18F-FDG PET/CT对非小细胞肺癌EGFR基因突变诊断价值的Meta分析

 目的 采用Meta分析系统评价¹⁸F-FDG PET/CT对非小细胞肺癌EGFR基因突变的诊断价值。方法 计算机检索PubMed、EMbase、The Cochrane Library、中国期刊全文数据库、万方数据库、中文科技期刊数据库,查找有关¹⁸F-FDG PET/CT对非小细胞肺癌EGFR基因突变的诊断性试验。由 2 位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Meta DiSc1.4软件进行Meta分析。结果 最终纳入16篇文献,非小细胞肺癌3308例。病理确诊为肺腺癌2914例(88.09%),其他病理类型394例(11.91%)。Meta分析结果示,SEN合并=0.57[95%CI(0.55,0.60)],SPE合并=0.65[95%CI(0.62,0.67)],+LR合并=1.82[95%CI(1.49,2.23)],-LR合并=0.67[95%CI(0.59,0.76)],DOR合并=2.93[95%CI(2.08,4.15)],AUC=0.6678。结论 ¹⁸F-FDG PET/CT的SUV_max对NSCLC患者的EGFR突变有一定的预测能力,其特异度优于敏感度,可以用于EGFR突变的诊断。     

喉癌18F-FDG PET/CT显像的临床应用价值

目的探讨18F-脱氧葡萄糖(FDG)PET/CT显像相对于单独的18F-FDG PET显像在喉癌诊断中的临床价值以及评价平均标准化摄取值(SUVmean)在喉癌和喉生理性显像鉴别中的作用。方法疑似喉癌患者23例。男19例,女4例,年龄30～70岁。空腹6H以上,静脉注射7.4MBq/kg 18F-FDG后40min后仰卧位行头颈部或全身扫描。分别评价18F-FDG PET和18F-FDG PET/CT显像对病灶诊断的灵敏度和特异性。19例病理为鳞癌的喉癌患者与15例喉生理性显像患者作为对照,测定显像部位的SUVmean,试用受试者工作曲线特征(Receivrer Operation Characteristic,ROC)及阳性似然比(positive likelihood ratio,+LR)确定SUVmean阈值。结果 23例喉癌患者,108处病灶。18 F-FDGPET显像和18F-FDG PET/CT显像对病灶诊断的灵敏度分别为85.1%(40/47)和89.4%(42/47),差异无统计学意义(P>0.05),特异性分别为和72.1%(44/61)和91.8%(56/61),差异有统计学意义(P<0.05)。19例病理为鳞癌的喉癌患者SUVmean均数为7.3±2.9,15例喉生理性显像SUVmean均数为4.9±1.1,差异有统计学意义(P<0.05)。SU-Vmean阈值选定为6.1,18 F-FDG PET/CT显像喉癌诊断的灵敏性为63.2%,特异性为86.7%。结论 18 F-FDG PET/CT显像明显改善18F-FDG PET显像的特异性。SUVmean阈值选定为6.1,有利于喉癌和喉生理性显像的鉴别。     

68Ga-PSMA PET-CT与mpMRI显像对前列腺癌淋巴结转移的诊断价值比较

 目的 系统评价⁶⁸Ga-PSMA PET/CT与mpMRI显像对前列腺癌淋巴结转移的诊断价值。方法 通过检索国内外中英文数据库,纳入⁶⁸Ga-PSMA PET/CT与mpMRI显像诊断前列腺癌淋巴结转移的诊断性临床试验,并分别基于患者或病灶提取文献中的原始数据。通过软件将数据合并进行分析,分别合并⁶⁸Ga-PSMA PET/CT与mpMRI显像诊断前列腺癌淋巴结转移的敏感性(sensitivity,SEN)、特异性(specific,SPE)、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnostic odds ratio,DOR)以及SROC曲线下面积(area under curve,AUC)等。结果 共纳入13篇符合条件的文献,系统评价结果显示,基于患者的分析结果中,⁶⁸Ga-PSMA PET/CT与mpMRI对前列腺癌淋巴结转移的SEN、SPE、PLR 、NLR、DOR、AUC分别为0.44、 0.93、5.25、 0.61、 9.6、0.90及0.44、0.95、5.46、0.62、12.06、0.90。基于淋巴结的分析结果中,⁶⁸Ga-PSMA PET/CT与mpMRI对前列腺癌淋巴结转移的SEN、SPE、PLR 、NLR、DOR、AUC分别为0.58、0.99、61.22、0.24、 308.06、0.99及0.61、0.99、27.17、0.36、90.48、0.99。结论 ⁶⁸Ga-PSMA PET/CT与mpMRI显像诊断前列腺癌淋巴结转移的特异性均很高、敏感性欠佳, mpMRI对于PCa淋巴转移的诊断可能更具有临床价值。     

结核性与肿瘤性腹膜弥漫性病变的18F-FDG PET/CT影像特征比较

目的 探讨结核性与肿瘤性腹膜弥漫性病变的18 F-FDG PET/CT相关影像表现.方法 对结核性与肿瘤性腹膜弥漫性病变的相关18F-FDG PET/CT影像表现进行量化分级,采用x2检验、两样本独立t检验、Logistic回归及ROC曲线进行统计学分析.结果 单因素分析结果显示,腹膜SUVmax、腹水CT值、壁腹膜增厚情况、网膜增厚情况及其他脏器受累情况在结核性与肿瘤性腹膜弥漫性病变中差异有统计学意义(P＜0.05);多因素分析显示,网膜增厚情况及其他脏器受累情况在结核性与肿瘤性腹膜弥漫性病变中差异有统计学意义(P＜0.05),二元Logistic回归方程为Y=1.201+1.517X3+1.980X9,X3及X9的OR 值分别为4.559(95％ CI:0.707～ 29.391)及7.242(95％ CI:1.726～30.385);ROC曲线显示网膜增厚情况、其他脏器受累情况对结核性及肿瘤性病变的鉴别有效,两者的AUC分别是0.670(95％ CI:0.527～0.813)和0.655(95％ CI:0.525 ～0.785),前者的诊断效能较高(P＜0.05).结论 分析结核性与肿瘤性腹膜弥漫性病变的18F-FDG PET/CT影像表现,可提高两者的鉴别诊断水平.     

图像纹理特征在肺结节18F-FDG PET/CT显像诊断中的应用

目的 探讨18F-FDG PET/CT图像纹理特征参数对良恶性肺结节的鉴别能力,并与FDG SUVmax的诊断效能比较.方法 回顾性分析170例肺结节患者的18F-FDG PET/CT图像,其中男102例,女68例,年龄29 ～ 81(平均59)岁;恶性89例(PET图像230层),良性81例(PET图像193层).参照CT图像勾画ROI,获得病灶PET/CT图像的13项纹理特征参数值[包括均值、标准差、偏度、峰度、角二阶矩(ASM)、熵、对比性、相关性、粗糙度、对比度、频度、复杂度、强度]和SUVmax.采用logistic回归分析进行统计,提取有效的纹理参数,建立回归方程,并通过ROC曲线评估其判断肺结节良恶性的能力.利用Mann-Whitney u检验比较不同病理类型肺癌患者间纹理特征参数的差异.ROC曲线评价SUVmax对良恶性肺结节的检验效能,采用x2检验对纹理特征参数与SUVmax的诊断效能进行比较.结果 偏度、峰度、ASM和强度4项纹理特征参数与肺结节良恶性判断有关(β=1.7058、-1.0989、-4.4140和0.5626,均P＜0.05).纹理特征参数对应ROC AUC为0.775(95％ CI0.732～0.819;P＜0.001);灵敏度为89.6％ (206/230),特异性为50.8％ (98/193).89例肺癌患者中,鳞状细胞癌组(21例)和腺癌组(62例)的ASM和强度差异有统计学意义[ASM:0.0303 (95％CI0.0392～0.0724)和0.0594(95％ CI0.0721 ～0.0947);强度:2.4714(95％ CI 2.4632 ～4.1050)和1.5945(95％ CI1.9003 ～2.4652);u=3082.0和3115.0,均P＜0.01].ROC曲线示SUVmax诊断肺癌的AUC为0.757(95％ CI0.711 ～0.802;P＜0.001);SUVmax ≥2.5时灵敏度为80.9％ (186/230),特异性为50.3％ (97/193).纹理特征参数与SUVmax鉴别肺结节良恶性的灵敏度差异有统计学意义(x2=6.903,P＜0.01).结论 纹理特征参数可用于18F-FDG PET显像辅助诊断肺结节良恶性;不同病理类型肺癌的纹理特征参数不同,且纹理特征参数对肺结节性质鉴别灵敏度优于SUVmax.     

18F-FDG PET/CT预测胃肠道间质瘤对伊马替尼治疗反应的Meta分析

目的通过Meta分析评价18F-FDG正电子发射计算机体层摄影(PET/CT)预测胃肠间质瘤对伊马替尼治疗反应的价值。方法检索PubMed、EMBASE、Web of science、Cochrane图书馆、中国知网、万方和中国生物医学数据库建库以来到2018年3月公开发表的PET/CT预测胃肠间质瘤对伊马替尼治疗反应的前瞻性试验,经2名研究人员进行数据提取和质量评价后,采用Meta-Disc软件进行双变量随机效应模型的Meta分析。通过绘制受试者操作特征(ROC)曲线并计算曲线下面积(AUC),计算纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比以及相应的95%置信区间(95%CI)。将接受治疗的药物类型和治疗后PET/CT的检查时间进行亚组分析,采用Meta回归探讨非阈值效应引起的异质性。结果共纳入6项研究,包括115例病人。纳入研究的合并敏感度、合并特异度、合并阳性似然比、合并阴性似然比、合并诊断比值比和AUC分别为0.88(95%CI:0.77～0.96)、0.64(95%CI:0.49～0.78)、2.03(95%CI:1.04～3.95)、0.27(95%CI:0.13～0.55)、11.43(95%CI:2.82～46.41)和0.8771。Meta回归分析显示所接受的治疗药物和治疗后PET/CT检查的时间对诊断价值的影响差异无统计学意义(P=0.29和0.68)。Deek’s漏斗图提示存在发表偏倚的可能性(P=0.04)。结论 18F-FDG PET/CT用于预测胃肠间质瘤对伊马替尼的治疗反应具有较高的敏感度和特异度。     

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.     

18F-FDG PET/CT在寻找不明原发灶肿瘤患者原发灶中的价值

目的 探讨18F-FDG PET/CT在诊断不明原发灶肿瘤(CUP)患者原发灶中的价值.资料与方法 36例CUP患者行PET/CT检查拟寻找原发灶,根据转移灶部位分为淋巴结转移组(8例)、肝转移组(9例)、骨转移组(12例)及恶性胸腹水组(7例),比较18F-FDG PET/CT诊断淋巴结转移组与非淋巴结转移组CUP患者原发灶的灵敏度.结果 18F-FDG PET/CT寻找CUP原发灶的灵敏度为63.9％ (23/36),PET/CT诊断淋巴结转移组、肝转移组、骨转移组及恶性胸腹水组患者原发灶的灵敏度分别为87.5％ (7/8)、55.6％ (5/9)、58.3％(7/12)、57.1％ (4/7).18F-FDG PET/CT对淋巴结转移组原发灶的确诊率[87.5％(7/8)]显著高于非淋巴结转移组[57.1％( 16/28)],差异有统计学意义(P＜0.05).结论 18F-FDG PET/CT诊断CUP患者原发灶灵敏度较高,尤其适用于发生淋巴结转移的CUP患者.     

贲门癌术后吻合口复发18F-FDG PET/CT显像与形态分析

目的 探讨贲门癌术后吻合口复发18F-FDG PET/CT显像效果与形态特点.方法 收集武警江苏总队医院内镜、外科手术及病理证实贲门癌术后吻合口复发52例患者PET/CT、CT影像资料,对照分析贲门癌手术后复发患者PET/CT及CT影像表现.结果 (1)52例贲门癌术后复发18F-FDGPET/CT显像无摄取3例(5.77％,3/52),有摄取49例(94.23％,49/52),其中片絮状摄取14例(26.92％,14/52),结节状摄取19例(36.54％,19/52,),环状摄取16例(30.77％,16/52,);(2)CT显示吻合口管壁无明显增厚4例(7.69％,4/52),轻度增厚7例(13.46％,7/52),偏心性增厚19例(36.54％,19/52),环状增厚22例(42.31％,22/52);PET/CT与CT两者形态分类上显著相关(r=0.943,P＜0.001).(3)18F-FDG PET/CT显像片絮状摄取半定量标准值(SUVmax均数、SUVmean均数)与其他摄取形态及总体摄取值比较相对较低,且具有统计学差异(P＜0.01).(4) PET/CT显像明确及疑似诊断贲门癌术后复发45例(86.54％,45/52),未能作出复发诊断7例(13.46％,7/52);CT诊断及疑似诊断贲门癌术后复发41例(78.85％,41/52),未能作出复发诊断11例(21.15％,11/52),诊断结果两者无明显差异(x2=13.48,P=0.063);PET/CT摄取分型中无摄取、片絮状摄取诊断结果与结节状摄取、环状摄取诊断结果存在一定差异(x2=27.25,P=0.017,P＜0.05).(5)PET/CT不能明确诊断术后复发无摄取3例及片絮状摄取4例;CT不能明确诊断术后复发为吻合口无明显增厚4例及轻度增厚7例患者.结论 贲门癌术后吻合口复发18F-FDG PET/CT无摄取及片絮状摄取是诊断中的难点,在实际工作中结合CT吻合口厚度及其形态,对提高贲门癌术后吻合口复发18F-FDG PET/CT诊断符合率有一定帮助.     

~(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, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: a systematic review and meta-analysis

Background and purpose

Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET), combined ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue.

Methods

MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of ¹⁸F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called “Meta-Disc 1.4” was used for data analysis.

Result

In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias.

Conclusion

PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma.     

18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy.

We evaluated the amino acid and glucose metabolism of brain tumors by using PET with 3,4-dihydroxy-6-(18)F-fluoro-l-phenylalanine ((18)F-FDOPA) and (18)F-FDG. METHODS: Eighty-one patients undergoing evaluation for brain tumors were studied. Initially, 30 patients underwent PET with (18)F-FDOPA and (18)F-FDG within the same week. Tracer kinetics in normal brain and tumor tissues were estimated. PET uptake was quantified by use of standardized uptake values and the ratio of tumor uptake to normal hemispheric tissue uptake (T/N). In addition, PET uptake with (18)F-FDOPA was quantified by use of ratios of tumor uptake to striatum uptake (T/S) and of tumor uptake to white matter uptake. The accuracies of (18)F-FDOPA and (18)F-FDG PET were determined by comparing imaging data with histologic findings and findings of clinical follow-up of up to 31 mo (mean, 20 mo). To further validate the accuracy of (18)F-FDOPA PET, (18)F-FDOPA PET was performed with an additional 51 patients undergoing brain tumor evaluation. RESULTS: Tracer uptake in tumors on (18)F-FDOPA scans was rapid, peaking at approximately 15 min after intravenous injection. Tumor uptake could be distinguished from that of the striatum by the difference in peak times. Both high-grade and low-grade tumors were well visualized with (18)F-FDOPA. The sensitivity for identifying tumors was substantially higher with (18)F-FDOPA PET than with (18)F-FDG PET at comparable specificities, as determined by simple visual inspection, especially for the assessment of low-grade tumors. Using receiver-operating-characteristic curve analysis, we found the optimal threshold for (18)F-FDOPA to be a T/S of greater than 1.0 (sensitivity, 96%; specificity, 100%) or a T/N of greater than 1.3 (sensitivity, 96%; specificity, 86%). The high diagnostic accuracy of (18)F-FDOPA PET at these thresholds was confirmed with the additional 51 patients (a total of 81 patients: sensitivity, 98%; specificity, 86%; positive predictive value, 95%; negative predictive value, 95%). No significant difference in tumor uptake on (18)F-FDOPA scans was seen between low-grade and high-grade tumors (P = 0.40) or between contrast-enhancing and nonenhancing tumors (P = 0.97). Radiation necrosis was generally distinguishable from tumors on (18)F-FDOPA scans (P < 0.00001). CONCLUSION: (18)F-FDOPA PET was more accurate than (18)F-FDG PET for imaging of low-grade tumors and evaluating recurrent tumors. (18)F-FDOPA PET may prove especially useful for imaging of recurrent low-grade tumors and for distinguishing tumor recurrence from radiation necrosis.     

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.     

Usefulness of F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: A meta-analysis

The aim was to evaluate the diagnostic value of ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET), combined ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and endoscopic ultrasonography (EUS) in diagnosing patients with pancreatic carcinoma. MEDLINE, EMBASE, Cochrane library and some other databases, from January 1966 to April 2009, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of ¹⁸F-FDG PET, PET/CT and EUS for patients with pancreatic cancer were collected. Methodological quality was assessed. The statistic software called “Meta-Disc 1.4” was used for data analysis. Results: 51 studies were included in this meta-analysis. The pooled sensitivity estimate for combined PET/CT (90.1%) was significantly higher than PET (88.4%) and EUS (81.2%). The pooled specificity estimate for EUS (93.2%) was significantly higher than PET (83.1%) and PET/CT (80.1%). The pooled DOR estimate for EUS (49.774) was significantly higher than PET (32.778) and PET/CT (27.105). SROC curves for PET/CT and EUS showed a little better diagnostic accuracy than PET alone. For PET alone, when interpreted the results with knowledge of other imaging tests, its sensitivity (89.4%) and specificity (80.1%) were closer to PET/CT. For EUS, its diagnostic value decreased in differentiating pancreatic cancer for patients with chronic pancreatitis.In conclusion, PET/CT was a high sensitive and EUS was a high specific modality in diagnosing patients with pancreatic cancer. PET/CT and EUS could play different roles during different conditions in diagnosing pancreatic carcinoma.     

18-F-FDG PET/CT儿童脑肿瘤高低级别诊断

目的：探讨^18 F-FDG PET/CT对儿童脑肿瘤高低级别诊断的价值。方法：回顾性分析19例脑肿瘤患儿（男10例,女9例,平均年龄2．13岁）术前PET/CT影像学表现。所有病例均经手术病理证实。图像分析分别按目测法、半定量法判定,以术后病理为金标准验证,分为高、低级别两组,用t检验比较两组代谢差别,通过ROC曲线获得曲线下面积（AUC）及最佳诊断界点（ODC）。结果：低级别肿瘤8例（Ⅰ级4例,Ⅱ级4例）,高级别肿瘤11例（Ⅲ级4例,Ⅳ级7例）。两组最大标准化摄取值（SUVmax）间差异明显,高级别组代谢水平明显高于低级别组（t＝-2．394,P＝0．028＜0．05）,且与病理分级显著相关（r＝0．478,P＝0．039＜0．05）。余半定量分析方法中,肿瘤白质比（T/W）两组间存在差异（t＝-2．579,P＝0．020＜0．05）。SUVmax 的 ROC AUC 为0．801（95％ CI：0．579-1．0,P＝0．029）,ODC 为3．3;L/W 的AUC为0．807（95％ CI：0．585-1．0,P＝0．026）,ODC 为1．94。结论：18 F-FDG PET/CT 显像对儿童脑肿瘤的级别分析有一定的价值,本文所指的半定量方法中SUVmax及T/W诊断意义较大,且前者与病理分级明显相关。     

^18F-FDG PET显像用于脑胶质瘤分级的Meta分析

目的用Meta分析法综合评价18F—FDGPET显像对脑胶质瘤分级的能力。方法搜索Medline、中国期刊网关于”F-FDGPET显像诊断脑胶质瘤的中英文文献。提取文献中用半定量法或目测法判定胶质瘤恶性程度的数据,同时按照Cochrane工作组推荐的诊断评价标准进行文献的质量方法学评估。用Meta分析软件（Meta—Disc）对纳入文献汇总分析,获得汇总灵敏度（Se）和特异性（Sp）及其95％可信区间（a）,并绘制汇总受试者工作特征（SROC）曲线,计算曲线下面积（AUC）。结果共获取文献17篇（英文16篇、中文1篇）,其中11篇可获取用半定量法[肿瘤／皮质放射性比值（T／C）组及肿瘤／白质放射性比值（T／W）组]判定胶质瘤恶性程度的数据,共272例患者;9篇可获取以目测法判定胶质瘤恶性程度的数据,共481例患者（目测组,部分文献包含2种以上判定方法）。通过异质性检验,分别采用不同效应模型进行分析。T／C组、T／W组和目测组的汇总Se分别为0．952,0．857和0．810;Sp分别为0．409,0．538和0．870;诊断比值（DOR）分别为11．746,22．066和15．282。汇总Se的95％CI分别为0．903—0．980、0．768～0．922和0．757—0．855;汇总Sp的95％凹分别为0．318～0．504,0．431—0．642和0．819～0．911;汇总DOR的95％口分别为5．368—25．702,7．077～68．800和3．716～62．851。3组AUC分别为0．8604,0．8373和0．8724。结论利用18F-FDGPET显像对脑胶质瘤进行恶性程度预测时,半定量组的Se较高,有利于阳性病例的检出,目测组sp较高,有利于阴性病例的排除。根据AUC判断,目测组总体诊断效能最高,T／C组次之,T／W组再次。     

18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中的诊断价值

目的 探讨18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中的诊断价值,并与增强CT及术后病理结果进行对比。 方法 胸段食管鳞癌患者54例,术前一周内行18F-FDG PET/CT和增强CT扫描,术后以病理学诊断为“金标准”,比较两种显像方法对胸段食管鳞癌淋巴结转移的灵敏度、特异度、准确率及不同短径范围的诊断准确率。应用SPSS13.0软件进行四格表χ2检验。 结果 手术共切取肿大淋巴结186枚,均经病理证实,其中淋巴结转移77枚,18F-FDG PET/CT诊断淋巴结转移的灵敏度、特异度及准确率分别为77.9%（60/77）、95.4%（104/109）和88.2%（164/186）,增强CT分别为40.3%（31/77）、75.2%（82/109）和60.8%（113/186）,二者诊断效能差异有统计学意义（χ2=24.04、15.77和36.77,P均 < 0.01）。对于短径>5 mm（5~10 mm及≥10 mm）的淋巴结,18F-FDG PET/CT诊断的准确率高于增强CT,且差异有统计学意义（χ2=26.03和26.47,P均 < 0.01）;对于短径≤5 mm的淋巴结,二者间诊断的准确率差异无统计学意义（χ2=0.24,P>0.05）。 结论 18F-FDG PET/CT在胸段食管鳞癌淋巴结转移中具有较高的诊断价值,对于短径>5 mm的淋巴结优势明显。     

11C-胆碱与18F-FDG双时相PET/CT显像结合高分辨率CT在孤立性肺结节鉴别诊断中的应用

目的比较11C-胆碱（11C-CHO）PET/CT、18F-FDG双时相PET/CT、常规18F-FDG PET/CT、11C-CHO+18F-FDG双时相PET/CT显像结合高分辨率CT（HRCT）4种方法对鉴别诊断孤立性肺结节（SPN）良恶性的价值。方法对28例SPN患者进行18F-FDG PET/CT显像（注药后l h显像,2 h行延迟显像）和11C-CHO PET/CT显像（于注药10 min后进行）。PET图像判断以SPN最大截面勾画ROI,计算SUV_max作为半定量指标,SUV_max ≥ 2.5为阳性,18F-FDG PET/CT延迟显像SUV_max上升10%为恶性病变（阳性）,下降或升高 < 10%为良性病变（阴性）。HRCT以是否有分叶征、短细毛刺、胸膜尾征、支气管充气征、血管集束征、空泡征为分析良恶性的指征。所有病例进行临床综合分析及随访,以影像诊断是否符合临床随访及病理结果作为判断标准。组间SUV_max的比较采用t检验;计数资料的比较采用χ2检验。结果 28例SPN患者中,病理或临床随访诊断发现肺癌17例,结核7例,结节病4例。常规18F-FDG PET/CT显像确诊21例,18F-FDG双时相PET/CT显像确诊24例,11C-CHO PET/CT显像确诊23例,11C-CHO +18F-FDG双时相PET/CT+HRCT确诊27例。28例患者良恶性结节的18F-FDG及11C-CHO PET/CT的SUV_max比较,差异有统计学意义（t=10.57和13.19,均P < 0.05）。良恶性结节分叶、毛刺、胸膜尾征、血管集束征之间的差异有统计学意义（χ2=9.27、10.36、14.31和17.52,均P < 0.05）。11C-CHO+18F-FDG双时相PET/CT+HRCT联合显像的灵敏度为81.8%,特异度为94.1%,准确率为96.4%,明显高于非联合显像。结论 11C-CHO+18F-FDG双时相PET/CT+HRCT能较好地鉴别SPN的良恶性,三者联合能提高对SPN的诊断率。     

18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者的诊断效能:Meta分析

目的 系统评价18F-氟脱氧葡萄糖（FDG）PET/CT对甲状腺球蛋白（Tg）表达阳性（简称Tg阳性）且131I全身显像（WBS）结果阴性（简称131I-WBS阴性）的分化型甲状腺癌（DTC）复发患者的诊断效能。 方法 检索PubMed、Embase、Cochrane Library和万方数据知识服务平台、中国知网、维普数据库、中国生物医学文献数据库中关于18F-FDG PET/CT对DTC复发患者诊断的相关研究,检索时间从建库至2020年12月。根据纳入和排除标准筛选文献,提取研究的基本特征和诊断参数,采用Spearman相关系数分析文献是否存在阈值效应,对纳入文献进行异质性Q检验,采用Deeks线性回归分析法评价文献的发表偏倚。绘制综合受试者工作特征（SROC）曲线,计算曲线下面积（AUC）,采用Z检验分析行诊断性全身显像（Dx-WBS）与治疗性全身显像（Rx-WBS）的患者18F-FDG PET/CT诊断效能的差异,并分析在促甲状腺激素（TSH）刺激状态与抑制状态下18F-FDG PET/CT诊断效能的差异。 结果 最终纳入16篇文献,共1 036例DTC复发患者,纳入研究的异质性较低（I2=47.5%,P=0.018）,异质性可能源于病例数（r=1.462,P=0.021）,存在较小的发表偏倚（P=0.070）。18F-FDG PET/CT诊断Tg阳性且131I-WBS阴性的DTC复发患者的合并灵敏度为0.87（95%CI:0.82~0.91）、特异度为0.79（95%CI:0.68~0.86）、阳性似然比为3.76（95%CI:2.32~6.09）、阴性似然比为0.20（95%CI:0.14~0.27）、诊断优势比为23.89（95%CI:13.23~43.12）、SROC的AUC=0.91（标准误0.02）、Q指数为0.837（标准误0.023）。行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异无统计学意义（Z=0.041,P>0.05）。在TSH刺激状态与抑制状态下,行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异均无统计学意义（Z=1.864、0.525,均P>0.05）。 结论 18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者具有较高的诊断效能,行Dx-WBS与Rx-WBS、在TSH刺激状态与抑制状态下患者18F-FDG PET/CT的诊断效能均相当。