正电子发射体层成像在肺癌诊治中的应用

肺癌是最常见的肺部原发性恶性肿瘤 ,半个世纪以来 ,世界各地肺癌的发病率和病死率逐年上升 ,尤其在发达国家。我国肺癌的发病率也在上升 ,个别城市肺癌病死率已跃居恶性肿瘤死亡的首位。大部分肺癌患者是Ｘ线胸片或ＣＴ扫描首先发现 ,但Ｘ线检查仅显示病灶解剖形态学特征 ,与许多良性病变无法区别。用核素18氟标记的 2 (氟 18) 2 脱氧葡萄糖 (ＦＤＧ)正电子发射体层成像 (ＰＥＴ)可以提示病灶的生理和代谢特征 ,有助于区别良恶性病灶 ,是近 2 0年发展起来的诊治手段之一。一、ＦＤＧ ＰＥＴ成像原理肿瘤病灶组成比较复杂 ,包括肿瘤细胞…     

正电子发射体层扫描在肺癌诊断中的应用

正电子发射体层扫描系一种非损伤性的影像诊断技术,70年代以来已逐渐在临床上得到应用和受到重视。现就其诊断的原理和方法、以及在肺癌的诊断、分期及其在疗效判断方面的应用情况作一简介。     

氟脱氧葡萄糖F18正电子发射体层摄影术在肺癌诊断及分期中的价值

目的　探讨氟脱氧葡萄糖F18正电子发射体层摄影术(18FFDGPET)在肺癌诊断及分期中的价值。方法　94例疑诊为肺部肿瘤的患者进行了CT、18FFDGPET全身或局部检查,并对这些患者手术切除及活检的组织标本及痰液、胸腔积液的细胞标本进行了病理学检查。18FFDGPET图像分析采取单纯标准摄取值(SUV)法及目测与SUV值结合两种方法进行。SUV值法判定标准为:SUV值>25为恶性病灶,SUV值≤25为良性病灶;目测与SUV值结合法:根据病灶18FFDG摄取量与纵隔血池结构相比,并考虑SUV值、病变大小、形态及病史资料做出诊断。以病理及试验性治疗结果为确诊标准,分别计算18FFDGPET及CT在病变的定性、纵隔淋巴结转移、全身远端转移方面的敏感性、特异性、准确性、阳性预测值及阴性预测值,同时对18FFDGPETSUV值法与目测结合SUV值法的诊断效能进行比较。结果　(1)确诊情况:本组58例患者肺部病灶经组织病理学或细胞病理学检查证实为恶性;36例经病理检查或试验治疗证实为良性。(2)定性诊断:CT对肺部肿块定性诊断的敏感性、特异性、准确性、阳性及阴性预测值分别为:69%、65%、68%、82%、49%;18FFDGPET单纯SUV法分别为91%、89%、90%、93%和87%,目测+SUV值法分别为95%、94%、95%、97%和92%。(3)纵隔淋巴结转移:34例病理证实有纵隔淋巴结转移     

正电子发射体层成像在肺癌诊断和分期中的价值

目的了解正电子发射体层成像(PET)在肺癌诊断和分期中的价值。方法收集1998年9月至2003年4月间行PET和CT检查,且诊断明确的肺部疾病患者的临床资料,对PET和CT检查结果与病理检查结果进行对比分析。结果在此期间共收集104例患者,其中肺癌64例(60%),肺部良性疾病40例(40%)。肺癌患者PET的标准摄取比值(SUV值)中位值为4.5(1.2～11.7),明显高于良性患者的1.0(0～7.7);且肺癌患者的SUV值与肺癌组织学类型、分化程度、临床分期和病灶大小均无关(P>0.05)。PET诊断肺癌的敏感性、特异性和准确性分别为88%、85%和87%;CT的敏感性、特异性和准确性分别为73%、28%、57%,PET的特异性和准确性显著高于CT(P<0.05)。对于胸腔淋巴结转移诊断的敏感性、特异性和准确性CT:N1期分别为33%、73%、59%,N2期分别为80%、79%、79%,N3期特异性及准确性均为97%;PET:N1期分别为33%、82%、65%,N2期分别为60%、83%、85%,N3期特异性及准确性均为85%;两者差异无统计学意义(P>0.05)。结论PET在鉴别肺内病灶良恶性质上有优势,对胸腔内淋巴结转移的诊断要结合CT结果综合判断。     

正电子发射型断层扫描在肺癌诊断中的应用

本介绍以＾１８Ｆ－氟代脱氧葡萄糖作为示踪剂的正电子发射型断层显像技术（ＦＤＧ－ＰＥＴ）在肺部肿瘤诊断上的应用，尤其是在肺部孤立性结节（ＳＰＮ）、肺部块影、浸润性阴影、肺门及纵隔淋巴结的良恶性临别以及肺癌治疗后复发、转移性肺癌的诊断上的应用；并把ＰＥＴ与计算机断层扫描（ＣＴ）、核磁共振显像（ＭＲＩ）、经胸针吸肺活检（ＴＴＮＡ）作了比较。ＰＥＴ不仅是一种无创性检测手段，而且在肺部病变良恶性的鉴别诊断     

正电子发射体层显像技术及临床应用

现代医学认为 ,疾病的本质是从基因失调开始 ,是基因表达异常、代谢异常、功能失调、结构改变的生化过程。以往的影像学检查是在临床出现症状、体征或形态结构改变阶段进行诊断 ,而正电子发射体层显像 (PET)则具有在疾病功能、代谢改变早期阶段做出诊断的功能 [1 ] 。1　概述根据探测成像方式不同 ,将正电子成像设备分为两大类 :1探测器呈环形排列于被检测物周围的专用 PET。 2特殊设计的单光子计算机断层 (SPECT) ,即通过围绕被测物体旋转的多探头间符合探测 ,完成显像 [1 ] 。 PET的基本原理是示踪剂通过静脉注入人体后 ,在血管系统…     

正电子发射型断层扫描在肺癌诊断中的应用

本文介绍以~(18)F-氟代脱氧葡萄糖作为示踪剂的正电子发射型断层显像技术(FDG-PET)在肺部肿瘤诊断上的应用,尤其是在肺部孤立性结节(SPN)、肺部块影、浸润性阴影、肺门及纵隔淋巴结的良恶性鉴别以及肺癌治疗后复发、转移性肺癌的诊断上的应用;并把PET与计算机断层扫描(CT)、核磁共振显像(MRI)、经胸针吸肺活检(TTNA)作了比较。PET不仅是一种无创性检测手段,而且在肺部病变良恶性的鉴别诊断上有很高的准确性。     

正电子发射体层扫描在肺癌诊断中的应用

正电子发射体层扫描系一种非损伤性的影像诊断技术，７０年代以来已逐渐在临床上得到应用和受到重视。现就其诊断的原理和方法，以及在肺癌诊断，分期及其在疗效判断方面的应用情况作一简介。     

正电子发射型断层扫描在非小细胞肺癌中的应用

以18F－氟代脱氧葡萄糖为主要示踪剂的正电子发射型断层显像技术作为一种完全元创性检测手段在准确判断非小细胞肺癌的术前分期、治疗后复发、全身器官及淋巴结转移中发挥重要作用，在非小细胞肺癌的防治中显示出巨大的临床应用价值。     

The use and misuse of positron emission tomography in lung cancer evaluation

This article discusses the potential benefits and limitations of positron emission tomography (PET) for characterizing lung nodules, staging the mediastinum, identifying occult distant metastasis, determining prognosis and treatment response, guiding plans for radiation therapy, restaging during and after treatment, and selecting targets for tissue sampling. The key findings from the medical literature are presented regarding the capabilities and fallibilities of PET in lung cancer evaluation, including characterization of pulmonary nodules and staging in patients with known or suspected non-small-cell lung cancer. The discussion is limited to PET imaging with fluorodeoxyglucose.     

Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in gallbladder cancer: A meta-analysis

AIM: To meta-analyze published data about the diagnostic accuracy of fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the evaluation of primary tumor in patients with gallbladder cancer (GBCa).METHODS: A comprehensive literature search of studies published through 30^th June 2014 regarding the role of ¹⁸F-FDG PET and PET/CT in the evaluation of primary gallbladder cancer (GBCa) was performed. All retrieved studies were reviewed. Pooled sensitivity and specificity of ¹⁸F-FDG PET or PET/CT in the evaluation of primary GBCa were calculated. The area under the summary receiving operator characteristics curve (AUC) was calculated to measure the accuracy of these methods. Sub-analyses considering the device used (PET vs PET/CT) were carried out.RESULTS: Twenty-one studies comprising 495 patients who underwent ¹⁸F-FDG PET or PET/CT for suspicious GBCa were selected for the systematic review. The meta-analysis of 13 selected studies provided the following results: sensitivity 87% (95%CI: 82%-92%), specificity 78% (95%CI: 68%-86%). The AUC was 0.88. Improvement of sensitivity and specificity was observed when PET/CT was used.CONCLUSION: ¹⁸F-FDG-PET and PET/CT demonstrated to be useful diagnostic imaging methods in the assessment of primary tumor in GBCa patients, nevertheless possible sources of false-negative and false-positive results should be kept in mind. PET/CT seems to have a better diagnostic accuracy than PET alone in this setting.     

~（18）F-fluorodeoxyglucose positron emission tomography in the diagnosis of small pancreatic cancer

AIM:To investigate the role of 18 F-fluorodeoxyglucose positron emission tomography(FDG-PET) in the diagnosis of small pancreatic cancer. METHODS:This study involved 31 patients with proven invasive ductal cancer of the pancreas.The patients were divided into 3 groups according to the maximum diameter of the tumor:TS1(maximum tumor size≤2.0 cm) ,TS2(>2.0 cm and≤4.0 cm) or TS3-4(>4.0 cm) .The relationships between the TS and various diagnostic tools,including FDG-PET with dual time point evaluation,were anal...     

Diagnosis and evaluation of gastric cancer by positron emission tomography

Gastric cancer is the second leading cause of cancer mortality worldwide.The diagnosis of gastric cancer has been significantly improved with the broad availability of gastrointestinal endoscopy.Effective technologies for accurate staging and quantitative evaluation are still in demand to merit reasonable treatment and better prognosis for the patients presented with advanced disease.Preoperative staging using conventional imaging tools,such as computed tomography(CT)and endoscopic ultrasonography,is inadequate.Positron emission tomography(PET),using 18F-fluorodeoxyglucose(FDG)as a tracer and integrating CT for anatomic localization,holds a promise to detect unsuspected metastasis and has been extensively used in a variety of malignancies.However,the value of FDG PET/CT in diagnosis and evaluation of gastric cancer is still controversial.This article reviews the current literature in diagnosis,staging,response evaluation,and relapse monitoring of gastric cancer,and discusses the current understanding,improvement,and future prospects in this area.     

Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography

We report port site and distant metastases of unsuspected gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography （PET） in two patients. Patient 1, a 72-yearold woman was diagnosed as cholelithiasis and cholecystitis and received laparoscopic cholecystectomy. Unsuspected gallbladder cancer was discovered with histological result of well-differentiated squamous cell carcinoma of the gallbladder infiltrating the entire wall. A PET scan using F-18-fluorodeoxyglucose （FDG- PET） before radical resection revealed residual tumor in the gallbladder fossa and recurrence at port site and metastases in bilateral hilar lymph nodes. Patient 2, a 69-year-old woman underwent laparoscopic cholecystectomy more than one year ago with pathologically confirmed unsuspected adenosquamous carcinoma of stage pTlb. At 7-mo follow-up after surgery, the patient presented with nodules in the periumbilical incision. Excisional biopsy of the nodule revealed adenosquamous carcinoma. The patient was examined by FDG-PET, demonstrating increased FDG uptake in the right lobe of the liver and mediastinal lymph nodes consistent with metastatic disease. This report is followed by a discussion about the utility of FDG-PET in the gallbladder cancer.     

SUVmax after (18)fluoro-deoxyglucose positron emission tomography/computed tomography: A tool to define treatment strategies in pancreatic cancer

Background(18)fluoro-deoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) might be a useful tool in the management of pancreatic ductal adenocarcinoma (PDAC).AimsThe aim of this study was to analyze maximum standard uptake value (SUVmax) after 18FDG-PET/CT as predictor of survival outcomes and method to determine treatment strategies.MethodsA consecutive series of patients who underwent preoperative 18FDG-PET/CT and subsequent resection for PDAC were retrospectively reviewed. Patients who underwent neoadjuvant chemotherapy were excluded.Results46 patients were included in the analysis. Median follow-up was 27 months (4–67). Patients who recurred within 12 months showed a significantly higher preoperative median SUVmax (8.1 vs 6.1, p = 0.039). Receiver operating characteristics (ROC) curves for disease-free survival (DFS) and disease-specific survival (DSS) identified SUVmax of 6.0 as optimal cut-off. Multivariate analysis showed that SUVmax ≥ 6.0 was an independent predictor of poor DFS (HR 2.288, p = 0.024) and DSS (HR 4.875, p < 0.001). The combination of SUVmax ≥6.0 with CA19.9 ≥200 U/ml was significantly associated with survival outcomes in comparison to patients without concordantly elevated values.ConclusionSUVmax ≥6.0 is an independent predictor of DFS and DSS in resected PDAC. 18FDG-PET/CT might be considered in the preoperative evaluation of patients with pancreatic cancer.     

The role of 18fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer

BackgroundThe role of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in pancreatic ductal adenocarcinoma is debated. We retrospectively assessed the value of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in addition to conventional imaging as a staging modality in pancreatic cancer.Methods¹⁸Fluoro-deoxyglucose positron emission tomography/computed tomography was performed in 72 patients with resectable pancreatic carcinoma after multi-detector computed tomography positron emission tomography was considered positive for a maximum standardized uptake value >3.ResultsOverall, 21% of patients had a maximum standardized uptake value ≤3, and 60% of those had undergone neoadjuvant treatment (P = 0.0001). Furthermore, 11% of patients were spared unwarranted surgery since positron emission tomography/computed tomography detected metastatic disease. All liver metastases were subsequently identified with contrast-enhanced ultrasound. Sensitivity and specificity of positron emission tomography/computed tomography for distant metastases were 78% and 100%. The median CA19.9 concentration was 48.8 U/mL for the entire cohort and 292 U/mL for metastatic patients (P = 0.112).ConclusionsThe widespread application of ¹⁸fluoro-deoxyglucose positron emission tomography/computed tomography in patients with resectable pancreatic carcinoma seems not justified. It should be considered in selected patients at higher risk of metastatic disease (i.e. CA19.9 > 200 U/mL) after undergoing other imaging tests. Neoadjuvant treatment is significantly associated with low metabolic activity, limiting the value of positron emission tomography in this setting.