FDG PET/CT与PET对食管癌淋巴结转移的诊断价值比较

目的比较脱氧葡萄糖(FDG)PET/CT和PET对食管癌淋巴结转移的诊断价值。方法随机选择拟行手术治疗的食管癌患者35例,行PET/CT检查。全部患者均行食管癌切除和淋巴结清扫术,以术后病理检查为金标准,比较PET/CT与PET对食管癌淋巴结转移的诊断价值。结果术后病理结果显示,25例患者存在淋巴结转移。共切取淋巴结313组,其中65组为转移淋巴结。PET确定转移真阳性淋巴结53组,真阴性淋巴结217组。PET/CT确定转移真阳性淋巴结61组,真阴性淋巴结229组。PET诊断转移假阴性淋巴结12组,其中8组被PET/CT校正,包括1组颈深淋巴结,4组食管旁淋巴结,1组胃左动脉干淋巴结,1组左贲门旁淋巴结,1组胃小弯淋巴结;PET诊断转移假阳性淋巴结31组,其中12组被PET/CT校正,3组缘于食管癌原发灶不均匀摄取,2组缘于颈部组织生理性摄取,7组缘于胃肠道生理性摄取或良性病变。PET的敏感性、特异性和准确性分别为81.54%、87.50%和86.26%,PET/CT的敏感性、特异性和准确性分别为93.85%、91.24%和92.65%,PET/CT诊断食管癌淋巴结转移的敏感性和准确性均高于PET(P<0.05)。结论与PET相比,FDG PET/CT诊断食管癌淋巴结转移具有更高的敏感性和准确性,可提供更多有价值的诊断信息。     

PET/CT确定进展期食管癌临床分期价值的探讨

目的:评价18-FDG PET/CT对进展期食管癌原发灶、转移淋巴结的敏感性、特异性、准确性以及原发灶指标与SUV的相关性,确定在食管癌分期中的价值.方法:27例食管癌患者行18-FDG PET/CT和CT检查,根据术后病理结果确定18-FDGPET/CT的诊断准确性.结果:18-FDGPET/CT探测到所有的原发肿瘤,敏感性、特异性和准确性均为100%.SUV与原发肿瘤位置(P=0.558)无明显相关性;与是否区域淋巴结转移有明显相关性(P=0.008),SUV与肿瘤病理分级的关系表现为分化越差SUV越大.SUV与肿瘤最大长径正相关,r=0.492,P=0.002.探测淋巴结转移,18-FDG PET/CT和CT的敏感性分剐为83.33%和69.05%(X2=2.363,P=0.124),特异性分别为93.69%和85.18%,X2=13.223,P=0.000;准确性分别为和92.78%和83.54%,X2=16.221,P=0.000.结论:18-FDG PET/CT在确定进展期食管癌原发肿瘤,诊断转移淋巴结敏感性、特异性和准确性均较CT高,有一定的临床价值.     

18F-FDGPET/CT全身显像对乳腺癌复发和转移诊断价值分析

目的:探讨18F-FDG PET/CT全身显像对治疗后乳腺癌复发和转移的诊断价值。方法:回顾性分析山东省肿瘤医院2004-12-01-2009-12-31行18F-FDG PET/CT显像检查的乳腺癌患者142例,统计18F-FDG PET/CT显像诊断的灵敏度、特异性和准确性,并与增强CT及全身骨扫描进行对比。结果:18F-FDG PET/CT和增强CT对乳腺癌复发和转移的灵敏度分别为85.5%(71/83)和77.1%(64/83),特异性分别为88.1%(52/59)和84.7%(50/59),准确性分别为86.6%(123/142)和80.3%(114/142)。18F-FDG PET/CT诊断淋巴结转移的阳性率为89.5%(34/38),高于增强CT的73.7%(28/38),P=0.031;对于局部复发、肺转移、肝转移和脑转移的诊断,18F-FDG PET/CT和增强CT差异无统计学意义;对于骨转移的诊断,18F-FDG PET/CT的灵敏度为70.0%,全身骨扫描为90.0%,两者的特异性分别为100.0%和58.3%。结论:18F-FDG PET/CT显像对治疗后乳腺癌复发和转移诊断具有较高的灵敏度和特异性,但对于不同部位转移灶的诊断应合理选择检查方法。     

头颈部肿瘤18F-FDG PET/CT诊断价值的探讨

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT诊断头颈部肿瘤的价值.方法:21例头颈部肿瘤患者行PET/CT显像,原发灶或转移灶经病理组织学确诊.行PET/CT融合图像、PET图像和CT图像帧对帧对比分析.基于PET/CT和CT结果对21例患者进行TNM分期,比较其结果.比较PET/CT和PET的定位准确性.结果:21例患者经PET/CT共检出恶性病灶65个.其中PET与CT皆显示清楚病灶者35个,占53.9%.PET阅片有肯定诊断结论而CT难以有肯定诊断结论者24个,占36.9%.CT显示有清楚病灶而PET显示为阴性或难以确定者共6个病灶,占9.2%.PET/CT的总检出率高于PET和CT.PET/CT使8例患者TNM分期发生改变(38.1%). PET/CT对病变定位的准确性为90.8%,总的不影响诊断的定位准确性为95.4%;PET分别为49.2%和66.2%(P＜0.05).结论:PET/CT显像能提高头颈部肿瘤的诊断、分期和定位的准确性.     

PET-CT在乳腺癌保乳微创治疗中的应用研究

目的:探讨PET蛳CT在早期乳腺癌保乳微创治疗中的可行性及其临床意义。方法:选取2002年12月—2004年3月行PET蛳CT检查的乳腺肿瘤或腋窝肿物患者40例(包括1例男性患者),给予常规检查及PET蛳CT扫描,根据疾病性质及患者情况给予相应手术治疗,根据术后病理结果评价PET蛳CT对于原发肿瘤及转移灶诊断的准确性,及其判断腋窝淋巴结转移情况的可行性,并与SLNB或ALND进行比较。结果:PET蛳CT诊断原发肿瘤的敏感性、特异性、准确率为95.2 %、50 %、88 %;在切检术后病例中,PET蛳CT诊断肿瘤是否残留的敏感性、特异性及准确率为25 %、83.3 %、60 %;肿瘤病理大小与PET蛳CT诊断大小相关性最为显著(Pearson系数=0.786,P=0.000);以SLNB和/或ALND作为金标准,PET蛳CT诊断腋窝淋巴结状况的敏感性、特异性及准确率是72.2 %、94.4 %、83.3 %,诊断转移淋巴结数目与病理诊断数目的符合率为41.2 %。结论:PET蛳CT与原发肿瘤病理诊断基本符合,两者诊断原发肿瘤大小一致性最佳,PET蛳CT有望成为准确判断肿瘤范围的可靠方法;但对于腋窝淋巴结,PET蛳CT尚没有足够的敏感性及准确率成为SLNB以外的准确诊断腋窝淋巴结状况的方法。     

18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值

背景与目的:颈部淋巴结转移瘤在颈部恶性肿瘤中最常见,原发灶检出与否直接影响患者的生存期和生活质量.本研究旨在评估18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值;另外,设定不同的PET/CT原发灶诊断标准,分别评价其阳性预测价值.方法:对93例病理学诊断为颈淋巴结转移瘤的患者行18F-FDG PET/CT显像,根据不同的PET/CT原发灶诊断标准寻找原发灶,即明确诊断、可疑诊断及未见原发灶征象;所有PET/CT诊断均与病理或其它影像检查相对照.结果:PET/CT明确诊断原发灶40例,均经病理或临床证实,阳性预测值100%;PET/CT可疑诊断28例,经病理证实为原发灶16例.其阳性预测值57.1%;2例患者经PET/CT提示为纵隔淋巴结转移但未见原发灶征象.最终临床诊断为原发纵隔型肺癌;2例患者PET/CT未见原发征象,经内窥镜检出原发灶;PET/CT原发灶检出率为60.2%(56/93).结论:18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中有较大的临床价值.     

18F-FDG PET/CT SUVmax及CT值双定量分析在肺癌纵隔淋巴结鉴别诊断中的价值

目的:探讨18F-FDG PET/CT显像对肺癌纵隔淋巴结的定量鉴别诊断方法.方法:回顾性分析天津医科大学附属肿瘤医院2005年4月至2009年10月间142例肺部病变患者手术前的CT、PET、PET/CT显像结果.142例患者行PET/CT检查前均未进行抗肿瘤治疗,行PET/CT检查后1个月内行手术或活检取得病理.手术淋巴结分区以1997年美国AJCC为标准.对CT、PET、PET/CT显像结果进行定量分析,比较纵隔淋巴结阳性及阴性者SUVmax、CT值、CT短径的差异,绘制SUVmax值、CT值的ROC曲线,找到最佳诊断界点.分别计算单纯PET、单纯CT值、单纯CT短径及PET/CT双定量分析的灵敏度、特异度、阳性预测值、阴性预测值、准确度等指标,并对其结果进行统计学分析.用多个样本率比较的卡方检验比较单纯PET、单纯CT值、单纯CT短径以及PET/CT SUVmax、CT值双定量分析对纵隔淋巴结的诊断效能.结果:SUVmax、CT值、CT短径差异有统计学意义,SUVmax取2.45,CT值取38.5Hu为诊断诊断界点.当SUVmax≥2.45时短径差异无统计学意义,CT值差异有统计学意义.当SUVmax≥2.45且CT值<38.5Hu,18F-FDG PET/CT显像诊断纵隔淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为50.9%、96.5%、92.8%、72.5%、77.0%,其准确性高于单纯PET、单纯CT值及单纯CT短径(χ2=19.192,P=0.000).结论:PET/CT显像对于纵隔淋巴结转移的诊断具有明显价值,其准确性优于单纯PET或CT;当SUVmax≥2.45且CT值<38.5Hu时,提示转移可能性大.     

18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值分析

目的:探讨18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值。方法:回顾性分析病理、术中所见或临床综合及随访资料证实的胰腺癌病人18F-FDG PET/CT和增强CT影像资料,对比二者及二者联合对胰腺癌可切除性评估价值。结果:74例病人中24例进行了手术,其中仅15例成功完整切除了肿瘤,另9例因术中发现不可切除因素而行姑息手术。余50例均经随访证实因多发转移而不可切除。以不可切除为阳性指标,18F-FDG PET/CT显像对不可切除评估的灵敏度、特异性及准确性分别为79.66%,86.67%和81.08%,增强CT的灵敏度、特异性及准确性分别为84.75%,93.33%和86.49%,二者差异无显著性。以其中一种方法阳性即认为不可切除,二者联合判断的灵敏度、特异性及准确性分别为91.53%,86.67%和90.54%,显著优于单独PET/CT或增强CT。结论:18F-FDG PET/CT与增强CT均为胰腺癌可切除性评估重要手段,二者价值相似,具有互补性,联合应用准确性更高。     

PET/CT双定量分析在良恶性颈部淋巴结鉴别诊断中的价值

  目的  探讨18F-FDG PET/CT SUVmax及CT短径双定量分析在良恶性颈部淋巴结鉴别诊断中的价值。  方法  回顾性分析本院2005年4月~2011年9月期间以颈部淋巴结肿大为首发症状行18F-FDG PET/CT检查的82例患者的显像情况。以病理诊断为金标准, 对CT、PET、PET/CT图像结果进行定量分析, 绘制SUVmax值及CT短径的ROC曲线, 找到最佳诊断界点, 分别计算单纯CT、单纯PET以及PET/CT双定量分析的敏感度、特异度、阳性预测值、阴性预测值、准确度等指标, 并对其结果进行统计学分析。  结果  当CT短径≥0.65cm且SUVmax≥1.95, 18F-FDG PET/CT显像诊断良恶性颈部淋巴结的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为79.30%、94.52%、95.15%、77.09%、85.76%, 其准确度高于单纯PET或单纯CT。  结论  18F-FDG PET/CT双定量分析对良恶性颈部淋巴结的鉴别诊断具有较高的临床价值, 其准确性优于单纯PET或单纯CT: 当CT短径≥0.65cm且SUV-max≥1.95.提示颈部淋巴结恶性可能性大。      

PET-CT和MRI诊断兔鼻咽肿瘤颈淋巴结转移的比较研究

目的 探讨18FDG PET-CT在诊断兔鼻咽肿瘤颈部淋巴结性质上的作用.方法 建立兔鼻咽VX2肿瘤模型,对颈部淋巴结行PET-CT诊断并用病理诊断证实,同时与MRI诊断相比较.结果 30只鼻咽VX2肿瘤兔解剖检出颈部淋巴结共53个,病理证实转移淋巴结42个,且淋巴结是否转移与淋巴结体积、最短径显著相关(r=9.18,P=0.007;r=2.77,P:0.008).体积>0.5 cm3(25个)、≤0.5 cm3(17个)淋巴结的PET-T诊断敏感性分别为96%(24个)、29%(5个),最短径≥0.5cm(30个)、<0.5 cm(12个)淋巴结的PET-CT诊断敏感性分别为83%(25个)、33%(4个),PET-CT诊断的总敏感性为69%(29/42),特异性为100%(11/11),准确性为95%(40/42).MRI诊断敏感性为60%(25/42),特异性为9l%(10/11),准确性为83%(35/42).PET-CT图像所测淋巴结体积与实测体积相当(t=-1.23,P=0.233),MRI的则大于实测体积(t=-3.99,P=0.001).结论 18FDGPET-CT诊断颈部淋巴结转移的敏感性、特异性均高于MRI,特别对体积>0.5 cm3或最短径≥0.5 cm的颈部淋巴结转移的敏感性更高,对更小淋巴结的诊断仍有参考价值,仉假阴性较高.     

颈部转移淋巴结的CT、B超扫描与临床触诊对比分析

目的评价ＣＴ、Ｂ超扫描与临床触诊诊断颈部淋巴结转移的准确性,分析ＣＴ、Ｂ超诊断颈部隐匿性淋巴结转移的价值。方法对６０例７４侧颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查,术后与病理对照,双盲法观察及分析影像所见,将其结果做统计学处理。结果在７４侧颈部淋巴结清扫术病理检查中５６侧有转移淋巴结,临床触诊检出其中４６侧（敏感性８２．１％,特异性８３．３％,准确性８２．４％）。ＣＴ扫描确诊其中的５３侧（敏感性９４．６％,特异性９４．４％,准确性９４．６％）;ＣＴ可以确诊７０％由临床漏诊的隐匿性转移淋巴结。Ｂ超扫描确诊其中５１侧（敏感性９１．１％,特异性９４．４％,准确性９１．９％）;可以检出５０％由临床漏诊的隐匿性转移淋巴结。结论ＣＴ、Ｂ超扫描评价颈部淋巴结的准确性明显优于临床触诊,可以检出５０％～７０％由临床漏诊的隐匿性转移淋巴结。     

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophagealcancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distantlymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT andcontrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophagealcancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCTscan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. Theprimary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed withinone week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the goldstandard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCTwas conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT indetecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05).The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, ascompared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with orwithout metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distantlymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity ofFDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitivethan MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophagealcancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detectingboth regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value indistinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CTwith MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.     

PET/CT在卵巢癌术后监测复发/转移上的优势:与血清CA125及增强CT比较

目的:探讨18F-脱氧葡萄糖(18F-FDG)PET/CT在早期发现卵巢癌术后复发/转移方面的价值,并与血清CA125检测及增强CT进行比较。方法:回顾性分析过去5年内在我院行卵巢癌二次手术,并在术前均行血清CA125、增强CT、PET/CT检查的患者36例（99个病灶）。分别计算出以患者个体为研究单位时血清CA125及PET/CT检查的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,并比较二者在监测卵巢癌术后个体复发/转移方面的效能。采用卡方检验或Fisher确切概率法来比较增强CT、PET/CT两种方法诊断卵巢癌术后转移/复发病灶的差异性,并分别计算出以病灶为研究单位时的阳性预测值、阴性预测值、灵敏度、特异度、准确度等参数,比较二者在诊断卵巢癌术后复发/转移病灶方面的效能。结果:PET/CT诊断出34/36例复发/转移的患者,而血清CA125以0~35 U/ml为基准时仅诊断出11/36例复发/转移的患者。前者诊断卵巢癌术后复发/转移患者的阳性预测值、灵敏度、准确度明显高于后者（97%、100%、97% vs 91%、32%、33%）。PET/CT与增强CT在诊断卵巢癌术后复发/转移病灶效能方面差异具有统计学意义（P=0.037）。PET/CT能够诊断出78/99个卵巢癌术后复发/转移的真阳性病灶,而增强CT仅能够诊断出70/99个。PET/CT以病灶为研究单位的阳性预测值、阴性预测值、灵敏度、特异度、准确度均比增强CT高（94% vs 89%、62.5% vs 30%、93% vs 83%、67% vs 40%、89% vs 77%）。结论:对于符合二次手术条件的患者,PET/CT诊断卵巢癌术后复发/转移方面的价值要优于血清CA125及增强CT。     

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma

The combination of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) has been reported to be more accurate than CT or PET alone in a preoperative setting. We compared the diagnostic utility of preoperative PET/CT, PET and CT/MRI in 167 patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC), of whom 104 underwent FDG PET and 63 underwent combined PET/CT with all receiving CT/MRI. These preoperative PET, PET/CT, and CT/MRI results were reviewed and their accuracies were compared in patients in whom diagnosis was confirmed histopathologically. Age, sex, primary sites and stage, and nodal involvement were comparable between two groups. The accuracy of PET and PET/CT for detecting primary tumors and cervical metastases was comparable, but significantly higher than that of CT/MRI (98%-97% vs. 86-88% for primary; 92%-93% vs. 85%-86% for neck on a level-by-level basis; P<.05). PET and PET/CT gave false negative results: in 2 (2%) and 2 (3%) patients for primary tumors; in 6 (6%) and 3 (5%) patients for neck metastases, respectively. PET and PET/CT also gave false-positive results for cervical metastases in 5 (5%) and 4 (6%) patients, respectively. Compared with PET alone, preoperative FDG PET/CT may not yield significantly improved diagnostic accuracy in patients with HNSCC. Moreover, despite their high accuracy, PET and PET/CT may not abrogate the need for conventional imaging and pathologic staging based on primary resection and neck dissection.     

Utility of 18F-fluorodeoxyglucose positron emission tomography in the preoperative staging of squamous cell carcinoma of the oropharynx.

BACKGROUND: 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been reported to be superior to computed tomography (CT)/magnetic resonance imaging (MRI) in the evaluation of head and neck cancers, but little is known about its usefulness in oropharyngeal squamous cell carcinoma (SCC). We therefore compared FDG PET and CT/MRI in the preoperative staging of previously untreated oropharyngeal SCC. METHODS: Thirty-two consecutive patients with oropharyngeal SCC underwent FDG PET and CT/MRI before surgery. Each method was interpreted separately to assess primary tumor and cervical node status. Their sensitivity and specificity were compared relative to histopathologic analysis. RESULTS: Histopathology revealed metastases in 29 of 39 dissected neck sides and in 47 of 163 dissected cervical levels. FDG PET had higher sensitivities than CT/MRI for primary tumor detection (25/32 vs. 30/32, P=0.063) and for identification of cervical metastases on neck side (22/29 vs. 28/29, P<0.05) and level-by-level (37/47 vs. 45/47, P<0.05) bases. In contrast, the specificity of the two methods did not differ significantly (P>0.5). FDG PET correctly interpreted the false-negative results of CT/MRI in 6 of 7 primary tumors and 8 of 10 cervical levels. CONCLUSIONS: The improved preoperative staging of FDG PET may help in planning treatment, but its accuracy is insufficient to replace pathologic staging based on neck dissection.     

The usefulness of MRI and PET imaging for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer

OBJECTIVE: The purpose of this study is to elucidate the usefulness of magnetic resonance imaging (MRI) and positron emission tomography (PET) for the detection of parametrial involvement and lymph node metastasis in patients with cervical cancer. METHODS: Thirty-six patients with cervical cancer were retrospectively enrolled. MRI and PET scans were performed for all patients within a week before radical surgery. The criterion for malignancy on MRI was >1 cm short axis diameter of the suspected lymph node. On PET, only fluorodeoxyglucose (FDG) uptake was significantly higher than the background and, if this FDG uptake showed on at least two consecutive axial slices, then the lesion was considered as a malignancy. We compared the extent of tumor on the surgical findings with the FIGO staging, MRI and PET scans. RESULTS: The accuracy of FIGO and MRI staging was 67 and 84.4%, respectively. The accuracy for detecting pelvic lymph node metastasis was better for PET than for MRI (78 versus 67%, respectively). All FDG uptake lymph nodes were confirmed as metastatic lymph nodes by pathological evaluation; this included five lymph nodes <1 cm in diameter. CONCLUSION: MRI provides an improved evaluation of local tumor extension, but PET is more useful for the evaluation of pelvic lymph nodes than MRI; however, PET still misses microscopic disease. Further studies are necessary to evaluate the usefulness of PET/computed tomography (CT) for the accuracy of the disease extension and the cost-effectiveness of MRI, PET or PET/CT in patients with cervical cancer.     

Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study

BACKGROUND: The objective of the current study was to determine the accuracy of magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for detecting lymph node metastases in patients with uterine cervical carcinoma compared with thin-section histopathologic results from systemic lymphadenectomy. METHODS: Twenty-two patients with International Federation of Obstetrics and Gynecology (FIGO) Stage IB-IVA cervical carcinoma who underwent both MRI and PET/CT before lymphadenectomy were included in this study. Lymphadenectomy involved removing all visible lymph nodes in the surgical fields. To enable region-specific comparisons, paraaortic and pelvic lymph nodes were divided into seven regions: the paraaortic area, both common iliac areas, both external iliac areas, and both internal iliac/obturator areas. Histopathologic evaluation of lymph nodes was the diagnostic standard. Chi-square analysis was used to compare the accuracy of MRI and PET/CT for the detection of metastatic lymph nodes. A P value < or = 0.05 was considered statistically significant. RESULTS: With MRI, the sensitivity, specificity, and accuracy rates for detecting metastatic lymph nodes in each lymph node group were 30.3% (10 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 72.7% (122 of 154 lymph node groups), respectively; with PET/CT, those rates were 57.6% (19 of 33 lymph node groups), 92.6% (112 of 121 lymph node groups), and 85.1% (131 of 154 lymph node groups), respectively. Statistical analysis showed that PET/CT was more sensitive than MRI (P = 0.026) but that there were no statistical differences noted with regard to specificity (P = 1.000) or accuracy (P = 0.180). Power analysis demonstrated that a sample size of 685 lymph node groups (98 patients) would be necessary to demonstrate that PET/CT was more accurate than MRI (alpha = 0.05; beta = 0.80). CONCLUSIONS: PET/CT was more sensitive than MRI for detecting lymph node metastases in patients with uterine cervical carcinoma.     

宫颈癌综合治疗后远处淋巴结转移临床分析

目的：探讨宫颈癌综合治疗后远处淋巴结复发转移的临床特征、治疗和预后。方法：对5例远处淋巴结转移的宫颈癌患者的临床资料进行分析。结果：5例患者接受手术、化疗或放疗等综合治疗，所有患者术前磁共振显像（MRI）／计算机断层扫描（CT）检查未发现远处转移，而于治疗结束后1个月～2年出现，其中4例发生腹主动脉旁淋巴结转移，2例合并左锁骨上淋巴结转移。经全身化疗及三维适形放疗，4例死亡，平均生存15．3个月．1例带瘤生存24个月。结论：腹主动脉旁及左锁骨上淋巴结转移可能是宫颈低分化癌患者远处复发转移部位之一，需要应用手术、化疗及放疗等综合治疗。正电子发射断层扫描（PET）／单光子发射扫描（SPECT）技术是诊断、随访及评价预后的重要工具。     

Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients

We evaluated the additional diagnostic value of magnetic resonance/positron emission tomography (MR/PET) fusion in the detection of metastatic lymph nodes in cervical cancer patients.Seventy nine patients with FIGO stage IB-IVA cervical cancer who had undergone both magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) before lymphadenectomy were included in this study. Image analysis was first performed with PET/CT images only. A second analysis was then performed with MR/PET fused images that focused on the additional information obtained from the MR images. Lymphadenectomy involved removing all visible lymph nodes in the surgical field. To enable nodal group-specific comparisons, para-aortic and pelvic lymph nodes were divided into seven nodal groups: para-aortic, both common iliac, both external iliac and both internal iliac/obturator areas. Histopathological evaluation of lymph nodes has been the diagnostic standard. The value of the additional information from the MR images was evaluated by means of receiver operating characteristic (ROC) analysis.Fused MR/PET rendered readers to detect six more metastatic lymph node groups. The sensitivity and specificity of PET/CT and fused MR/PET were 44.1%, 93.9% and 54.2%, 92.7% respectively. The ROC analysis demonstrated a higher diagnostic performance of fused MR/PET compared to PET/CT alone for detecting lymph node metastases (p = 0.0259).The findings of this study demonstrate the additional diagnostic value of fused MR/PET images compared with PET/CT in the detection of metastatic lymph nodes in patients with uterine cervical cancer.     

Effect of (18)F-FDG PET/CT imaging in patients with clinical Stage II and III breast cancer

PURPOSE: To investigate the potential effect of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. METHODS AND MATERIALS: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. RESULTS: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. CONCLUSIONS: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.