多模态超声及影像组学在甲状腺乳头状癌诊断及预后评估中的应用进展

甲状腺乳头状癌（PTC）作为甲状腺癌最常见的病理类型,发病率高,进展缓慢,预后良好,但仍有部分PTC在早期发生颈部淋巴结转移（CLNM）,故早期诊断PTC及术前预测CLNM极其重要。近年来以超声造影、弹性成像等为基础的多模态超声在甲状腺疾病方面的应用愈加广泛,加之影像组学大数据的飞速发展,很大程度上提高了PTC诊断及CLNM的预测效能,满足了临床精准诊疗的需求。本文详细分析了多模态超声及超声影像组学在PTC诊断及预后评估中的研究现状和应用进展,探讨目前所面临的困难及挑战,并对其未来前景进行展望。     

肾癌的多模态MRI研究进展

肾癌是泌尿系统常见的恶性肿瘤之一,其早期诊断仍是临床中的挑战性难题.多模态MRI借助新技术在结构和功能成像层面分析疾病,为肾癌的早期诊断、临床决策和疗效反应评估提供重要参考,以期改善患者的临床预后.作者就近年来多模态MRI在肾癌中的研究进展进行综述.     

原发性癫痫的多模态磁共振成像研究进展

原发性癫痫是常见的神经系统疾病,为神经元异常放电导致反复的大脑机能紊乱所致。其发病机制繁杂,临床表现多样,因此加深对该病本质的认识,对患者的诊治具有重大意义。近年来,多模态磁共振技术不断进步,已经从形态结构水平成像发展到代谢、功能以至分子水平成像,在癫痫的定位、定侧诊断,术前及预后的脑功能评估等方面发挥着越来越重要的作用,本文综述了近年来多模态磁共振新技术在癫痫领域的进展。     

从甲状腺癌患者的临床资料探讨早期发现甲状腺癌的方法

近年来,甲状腺癌的发病率越来越高,越来越年轻化,且大部分甲状腺癌患者早期无明显不适,这给早期诊断带来困难。虽然分化良好型甲状腺癌（包括乳头状癌与滤泡状癌）预后良好,但仍有一些甲状腺乳头状癌易早期复发和死亡[1]。多项研究表明,在诸多影响预后的因素中，分期是其中重要因素之一^[2-4]。故早期发现是提高甲状腺癌患者预后的重要手段。     

磁共振多模态影像在脑胶质瘤诊断及其分级中的应用分析

多模态磁共振是将不同功能的磁共振技术融合到为患者进行诊断和检查的一种新兴颅脑成像技术。由于具有精确度高,图像分辨率高,检查侵入性低等优势,同时还可以提供颅脑组织解剖、脑部代谢、细胞功能等信息,多模态磁共振技术已被广泛的运用到各种脑组织病变和神经疾病的诊断和治疗中。本文重点综述了多模态磁共振在诊断脑胶质瘤和对其进行分级中的应用。     

多模态磁共振成像在脑胶质瘤分级诊断及预后评估中的研究进展

脑胶质瘤是中枢神经系统中常见的恶性肿瘤,其具有弥漫性浸润生长的特点,在治疗的过程中具有较大的难度,肿瘤恶性程度高,容易复发、预后较差。多模态磁共振成像技术多用于肿瘤术前的初步诊断,在胶质瘤分级判断以及预测预后方面具有重要的价值。本文就扩散加权磁共振成像、弥散张量磁共振成像、动态磁敏感对比灌注加权成像、动态对比增强磁共振成像、动脉自旋标记成像和磁共振波谱成像等几种多模态磁共振成像技术在脑胶质瘤术前分级诊断及预后评估方面的研究进展进行综述。      

多模态MRI及影像组学在帕金森病伴抑郁的研究进展

抑郁是帕金森病(Parkinson’s disease,PD)非运动症状中较常见的类型,帕金森病伴抑郁(depression in Parkinson’s disease,DPD)可加重患者运动及认知功能障碍,降低预后。因此,DPD的早期诊断并及时干预对改善病情、缓解其他症状恶化具有重要意义。但DPD症状易与PD其他症状重叠,临床诊疗中不易发现。而基于体素的形态学测量、静息态功能磁共振成像、扩散张量成像、扩散谱成像、高角分辨率扩散成像可客观显示中枢神经系统结构及功能改变;此外,影像组学通过提取病变的影像特征,对疾病的诊断和鉴别诊断具有较高的准确性。本文对近年来多模态MRI及影像组学在DPD的研究进展作一综述。     

影像学技术应用于阿尔茨海默病早期诊断的研究进展

对阿尔茨海默病(AD)的临床诊断主要根据临床病史,但敏感性和准确性有限。正电子发射计算机断层显像技术可通过葡萄糖代谢成像以及生物标记物成像较为准确地早期诊断AD;磁共振成像技术则通过结构成像以及功能成像,为AD的早期诊断和鉴别诊断提供基础。近年来,多模态成像技术将放射学与核医学紧密结合,可更为准确地诊断AD。     

多模态MRI术前诊断肝细胞癌微血管浸润应用进展

肝细胞癌（HCC）微血管浸润（MVI）是影响肿瘤术后复发及患者预后的重要因素。术前明确诊断MVI对改善HCC预后意义重大。目前诊断MVI主要依据HCC术后组织病理学检查,难以满足术前诊断的需要。随着影像学技术的发展,临床已将DWI、扩散峰度成像、体素内不相干运动、增强MRI及MRI影像组学分析等多模态MRI技术应用于术前诊断MVI。本文对上述多模态MRI应用于HCC术前诊断MVI的进展进行综述。     

多模态磁共振预测乳腺癌淋巴结转移状态的研究进展

乳腺癌是女性最常见的肿瘤相关死亡原因之一，占女性恶性肿瘤发病率的第1位，其发病率逐年上升、逐渐年轻化。淋巴结（LN）转移是评估乳腺癌患者复发和生存率最重要的预测指标，准确评估腋窝淋巴结是否受累是乳腺癌分期的重要组成部分。前哨淋巴结活检术（SLNB）和腋窝淋巴结清扫术（ALND）均是有创检查，存在并发症风险及穿刺假阴性率较高，因此无创性影像学检查方法预测腋窝淋巴结转移成为近年的研究热点。多模态磁共振较其他成像方式预测乳腺癌淋巴转移更具优势，如无辐射、软组织分辨率更高、可进行多参数及多序列成像，应用于鉴别良恶性乳腺病变、评估乳腺癌患者预后、预测淋巴结转移状态、评估新辅助化疗的疗效等。本文就多模态磁共振中各指数模型及峰度扩散成像预测乳腺癌腋窝淋巴结转移的研究进展进行综述。     

PET-CT detection of abdominal recurrence of ovarian cancer: radiologic–surgical correlation

The diagnosis of recurrent ovarian cancer can be difficult on cross-sectional imaging, and variable sensitivities and specificities have been reported for positron emission tomography (PET). Combined functional and anatomic imaging with PET plus computed tomography (CT) potentially allows for improved detection of tumor masses. We investigated the sensitivity, specificity, and accuracy of PET-CT for the diagnosis of recurrent ovarian cancer. Sixteen women with previously treated ovarian cancer underwent imaging on a combined PET-CT scanner followed by surgery to assess for possible recurrent disease. The fused PET-CT images were retrospectively reviewed for recurrent disease, and the results of PET-CT were compared with the operative notes. Eleven of the 16 patients had recurrent disease at surgery. The sensitivity, specificity, and accuracy of PET-CT for disease detection on a per-patient basis were 72.7%, 40%, and 62.5%, respectively. For cases of malignant adenopathy (n = 7), 100% were detected on PET-CT. For peritoneal lesions no larger than 1 cm (n = 23), 13% were detected on PET-CT. For peritoneal lesions larger than 1 cm (n = 8), 50% were detected on PET-CT. The sensitivity of PET-CT for recurrent ovarian cancer is moderate in patients with low volume disease. A trial involving a larger number of patients with a spectrum of disease volumes is necessary to determine the impact of PET-CT in clinical practice.     

Role of 18F-FDG-PET and PET/CT imaging in thyroid cancer.

In patients affected by differentiated thyroid cancer (DTC), the lacking of 131Iodine trapping by metastatic tissue does not allow 131Iodine whole body scintigraphy to visualize matastatic spread as well as the use of 131Iodine therapy to cure such metastatic spread. Prognosis of 131Iodine-negative DTC metastasis, so-called non-functioning metastasis, is significantly worst. In these patients an early diagnosis of non-functioning metastasis and their surgical extirpation remains the optimal therapeutic approach. In this view, a high sensitive localizing imaging different form 131Iodine whole body scintigraphy is required. Ultrasonography is characterized by a relatively high sensitivity in these patients but it is highly operator-dependent and, moreover, it can be used to explore neck alone. Computed tomography (CT) scan and magnetic resonance (MR) imaging are characterized by a relatively low sensitivity even if they are useful to provide the surgeon with anatomical information of the operating basin. Various tumor-seeking radiotracers have been proposed, mainly using SPECT as 201Thallium, 99mTc-Sestamibi and 99mTc-Tetrofosmin with good results. Even more favorable results have been reported with some positron radiotracers, mainly the 18F-FDG with PET and more recently with PET/CT tomographs. The typical indication to performing with examination is the DTC patient previously treated by total thyroidectomy and 131Iodine ablative therapy, with increased serum thyroglobulin (Tg) or anti-thyroglobulin (TgAb) antibodies during follow-up but with negative 131Iodine whole body scintigraphy even obtained after high, therapeutic 131Iodine doses. Several studies in literature have reported high sensitivity (up to 85%) and specificity (up to 95%) of FDG-PET in metastatic DTC patients. The integrated PET/CT fusion imaging systems, seem able to provide some additional advantages over PET alone, mainly related to a better anatomical localization of the hypermetabolic metastatic lesions. A change in the management of DTC patients affected by non-functioning metastatic spread not visualized by other imaging techniques has been reported in 30% of patients. Lastly, the role of PET and PET/CT fusion imaging systems seem to be promising also in patients affected by medullary thyroid carcinoma (MTC), especially for the detection of neck and mediastinal lesions, with a sensitivity superior to the other currently available imaging methods, however the data reported on medullary cancer are little and further studies are needed to elucidate the preliminary promising results.     

恶性肿瘤患者行PET-CT检查的护理

目的总结肿瘤患者应用吓一氟代脱氧葡萄糖（^8F—FDG）进行PET-CT显像检查的护理要点。方法应用IF-FDG对95例恶性肿瘤患者行PET-CT显像定性诊断,显示肿瘤复发部位和范围。同时进行全程的护理配合,包括检查前的心理护理、饮食护理、药物护理等;检查中患者保持正确体位;检查后加强患者病情观察及健康宣教。结果PET-CT图像高度清晰,能清楚观察到肿瘤病灶及其转移。结论完善及有针对性的全程护理是PET-CT检查获得清晰高质量图像的重要保证。     

FDGPET评价结直肠癌术后复发及转移的价值

目的评价FDG PET对结直肠癌术后复发及转移的价值.方法51例结直肠癌术后患者行FDG PET显像,并与CT及血清CEA结果进行比较.结果FDG PET诊断结直肠癌术后复发的灵敏度、特异性、准确性分别为94.3%、93.8%、94.1%;CT结果为84.4%、57.9%、74.5%;血清CEA结果为57.9%、85.7%、65.4%.51例患者中FDG PET显像发现29例肝脏转移,灵敏度为100%,CT诊断肝转移21例,灵敏度为72.4%.结论FDG PET显像评价结直肠癌术后复发与转移明显优于CT及血清CEA.     

Usefulness of 18F-FDG PET in the diagnosis for breast cancer patients

Whole-body 18F-FDG PET is useful for qualitative diagnosis of breast mass and for preoperative staging, evaluation of therapeutic effect, prediction of prognosis, and detection of recurrence or metastasis in case of breast cancer. In addition, 18F-FDG PET is being actively used for cancer screening in Japan. 18F-FDG PET has almost equal or higher. capacity in detecting recurrence or metastasis of breast cancer as compared with conventional morphological study such as CT or MRI. However it should be noticed of the existence of false-negative and false-positive findings in some cases. In this paper we refer to the advantages and disadvantages of 18F-FDG PET in managing patients with breast cancer.     

18F-FDG PET/CT显像在评估宫颈癌根治术后转移或复发的价值分析

[目的] 分析18F氟脱氧葡萄糖(18F-FDG )正电子发射断层显像术/计算机体层摄影术(PET/ CT)评估宫颈癌根治术后转移或复发的临床价值.[方法] 可疑宫颈癌术后复发或转移患者60例,均为宫颈癌根治术术后患者,且有明确病理结果,均进行18F-FDG PET/CT显像检查,与病理及随访结果对照,评定18F-FDG PET/CT在宫颈癌术后转移、复发诊断中的应用价值.[结果] ①18F-FDG PET/CT显像检出宫颈癌根治术后转移或复发阳性47例,阴性13例,其中30例肿瘤转移,17例肿瘤局部复发,其诊断灵敏度、特异性、准确性分别为97.83%、85.71%、95.00%,阳性预测值、阴性预测值分别为95.74%、90.31%;②18F-FDG PET/CT与病理及随访检查结果一致性较高(P=0.000).[结论] 18F-FDG PET/CT显像对宫颈癌根治术后复发、转移诊断价值高,有其较高的敏感度、特异性、准确性,可为患者的临床治疗提供有效参考.     

Diagnostic Accuracy of Ultrasound and 18-F-FDG PET or PET/CT for Patients with Suspected Recurrent Papillary Thyroid Carcinoma

The purpose of this study was to evaluate the diagnostic accuracies of ultrasound (US) and 18-F-FDG positron emission tomography (PET) or PET/computed tomography (CT) for detecting recurrent papillary thyroid carcinoma (PTC) after total thyroidectomy. Our study enrolled 76 postoperative patients who underwent both neck US and PET because of the suspicion of recurrence. The results of US and PET were correlated with the histopathology, the radioactive iodine whole body scan (WBS) or the clinical follow-up results. Among them, 53 patients had recurrent disease (local recurrence, 42; distant metastasis, 3; elevated Tg level, 8) and 23 showed no evidence of disease. From the analysis, US showed higher diagnostic accuracy, sensitivity and specificity compared with those of PET (71.1%, 71.7% and 69.6% vs. 55.3%, 56.6%, and 52.2%). PET added diagnostic information in a limited number of patients with negative results on neck US (3 with neck recurrence and 2 with distant metastasis). (E-mail: jeonghlee@hanmir.com)     

18F-FDG PET/CT监测结肠癌术后复发转移

目的 评价PET/CT监测结肠癌术后复发转移的价值。方法 收集结肠癌术后可疑复发转移患者78例,男46例,女32例。回顾性分析比较PET/CT、传统影像学与组织病理学诊断或临床随访资料之间的差异,并比较PET/CT与传统影像学诊断结肠癌术后可疑复发转移的价值。结果 78例中,54例经组织病理学诊断或临床随访确诊存在复发、转移。PET/CT诊断结肠癌术后总体复发转移的灵敏度及准确率明显优于传统影像学,灵敏度分别为90.74%和51.85%(P<0.01),准确率分别为89.74%和58.97%(P<0.01)。PET/CT诊断结肠癌术后局部复发转移的灵敏度及准确率亦明显优于传统影像学,灵敏度分别为90.91%和42.42%(P<0.01),准确率分别为96.15%和75.64%(P<0.01)。结论 PET/CT在诊断结肠癌术后可疑复发转移中具有较高的灵敏度及准确率,是一种较理想的监测方法。     

Locally recurrent rectal cancer: what the radiologist should know

Despite advances in surgical techniques and chemoradiation therapy, recurrent rectal cancer remains a cause of morbidity and mortality. After successful treatment of rectal cancer, patients are typically enrolled in a surveillance strategy that includes imaging as studies have shown improved prognosis when recurrent rectal cancer is detected during imaging surveillance versus based on development of symptoms. Additionally, patients who experience a complete clinical response with chemoradiation therapy may elect to enroll in a “watch-and-wait” strategy that includes imaging surveillance rather than surgical resection. Factors that increase the likelihood of recurrence, patterns of recurrence, and the imaging appearances of recurrent rectal cancer are reviewed with a focus on CT, PET CT, and MR imaging.

     

18F-FDG PET/CT显像在卵巢癌术后随访中的价值及与血清CA125检测的关系

目的：研究18F-FDG PET/CT显像在卵巢癌术后随访中的价值及与血清CA125检测的关系。方法：对45例卵巢癌术后患者行18F-FDG PET/CT显像及血清CA125检测,与手术病理或临床随访结果比较判断其诊断复发、转移灶的准确性并比较二者之间的关系。结果：18F-FDG PET/CT显像诊断卵巢癌复发、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90.3%（28/31）、92.8%（13/14）、91.1%（41/45）、96.5%（28/29）和81.5%（13/16）。血清CA125诊断卵巢癌复发、转移的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为74.2%（23/31）、78.5%（11/14）、75.5%（34/45）、88.4%（23/26）和57.9%（11/19）。18F-FDG PET/CT显像与血清CA125检测结果有一定相关性,26例血清CA125升高者中23例PET/CT检查显示数目不等的复发;19例CA125正常患者,8例PET/CT检查显示复发,二者有显著性差异（χ2=11.007,P=0.001）。10例血清CA125≤100 U/mL的复发患者病灶数均较少,90%（9/10）为1～3个;21例CA125>100 U/mL复发患者病灶数80.9%（17/21)为3个以上,二者有显著性差异（χ2=14.006,P=0）。结论：18F-FDG PET/CT显像在卵巢癌术后随访中具有重要临床价值,与血清CA125检测有一定的相关性和互补性。