胆管癌的18F-FDG PET/CT诊断价值

目的 总结胆管癌18F-FDG PET/CT显像表现,提高胆管癌的诊断准确性.方法 回顾经病理或临床综合手段证实的53例胆道疾病的18F-FDG PET/CT表现,分析PET/CT诊断胆管癌的敏感性、特异性和准确性.结果 肝内胆管癌14例、近段胆管癌18例、中远段胆总管癌15例、胆管炎性病变或伴结石6例.肝内转移9例,腹腔及腹膜后淋巴结转移15例,椎体等远处转移3例.PET/CT诊断胆管癌的敏感性为95.7％、特异性为83.3％、准确性为94.3％.结论 18F-FDG PET/CT在胆管癌的诊断与鉴别诊断、分期、检测疗效及预后等具有独特的应用价值.     

浅析18F-FDG PET/CT肿瘤显像前应注意的几个问题

随着18F-FDG PET/CT显著的临床价值以及临床医生对18F-FDG PET/CT检查的认可,越来越多的肿瘤患者选择了18F-FDG PET/CT检查。为了尽可能使行18F-FDG PET/CT肿瘤显像的患者感到检查的舒适性和无创性,并最大限度获得准确和高质量的影像结果,本文就患者行18F-FDG PET/CT肿瘤显像前     

18F-FDG PET/CT显像中的脂肪摄取

单纯PET图像难以区分脂肪或肌肉组织摄取^18F-脱氧葡萄糖（FDG）及是否为病理性摄取，CT特异性脂肪密度为其定性诊断提供了有力的佐证。现将本院在^18F-FDG PET/CT检查中的12例脂肪摄取病例报道如下。     

18F-FDG PET/CT显像诊断甲状腺癌复发和转移的价值

^18F-脱氧葡萄糖（FDG）PET显像对诊断甲状腺癌术后甲状腺球蛋白（Tg）水平升高患者有较大价值.笔者对21例血清Tg水平升高而疑甲状腺癌复发患者行PET/CT显像,并与^131I全身显像比较,现将结果报道如下.     

客观评价18F-FDG PET/CT肿瘤显像误诊现象

大量的研究与临床实践证实，全身18^F-FDG PET／CT显像在恶性肿瘤诊断、分期、疗效评价和预后判断等方面有明确的临床价值，与CT和MRI比较具有更高的诊断正确性。在部分欧美国家，其对多种恶性肿瘤的诊断及分期应用已列入医疗保险支付范围。     

~(18)F-FDG PET/CT在行结肠癌检查时发现同时性重复癌的价值

目的探讨18氟-氟脱氧葡萄糖(18F-FDG)PET/CT用于检查结肠癌时发现同时性重复癌的价值。方法回顾性分析232例经病理证实结肠癌病人的18F-FDG PET/CT影像资料和临床病理结果,采用卡方检验比较18F-FDG PET/CT结果与病理结果并行kappa系数一致性检验,分析PET/CT显像的诊断效能。结果 232例病理证实的结肠癌病人中,56例病理证实为重复癌。18F-FDG PET/CT诊断真阳性53例,假阳性4例,其中2例经肠镜病理证实分别为息肉和管状腺瘤(癌前病变),1例病理证实为甲状腺腺瘤,1例为肺炎性假瘤。假阴性3例,其中1例为胃窦部印戒细胞癌,1例为肾透明细胞癌,另1例18F-FDG PET/CT显像为高代谢,诊断为结肠癌肝转移,结果病理证实为结肠癌+原发性肝癌。18F-FDG PET/CT诊断重复癌的敏感度为94.64%,特异度为97.58%,准确度为96.83%,阳性预测值92.98%,阴性预测值98.17%。与病理诊断结果比较,两者间差异无统计学意义(P≈1.000),而且两者间一致性良好(κ=0.917,P=0.000)。结论应用18F-FDG PET/CT进行结肠癌检查时可以有效发现同时性重复癌。     

18F-FDG PET/CT显像对肺癌合并阻塞性肺不张的诊断价值

笔者对16例肺癌并阻塞性肺不张患者进行^18F-脱氧葡萄糖（FDG）PET／CT显像，探讨其临床价值，现报道如下。     

脾恶性淋巴管瘤18F-FDG PET/CT显像一例

患者男,76岁。2005年2月底患者感上腹部不适,饮食欠佳,半年来体重减轻1.5 kg。CT 检查示:肝内胆管钙化灶,脾脏大小正常,脾脏下极见一2.1 cm×2.2 cm 低密度灶,CT 值约为35 HU,其与脾脏正常组织界限欠清晰,考虑为低密度良性病变。MRI 检查示:脾脏可见一 T_1WI 呈低信号,T_2WI 呈高信号病灶,考虑为血管瘤。2005年3月22日行~(18)F-脱氧葡萄糖(FDG)PET/CT 检查,于脾脏下极见一异常放射性浓聚灶,其标准摄取值(SUV)为12.3。考虑为脾脏     

原发性纵隔绒毛膜癌18F-FDG PET/CT显像1例

<正>原发性绒毛膜癌,又称为非妊娠性绒毛膜癌,是一种极少见的高度侵袭性妊娠滋养细胞肿瘤^[1]。原发性纵隔绒毛膜癌(primary mediastinal choriocarcinoma, PMC)更为罕见,占所有纵隔恶性肿瘤的1%～4%,占所有生殖细胞恶性肿瘤的5%^[2]。目前关于PMC的影像学报道较少,多以临床个案为主。本文报道1例PMC的临床及PET/CT影像资料,并结合国内外文献进行回顾性分析,以提高对PMC的认识。     

PET/CT在恶性淋巴瘤疗效评估及复发诊断中的临床价值

目的探讨PET/CT用于恶性淋巴瘤的疗效预测、评估及复发诊断的临床应用价值。方法选择经病理证实的78例恶性淋巴瘤患者,男性51例,女性27例,年龄17～74岁,均行4～6疗程化疗或化疗加局部放疗。均分别分别在治疗前、治疗中及治疗后行18F-FDG全身PET/CT扫描检查2～6次,对PET、CT及PET/CT图像进行综合分析。结果本组78例中,16例治疗过程中用18F-FDG PET/CT监测发现疗效不佳,更换了治疗方案。PET/CT图像标准化摄取值(SUV值)呈阳性的43例中,39例为肿瘤残存或复发,4例为炎症;SUV值呈阴性的35例中,3例复发。本组疗效:完全缓解(CR)36例;部分缓解(PR)21例;稳定(SD)8例:进展(PD)13例。结论18F-FDG PET/CT在性淋巴瘤早期疗效预测、疗效评估及残留肿块的性质鉴别、预后及生存率评估等方面,均有很高的临床应用价值。     

多发性骨髓瘤的18F-FDGPET/CT诊断

目的:多发性骨髓瘤是一种浆细胞恶性增殖性疾病,大约有80％的患者存在骨骼侵犯.本文探讨多发性骨髓瘤的18F-fluorodexoxyglucose(18F-FDG)PET/CT表现特点,提高对多发性骨髓瘤的认识.方法:26例按2001年WHO诊断标准确诊为多发性骨髓瘤的患者,均在治疗前行18F-FDG PET/CT显像.所有患者均依赖骨髓穿刺或活检取得明确病理学诊断.结果:26名患者均出现不同程度的骨质疏松.25例患者出现多发性骨质破坏,占总数的96.2％;其中11例患者出现颅骨破坏,占42.3％;25例出现脊柱骨质破坏,占96.2％;15例出现胸骨骨质破坏,占57.7％;21例出现肋骨骨质破坏,占80.8％;21例出现骨盆骨质破坏,占80.8％.部分骨破坏病灶呈18F-FDG高代谢灶.结论:多发性骨髓瘤的18F-FDG PET/CT表现具有一定特征,结合临床、影像、实验室和病理学检查能提高本病的诊断率.     

^18F-FDG和^18F—FLTPET／CT诊断肺结节影响因素的多中心临床研究

目的:探讨18F-FDG和18F-FLT PET/CT诊断肺结节的影响因素,以提高PET/CT对肺结节的诊断价值.材料和方法:选择肺结节患者55例为研究对象,其中男性33例,女性22例,年龄17～82岁,28例为肺内孤立结节,其余为2～3个结节,结节大小0.6～11.0cm,所有患者均行肺部18F-FDG和18F-FLT PET/CT检查,分析18F-FDG和18F-FLT标准摄取值(SUV)与肺结节患者的性别、年龄、结节大小及病理类型等相互关系和意义.结果:55例肺结节患者,18F-FDG和18F-FLT标准摄取值与患者的性别、年龄、结节大小等均无统计学差异(P>0.05),18F-FDG标准摄取值与患者的病理类型亦无统计学差异(P>0.05),而18F-FLT标准摄取值与患者的病理类型有统计学差异(P<0.05).结论:肺结节患者结节的病理类型是影响18F-FLT标准摄取值的重要因素.18F-FLT PET/CT鉴别诊断肺结节良恶性具有重要的价值和意义.     

18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: A systematic review and meta-analysis

The present study assessed the diagnostic performances of 18F-FDG PET or PET/CT in detecting pelvic and/or paraaortic lymph node metastasis in patients with endometrial cancer. METHODS: Through a search of MEDLINE (January 1998 to March 2011), an overall weighted average for sensitivity and specificity as well as pooled estimates of positive and negative likelihood ratios were calculated. A summary receiver-operating-characteristics (sROC) curve was constructed and the area under the sROC curve (AUC) was calculated. I-square was calculated to explore heterogeneity. RESULTS: The present study included 243 patients from seven studies. Results indicated a lack of significant heterogeneity for sensitivity and specificity (I(2)<50% and p>0.05). The overall pooled estimates for sensitivity and specificity of FDG-PET or PET/CT scans in the detection of pelvic and/or paraaortic metastasis were 63.0% (95% CI, 48.7-75.7%) and 94.7% (95% CI, 90.4-97.4%), respectively. The positive likelihood ratio was 10.465 (95% CI, 5.646-19.396) and the negative likelihood ratio 0.399 (95% CI, 0.284-0.560). The AUC was 0.9533. The overall diagnostic accuracy (Q* index) was 89.5%. Conclusion The high positive likelihood value confirms the reliability of a positive FDG-PET or PET/CT to detect pelvic and/or paraaortic lymph nodes metastasis in patients with untreated endometrial cancer. FDG-PET or PET/CT may prove beneficial to surgeons when selecting appropriate patients on whom to perform lymphadenectomy.     

Nonfunctioning endocrine pancreatic tumor examined with 18F-FDG PET/CT

A 71-year-old woman with type 2 diabetes mellitus complained of generalized fatigue. A 36-mm tumor in the pancreatic tail was detected with ultrasonography. The tumor was found to have marked hypervascularity with contrast-enhanced computed tomography (CT) and magnetic resonance. Combined ¹⁸F-fluorodeoxyglucose positron emission tomography and CT (¹⁸F-FDG PET/CT) showed ¹⁸F-FDG by the tumor with a maximal standardized uptake value of 2.98 at 50 min and 3.29 at 100 min following injection of ¹⁸F-FDG. ¹⁸F-FDG PET/CT suggested no extrapancreatic spread of the tumor. The patient had no pancreatic hormone-associated symptoms. Distal pancreatectomy was performed, and a well-differentiated endocrine tumor was diagnosed. The resected specimen showed neither infiltration of adjacent structures nor metastasis to regional lymph nodes. The present case suggests that ¹⁸F-FDG PET/CT is a reliable modality for staging endocrine pancreatic tumors.     

Common hepatic artery aneurysm detected by 18F-FDG PET/CT Imaging

Hepatic artery aneurysm (HAA) is a rare, yet clinically important, condition. While the causes of HAA are poorly understood, it is estimated that mortality following spontaneous rupture is as high as 40%. We discuss the case of a 77-year-old man who presented to our hospital due to a 10 mm pulmonary lesion in the left lower lung lobe, which was identified by a computed tomography scan of the lung at another institution. An examination with 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in our department, but no significant uptake of 18F-fluorodeoxyglucose was found in the lung, and HAA was diagnosed only incidentally. A magnetic resonance imaging angiography supported the differential diagnosis of HAA, and the aneurysm was confirmed by targeted angiography. It was located in the common hepatic artery and was coiled during an intervention session. HAA accounts for 20% of all visceral aneurysms and, with a poorly understood natural history, is difficult to diagnose clinically, but early detection and treatment of HAA can improve prognosis.     

Prospective assessment of 18F-FDG PET/CT in detection of recurrent ovarian cancer

Objective

To assess the use of positron emission tomography (PET)/computed tomography (CT) in patients with suspected ovarian cancer recurrence and describe the distribution of metastasis.

Patients and methods

This study included (39) patients suspected to have recurrent ovarian malignancy. This suspicion was either clinically, radiologically or due to raised CA-125 levels. All patients underwent 18F-FDG PET/CT, surgery was performed within 8 weeks of imaging studies. Surgical and/or histopathological examinations were available in 31 patients, and clinical, radiological and CA 125 serum level follow up in 8 patients.

Results

The overall lesion-based sensitivity, specificity, and accuracy of PET/CT for revealing recurrent ovarian carcinoma were 90%, 98% and 97%, respectively. The patient – based sensitivity, specificity, and accuracy of PET/CT were 97%, 75% and 95%, respectively.

Conclusion

18F-FDG PET/CT is a useful tool for evaluating the recurrence of ovarian cancer after first-line therapy in patients with a high risk of relapse, equivocal radiologic findings, increased or normal levels of serum CA-125. It can more accurately diagnose and localize recurrence, hence decreasing the rate of second look surgery and changing treatment plan.     

18F-FDG PET/CT在鼻咽癌中的诊断价值

目的 探讨18F-FDG PET/CT在鼻咽癌中的诊断价值.方法 回顾性分析我院2007年3月～2010年3月以鼻咽部肿块就诊的36例患者资料,所有患者均行鼻咽部18F-FDG PET/CT检查及鼻内镜下取材病检确诊.结果 24例病检后确诊为鼻咽癌患者,18F-FDG PET/CT检查均为局限性高代谢灶;12例病检后确诊为鼻咽部炎性肿块患者中,8例18F-FDG PET/CT检查均为鼻咽部局限性低代谢灶,考虑炎症,有4例18F-FDG PET/CT检查为鼻咽部局限性高代谢灶,误诊为鼻咽癌.结论 18F-FDG PET/CT检查是诊断鼻咽癌的较好方法,结合患者临床症状,可以为鼻咽部肿块的良恶性鉴别提供可靠依据.     

PET/CT在早期鼻咽癌与鼻咽炎性肿块鉴别诊断中的价值

目的：探讨18F-FDGPET/CT在早期鼻咽癌与鼻咽炎性肿块临床鉴别诊断中的价值。方法：回顾性分析我院2005年1月～2008年5月经确诊的18例早期鼻咽癌和11例鼻咽炎性肿块患者的临床资料,所有患者均行鼻咽部18F-FDGPET/CT检查及鼻内镜下取材病检确诊。结果：18例早期鼻咽癌18F-FDGPET/CT检查均为鼻咽部局限性高代谢灶,病检前考虑为鼻咽癌;11例鼻咽炎性肿块患者中,7例18F-FDGPET/CT检查均为鼻咽部局限性低代谢灶,考虑炎症,有4例18F-FDGPET/CT检查为鼻咽部局限性高代谢灶,误诊为鼻咽癌。结论：18F-FDGPET/CT检查是鉴别诊断早期鼻咽癌与鼻咽部炎性肿块较好方法,结合患者临床症状,可以为早期鼻咽癌与鼻咽炎性肿块的鉴别诊断提供可靠依据。     

(18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients.

OBJECTIVE: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.