胸腔积液引流沉淀物在恶性胸腔积液中的诊断价值

目的评价胸腔积液引流沉淀物在恶性胸腔积液中的诊断价值。方法对36例恶性胸腔积液用中心静脉导管（ARROW管）行胸腔闭式引流,引流袋中的沉淀物行组织病理学检查,同时,胸腔积液行脱落细胞学检查作为对照。结果胸腔积液引流沉淀物组织病理学检查肿瘤阳性率明显高于胸腔积液脱落细胞学检查（P〈0.05）。结论胸腔积液引流沉淀物组织病理学检查肿瘤阳性率高,值得临床推广应用。     

胸腔积液VEGF和Endostatin检测的鉴别诊断价值

目的:探讨血管内皮生长因子(VEGF)和Endostatin联合检测在肺癌患者胸腔积液中的诊断价值.方法:采用ELISA方法检测70例肺癌和46例结核性胸膜炎并胸腔积液患者胸腔积液中VEGF和Endostatin表达水平,同时采用电化学发光法测定CEA、CYFRA211和NSE表达水平.结果:肺癌胸腔积液中VEGF和Endostatin表达水平明显高于结核性胸膜炎组,差异有统计学意义,P<0.01.VEGF在诊断恶性胸腔积液中的灵敏度、特异性和准确率分别为74.28%、67.39%和71.55%;Endostatin的评价指标分别为70.00%、82.61%和75.00%;而VEGF和Endostatin联合检测时各项评价指标均有很大提高,分别为82.86%、95.65%和87.93%.结论:胸腔积液中VEGF和Endostatin水平的增高有助于恶性胸腔积液的诊断,两者联合检测能提高灵敏度、特异性和准确性.     

以胸腔积液为首发症状的原发性腹膜癌PET/CT显像分析并文献复习

<正>原发性腹膜癌(primary peritoneal carcinoma, PPC)是一种少见的原发于腹膜的恶性肿瘤,早期无特异性临床表现,病情隐匿,进展迅速,患者一般以腹痛及腹胀为初期症状^[1]。近期我院收治1例以胸腔积液为首发症状的病人,术后诊断为原发性腹膜癌,临床十分少见,现报告如下,并结合相应文献复习,旨在提高对该病的认识。1 病例资料患者,女,57岁,以胸痛、喘息、气短3天入院。体格检查：体温36.5 ℃,     

肺癌胸腔积液树突状细胞培养与鉴别及其抗肿瘤作用的观察

目的:证实肺癌胸腔积液中存在树突状细胞(DCs)的前体细胞,体外培养可以获得成熟的DCs,并探讨DCs对自体癌细胞的杀伤作用.方法:通过Ficoll淋巴细胞分离液对15例肺癌患者的恶性胸腔积液进行密度梯度离心,以两步贴壁法分别获得DCs的前体细胞和自体癌细胞.前者加入粒细胞/巨噬细胞集落刺激因子(rhGM-CSF)、白细胞介素-4(rhIL-4)及肿瘤坏死因子-α(TNF-α)培养.显微镜观察细胞形态,流式细胞仪鉴定DCs表型.MTT法检测DCs对自体癌细胞的杀伤作用.结果:体外培养9d后获得大量成熟的DCs,具有典型树突状形态,且高表达HLA-DR[(84.2±6.3)％]、CD80[(75.8±8.8)％]、CD83[(58.0±9.4)％]和CD86[(83.3±7.5)％];MTT法结果显示,DCs对自体癌细胞有较强的杀伤作用,当效靶比为20∶1时杀伤率为(50.62±7.51)％.结论:肺癌恶性胸腔积液中的DCs前体细胞经诱导培养后可转化为功能健全的成熟DCs,成熟的DCs对自体癌细胞有直接杀伤作用,为恶性胸腔积液的免疫治疗提供理论依据.     

肺癌胸腔积液CEA和CYFRA21-1及NSE术中联检的临床价值

目的:探讨术中胸液CEA、CYFRA21-1和NSE联检对肺癌患者预测胸膜微转移的价值。方法:术中采集35例肺癌患者和20例良性肺疾病患者的胸腔积液,应用电化学发光免疫分析(ECLIA)技术,进行CEA、CYFRA21-1和NSE联检。结果:肺癌组CEA、CYFRA21-1和NSE水平分别为(144·81±272·56)、(252·20±171·91)和(107·30±88·53)μg/L,明显高于良性疾病组的(1·94±3·72)、(45·46±34·74)和(43·66±29·88)μg/L,t值分别为-2·335、-5·296和-3·105,P值分别为0·023、0·000和0·003。分别以>8、102和92μg/L为阳性界值,以其中两项或三项阳性为诊断依据,对胸膜微转移有较高的诊断灵敏度(74·3%)和特异度(100%);随访1~12个月,已有5例患者术后出现癌性胸腔积液,其中腺癌4例,鳞状细胞癌1例。结论:初步断定此方法对胸膜微转移有重要的预测价值,其中对肺腺癌患者价值更大。     

CT对恶性和良性胸腔积液鉴别诊断价值

目的 评价胸部CT对恶性胸腔积液(胸水)和良性胸水鉴别诊断的价值。方法 回顾性分析了已确诊的54例恶性胸水和42例良性胸水患者的胸部CT征象。结果 恶性胸水患者CT上常见的胸膜改变为结节状胸膜增厚,纵隔胸膜受累,胸膜增厚>10mm,环状胸膜增厚。此外,肺内肿块与结节灶和纵隔淋巴结肿大多提示为恶性胸水。良性胸水CT上的主要胸膜改变为基底部胸膜受累或基底部胸膜增厚较中上部胸膜明显,脏层胸膜受累,包裹性胸水和胸膜钙化。结论 CT可为恶性和良性胸水的鉴别诊断提供有价值的影像学征象。     

端粒酶检测在良恶性胸腔积液鉴别诊断中的应用价值

端粒酶是一种能以自带RNA为模板，反转录合成端粒DNA加于染色体末端的核糖核酸蛋白酶，作用是维持染色体稳定，使细胞具有永生化特性。胸腔积液可由多种疾病引起，与肿瘤因素有关者占30％～60％。作为目前最具特异性和普遍性的恶性肿瘤标志物，检测胸腔积液中端粒酶的活性，对早期发现肿瘤，具有重要意义。     

癌胚抗原,腺苷脱氨酶的检测对良恶性胸腔积液的鉴别价值

目的　探讨癌胚抗原 (CEA)和腺苷脱氨酶 (ADA )的检测对良性 (结核 )与恶性胸腔积液的鉴别价值。方法　分别采用ELISA和氨试剂法对 134例胸腔积液患者的CEA、ADA进行检测分析。结果　结核性胸腔积液和恶性胸腔积液患者CEA阳性检出率分别为 1.2 % (1/ 86 )和 6 8.8% (33/ 4 8) ,特异性为 98.8% (P <0 .0 1)。结核性胸腔积液和恶性胸腔积液患者ADA活性分别为 (41.5± 2 5 .7)U /L和 (9.6± 7.7)U /L ,前者是后者的 4倍 (P <0 .0 1)。结论　胸腔积液CEA及ADA的检测对结核与恶性胸腔积液有鉴别诊断价值。     

液体活检在肺癌伴恶性胸腔积液诊疗中的研究进展

肺癌是全球范围内死亡率最高的恶性肿瘤.晚期肺癌所致的恶性胸腔积液(malignant pleural effusion,MPE)严重影响患者的生活质量和预后.针对肿瘤的基因检测是制定精准治疗决策的基础,而组织活检取材存在风险,难以反复多次取样.液体活检由于具有无创性和可以反映肿瘤基因全貌的特点,在肺癌诊疗中的应用日益增...     

Potential Impact of Atelectasis and Primary Tumor Glycolysis on F-18 FDG PET/CT on Survival in Lung Cancer Patients

Background: Atelectasis is an important prognostic factor that can cause pleuritic chest pain, coughing ordyspnea, and even may be a cause of death. In this study, we aimed to investigate the potential impact of atelectasisand PET parameters on survival and the relation between atelectasis and PET parameters. Materials andMethods: The study consisted of patients with lung cancer with or without atelectasis who underwent 18F-FDGPET/CT examination before receiving any treatment. 18F-FDG PET/CT derived parameters including tumorsize, SUVmax, SUVmean, MTV, total lesion glycosis (TLG), SUV mean of atelectasis area, atelectasis volume,and histological and TNM stage were considered as potential prognostic factors for overall survival. Results:Fifty consecutive lung cancer patients (22 patients with atelectasis and 28 patients without atelectasis, medianage of 65 years) were evaluated in the present study. There was no relationship between tumor size and presenceor absence of atelectasis, nor between presence/absence of atelectasis and TLG of primary tumors. The overallone-year survival rate was 83% and median survival was 20 months (n=22) in the presence of atelectasis; theoverall one-year survival rate was 65.7% (n=28) and median survival was 16 months (p=0.138) in the absenceof atelectasis. With respect to PFS; the one-year survival rate of AT+ patients was 81.8% and median survivalwas 19 months; the one-year survival rate of AT- patients was 64.3% and median survival was 16 months(p=0.159). According to univariate analysis, MTV, TLG and tumor size were significant risk factors for PFS andOS (p<0.05). However, SUVmax was not a significant factor for PFS and OS (p>0.05). Conclusions: The presentstudy suggested that total lesion glycolysis and metabolic tumor volume were important predictors of survivalin lung cancer patients, in contrast to SUVmax. In addition, having a segmental lung atelectasis seems not to bea significant factor on survival.     

18F-FDG PET/CT鉴别肺占位病变性质方法的研究

目的：探讨^18F-FDG PET／CT对肺占位病变性质鉴别诊断方法的研究。方法：发现肺部占位病变患者74例，不含有支气管阻塞性肺炎，所有患者均进行3-14个月的随访。恶性患者55例（包括1例假阴性）其中23例经手术病理证实，32例临床诊断肺癌；良性患者19例其中7例经手术病理证实，12例经3～14个月随访病灶范围缩小或消失。所有患者均进行^18F-FDG PET／CT全身检查、呼吸控制的CT扫描及重建1．25mm薄层图像。^18F-DDG PET／CT诊断恶性的标准：1）肺病灶的SUVmax≥2．5；2）延迟显像SUVmax升高明显（≥20％～30％）；3）1．25mm薄层CT图像典型形态学征象；4）从病灶中心至各个胸壁变化曲线SUVmax变化曲线。结果：74例肺部痛灶患者中恶性55例，其中临床诊断肺癌32倒，腺癌13例，鳞癌5例，细支气管肺泡癌3倒，小细胞肺癌2例；良性19例，其中慢性炎症13例，肉芽肿2例，炎性假瘤2例，结核2例。PET、图像SUVmax、延迟SUVmax增高情况及薄层CT的典型征象综合最终^18F-FDG PET／CT诊断恶性病灶共57例，其中真阳性54例，假阳性3例；良性病灶共17例．其中真阴性16例，假阴性1例其敏感性、特异性、准确率、阳性预测值及阴性预测值分别为：98．2％，84．2％，94．6％，94．7％及94．1％。结论：PET／CT检查观察病灶SUVmax、延迟SUVmax结合薄层CT图像典型的形态学征象，并从每个病灶中心至各胸壁做SUVmax空间变化曲线等，明显提高了诊断的准确率。     

^18F-FDG PET/CT双时相显像鉴别诊断肺良恶性病变的临床研究

[目的]探讨18F-FDGPET/CT双时相显像鉴别诊断肺良恶性病变的临床价值。[方法]65例肺病变患者（80个病灶）行18F-FDGPET/CT双时相显像,计算最大标准化摄取值SUVmax及早期、延迟显像SUVmax的变化幅度（ΔSUVmax）,并与病理及随访结果对比。利用ROC曲线计算SUVmax和ΔSUVmax诊断肺病变的最佳阈值。比较PET/CT与PET及CT的诊断效能。[结果]（1）65例共计80个肺内结节中良性结节38个,恶性结节42个。恶性结节组早期相SUVmax值为5.35（4.6）,高于良性结节组的1.75（2.0）,差异有统计学意义（Z=-4.846,P=0.0001）。恶性结节组双时相ΔSUVmax值为30.54（2.0）,高于良性结节组的16.84（2.0）,差异有统计学意义（Z=-2.861,P=0.0042）。（2）ROC分析显示早期显像SUVmax值〉2.45和双时相显像ΔSUVmax值〉24.66%是两者鉴别诊断肺良恶性结节时的最佳阈值。早期相SUVmax值〉2.45诊断肺恶性病变的灵敏度、特异性、准确率、阳性预测值和阴性预测值分别为88.10%、63.16%、76.25%、72.55%、82.76%,双时相ΔSUVmax值〉24.66%时,分别为64.29%、71.05%、67.50%、71.05%、64.29%。（3）PET/CT诊断肺病变的准确率优于PET和CT（P〈0.05）,诊断灵敏度优于CT（P〈0.05）。[结论]18F-FDGPET/CT诊断肺恶性病变,早期相SUVmax值及双时相ΔSUVmax值的最佳阈值为〉2.45和〉24.66%;并需结合病灶CT形态学特征及临床病史进行综合诊断。     

18F-FDG PET/CT在诊断乳腺肿瘤中的应用价值

影像学检查中的正电子发射型电子计算机断层扫描(PET/CT)从解剖结构的精细图像为肿瘤的诊断提供了准确的影像依据,随着现代影像技术的不断进步,2-氟-18-氟-脱氧-D-葡萄糖(18F-2-Fluoro-2-deoxy-glucose,18F-FDG)已成为临床应用最广泛且成熟的正电子核素显影剂,18F-FDG与PET/CT技术联合使用从分子水平反映肿瘤的功能和代谢信息为肿瘤的诊断比PET/CT提供了更为精确的影像依据,为临床提供疾病的生物代谢信息,为今后乳腺癌影像诊断的主要发展趋向提供一定的应用价值。     

^18F—FDGPET／CT显像与CT增强在肾癌诊断中的对比研究

目的:评价18F-脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)PET/CT显像对肾癌诊断和治疗方案选择的临床应用.方法:回顾性分析50例临床诊断为肾癌患者的全身18F-FDG PET/CT及CT平扫加增强的影像学资料,比较两者对肾癌的诊断价值.结果:50例中,经手术病理证实为肾癌的有41例,其余9例因18F-FDG PET/CT显像发现远处转移放弃手术.18F- FDG PET/CT检查敏感度80%;CT平扫加增强敏感度92%.9例转移病例中4例为腹膜后淋巴结转移,2例两肺多发转移,2例伴有下腔静脉和肾静脉癌栓形成,1例骨转移合并肝转移,而CT平扫加增强仅发现1例肾静脉和下腔静脉癌栓形成.结论:18F-FDG PET/CT对诊断原发性肾癌的敏感性不如CT,但对淋巴结转移及远处转移的诊断优于CT,对肾癌的分期及治疗方案的选择有重要意义.     

Role of F-18 FDG PET/CT imaging in the diagnosis of paraneoplastic neurological syndromes

Paraneoplastic neurological syndromes （PNS） is a series of rare neurologic disorders which happen with an underlying malignancy. It has various clinical symptoms proceding to the diagnosis of tumors. Although the abnormality of anti-neuronal antibodies is suggestive of PNS and tumors, there exist many false positive and false negative cases. The diagnosis of PNS is usually a challenge in clinic. Positron emission tomography/computed tomography （PET/CT） imaging is an anatomical and functional fusion imaging method, which provides the whole-body information by single scan. Fluorodeoxy- glucose （FDG） PET/CT imaging can not only detect potential malignant lesions in the whole body, but also assess functional abnormality in the brain. In this review, the mechanism, clinical manifestation, diagnostic procedure and the recent progress of the utility of FDG PET/CT in PNS are introduced respectively.     

Diagnostic Performance of F-18 FDG PET/CT Compared with CA125, HE4, and ROMA for Epithelial Ovarian Cancer

Objective: This study aimed to examine the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (F-18 FDG PET/CT) compared with cancer antigen 125 (CA125), human epididymis protein 4 (HE4), and risk of ovarian malignancy algorithm (ROMA) score to distinguish epithelial ovarian cancer from benign tumors. Methods: A total of 46 patients with pelvic masses, who underwent F-18 FDG PET/CT, CA125, and HE4 before surgery between January 2015 and December 2018, were included in this retrospective study. The diagnostic performance of CA125, HE4, ROMA score, and maximum standardized uptake value (SUVmax) to differentiate epithelial ovarian cancer from benign pelvic tumors was examined by receiver operating characteristic curve analysis. Results: Among the 46 patients, 28 were cases of ovarian cancers and 18 were of benign. The mean values of CA125, HE4, ROMA score, and SUVmax were significantly higher in the ovarian cancer group than the benign group. In early cancer stages (stages I and II), Area under the curve for SUVmax was significantly higher than CA125 and ROMA score (0.778 for CA125, 0.753 for HE4, 0.682 for ROMA score, and 0.922 for SUVmax). Conclusion: SUVmax using F-18 FDG PET/CT showed a high diagnostic accuracy for differentiating epithelial ovarian cancer from benign pelvic tumors, including early stage ovarian cancer. F-18 FDG PET/CT can be a useful modality for the assessment of pelvic mass.     

Detection and prediction of local recurrence of maxillary sinus cancer using F-18 FDG PET/CT

Purpose

The aim of the current study was to investigate the role of F-18 FDG PET/CT in the detection and prediction of local recurrence of maxillary sinus cancer.

Methods

Retrospectively, we analyzed F-18 FDG PET/CT images of maxillary sinus cancer patients for the surveillance after treatment. Twenty-two consecutive patients with maxillary sinus cancer, who underwent maxillectomy followed by adjuvant radiation treatment, were included in the study. F-18 FDG PET/CT images were analyzed visually and quantitatively.

Results

The median age of the patients included in the current study population was 54.5 years (range, 35–78). Seven patients (29.1%) had local recurrent diseases. Recurrent diseases show statistically significant higher values in SUV_max (recurrent: 5.09 ± 3.3, non-recurrent; 3.05 ± 0.7, p < 0.05), L/NL (recurrent: 2.95 ± 0.9, non-recurrent; 1.86 ± 0.5, p < 0.05), L/Ao (recurrent: 3.37 ± 2.1: non-recurrent; 1.88 ± 0.4, p < 0.05), and L/Cbr (recurrent: 1.06 ± 0.7: non-recurrent; 0.46 ± 0.1, p < 0.05) than those of non-recurrent disease of maxillary sinus cancer. There were no statistical differences between visual assessment and quantitative indices for the detection of local recurrence. The visual assessment was the potent predictor by logistic regression analysis for prediction of local recurrence.

Conclusion

The visual assessment of F-18 FDG uptake pattern was potential predictor for local recurrence of maxillary sinus cancer. However, the diagnostic performances were similar between visual assessment and quantitative indices. Further studies are needed to confirm these results and improve statistical accuracy.