^18F-FDG PET用于头颈部肿瘤疗效评价和预后分析的研究进展

正电子发射型计算机断层显像(positron emission tomograph，PET)通过探测肿瘤标准摄取值(standard uptake value，SUV)的大小来判断肿瘤的良恶性、生物学行为、监测放化疗的疗效和早期发现肿瘤的复发等。^18F-脱氧葡萄糖(^18F-FDG)是目前最常用的PET显像药物，主要反映细胞的葡萄糖代谢情况，^18F-FDG的吸收与肿瘤生物学行为、代谢特征、病理学类型及分化程度的相关性为临床判断肿瘤的恶性程度提供了一定的依据，进而为反映肿瘤的预后提供了分子基础。综述了^18F-FDG PET在头颈部肿瘤疗效评价和预后分析的研究进展。     

头颈部肿瘤18F-FDG PET/CT诊断价值的探讨

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT诊断头颈部肿瘤的价值.方法:21例头颈部肿瘤患者行PET/CT显像,原发灶或转移灶经病理组织学确诊.行PET/CT融合图像、PET图像和CT图像帧对帧对比分析.基于PET/CT和CT结果对21例患者进行TNM分期,比较其结果.比较PET/CT和PET的定位准确性.结果:21例患者经PET/CT共检出恶性病灶65个.其中PET与CT皆显示清楚病灶者35个,占53.9%.PET阅片有肯定诊断结论而CT难以有肯定诊断结论者24个,占36.9%.CT显示有清楚病灶而PET显示为阴性或难以确定者共6个病灶,占9.2%.PET/CT的总检出率高于PET和CT.PET/CT使8例患者TNM分期发生改变(38.1%). PET/CT对病变定位的准确性为90.8%,总的不影响诊断的定位准确性为95.4%;PET分别为49.2%和66.2%(P＜0.05).结论:PET/CT显像能提高头颈部肿瘤的诊断、分期和定位的准确性.     

18F-FDG PET显像在食管癌诊断中的临床意义

目的探讨正电子发射型电子计算机断层(positron emission computed tomography,PET)显像在食管癌早期诊断以及临床分期中的临床应用价值.方法23例食管癌患者,进行全身18F-脱氧葡萄糖(18F-fluoro-deoxy-glucose,18F-FDG ) PET显像,并与外科手术或内镜活检病理结果和CT检查结果对照.结果46例患者中PET显像食管部位均有异常放射性浓聚灶,经病理确诊,46处食管浓聚灶均为食管癌原发病灶.其中28例为单发病灶,2例为食管多发灶,其余16例除食管原发病灶外,还有其他部位32个病灶,经临床和病理证实为远处转移病灶.与46例PET显像前CT结果相比较,PET共检出食管部位恶性病灶46例,检出率为100.0%,而CT仅检出34例,检出率为73.9%.46例中确诊有其他部位转移者18例,PET检出18例,检出率为100.0%,而PET显像前CT仅检出6例,检出率为33.3%.27例手术治疗者PET分期与临床病理分期一致,而常规检查对食管癌临床分期高估5例,低估12例,PET显像改变了这17例患者的临床治疗方案.结论18F-FDG PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值.     

^18F-FDG PET显像在食管癌诊断中的临床意义

目的：探讨正电子发射型电子计算机断层(positron emission computed tomography，PET)显像在食管癌早期诊断以及临床分期中的临床应用价值。方法：23例食管癌患者，进行全身^18F-脱氧葡萄糖(^18F-fluorodeoxy-glucose，^18F-FDG)PET显像，并与外科手术或内镜活检病理结果和CT检查结果对照。结果：46倒患者中PET显像食管部位均有异常放射性浓聚灶，经病理确诊，46处食管浓聚灶均为食管癌原发病灶。其中28例为单发病灶，2例为食管多发灶，其余16例除食管原发病灶外，还有其他部位32个病灶，经临床和病理证实为远处转移病灶。与46例PET显像前CT结果相比较，PET共检出食管部位恶性病灶46例，检出率为100．0％，而CT仪检出34例，检出率为73．9％。46例中确诊有其他部位转移者18例，PET检出18例，检出率为100．0％，而PET显像前CT仅检出6例，检出率为33．3％。27例手术治疗者PET分期与临床病理分期一致，而常规检查对食管癌临床分期高估5例，低估12例，PET显像改变了这17例患者的临床治疗方案。结论：^18F-FDG-PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值。     

18F-FDG PET在胰腺癌诊疗中的应用

正电子发射体层显像是目前唯一在活体分子水平完成生物学显示及定量评价体内生化改变的医学影像技术，其中放射性核素^18F标记的2-脱氧葡萄糖（^18F—FDG）在临床肿瘤学中已得到较为广泛的应用。现有临床研究资料表明，^18F—FDG PET显像在胰腺癌中的作用主要包括：1）具有较高的诊断和鉴别诊断效能。敏感性、特异性与准确性分别为71％～100％、64％～100％与85％～93％；2）能较常规影像学方法检出更多的淋巴结及肝、肺等远处转移灶，提高准确的临床分期，指导制定合理的治疗方案；3）早期评价肿瘤对放化疗的响应和监测术后的复发与转移，为临床及时调整治疗方案和采取治疗措施提供客观、准确依据：4）通过定量分析肿瘤组织葡萄糖的代谢程度，可有效地判断胰腺癌患者的预后。     

18F-FDG PET在消化道肿瘤疗效评估中的应用

肿瘤患者理想的治疗方案是疗效最好，同时毒副作用最少。化疗、放疗是现阶段最常用的辅助治疗手段，如何及时准确地评价其疗效已成为临床医师关注的焦点。传统的对实体瘤治疗响应的评估是根据治疗前后肿瘤大小、瘤体血供及病灶密度等因素的改变程度来判断的，主要有CT、MRI和B超等检查手段。但上述因素的改变是肿瘤治疗后细胞水平、亚细胞水平一系列复杂极链反应后的结果，常常需要几个疗程才能观察到，故传统的影像学检查不能及时评判疗效。     

18F-FDG PET/CT显像在胃癌诊断中的应用

[目的]评价18F-FDG PET/CT显像在胃癌诊断中的应用.[方法]49例经胃镜和病理确诊的胃癌患者进行18F-FDG PET/CT显像,其诊断结果与病理学检查、其他影像学检查及临床随访比较.[结果] 49例患者18F-FDG PET/CT阳性44例,阳性率89.8％;39例有淋巴结转移患者中18F-FDGPET/CT显像发现32例,灵敏度为82.1％(32/39); 12例有远处转移患者中18F-FDG PET/CT显像发现11例,灵敏度91.6％(11/12).[结论]18F-FDG PET/CT显像对胃癌原发灶、淋巴结转移和远处转移具有较高的灵敏度,18F-FDG PET/CT显像在胃癌诊断中具有较高的临床价值.     

18F-FDG PET/CT相关代谢参数评估胰腺癌患者的预后

目的:利用18F-FDG PET/CT显像中的MTV、TLG评估胰腺癌患者预后的价值。方法:回顾性分析2011年1月至2015年1月间治疗前行18F-FDG PET/CT检查、经临床证实并有随访结果的60例胰腺癌患者（男36例,女24例,中位年龄58.5岁）资料。所入组患者在PET/CT检查前1周均行血清CA19-9检测。在PET/CT图像上分别测量胰腺癌原发灶SUVmax、MTV和TLG,同时进行PET/CT分期评估。全部患者随访截止至2016年6月。应用ROC曲线Kaplan-Meier法及Cox比例风险模型分析血清CA19-9、MTV、TLG、SUVmax、PET/CT分期、年龄、性别及治疗手段与预后的关系。结果:60例患者的中位生存时间为（11.20±7.25）个月。MTV、TLG、SUVmax及血清CA19-9水平评估预后的AUC值分别为0.772、0.748、0.604和0.474。Kaplan-Meier单因素分析表明不同治疗前原发灶MTV（＜8.43 cm3与≥8.43 cm3）、TLG（＜40.06 cm3与≥40.06 cm3）、SUVmax（＜8.86与≥8.86）、PET/CT分期（Ⅰ/Ⅱ期与Ⅲ/Ⅳ期）及治疗手段组（手术治疗组与非手术治疗组）间的生存差异具有统计学意义（log-rank检验,χ2=14.844、13.667、5.600、6.182、4.854,均P<0.05）;Cox回归模型单因素分析示患者的1年生存率与胰腺癌治疗前原发病灶MTV［危险比（HR） =0.333,P=0.001］、TLG［危险比（HR）=2.811,P=0.001］、PET/CT分期［危险比（HR）=1.891,P=0.022］、SUVmax（HR=1.794,P=0.030）、治疗手段［危险比（HR）=0.506,P=0.044］相关;Cox回归模型多因素分析显示MTV及TLG是患者生存预后的独立影响因素。结论:MTV和TLG可以作为胰腺癌患者预后的评估指标,也有助于临床为高危患者制定有针对性的治疗方案。     

18F-FDG PET及PET/CT在食管癌诊断中的应用

食管癌是常见的消化道肿瘤,预后差,是当今严重危害人类健康的主要疾病之一。目前手术切除仍是其治疗的主要手段。早期诊断和准确的临床分期是食管癌治疗成功的关键。以往食管癌影像学检查主要依赖消化道造影、CT扫描、超声及食管内窥镜超声检查(transesophageal endoscopic ult     

子宫颈癌治疗后18F-FDG PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG) PET/CT显像在子宫颈癌治疗后监测有无肿瘤复发及转移灶中的临床应用价值.方法 子宫颈癌治疗后患者48例,行全身18F-FDG PET/CT检查,肿瘤复发和(或)转移病灶根据病理结果、多种影像学诊断及临床随访而确诊.随访时间＞1年.采用SPSS 11.5软件进行统计学处理.结果 48例患者共行54次PET/CT显像,真阳性26例次,真阴性24例次,假阴性1例次,假阳性3例次.18F-FDG PET/CT显像诊断子宫颈癌治疗后肿瘤复发和(或)转移病灶的敏感度、特异性、准确性、阳性预测值及阴性预测值分别为96.3％ (26/27)、88.9％(24/27)、92.6％ (50/54)、89.7％(26/29)、96.0％(24/25).检查后部分患者的诊断和治疗方案发生了改变,有24例(50.0％)患者改变了诊断,其中21例(43.8％)改变了治疗方案.结论 PET/CT显像可以较准确地早期探查子宫颈癌治疗后的复发病灶和转移灶,包括盆腔外的远处转移,明确再分期,有助于临床医生确定正确的治疗方案.尽管有其一定的局限性,PET/CT显像仍可作为子宫颈癌治疗后监测的常规检查手段.     

18F-FDG PET判断头颈部癌复发的作用

目的：探讨^18F-氟脱氧葡萄糖（^18F-fluoro-deoxyglucose,^18F-FDG）正电子发射断层显像术（positron emission tomography,PET）在头颈部癌复发诊断中的作用。方法：54例临床上怀疑复发的头颈部癌患者同期均行^18F-FDGPET显像（25例全身显像,29例局部显像）和CT或MR检查,最后诊断依靠病理检查或临床随访。结果：54例患者中^18F-FDGPET显像阳性39例,其中假阳性2例;阴性15例,其中假阴性3例。^18F-FDGPET显像和CT或MR的敏感性分别为92.5%（37/40）和55.0%（22/40）,差异有统计学意义,χ^2=14.528,P〈0.05;特异性分别为85.7%（12/14）和85.7%（12/14）,差异无统计学意义,χ^2=1.875,P=0.483;阳性预测值、阴性预测值分别为94.9%（37/39）、80.0%（12/15）和100.0%（22/22）、52.2%（12/23）;准确率分别为90.7%（49/54）和63.0%（34/54）,差异有统计学意义,χ^2=11.711,P=0.001。在25例18F-FDGPET全身显像中,16例除头颈^18F-FDG异常浓聚外,9例还发现有远处转移。结论：判断头颈部癌治疗后复发,^18F-FDGPET比CT或MR更敏感和有更高的准确性,并且在临床分期上有一定价值。     

18F-FDG PET/CT显像对肾细胞癌分级和临床分期及预后预测的价值

目的:评价PET/CT显像对于肾细胞癌恶性程度分级、临床分期及预后的价值。方法:回顾性分析46例临床诊断为肾细胞癌患者的PET/CT显像结果,与其他影像资料结果相比较,探讨其与肾细胞癌分级、临床分期及预后的关系。结果:46例患者中,经手术病理确诊为肾细胞癌者37例,其余9例因PET/CT显像发现有转移病灶放弃手术。PET/CT检查结果真阳性41例,假阴性5例,敏感度为89.1%,其他影像资料敏感度为84.8%。37例手术患者中,3级肾细胞癌病理分组间SUV差异均有统计学意义,P值分别为0.034、0.012和0.021。17例死亡病例,平均生存期为9个月,最大SUV越高,患者的生存期相对就越短。结论:PET/CT显像结果与肾细胞癌分级有关,分级越高,阳性率越高;PET/CT显像对于肾细胞癌临床分期及预后亦有重要价值。     

Prognostic value of post-treatment 18F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy简

Objective：To clarify the prognostic value of post-treatment 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） in patients with advanced head and neck squamous cell carcinoma （HNSCC） after combined intra-arterial chemotherapy and radiotherapy （IACR）.Methods：Thirty-six patients with HNSCC who underwent IACR were recruited.The period from the end of IACR to the last post-treatment 18F-FDG PET/CT examination was 8-12 weeks.Both patient-based and lesion-based analyses were used to evaluate the PET/CT images.For lesion-based analysis,36 regions （12 lesions of recurrences and 24 scars at primary sites） were selected.The Kaplan-Meier method was used to assess the overall survival （OS） stratified by 18F-FDG uptake or visual interpretation results.Results：Twelve patients with recurrence were identified by six months after IACR.The sensitivity and specificity in the patient-based analysis were 67％ （8/12） and 88％ （21/24）,respectively.The mean OS was estimated to be 12.1 months （95％ CI,6.3-18.0 months） for the higher maximum standardized uptake value （SUVmax） group （n=7） and 44.6 months （95％ CI,39.9-49.3 months） for the lower SUVmax group （n=29）.OS in the higher SUVmax group （cut-off point,6.1） or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group （P＜0.001 and P＜0.05,respectively）.Conclusions：The SUVmax and visual interpretation of HNSCC on post-IACR 18F-FDG PET/CT can provide prognostic survival estimates.     

18F-FDG PET-CT在结肠直肠癌术后CEA增高患者中的应用

目的 评价18F-FDG PET-CT在查找结肠直肠癌术后CEA再次增高患者可能复发转移的应用价值.方法 回顾性分析了47例结肠直肠癌术后患者,所有患者均术前肿瘤标志物CEA升高,术后有/无放、化疗,治疗后肿瘤标志物CEA降至正常范围,后临床随访中再次出现CEA增高,临床怀疑复发转移,行18F-FDG PET-CT全身...     

PET/CT与增强CT诊断头颈肿瘤颈淋巴结转移的对比研究

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT显像与螺旋CT增强扫描检测头颈肿瘤淋巴结转移的临床价值。方法:13个头颈肿瘤病人在颈部手术前,行PET/CT和增强CT检查。术后病理结果作为参考标准,PET/CT与增强CT的发现以左、右颈侧为记录单位进行比较。结果:在21个颈侧清扫(8个双侧,5个单侧)中,共清扫出440个淋巴结,其中的45个颈部淋巴结转移癌分布在14个颈侧。PET/CT检测颈淋巴结转移的敏感性、特异性和准确性分别为86%、100%和90%,增强CT分别为79%、86%和81%,PET/CT诊断的敏感性和准确性均显著高于增强CT(P<0.05)。结论:PET/CT在头颈肿瘤淋巴结转移的诊断中优于增强CT。本文结果为PET/CT在临床和放射影像诊断为颈部淋巴结阴性病人中发现转移的研究提供了可行性依据。     

The Indications and Clinical Curative Effects of Modified Neck Dissection in Head and Neck Cancers

OBJECTIVE Functional neck dissection was first described by Bocca and Pignataro in 1967. It has been used in clinical practice for years, but remains controversial among neck-surgery experts. This study was designed to evaluate indications and curative effects of functional-neck dissection (FND). METHODS One hundred and fifty-two cases which underwent FND were reviewed with an analysis of pathological specimens and follow-up datas. RESULTS The series of FND included 20 cases of tongue carcinoma, 23 cases of larynx carcinoma, 96 cases of thyroid papillary adenocarcinoma, 9 cases of follicular adenocarcinoma and 4 cases of medullary adenocarcinoma; the five-year recurrence rate for tongue carcinoma was 12.5%, 14.3%, 40.0% and for a larynx carcinoma was 20.0%, 16.7%, 50.0% in N0 stage, N1 stage, N2a stage, respectively. The 5-year recurrence rate of thyroid papillary adenocarcinoma was 6.5%, 7.1% in N1a, N1b, respectively. CONCLUSION Functional neck dissection is indicated in early and low malignant head and neck neoplasms and results in satisfactory curative effects.     

Impact of positron emission tomography/computed tomography surveillance at 12 and 24 months for detecting head and neck cancer recurrence

BACKGROUND:

In head and neck cancer (HNC), 3‐month post‐treatment positron emission tomography (PET)/computed tomography (CT) reliably identifies persistent/recurrent disease. However, further PET/CT surveillance has unclear benefit. The impact of post‐treatment PET/CT surveillance on outcomes is assessed at 12 and 24 months.

METHODS:

A 10‐year retrospective analysis of HNC patients was carried out with long‐term serial imaging. Imaging at 3 months included either PET/CT or magnetic resonance imaging, with all subsequent imaging comprised of PET/CT. PET/CT scans at 12 and 24 months were evaluated only if preceding interval scans were negative. Of 1114 identified patients, 284 had 3‐month scans, 175 had 3‐ and 12‐month scans, and 77 had 3‐, 12‐, and 24‐month scans.

RESULTS:

PET/CT detection rates in clinically occult patients were 9% (15 of 175) at 12 months, and 4% (3 of 77) at 24 months. No difference in outcomes was identified between PET/CT‐detected and clinically detected recurrences, with similar 3‐year disease‐free survival (41% vs 46%, P = .91) and 3‐year overall survival (60% vs 54%, P = .70) rates. Compared with 3‐month PET/CT, 12‐month PET/CT demonstrated fewer equivocal reads (26% vs 10%, P < .001). Of scans deemed equivocal, 6% (5 of 89) were ultimately found to be positive.

CONCLUSIONS:

HNC patients with negative 3‐month imaging appear to derive limited benefit from subsequent PET/CT surveillance. No survival differences were observed between PET/CT‐detected and clinically detected recurrences, although larger prospective studies are needed for further investigation. Cancer 2013. © 2012 American Cancer Society.     

The diagnostic and prognostic utility of positron emission tomography/computed tomography‐based follow‐up after radiotherapy for head and neck cancer

BACKGROUND:

The detection of subclinical head and neck cancer recurrence or a second primary tumor may improve survival. In the current study, the authors investigated the clinical value of a follow‐up program incorporating serial ¹⁸F?fluorodeoxyglucose?positron emission tomography integrated with computed tomography (PET/CT) in the detection of recurrent disease in patients with head and neck cancer.

METHODS:

A total of 240 PET/CT scans were reviewed in 80 patients with head and neck cancer who were treated with radiotherapy (RT) from July, 2005 through August, 2007. All patients were followed with clinical examination, PET/CT, and correlative imaging for a minimum of 11 months (median follow?up, 21 months).

RESULTS:

The sensitivity, specificity, and positive and negative predictive values of PET/CT‐based follow‐up for detecting locoregional recurrence were 92%, 82%, 42%, and 98%, respectively. Corresponding values for distant metastases or second primary tumors were 93%, 96%, 81%, and 98%, respectively. Eight patients (10%) developed disease recurrences or second primary tumors that were amenable to salvage surgery with negative surgical margins. The 2‐year progression‐free survival and 2‐year overall survival rates were significantly different between patients who had a negative and those with a positive PET/CT result within 6 months of the completion of RT (93% vs 30% [P<.001] and 100% vs 32% [P<.001], respectively).

CONCLUSIONS:

Although post‐therapy follow‐up using PET/CT is reportedly associated with a high false‐positive rate in the irradiated head and neck, PET/CT appears to be a highly sensitive technique for the detection of recurrent disease. Furthermore, negative PET/CT results within 6 months of the completion of RT offer significant prognostic value. Cancer 2009. © 2009 American Cancer Society.