PET/CT在结直肠癌术后复发及转移诊断中的应用价值

对66例结直肠癌术后临床可疑复发或转移的患者行全身PET/CT显像, 根据病理诊断、临床随访结果计算PET/CT诊断复发及转移的敏感性和特异性,并与CT平扫检查结果比较.结果 PET/CT诊断结直肠癌术后复发的灵敏性和特异性分别为100%、94.6%,CT平扫分别为82.3%、85.8%;诊断术后转移的灵敏性和特异性分别为97.0%、91.7%,CT平扫分别为83.5%、76.6%. 半定量法示复发者标准摄取18F-脱氧葡萄糖(18F-FDG)最大值明显高于良性病变者(P﹤0.01).认为 PET/CT诊断结直肠癌术后复发转移具有较高的灵敏度和特异度,是结直肠癌术后理想的影像监测手段.     

18F-FDG符合探测正电子显像对淋巴瘤的临床应用研究

目的 探讨氟[^18F]—氟代脱氧葡萄糖(^18F—FDG)符合探测正电子代谢显像(SPECT／PET)对淋巴瘤的临床应用价值。方法 经确诊的18例非霍奇金淋巴瘤(NHL)患者在治疗前后进行^18F—FDG符合线路显像，对显像结果用定性和半定量方法分析，并与B超和CT检查结果进行比较。结果 18例患者共进行30例次检查，真阳性21例次，真阴性6例次，假阳性2例次，假阴性1例次，其准确率90．0％，灵敏度95．5％，特异性75．0％，阳性预测值91．3％，阴性预测值85．7％。^18F—FDG显像改变了16．7％(3／18)临床分期和46．7％(14／30)的治疗方案。治疗后^18F—FDG对复发的阳性预测值100％，阴性预测值为80．0％。CT的阳性预测值50．0％，阴性预测值25．0％。治疗后阴性^18F—FDG显像患者无疾病进展生存期为16～47个月，平均28．7个月，治疗后阳性^18F—FDG显像的患者无疾病进展生存期为3～46个月，平均8．3个月。结论 ^18F—FDG SPECT／PET在NHL中具有重要的临床价值。     

^18F-FDG PET／CT显像监测卵巢癌患者术后复发／转移的临床价值分析

目的 探讨18-氟代脱氧葡萄糖（^18F-FDG）PET／CT显像在卵巢癌术后监测中的价值。方法回顾性分析19例卵巢癌术后患者的全身PET／CT显像结果,并以病理和随访诊断结果为标准计算其诊断卵巢癌复发／转移的灵敏度、特异性等。结果 “F-FDGPET／CT显像预测卵巢癌术后复发／转移的灵敏度为100．O％（14／14）、特异性为60．0％（3／5）、阳性预测值为87．5％（14／16）、阴性预测值为100．O％（3／3）。结论”F-FDGPET／CT显像对监测卵巢癌术后复发／转移的价值优于传统影像学方法,与血清癌胚抗原（CAl25）联合检查可早期检出复发／转移灶。     

18F-FDG PET/CT显像判断乳腺癌复发及转移的价值

目的探讨^18F-FDG PET/CT显像判断乳腺癌复发和转移的临床价值.方法28例手术治疗后临床疑有肿瘤复发或转移的乳腺癌患者均进行^18F-FDG PET/CT全身显像,应用目测法和半定量分析法判断结果（标准摄取值,SUV）.结果病理、活检、细胞学检查等证实17例有局部复发和（或）转移,^18F-FDG PET/CT显像正确诊断16例,检测灵敏度、特异性（94.12%,90.91%）明显高于传统影像学方法;在62个肿瘤复发和（或）转移灶中,PET/CT及常规影像学检查检出率分别为91.94%（57/62）、72.58%（45/62）,P＜0.05.结论^18F-FDG PET/CT显像是早期诊断乳腺癌复发和（或）转移良好的、无创性方法.     

18F-FDG显像和CEA、CA242联合诊断结、直癌术后复发临床研究

对52例结、直肠癌术后可疑复发或转移的患者行^18F-脱氧葡萄糖（FDG）双探头符合线路显像，同时检测癌胚抗原（CEA）、糖蛋白（CA242），并与同期CT、核磁共振（MR）、B超影像进行对比。经^18F—FDG显像发现复发患者36例，1例CEA明显升高而FDG显像未见异常，经CT和MR发现复发，行手术切除为黏液癌。提示“^18F-FDG显像联合血肿瘤标志物检测能明显提高结、直肠癌复发的检出率。     

符合线路18F-脱氧葡萄糖代谢显像在卵巢癌复发中的应用

目的：探讨符合线路18F-脱氧葡萄糖代谢显像（符合线路18F—FDG）在卵巢癌复发中的诊断价值。方法：对40例在核医学科接受符合线路18F-FDG显像的卵巢癌术后患者进行分析，并与CA125进行比较。结果：40例临床疑有复发的卵巢癌患者中，经临床或病理证实复发28例，24／28例符合线路18F—FDG显示阳性；22／28例血清CA125升高。符合线路18F-FDG显像，CA125监测卵巢癌复发和转移的灵敏度、特异性和准确性分别为85．7％、66．7％和80％；78．6%、83．3％和80％。结论：符合线路18F-FDG显像作为无创伤性检查技术，能及时探测到复发或扩散肿瘤的代谢变化，可以为卵巢癌术后随访，特别是CA125升高的患者提供一种有效的非侵入性影像学诊断方法。     

^18F—FDGPET显像在判断胰腺占位性质和术后随访的价值

目的 评价^18F-FDGPET显像在判断胰腺占位性质和肿瘤术后随访中的作用。方法 检查33例胰腺疾病患，以^18F-FDG显像。结果 23例胰腺占位性病变PET检查发现14例胰腺高代谢区（SUV3.1-6.8)，其中3例伴多发性肝转移，1例肝转移伴腹膜后淋巴结转移。2例CT诊断为胰腺癌合并肝转移经检查显示胰腺高代谢区，但肝脏无阳性表现；1例左肺中部稍高代谢区（SUV1.31)，诊断为良性结节，经随访证实，3例因发现其他部位转移寻找原发灶，PET见胰腺放射性浓聚影，5例胰腺癌术后PET发现1例肝脏，腹腔淋巴结转移。结论 ^18F-FDGPET显像对胰腺占位定性，鉴别诊断和术后随访具有重要的价值。     

99Tcm-生长抑素受体显像对肺癌的诊断价值

目的探讨^99Tc^m-生长抑素受体(^99Tc^m-奥曲肽)显像对肺部肿瘤的诊断价值。方法56例胸部cT检查疑诊为肺癌的患者，行^99Tc^m-奥曲肽显像检查，其中23例行氟脱氧葡萄糖F18(^18F—FDG)双探头符合线路显像(DHC)，并将影像学结果与病理检查结果进行对比分析。结果病理检查证实，56例患者中，肺癌46例，肺良性病变10例。^99Tc^m-奥曲肽显像：53例结果与病理结果相同(44例肺癌、9例肺良性病变)；2例病理检查为肺腺癌，^99Tc^m-奥曲肽显像为肺良性病变，1例病理证实为肺结核球，^99Tc^m-奥曲肽显像为肺癌。^18F—FDG DHC：19例结果与病理结果相同(13例肺癌、6例肺良性病变)；4例病理证实为肺良性病变，^18F—FDG DHC检查为肺癌。以病理结果为诊断标准，^99Tc^m-奥曲肽显像诊断肺癌的敏感性、特异性和准确性分别为95．7％、90．0％和94．6％，阳性预测值(PPR)为97．8％，阴性预测值(NPR)为81．8％；^18F—FDG DHC诊断肺癌的敏感性、特异性、准确性分别为100％、60．0％、82．6％，PPR为76．5％，NPR为100％。^18F—FDG DHC诊断为肺癌的13例患者，6例有淋巴结转移，^18F—FDG DHC共检出10枚转移淋巴结，^99Tc^m-奥曲肽显像仅检出2枚。2例肺癌脑转移，两种显像方法均清晰显示脑部转移灶。结论^99Tc^m-奥曲肽显像是一种无创、安全、经济的检查方法，对肺癌原发病灶有较好的诊断价值，但对淋巴结转移诊断价值有限，它是^18F—FDG DHC的有效补充。     

51例胶质瘤患者18F-FDG PET显像特征及分析

目的探讨胶质瘤18F-氟代脱氧葡萄糖（18F—FDG）PET显像特征,以提高其术前诊断、分级的准确性。方法对经病理证实的51例胶质瘤患者的18F-FDGPET显像特征进行总结,分析其目测法和半定量方法诊断结果与病理诊断的符合率。结果目测法与病理诊断的符合率星形细胞起源肿瘤为97．4％,少突胶质细胞起源肿瘤为66．7％（4／6）,混合性细胞瘤为83．3％（5／6）;半定量法与病理诊断的符合率为86．3％,诊断灵敏性为93．1％、特异性为88．9％。结论不同类型、级别的胶质瘤在18F-FDGPET显像上有其特征性表现,此有利于术前鉴别肿瘤性质及进行分级诊断。     

18↑F-FDG PET/CT显像在软组织肿瘤诊断中的应用

目的探讨18氟脱氧葡萄糖（18↑F-FDG）PET/CT显像在软组织肿瘤诊断中的临床应用价值。方法软组织肿瘤患者65例,静脉注射18↑F-FDG后PET/CT显像。经衰减校正后行目测法和半定量分析法测定病灶的最大标准摄取值（SUVm ax）进行图像分析,并与病理检查结果对照。结果根据病理结果目测法发现局部软组织病灶47例,其中良性5例、恶性42例,淋巴结转移6例、骨转移10例、软组织转移7例、肺转移10例。目测法发现局部病灶的准确性、灵敏性均为100%,诊断转移病灶的准确性、灵敏性、特异性分别为96.9%、100%、95.1%。36.9%的病例根据PET/CT结果改变肿瘤分期。半定量分析对鉴别软组织恶性肿瘤的准确性、灵敏性、特异性分别为85.1%、92.9%和20%。结论在软组织肿瘤诊断中18↑F-FDG PET/CT显像是一种无创性、高灵敏性的检查,特别是对确定软组织肉瘤的分期。     

Use of [18F]fluorodeoxyglucose positron emission tomography in evaluating locally recurrent and metastatic adrenocortical carcinoma

CONTEXT: Adrenocortical carcinomas are uncommon, and their evaluation by [(18)F]fluorodeoxyglucose positron emission tomography (FDG PET) has not been well evaluated. OBJECTIVE: The purpose of this study was to examine the potential utility of FDG PET in the detection of recurrent or metastatic adrenocortical carcinoma. DESIGN: In patients with known adrenocortical carcinoma who underwent FDG-PET imaging for suspected recurrence or metastasis, FDG activity was compared with other imaging findings, clinical features, and the presence or absence of disease as confirmed by resection, biopsy, or clinical follow-up. SETTING: The study took place at four tertiary referral centers. PATIENTS OR OTHER PARTICIPANTS: Twelve patients (10 females and two males, 5-71 yr of age) were evaluated. MAIN OUTCOME MEASURES: The main outcome measures were FDG activity, other imaging findings, and clinical features. RESULTS: Abnormal FDG uptake correctly indicated tumor recurrence in 10 patients. One patient with no abnormal FDG activity had a morphological abnormality subsequently proven to be a postoperative scar. Two patients, one with very small pulmonary lesions and one with a hepatic metastasis, had false-negative findings. CONCLUSIONS: Most adrenocortical carcinomas accumulate and retain FDG and thus can be visualized by PET. However, false-negative findings are possible, especially with very small lesions.     

Whole-body F-18 FDG PET for hepatocellular carcinoma patients after interventional treatment

For hepatocellular carcinoma (HCC) patients after primary treatment, conventional anatomical imagings may not be reliable in detecting residual, recurrent or metastatic lesions. The aim of this retrospective study was to evaluate the usability of FDG PET in the follow-up of HCC patients after prior interventional treatments. The database consisted of 10 male and 2 female (age range, 46-82 years; mean age, 63.4 +/- 11.7 years) who had received primary HCC treatments and underwent FDG PET scans at the National Taiwan University Hospital. The accuracy of FDG PET detection was determined by the histopathological results or other clinical evidences afterwards. Of the 22 lesions, FDG PET studies were able to detect 8 (8/10, 80%) intrahepatic lesions and 8 (8/12, 66.7%) extrahepatic lesions. The lesion based detection rate of FDG PET is 72.7% (16/22). FDG PET was able to detect at least 1 lesion in 11 patients. The 6 false negative lesions in 6 patients include 2 intrahepatic lesions, 1 brain lesion, 1 sphenoid sinus lesion and 2 multiple subcentimeter pulmonary lesions. FDG PET scan is able to provide valuable auxiliary information for the follow up of HCC patients clinically suspicious of recurrence if their conventional image findings are not unambiguous.     

Use of integrated FDG PET/CT imaging in pulmonary carcinoid tumours

BACKGROUND: Integrated positron emission tomography (PET)/computed tomography (CT) scanners have been recently introduced in the diagnostic work-up of suspected pulmonary malignancy and demonstrate encouraging results in the staging of nonsmall-cell lung cancer. OBJECTIVE: To evaluate the usefulness of integrated FDG PET/CT in pulmonary carcinoid tumours. SETTING: University hospital. METHODS: We studied 13 patients (mean age +/- 1 SD, 57 +/- 11 years) with pulmonary carcinoid tumours. All patients demonstrated a single pulmonary lesion. Integrated PET/CT scan and surgical resection were performed in all patients. RESULTS: The pulmonary lesion size ranged from 1.1 to 5.0 cm. Final histological diagnosis confirmed 12 typical and one atypical pulmonary carcinoid. Mean proliferation rate of the typical carcinoids was 1.7 +/- 1.4%. None of the patients had recurrent carcinoid disease or died during follow-up (864 +/- 218 days). Mean standardized uptake value (SUV) of (18)F-fluorodeoxyglucose (FDG) in typical carcinoids was 3.0 +/- 1.5 (range 1.2 - 6.6); SUV in the atypical carcinoid was remarkably high with a value of 8.5. The SUV was lower than 2.5 in 6 of 12 patients (50%). Mediastinal lymph node metastases or extrathoracic metastases were not detected in any patient. CONCLUSIONS: (18)F-fluorodeoxyglucose PET/CT imaging improves accurate localization of metabolic activity and thus the interpretation of pulmonary lesions on CT. FDG uptake in pulmonary carcinoid tumours is often lower than expected for malignant tumours. Therefore, surgical resection or biopsy of lesions suspected to be carcinoids should be mandatory, even if they show no hypermetabolism on FDG PET images.     

18F]fluorodeoxyglucose uptake in recurrent thyroid cancer is related to hexokinase i expression in the primary tumor

Patients suspected of recurrent differentiated thyroid cancer (DTC) may require "blind" (131)I therapy, with the disadvantage of unpredictable efficacy and toxicity. Alternatively, positron emission tomography (PET) with [(18)F]fluorodeoxyglucose ((18)FDG) can document the recurrence, thereby rationalizing therapeutic options. This study compared (18)FDG uptake in vivo with biomarkers expected to be involved in the underlying biological mechanisms. Additionally, we investigated whether such features were present in the primary tumors. Preoperatively, 19 patients with recurrent DTC underwent PET. (18)FDG uptake was compared with histological and immunohistochemical features in surgical specimens of recurrent and primary tumor. Thirteen of 19 recurrences were positive at PET, and (18)FDG uptake was associated with the expression of hexokinase type I (HK I; P = 0.011). All lesions with HK I overexpression were positive on (18)FDG PET. HK I expression in the original primary tumor and the metastases was similar in 82% (rho = 0.648; P = 0.005). In suspected recurrent thyroid cancer, stratification for (18)FDG PET may benefit from pretest immunohistochemical analysis of HK I of the primary tumor, as HK I negativity indicates a low likelihood of PET positivity.     

Recombinant human thyrotropin stimulation of fluoro-D-glucose positron emission tomography uptake in well-differentiated thyroid carcinoma

TSH stimulates thyrocyte metabolism, glucose transport, and glycolysis. 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) is a glucose analog used in positron emission tomography (PET) to detect occult well-differentiated thyroid carcinoma. The objective of this study was to examine the effects of recombinant human TSH (rTSH) on FDG PET uptake in patients with residual or recurrent disease. Seven patients with well-differentiated thyroid carcinoma, negative 131-I scintigraphy, and biochemical evidence of residual disease were randomized and prospectively studied with FDG PET both on thyroid hormone suppression and rTSH stimulation within 1 wk. All lesions seen on the TSH suppression scans were seen on the rTSH stimulation studies. rTSH stimulation studies identified four additional lesions not seen on TSH suppression. One patient was positive on rTSH stimulation alone. The mean (2.54 +/- 0.72 vs. 1.79 +/- 0.88) and maximum (2.49 +/- 0.95 vs. 1.74 +/- 0.81) lesion to background ratios were significantly higher with rTSH stimulation, compared with TSH suppression (P = 0.02 for both). rTSH stimulation improves the detectability of occult thyroid metastases with FDG PET, compared with scans performed on TSH suppression.     

Usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated serum levels of tumor marker

The aim of this study was to evaluate practice usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated tumor marker (CA-125) serum levels. Whole-body FDG-PET was performed in 28 patients with suspected recurrent ovarian cancers and asymptomatically increased serum levels of tumor marker (CA-125 antigen) but negative or equivocal other imaging modality results. All of these 28 asymptomatic patients had serum levels of CA-125 antigen >35 U/ml. The final diagnosis of recurrent ovarian cancer was established by operation/biopsy histopathological findings or clinical follow-up longer than 1 year by additional morphologic imaging techniques. Among the 28 patients, the final diagnoses of recurrent ovarian cancers and benign lesions were established in 20 and 8 patients, respectively. FDG-PET accurately diagnosed recurrent ovarian cancers in 19 patients and benign lesions in 7 patients. When asymptomatically elevated serum levels of CA-125 antigen, the diagnostic sensitivity, specificity, and accuracy of FDG-PET to detect recurrent ovarian cancers were 95.0%, 87.5%, and 92.9%, respectively. FDG-PET is a useful technique to detect recurrent ovarian cancers for patients suspected of recurrent ovarian cancers due to asymptomatically elevated serum levels of CA-125 antigen.     

Multiple values of <Superscript>18</Superscript>F-FDG PET/CT in idiopathic inflammatory myopathy

This study aimed to investigate the multiple values of ¹⁸F-FDG PET/CT in detecting malignant tumors, evaluating myopathy, and determining interstitial lung disease in patients with idiopathic inflammatory myopathy (IIM). We retrospectively analyzed the data of 38 patients who were examined by ¹⁸F-FDG PET/CT and eventually diagnosed as IIM. We also collected the data of another 22 cases with negative PET/CT as the control. Pulmonary HRCT images were acquired simultaneously with regular ¹⁸F-FDG PET/CT imaging for each patient. Image analysis included the presence of malignant lesions, muscular FDG uptake, and interstitial lung disease and its imaging features. IIM was classified into polymyositis (PM), classic dermatomyositis (CDM), and clinical amyopathic dermatomyositis (CADM). All suspected malignant lesions were confirmed by histopathological examination. Interstitial lung disease was diagnosed by HRCT. Rapidly progressive interstitial lung disease (RP-ILD) was determined according to clinical follow-ups. The significance of ¹⁸F-FDG PET/CT in the detection of malignancy, observation of activity of myopathy, and determination of interstitial lung disease in IIM patients was explored based on the final clinical diagnosis. In the 38 patients with IIM, 3 cases were classified as PM, 18 as CDM, and 17 as CADM. PET/CT correctly detected 7 cases (18.4%) of malignant tumors, and all of which were found in CDM and PM patients. The muscular FDG uptake in IIM patients was higher than the control population, and it was higher in patients with myopathy (including PM and CDM) than in patients with CADM. The muscular FDG uptake in IIM patients was correlated with elevated serum creatine kinase level (r = 0.332, P = 0.042) and impaired muscle strength (r = ?0.605, P < 0.001). Interstitial lung disease was detected by HRCT in 30 patients (78.9%), and 7 of them were eventually confirmed as RP-ILD, according to the clinical outcome. The FDG uptake in lung lesions of RP-ILD patients was higher than those with chronic interstitial lung diseases, even though no significant difference was found between the CT features of RP-ILD and chronic interstitial lung disease. When SUV_max ≥ 2.4 was employed as the threshold for RP-ILD prediction, the diagnostic efficiency was yield with a sensitivity of 100.0% (7/7), specificity of 87.0% (20/23), and accuracy of 90.0% (27/30), respectively. For IIM patients, ¹⁸F-FDG PET/CT has multiple values in identifying malignancies, observing the status of inflammatory myopathy, detecting interstitial lung disease, and predicting the occurrence of RP-ILD. Therefore, it is recommended to use PET/CT in the clinical course of diagnosis and management of IIM.     

Impact of FDG-PET/MRI image fusion on the detection of pancreatic cancer.

BACKGROUND: This study assessed the value of image fusion with (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in patients suspected of having pancreatic cancer. METHODS: 32 patients (12 women, 20 men; age 24-79 years; mean 56.6 years) were included. All patients underwent whole-body FDG-PET examinations and contrast-enhanced MRI. Image fusion used a semiautomatic voxel-based algorithm. Separate reading, side-by-side analysis and evaluation of fused PET/MRI images were performed. Results were correlated to histopathology (n = 30), or clinical follow-up (n = 2). RESULTS: 15/32 patients had pancreas cancer and 17/32 patients benign disease. The sensitivity and specificity for cancer detection by FDG-PET were 93 and 41% for visual and 86 and 58% for semiquantitative analysis whereas MRI achieved 100 and 76% respectively. Topographical assignment of PET foci by image fusion was superior to side-by-side analysis in 11/39 (28%) foci (in 8/32 patients). However, a true impact on therapeutic strategy was observed only in 1/8 patients as the presence of multiple metastases, irresectable primaries or medical reasons for inoperability prevented a curative setting. CONCLUSION: Compared to side-by-side analysis, PET/MRI image fusion improves the anatomical assignment and interpretation of FDG foci. The therapeutic benefit for the patient however is limited in patients with multiple lesions or incurable primaries.     

The role of FDG‐PET/CT in the evaluation of residual disease in paediatric non‐Hodgkin lymphoma

¹⁸F‐labelled–fluorodeoxyglucose positron emission tomography (FDG‐PET) findings are challenging to interpret for residual disease versus complete response in paediatric patients with non‐Hodgkin lymphoma (NHL). A biopsy is often warranted to confirm the presence or absence of viable tumour if there is clinical or radiographic evidence of residual disease. In this study, we compared conventional imaging and FDG‐PET/computerized tomography (CT) findings with biopsy results in 18 children with NHL. Our goal was to provide additional data to establish more reliable criteria for response evaluation. Residual disease was suspected after conventional imaging alone in eight patients, after FDG‐PET/CT alone in three and after both modalities in seven patients. Biopsy confirmed the presence of viable tumour in two patients. Two additional patients experienced progressive disease or relapse. The sensitivity and negative predictive value of FDG‐PET/CT using the London criteria to indicate residual tumour detectable by biopsy were 100%, but specificity was low (60%), as was the positive predictive value (25%). Thus, in this study, a negative FDG‐PET/CT finding was a good indicator of complete remission. However, because false‐positive FDG‐PET/CT findings are common, biopsy and close monitoring are required for accurate determination of residual disease in individual patients.