灶存活或复发18F-FDGPET/CT和增强CT诊断价值Meta分析

目的采用Meta分析方法评价¹⁸F-脱氧葡萄糖正电子发射计算机体层摄影(¹⁸F-FDG PET/CT)和增强CT(CECT)诊断经导管肝动脉化疗栓塞术(TACE)术后存活或复发病灶的临床价值。方法根据PRISMA报告规范开展Meta分析。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普数据库中¹⁸F-FDG PET/CT和CECT诊断TACE术后存活或复发病灶的临床研究,时间至2019-04。由2位研究人员独立筛选文献、提取资料,根据诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算其汇总敏感度(Sen)和特异度(Spe),绘制受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果共纳入10篇¹⁸F-FDG PET/CT及13篇CECT诊断TACE术后存活或复发病灶的原始研究,分别包括322例患者的467个病灶和748例患者的943个病灶。Meta分析显示,¹⁸F-FDG PET/CT诊断TACE术后存活或复发病灶的Sen=0.92(95%CI为0.87~0.94)、Spe=0.95(95%CI为0.82~0.99)、AUC=0.97(95%CI为0.93~0.99);CECT诊断TACE术后存活或复发病灶的Sen=0.72(95%CI为0.66~0.78)、Spe=0.99(95%CI为0.93~1.00)、AUC=0.87(95%CI为0.83~0.89)。此外,CECT诊断TACE术后存活或复发Sen(Z=2.34,P=0.02)和AUC(Z=2.21,P=0.03)值低于¹⁸F-FDG PET/CT,差异有统计学意义。结论相比于CECT,¹⁸F-FDG PET/CT对TACE术后存活或复发病灶具有较高诊断效能,可视为TACE术后存活或复发病灶有效的影像学诊断方法。     

18F-FDG PET/CT在阿帕替尼治疗肺多发转移性碘难治性分化型甲状腺癌评估中的价值

背景与目的：碘难治性分化型甲状腺癌(radioactive iodine-refractory differentiated thyroid cancer,RAIR-DTC)是近年来研究的热点。因肿瘤细胞的异质性,不同病灶的生长速度及治疗疗效不尽相同。该研究探讨¹⁸F-FDG PET/CT在RAIR-DTC多发肺转移患者经阿帕替尼治疗效果评估中的价值。方法：纳入于中国医学科学院北京协和医学院北京协和医院经阿帕替尼治疗的RAIRDTC患者。入组患者于基线、治疗后4周及8周行CT及¹⁸F-FDG PET/CT检查。结果：共7例患者,49个肺转移灶,SUV_max在基线时为0.8~23.2。基线时病灶的SUV_max水平与治疗后4周及8周的SUV_max变化（SUV_max-4w/SUV_max-baseline,SUV_max-8w/_{SUVmax-baseline}）显著相关(P<0.000 1,P<0.000 1)。4周及8周的病灶直径变化率(CT4w/b,CT8w/b)与基线SUV_max无明显线性相关（P=0.666 4,P=0.478 7）。而4周的SUV_max变化（SUV_max-4w/SUV_max-baseline）与CT4w/b及CT8w/b显著相关（P=0.033 3,P=0.004 8）。对于基线水平SUV_max大于5的病灶,SUV_max-baseline与CT4w/b、CT8w/b均具有线性关系（P=0.008 2,P=0.016 9）。结论：¹⁸F-FDG PET/CT在RAIR-DTC多发肺转移患者靶向药物治疗中具有广阔的应用前景,可以识别肿瘤一致性,辅助选取靶病灶,并通过病灶的SUVmax预测患者对靶向药物治疗的疗效。     

18F-FDG PET/CT显像偶发甲状腺癌的葡萄糖代谢与临床病理学的相关性研究

背景与目的：18F-FDG PET/CT的广泛应用导致偶发甲状腺癌的比例明显增加,偶发甲状腺癌灶的糖代谢与甲状腺癌病理学的相关性尚不清楚。研究因非甲状腺疾病行18F-FDG PET/CT显像、偶发甲状腺癌的患者,分析甲状腺癌灶的糖代谢与肿瘤的分化程度、淋巴结转移的相关性。方法：回顾性分析18F-FDG PET/CT显像偶发甲状腺瘤患者195例,53例患者手术病理诊断为甲状腺癌。分别测量甲状腺癌灶的最大标准摄取值(SUVmax)、病变大小、病变个数,同时测量患者正常甲状腺组织的SUVmax。通过病理分析病理学分型、淋巴结转移,患者分为G1组(分化型甲状腺癌)、G2组(非分化型甲状腺癌)、G3组(甲状腺癌无淋巴结转移)和G4组(甲状腺癌有淋巴结转移)。分析G1组与G2组、G3组与G4组间甲状腺癌灶的糖代谢的差异。结果：53例患者中,PET显像发现甲状腺癌灶53个。病理学发现甲状腺癌灶62个,乳头状甲状腺癌37例,滤泡状甲状腺癌4例,髓样癌9例,低分化癌3例。正常甲状腺组织的SUVmax为1.51±0.30,G1组(41例)SUVmax为4.25±1.70,G2组(12例)SUVmax为6.34±2.45,G1组和G2组的SUVmax均显著高于正常甲状腺组织(t=11.0,t=7.10,P<0.01),但G1组与G2组的SUVmax差异无统计学意义(t=3.61,P>0.05)。G3组(29例)的SUVmax为4.77±2.15,G4组(24例)的SUVmax为4.67±2.02,差异无统计学意义(t=0.33,P=0.56)。结论：18F-FDG PET/CT显像偶发癌分化型甲状腺癌、非分化型甲状腺癌均具有高糖代谢改变;不同分化程度、淋巴结转移能力的甲状腺癌灶的糖代谢水平差异无统计学意义。     

18F-FDG PET/CT显像在肝脏恶性肿瘤的初步应用

目的：评价^18F-FDGPET／CT对于肝脏恶性肿瘤的诊断、分期及疗效评判的价值。方法：对55例肝脏恶性肿瘤患者的PET／CT检查资料进行回顾性分析。原发性肝细胞性肝癌（PHC）11例,胆管细胞性肝癌1例,转移性肝癌40例,白血病肝浸润1例,淋巴瘤肝浸润2例。其中原发性肝癌经手术或穿刺证实,继发性肝脏恶性肿瘤均有明确肿瘤病史或临床检查随访证实。所有患者均行双时相全身PET／CT显像检查。结果：低分化PHC4例及胆管细胞癌1例,^18F—FDG异常高摄取,延迟后大部分病灶^18F—FDG摄取SUVmax上升;高分化原发性肝癌7例,其中^18F-FDG等摄取5例,相对肝本底为略低摄取2例;9例PHC及1例胆管细胞癌CT表现为低密度灶,2例PHC为等密度,7例患者有肝炎肝硬化基础,另外同时发现肝外病灶6例。继发性肝脏恶性肿瘤43例（含淋巴瘤、白血病肝浸润）中PET／CT上共发现109个病灶;其中99个肝内病灶表现为^18F-FDG高摄取,31个病灶CT未显示,另外有2例患者有4个病灶经手术证实有肝内微小病灶而PET／CT未检出;而淋巴瘤、白血病肝浸润表现为大片状或弥漫性^18F—FDG明显异常高摄取;大部分患者改变了原有的治疗方案。结论：^18F-FDGPET／CT在肝脏恶性肿瘤诊断、分期、评价分化程度及治疗方案的选择有较好的临床价值,PET／CT诊断肝脏恶性肿瘤明显优于单纯PET。充分认识PET／CT在肝脏恶性肿瘤中的应用价值及局限性,有利于临床对肝脏恶性肿瘤的诊治。     

甲状腺乳头状癌18F-FDG PET/CT显像葡萄糖代谢与BRAF突变的相关性研究

目的 评估甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)患者¹⁸F-FDG PET/CT的最大标准摄取值(SUV_max)与BRAF突变的相关性。方法 回顾性分析我院在甲状腺切除术前接受¹⁸F-FDG PET/CT显像和活检的患者51例(平均年龄为49.3±12.9岁),病理诊断为PTC 48例,甲状腺滤泡状癌(Follicular thyroid carcinoma,FTC)3例。采用基因检测法检测BRAF V600E突变状态,半定量分析法测定甲状腺结节灶的SUV_max,分析患者临床资料包括性别、年龄、肿瘤大小和甲状腺球蛋白浓度与SUV_max之间的相关性;将患者分为BRAF V600E突变组和未突变组,分析比较两组间SUV_max值的差异。结果 在PTC患者中,33例患者肿瘤发生BRAF V600E突变,15例患者肿瘤未发生突变,BRAF V600E突变组的SUV_max显著高于未突变组(5.5±3.9 vs. 2.2±1.2,P=0.002);肿瘤直径≥1cm的患者的SUV_max明显高于肿瘤＜1cm(P＜0.05);甲状腺球蛋白浓度升高患者的SUV_max高于正常甲状腺球蛋白浓度的患者(P＜0.05);FTC组中未观察到BRAF V600E突变。结论 PTC患者携带BRAF V600E突变基因相对于未携带者具有更高的SUV_max值,不同肿瘤大小、血清甲状腺球蛋浓度的PTC患者SUV_max值存在统计学差异。     

18F-FDG PET/CT在随访血清鳞状细胞癌抗原升高的宫颈癌中的应用

背景与目的:宫颈癌患者治疗后早期、正确诊断复发并积极治疗可改善预后.血清鳞状细胞癌抗原(squamous cell carcinoma antigen.SCCAg)是检测无症状复发性宫颈癌最常用的肿瘤标志物.研究表明,宫颈癌随访期间血清SCCAg升高提示肿瘤复发.但并非所有随访SCCAg升高的宫颈癌患者经体格检查及传统影像均能探测到复发病灶.本研究探讨18F-FDG PET/CT在宫颈癌随访血清SCCAg升高中的应用,评估SCCAg升高在官颈癌随访中的价值.方法:对宫颈癌随访血清SCCAg升高并在中山大学肿瘤防治中心行18F-FDG PET/CT显像检查的31例患者进行回顾性分析,记录患者的病理类型、随访SCCAg升高水平、PET/CT显像结果、其他影像检查结果、病理及临床随访结果.结果:31例患者均为宫颈鳞癌.包括3例鳞腺癌.所有患者均经PET/CT探测到病灶,PET/CT诊断宫体或阴道局部复发3例,转移28例;最终经病理或临床证实局部复发3例,转移27例,原发肺鳞癌1例;PET/CT探测恶性病变率为100%(31/31),诊断宫颈癌复发准确率为96.8%(30/31).随访血清SCCAg值为1.5～37.8 pg/L,SCCAg值与PET/CT病灶最大标准化摄取值(SUVmax)无相关性.与其他影像检查相比,PET/CT明显提高探测效率,发现更多的病灶.结论:宫颈癌治疗后随访血清SCCAg升高提示肿瘤复发,PET/CT能有效探测病灶,并具有较高的准确率.     

CASE REPORT: The CT and 18F-FDG PET/CT appearance of primary renal malignant fibrous histiocytoma

Renal malignant fibrous histiocytoma (MFH) is a rare, primary renal tumour. Imaging findings of renal MFH, including ultrasound, CT and MRI, have, however, been reported. As to the best of our knowledge ¹⁸F-FDG PET/CT imaging of renal MFH has not been previously reported, we present the CT and ¹⁸F-FDG PET/CT appearance of a pathologically proven primary renal MFH.     

Preliminary PET/CT study of 18F-FDG uptake in cervical and supraclavicular brown adipose tissue

Objective  The clinical use of PET/CT in oncology has led to the realization that ¹⁸F-FDG uptake in brown adipose tissue (BAT) can be a common cause of potentially misleading false-positive PET scans. The goal of this study was to study ¹⁸F-FDG uptake in cervical and supraclavicular regions and its characteristics with PET/CT. Methods  All the PET/CT scans obtained at our institution from July 2007 to January 2008 were retrospectively reviewed for increased ¹⁸F-FDG uptake in BAT. The cases in which increased ¹⁸F-FDG in cervical and supraclavicular regions was not localized to a soft-tissue mass or lymph node or muscle on the CT images, were included in this study. The following features were recorded: body weight, body mass index (BMI) and maximal standardized uptake value (SUVmax). In these selected patients, the BAT uptake in other area of the body was also recorded. Results  PET/CT scans were obtained in 457 patients (259 males and 198 females). In all of the scans, cervical and supraclavicular BAT uptake was observed in 12 patients (2 males and 10 females) and was typically bilateral, symmetric and intense. The range of the SUVmax was 3.6∼12.82 (mean 6.9 ± 2.6). BAT uptake was more common in females than in males, showing a significant difference (P = 0.004). Although ¹⁸F-FDG uptake in BAT occurred more often in underweight patients with low BMI, there was no difference in the body weight (P = 0.607) or BMI (P = 0.491) of these patients with hypermetabolic BAT compared with controls. Conclusion  Hypermetabolic BAT uptake can be localized in cervical and supraclavicular regions with it occurring more commonly in females compared to males. Knowledge of this potential pitfall with PET/CT is important in improving diagnostic interpretation and accurate staging.     

18F-FCH联合18F-FDG PET/CT显像在AFP阴性肝癌中的诊断价值

目的探究18F-FCH联合18F-FDG PET/CT显像对甲胎蛋白阴性肝癌(AFP-negative hepatocellular carcinoma,AFP-NHCC)的诊断价值。方法收集AFP-NHCC患者250例为病例组,肝良性病变300例为对照组,对2组患者行18F-FCH联合18F-FDG PET/CT检查。图像分别采用视觉分析和半定量分析,比较2种检查方法对AFP-NHCC的联合诊断价值。结果视觉分析法显示,18F-FCH PET/CT诊断AFP-NHCC的敏感性71. 20%,特异度86. 00%,准确性79. 27%;18F-FDG PET/CT诊断AFP-NHCC的敏感性74. 80%,特异度83. 00%,准确性为84. 36%;联合诊断的敏感性78. 75%,特异度80. 54%,准确性为79. 65%。半定量分析法显示,18F-FCH PET/CT诊断AFP-NHCC的敏感性93. 94%,特异度88. 08%,准确性91. 01%;18F-FDG PET/CT诊断AFP-NHCC的敏感性90. 94%,特异度87. 09%,准确性为89. 02%;联合诊断的敏感性95. 52%,特异度82. 08%,准确性为88. 80%。结论使用半定量分析法对18F-FCH联合18FFDG PET/CT显像诊断AFP-NHCC具有较高的价值,可考虑在临床推广使用。     

18F-FDG PET/CT在评价索拉非尼治疗131I难治性分化型甲状腺癌疗效中的应用

背景与目的：肿瘤的疗效评价是阻碍确定肿瘤治疗最佳策略的因素之一。在淋巴瘤及其他实体肿瘤,基于正电子发射断层显像/电子计算机断层扫描(positron-emission tomography/computed tomography,PET/CT )的疗效评价的价值已经显现,尤其是对于靶向治疗(导致肿瘤活性改变而肿瘤大小可能未变)的疗效评价。通过对比实体瘤反应评价标准(Response Evaluation Criteria in Solid Tumors,RECIST 1.1)和欧洲癌症研究和治疗组织(European Organization for Research and Treatment of Cancer,EORTC)标准,研究18F-FDG PET/CT在评价索拉非尼(sorafenib)治疗131I难治性分化型甲状腺癌(radioiodine-refractory differentiated thyroid cancer,RR-DTC)疗效中的作用。方法：回顾性分析2011年—2014年索拉非尼治疗前和治疗3个月后均行18F-FDG PET/CT检查的14例RR-DTC 患者(男性6例,女性8例,平均年龄55.6岁)。用Wilcoxon符号秩和检验分析靶病灶直径之和与∑SUVmax变化百分比的差异。用χ2检验比较两种标准的疗效评分有无差异。用Wilcoxon 秩和检验比较按照RECIST 1.1或 EO-RTC 标准不同反应组间的无进展生存期(progression-free survival,PFS)有无差异。用Spearman 秩相关评估 PFS与形态学(RECIST 1.1)或功能学(EORTC criteria)反应分组的相关系数。结果：不同反应组间靶病灶直径之和与∑SUVmax变化百分比差异无统计学意义(Z=-0.408,P=0.683)。根据两种评价标准,14例患者中10例的评价结果是一致的(χ2=2.345,P=0.424),其余4例中,2例为SD/PMR,2例为SD/PMD。无论是按照RECIST 1.1(χ2=8.571, P=0.003)还是按照EORTC标准(χ2=8.781,P=0.003),各反应组间的PFS均有差异。PFS既与形态学评价结果相关(r=0.741,P=0.002),也与代谢学评价结果相关(r=0.816,P=0.0004)。结论：18F-FDG PET/CT可用于RR-DTC患者索拉非尼治疗后的疗效评价。尽管71.4%的患者RECIST 1.1和 EORTC 标准结果一致,但是基于PET的代谢学评价标准在预测治疗效果方面更为准确,可能比形态学评价标准更适用于靶向治疗的疗效评估。     

Biologic correlates of F-FDG uptake on PET in pulmonary pleomorphic carcinoma

Background

Pulmonary pleomorphic carcinoma is a rare epithelial tumor, and little is also known about the information on the usefulness of 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) positron emission tomography (PET). Therefore, we conducted the study including the underlying biologic analysis of ¹⁸F-FDG uptake.

Methods

Fifteen patients with pulmonary pleomorphic carcinoma who underwent ¹⁸F-FDG PET before treatment were included in this study. Tumor sections were stained by immunohistochemistry for glucose transporter 1 (Glut1); glucose transporter 3 (Glut3); hypoxia-inducible factor-1 alpha (HIF-1α); cell proliferation (Ki-67 labeling index); vascular endothelial growth factor (VEGF); microvessels (CD34); cell cycle control marker (p53); and apoptosis marker (bcl-2). These parameters were correlated with a control group of patients with other non-small cell lung cancer (NSCLC) (n = 33).

Results

The maximal standardized uptake value (SUV_max) of the primary tumors in 15 patients ranged from 6.1 to 26.8 (median 19.3). There were positive correlation between ¹⁸F-FDG uptake and Glut1 (p = 0.0016), Glut3 (p = 0.0080), VEGF (p = 0.0048), and microvessel density (MVD) (p = 0.0005). HIF-1α, p53 and bcl-2 showed no positive correlation with ¹⁸F-FDG uptake. ¹⁸F-FDG uptake, Glut1, Glut3, HIF-1α, VEGF and Ki-67 were significantly higher in patients with pulmonary pleomorphic carcinoma than those with other NSCLC.

Conclusion

¹⁸F-FDG uptake in pulmonary pleomorphic carcinoma is closely associated with the presence of glucose metabolism (Glut1 and Glut3) and angiogenesis (VEGF and MVD). The relationship between ¹⁸F-FDG uptake and these biomarkers may lead to a more rational use of PET scan in pulmonary pleomorphic carcinoma.     

18F-FDG PET/CT在多系统性结节病诊断中的应用价值

目的:探讨18F-FDG PET/CT显像在多系统性结节病诊断中的应用价值。方法:回顾性分析2015年01月至2020年04月期间于我科行PET/CT检查,并经病理及随访证实的结节病患者38例。结果:38例患者均可见纵隔及双侧肺门淋巴结肿大,合并颈部、锁骨上窝淋巴结增大者21例,合并腹腔淋巴结增大者15例,伴有肺内病变者32例,肝脏受累3例,脾脏受累3例,心肌受累1例,2例伴有皮下结节,骨骼受累2例,肌肉受累3例,以上病变FDG摄取均增高。结论:18F-FDG PET/CT显像能够从代谢角度全面、无创的评价全身各器官受累情况,对多系统性结节病的诊断及鉴别诊断具有较大的临床意义。     

Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer

PURPOSE: To investigate the potential effect of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. METHODS AND MATERIALS: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. RESULTS: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. CONCLUSIONS: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.     

Diagnostic and Clinical Impact of Staging 18F-FDG PET/CT in Mantle-Cell Lymphoma: A Two-Center Experience

IntroductionThe diagnostic accuracy of fluorine-18–fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in staging mantle-cell lymphoma has not yet investigated. The aim of this 2-center retrospective study was to investigate the utility of ¹⁸F-FDG PET/CT in assessing nodal, splenic, bone marrow (BM), and gastrointestinal (GI) disease compared to CT, BM, and GI endoscopy; and to assess its clinical impact.Patients and MethodsOne hundred twenty-two patients with histologically proven mantle-cell lymphoma were included. PET/CT BM findings were considered positive if isolated/multiple focal uptake in the BM not explained by benign findings and/or diffuse BM uptake higher than liver with/without focal uptakes were present. PET/CT findings were considered positive for GI involvement in the presence of isolated/multiple focal uptake in the GI organ.ResultsAll patients had positive PET/CT showing the presence of at least one hypermetabolic lesion, with the exception of one case. PET/CT results, compared to CT, detected more nodal and/or splenic lesions in 26 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT for BM were 52%, 98%, 97%, 65%, and 74%; for GI 64%, 91%, 69%, 90%, and 85%; and for GI excluding diabetic patients, 78%, 92%, 72%, 94%, and 89%. PET/CT permitted upstaging of 21 cases and downstaging of 2.Conclusion¹⁸F-FDG PET/CT showed excellent detection rate in nodal and splenic disease—a rate better than CT. For BM and GI evaluation, in order to reach good accuracy, the selection of patients and the use of specific criteria for evaluation of these organs seems to be crucial. Moreover, PET/CT altered the management and therapeutic approach in about 20% of patients.     

^18F-FDG PET/CT联合胸部薄层CT诊断肺部病灶的价值

[目的]探讨18F-FDGPET/CT联合胸部薄层CT诊断肺部病灶的准确性。[方法]50例患者（其中肺癌34例,肺良性病变16例）行单纯18F-FDGPET/CT或胸部薄层CT及两者联合检查,评价各检查方法的诊断准确性。[结果]18F-FDGPET/CT和18F-FDGPET/CT联合胸部薄层CT两种方法诊断结果相同,灵敏度、特异性、阳性预测值、阴性预测值、准确率均分别为91.2%、93.8%、96.9%、83.3%和92.0%,而胸部薄层CT分别为76.5%、43.8%、74.3%、46.7%和66.0%。18F-FDGPET/CT和18F-FDGPET/CT联合胸部薄层CT的诊断特异性、阳性预测值、阴性预测值均优于胸部薄层CT（P〈0.05）。以病理或临床诊断为标准的一致性分析显示,18F-FDGPET/CT和18F-FDGPET/CT联合胸部薄层CT的一致性好（Kappa值均为0.82）,胸部薄层CT的一致性差（Kappa值为0.21）。胸部薄层CT显示了更多的CT征象。[结论]18F-FDGPET/CT和18F-FDGPET/CT联合胸部薄层CT对肺部病灶诊断有一定价值。加行胸部薄层CT有助于做出符合病理类型的影像学判断。