18F-FDG PET/CT显像在恶性胸膜间皮瘤诊断中的价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在恶性胸膜间皮瘤(MPM)诊断中的临床价值及原发肿瘤病灶平均标准摄取值(SUVmax)对患者预后的判断价值.方法 回顾性总结17例2002-2008年临床疑诊MPM患者18F-FDG PET/CT显像资料,测量病灶的SUVmax.将病理检查及临床随访证实的MPM患者按照有无转移分为2组,测定每例患者原发肿瘤病灶的SUVmax,用受试者工作特征(ROC)曲线评价SUVmax对患者转移与否的诊断价值,判断预后.采用SPSS 11.0软件进行t检验.结果 经病理及随访结果证实MPM 12例,良性胸膜病变5例,二者的SUVmax分别为5.78±1.81和2.72±2.51,差异有统计学意义(t=2.8,P<0.05).全身18F-FDG PET/CT显像诊断MPM的灵敏度为100%(12/12),特异性为4/5,准确性为94%(16/17),18F-FDG PET/CT显像有7例MPM伴有骨和(或)淋巴结转移.SUVmaxROC曲线分析表明曲线下面积(AUC)为0.80.结论 全身18F-FDG PET/CT显像对于MPM的诊断有重要价值.原发肿瘤病灶SUVmax越高越易发生转移,预后越差.     

18F-FDG PET/CT和增强MSCT评价食管癌淋巴结转移

目的 探讨18F-FDG PET/CT显像和增强多层螺旋CT(MSCT)检查评价食管癌淋巴结转移的价值.方法 食管癌患者46例,均在18F-FDG PET/CT检查前1周内行MSCT检查,并在18F-FDGPET/CT检查后1周内接受手术治疗,切除组织均行病理检查.采用16层MSCT增强扫描和18F-FDG PET/CT显像检查颈、胸和上腹部,分别观察食管癌原发病灶、转移淋巴结的部位及转移淋巴结组数,其结果与病理检查结果对照.比较18F-FDG PET/CT和增强MSCT诊断食管癌淋巴结转移的灵敏度、特异性、准确性、阳性预测值和阴性预测值.结果 46例食管癌中位于上胸段6例,中胸段32例,下胸段8例.手术清除326组淋巴结,病理检查证实其中83组内有肿瘤转移.18F-FDG PET/CT与增强MSCT诊断淋巴结转移的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为83.1%(69/83),96.3%(234/243),92.9%(303/326),88.5%(69/78),94.4%(234/248)与72.3%(60/83),98.4%(239/243),91.7%(299/326),93.7%(60/64),91.2%(239/262).2种方法诊断食管癌淋巴结转移的灵敏度差异有统计学意义(P=0.022),余诊断效能指标差别无统计学意义(P均＞0.05).在诊断食管旁淋巴结转移方面,18F-FDG PET/CT与增强MSCT的灵敏度分别为79.2%(19/24)与54.2%(13/24),差异有统计学意义(P=0.031).结论 18F-FDG PET/CT诊断食管癌淋巴结转移,尤其食管旁淋巴结转移的灵敏度高于增强MSCT,但MSCT增强扫描对于发现18F-FDG PET/CT显像阴性的淋巴结转移有重要价值,两者结合应用可明显提高对食管癌淋巴结转移的判断准确性.     

18F-FLT PET/CT与18F-FDG PET/CT在鼻咽癌诊断和分期中的应用比较

目的 通过与18F-FDG PET/CT显像对比,探讨18 F-FLT PET/CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性.方法 12例初治且经病理确诊的鼻咽癌患者(年龄22～62岁)自愿进入该前瞻性临床研究.每位患者先行18F-FDG PET/CT检查,次日行18F-FLF PET/CT检查.至少有2位核医学科和放射科医师阅片,比较18F-FDG PET/CT和18F-FLT PET/CT图像,采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对18F-FDG、18F-FLT的SUVmax、SUVmean和MTV.采用非参数Wilcoxon秩和检验比较组间摄取和MTV差异.结果 12例鼻咽癌患者病灶均明显摄取18F-FLT.18F-FLT PET/CT和18F-FDG PET/CT均可准确诊断该组病例,二者对原发灶和淋巴结转移灶的检测结果无明显差别.鼻咽癌病灶的18F-FDG和18F-FLT SUVmax分别为10.7±5.8和6.0±2.4,SUVmean分别为5.8±3.0和3.6±1.5;SUVmax和SUVmean组间差异均有统计学意义(Z=-2.589和-2.353,P均＜0.05),而 MTV在18F-FDG和8F-FLT PET/CT 2种显像方法之问的差异无统计学意义(15.9±9.2和18.1±11.1;Z=-0.786,P＞0.05).6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义(8.5±6.2比6.4±2.5、5.3±4.2比3.8±1.4、6.5 ±4.8比6.0±4.4;Z=-0.734、-0.734和-0.674,P均＞0.05).18F-FLT在颞叶摄取(SUVmax 0.7±0.3)明显低于18F-FDG(SUVmax 8.3±2.7;Z=-3.062,P＜0.01),其对于原发灶颅内浸润显示较18F-FDG更清晰.结论 18F-FLT PET/CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与18F-FDG PET/CT相当,对于显示原发灶的颅底附近侵犯更有利,其临床应用值得进一步研究.     

18F-FDG PET/CT显像联合HRCT对孤立性原发肺浸润性黏液腺癌的诊断价值

目的探讨孤立性原发肺浸润性黏液腺癌18F-FDG PET/CT显像和HRCT征象及两者联合对该病的诊断价值。方法回顾性分析经病理证实为浸润性黏液腺癌、有18F-FDG PET/CT双时相显像及病灶层面同机HRCT扫描资料的9例患者,对PET/CT早期、延迟显像及滞留指数、HRCT征象进行综合分析。结果HRCT图像上表现为2例呈实性结节、病灶周围无类似卫星灶样影,6例实性结节周围伴小点片及磨玻璃样影,1例为单纯磨玻璃样结节;分叶征(6例)、血管集束征(6例)、支气管充气征(4例)、空泡征(2例)、毛刺征(1例);18F-FDG PET/CT融合图像上8例病灶表现为不均匀FDG代谢增高,早期显像平均SUVmax为3.2±2.5,延迟现象SUVmax增高6例、降低2例,平均SUVmax为3.5±2.4,平均滞留指数为(10.4±29.3)%,9例均未见纵隔、双侧肺门淋巴结及其他部位转移征象,其18F-FDG PET/CT融合图像上18F-FDG摄取与HRCT相匹配,18F-FDG摄取相对集中于结节的实性区域,病灶磨玻璃区18F-FDG摄取不明显;综合手术病理结果等临床资料证实,9例均为T1N0M0期,与PET/CT分期一致。结论对于影像学检查发现肺孤立性占位患者,在单一影像学检查难以明确诊断的情况下,18F-FDG PET/CT双时相显像上病灶不均匀18F-FDG摄取相对集中于其实性区域的代谢方式与HRCT相联合,可辅助孤立性原发性肺浸润性黏液腺癌的诊断。     

T1期肺癌原发灶18F-FDG摄取与转移的关系

目的 探讨T1期肺癌原发灶18F-脱氧葡萄糖(FDG)摄取与病灶大小、淋巴结转移、远处转移、病理类型的关系.方法 对61例治疗前行全身18F-FDG PET/CT扫描的T1期肺癌患者,确定其临床分期以及原发灶大小(最大径)和18F-FDG摄取值[以最大标准摄取值(SUVmax)表示],并分为无转移组、仅淋巴结转移组和有远处转移组.分析各组的18F-FDG摄取与原发灶大小、淋巴结转移、远处转移、病理类型的关系.结果 原发灶大小与SUVmax呈正相关(r=0.466,P＜0.05),各组间大小差异无统计学意义.SUVmax在无转移组(5.05±1.97)与仅淋巴结转移组(7.96±2.98)、远处转移组(8.25±2.93)之间差异均有统计学意义(P值分别为0.003,0.002).而仅淋巴结转移组与远处转移组之间SUVmax差异无统计学意义(P=0.718).肺腺癌、鳞癌的大小(t=1.566,P=0.111)和SUVmax(t:0.478,P=0.623)差异均无统计学意义.结论 T1期肺癌原发灶18F-FDG摄取可能对预测转移有一定的价值.     

CT及18F-FDGPET/CT诊断食管癌术前淋巴结转移及N分期对比研究

目的 研究CT及18F-氟脱氧葡萄糖(FDG) PET/CT术前诊断食管癌淋巴结转移及确定N分期的价值.资料与方法 连续随机选择经食管镜或胃镜证实、拟行手术治疗、能够耐受手术的47例食管癌患者,术前1周内行CT及18F-FDG PET/CT检查,以术后病理为“金标准”,比较CT及18F-FDG PET/CT诊断食管癌淋巴结转移及N分期的敏感性、特异性、准确性、阳性预测值及阴性预测值.结果 31例存在淋巴结转移,共切除并分离淋巴结387枚(209组),其中65枚(46组)发现转移.CT诊断淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为53.8％、92.8％、86.3％、60.3％和90.9％;18F-FDG PET/CT分别为89.2％、93.8％、93.0％、74.4％和97.7％.PET/CT诊断淋巴结转移的敏感性、准确性及阴性预测值均显著高于CT,差异有统计学意义(P＜0.05),特异性及阳性预测值差异无统计学意义(P＞0.05).CT及18F-FDG PET/CT确定淋巴结分期的准确率分别为74.5％和91.5％,差异有统计学意义(P＜0.05).伴淋巴结转移的食管癌原发灶最大标准摄取值(SUVmax)为( 14.899±3.770),而无淋巴结转移者为(9.427±2.854).结论 18F-FDGPET/CT术前诊断食管癌淋巴结转移及确定N分期优于CT;食管癌原发灶SUVmax在一定程度上可以反映淋巴结转移情况.     

18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在诊断乳腺癌及其区域淋巴结转移中的临床价值.方法 对27例疑原发性乳腺癌及经临床随访(＞12个月)证实的12例单发乳腺良性病变患者行18F-FDG PET/CT显像,患者均为女性.对显像结果分别行定性、半定量分析.27例疑乳腺癌患者均行手术治疗.结果 疑乳腺癌患者术后病理检查示24例为乳腺癌,共25个病灶;良性病灶7个.18F-FDG PET/CT显像定性分析诊断乳腺癌的灵敏度为76.0%(19/25),特异性为94.7%(18/19);以最大标准摄取值(SUVmax)＞2.5为界值,18F-FDG PET/CT诊断乳腺癌的灵敏度为72.0%(18/25),特异性为63.2%(12/19);以病灶SUVmax大于对侧正常乳腺腺体SUVmax的-x+2s为界值,PET/CT诊断乳腺癌的灵敏度为96.0%(24/25),特异性为63.2%(12/19),其灵敏度明显高于前2种分析方法(X2=4.15,4.14;P均＜0.05).定性方法的特异性明显高于半定量分析(X2值均为5.7,P均＜0.05).23例行区域淋巴结廓清术的患者病理检查示10例有淋巴结转移.18F-FDGPET/CT定性诊断乳腺癌区域淋巴结转移的灵敏度为60.0%(6/10),特异性为84.6%(11/13);以SUVmax＞2.5为界值,18F-FDG PET/CT诊断淋巴结转移的灵敏度为60.0%(6/10),特异性为92.3%(12/13).结论 在18F-FDG PET/CT诊断乳腺癌中,以病灶SUVmax大于正常乳腺腺体sUVmax的-x+2s为界值的半定量分析有较好的灵敏度;定性分析的诊断特异性优于半定量分析.     

薄壁囊腔型肺腺癌的18F-FDG PET/CT显像表现与特征分析

目的探讨薄壁囊腔型肺腺癌的18F-FDG PET显像和MSCT征象特点,以提高对该病的诊断准确性。方法回顾性分析2007年7月~2017年12月,影像学表现为囊性病变、囊壁厚度≤4mm、经病理证实为肺腺癌病例18例,其中男性15例,女性3例,平均年龄(63.83±11.97)岁。18例均有MSCT、18F-FDG PET/CT双时相显像,对PET/CT早期显像、延迟显像及滞留指数、基于SUVmax的肿瘤与对侧正常肺本底的比值变化率、病灶边缘分叶及胸膜尾征、血管束是否穿过囊壁、囊壁均匀程度及囊壁周围是否伴有磨玻璃等征象进行综合分析。结果所有18例病灶的早期显像平均SUVmax为1.81±0.92(对侧肺本底SUVmax为0.80±0.31),注药后2.0h延迟显像平均SUVmax为2.21±0.10(对侧肺本底SUVmax为0.54±0.23);平均双时相显像滞留指数为(25.87±21.96)%;△T/Nmax平均值为(87.72±53.96)%。病灶常规显像与延迟显像之间SUVmax差异有统计学意义,t=-5.205,P<0.05(P=0.003);与对侧肺本底SUVmax之间差异也有统计学意义,t=3.402,P<0.05(P=0.019);RI和△T/Nmax之间差异无统计学意义,t=-2.42,P>0.05(P=0.06)。MSCT征象发病部位,右肺下叶3例,右肺上叶9例,左肺下叶6例;病灶最大径平均值为(2.88±1.33)cm;病灶均呈边界清晰的类圆形或椭圆形囊样影,15例边缘有分叶,6例有胸膜尾征,15例有血管束穿过囊壁(6例分别有1条血管束穿过囊壁,6例分别有2条血管束穿过囊壁,3例有3条血管束穿过囊壁),12例囊周伴有磨玻璃改变,18例病例囊壁厚度均不均匀。结论肺内囊性病变具有一定CT特征,呈略高于本底的18F-FDG摄取增高,提示薄壁囊腔型肺腺癌可能。     

三维平均CT值和PET/CT最大标准化摄取值预测磨玻璃密度结节型肺腺癌侵袭性的研究

目的 探讨三维平均CT值和PET/CT最大标准化摄取值(SUVmax)对磨玻璃密度结节(GGN)型肺腺癌侵袭性的预测价值.方法 回顾性分析经手术病理证实的81例表现为GGN的肺腺癌,均行PET/CT和HRCT检查.在病变最大直径的CT横断面上测量其平均直径(最大径和垂直径的均值);逐层手动描绘出GGN的轮廓,计算GGN的三维平均CT值;记录18 F-脱氧葡萄糖(18F-FDG) PET/CT的SUVmax.按照病理类型分为浸润前病变、微浸润腺癌、浸润性腺癌3组,并统计3组间肿瘤大小、三维平均CT值及SUVmax之间是否有统计学差异.结果 浸润前病变、微浸润腺癌和浸润性腺癌的肿瘤大小分别为(10.53士4.3)mm、(11.6±6.07)mm、(20.3士9.0)mm;三维平均CT值分别为(-568.59士128.7) HU、(-522士100.51)HU、(-321.9±165.2)HU;SUVmax分别为0.15±0.43、0.00±0.00、2.51±2.61,3组间差异有明显统计学意义(F值分别为11.06、18.624、9.06,P＜0.001).受试者工作特征曲线(ROC)显示,肿瘤大小、三维平均CT值、SUVmax的诊断价值中等,曲线下面积(AUC)分别为0.855、0.867、0.895.三者分别取最佳临界值11.5 mm、-486 HU、0.95,其相对应的诊断浸润性病变的敏感度分别为91.5％、83.1％、79.7％;特异度分别为68.2％、77.3％、95.5％.结论 肿瘤大小、三维平均CT值、SUVmax是判断GGN型腺癌侵袭性的重要预测因子.     

18F-FDG PET/CT最大标准摄取值联合HRCT在肺癌诊断中的价值和影响因素分析

目的 探讨18F-FDG PET/CT联合高分辨率CT(HRCT)诊断肺癌的价值和主要影响因素.方法 回顾分析2010年8月至2011年8月因肺实性病灶行18F-FDG PET/CT检查及肺部HRCT扫描的122例患者资料,所有病例均经病理证实或影像学检查随访8个月以上确诊.利用x2检验对HRCT上不同影像特征在良恶性病变中的构成比差异进行比较,单因素方差分析比较不同病理类型病灶的SUVmax差异,多因素logistic回归分析SUVmax及HRCT影像特征等影响因素,探讨最佳SUVmax诊断界值和18F-FDG PET/CT对肺癌的诊断价值.结果 122例肺实性病灶患者中,恶性82例,良性40例.肺癌HRCT影像特征中前3位依次为毛刺征64.6％ (53/82)、分叶征63.4％(52/82)和胸膜牵拉征39.0％(32/82),高于在良性病变中的比例(x2=19.08、30.89、10.88,均P＜0.01).肺部鳞状细胞癌(简称鳞癌)、小细胞癌和腺癌的SUVmax依次为12.57±4.34、10.66±2.90和8.19±6.01,与肺部良性病变SUVmax (3.01±3.62)相比差异有统计学意义(F =20.83,P＜0.01).不同病理类型肺癌SUVmax从大到小依次为鳞癌、小细胞癌和腺癌,其中鳞癌与腺癌SUVmax差异有统计学意义(P＜0.01);SUVmax的ROC AUC为0.863,SUVmax界值2.99和2.50对肺癌诊断的灵敏度、特异性分别为89.0％(73/82)、75.0％ (30/40)和91.5％ (75/82)、65.0％(26/40);诊断一致性SUVmax 2.99优于SUVmax 2.50,Kappa值分别为0.644和0.597.多因素logistic回归分析显示SUVmax 2.99的诊断比值比(OR)优于SUVmax 2.50的OR,分别为5.42和3.93;SUVmax (OR=5.42,P=0.01)、肿瘤最大径(OR=7.27,P=0.02)、毛刺征(OR =7.70,P＜0.01))和分叶征(OR=12.38,P＜0.01)均为肺癌与良性病灶鉴别诊断有统计学意义的影响因素.结论 SUVmax对肺癌的诊断和鉴别诊断有较高价值.18F-FDGPET/CT联合HRCT诊断肺实性病灶时,SUVmax、肿瘤最大径、毛刺征和分叶征为其鉴别诊断的主要影响因素.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme     

改进的定位技术在胸部肿瘤穿刺活检中的应用

目的：探索CT-SIM三维定位系统、体模固定技术和PET-CT融合影像导引定位技术在胸部肿瘤经皮穿刺活检中的应用价值。方法：对380例胸部肿瘤患者行改进的CT定位技术下的经皮穿刺活检术。根据肿瘤的大小、深度、毗邻关系、活动度以及患者的心肺功能状态,综合运用CT-SIM系统、体模固定技术和PET-CT融合影像导引技术,为患者进行穿刺前定位。统计穿刺定位时间长度、成功率、确诊率、并发症发生情况,并与210例采用传统铅栅定位下胸部肿瘤穿刺活检的相应资料进行比较。结果：采用改进的CT定位技术的380例患者穿刺定位精确,平均定位时间（9.5 min）较传统方法（16.8 min）缩短7.3 min,活检成功率和确诊率分别是98.7%和95.3%,高于传统定位方法的93.3%和83.3%,两者差异均具有统计学意义（P〈0.05）。穿刺并发症发生率相似,气胸发生率分别为2.8%和2.9%,咯血发生率分别为11%和12.8%。结论：根据患者状态及肿瘤特点,在CT-SIM系统快速精确定位技术的基础上,综合运用体模固定技术和PET-CT融合影像导引技术,能显著缩短经皮穿刺活检的定位时间,提高活检成功率。