Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era?

BACKGROUND: The clinical impact of fused PET/CT data on staging and patient management of Hodgkin disease (HD) and non-Hodgkin lymphoma (NHL) was assessed. PATIENTS AND METHODS: A total of 103 consecutive patients with newly diagnosed NHL (n = 68) and HD (n = 35) were assessed retrospectively. Three comparisons were carried out in an attempt to assess the added value of each modality. RESULTS: For NHL patients, there were significant differences between staging by CT versus PET/CT (P = 0.0001). Disease was upstaged by PET/CT in 31% (mostly in stages I and II) and downstaged in only 1% of patients. In 25% of the patients, the treatment approach was changed according to CT versus PET/CT findings. For HD patients, disease was upstaged by PET/CT in 32% and downstaged by PET/CT in 15% (P = NS). As for NHL, upstaging by PET/CT versus CT was evident mostly for stages I and II. The treatment strategy was altered as determined by CT versus PET/CT in 45% of the patients. CONCLUSIONS: The addition of PET/CT to CT changed the management decisions in approximately a quarter of NHL and a third of HD patients, mostly in early disease stages. Thus, PET/CT performed as the initial staging procedure may well obviate the need for additional diagnostic CT in the majority of patients.     

Clinical staging and diagnosis of malignant lymphoma

Clinical staging of malignant lymphoma, especially that of non-Hodgkin lymphoma, should be made according to the organ of its origin and the histologic type, taking the natural course of each tumor type into consideration. This is only possible if a universal system of histopathological classification is present, such a classification is unlikely to be established in the near future. Under these circumstances, the Ann Arbor classification for Hodgkin's disease must be applied for the time being to clinical evaluation of lymphoma. Remarkable improvements have been made in the diagnostic modalities, but conventional procedure such as biopsy, lymphography, plain chest X-ray, and gastro-intestinal fluoroscopy still remain important in the diagnosis of malignant lymphoma.     

64排螺旋CT多期增强扫描对进展期胃癌术前评估的价值

目的探讨64排螺旋CT三期增强扫描对进展期胃癌术前评估中的价值。方法选择CT检查前已确诊为胃癌的患者80例,术前行64排螺旋CT三期增强扫描,然后进行病理分期TNM分期,分析螺旋CT与病理分期的效果,并且探讨增强CT对于手术判断的效果。结果CT影像学主要表现为胃壁异常增厚、肿瘤向周围直接侵犯、局部和远处淋巴结转移,CT与病理诊断对比在T分期与N分期上有显著性差异（P〈0．05）,而对M分期对比上无明显差异（P〉0．05）。CT预测治疗方式与临床相符合的敏感度为78．6％,特异性为86．5％,准确率为83．8％。结论多层螺旋CT（MSCT）可较准确地显示胃癌侵犯胃壁的深度、淋巴结转移和远处脏器的转移情况,在胃癌M分期判断上有较高的准确率,能为手术治疗方案选择提供参考。     

螺旋CT对甲状腺单发结节良恶性鉴别的价值

目的探讨甲状腺单发良、恶性结节的CT表现。方法通过经病理证实的47例甲状腺单发良性结节和21例恶性结节CT影像对比,分析两者间的CT表现差别。结果47例单发良性结节中39例病变边界清晰、8例病灶边界欠清、26例囊变、10例钙化;21例恶性结节有17例病变边界不清、4例病灶边界较清、8例囊变、9例钙化、6例表现强化残圈征、9例肿瘤侵犯周围组织器官和7例颈部淋巴结转移。结论螺旋CT对甲状腺结节的良、恶性鉴别有重要意义。     

肿块型胰腺淋巴瘤的CT诊断及鉴别

目的 分析肿块型胰腺淋巴瘤的CT表现,以提高诊断水平.方法 回顾性分析9例经病理或临床随访证实的肿块型胰腺淋巴瘤的CT和临床资料.结果 9例肿瘤均为单发,位于胰头部5例、颈体部3例、尾部1例;呈不规则分叶状7例,椭圆形2例;最大径约2.3～7.6 cm,平均4.9 cm.CT平扫肿瘤边界欠清,呈等或略低密度,CT值平均36.5 HU.增强扫描动脉期轻度强化,静脉期呈轻或中度持续强化,7例均匀强化,2例强化不均.5例肿瘤包绕邻近血管,类似“血管漂浮征”.所有肿瘤未见钙化,未见明显胰管增宽,2例出现胆总管轻度增宽.腹腔或腹膜后多发肿大淋巴结6例,增强较均匀一致,中等强化.结论 CT对肿块型胰腺淋巴瘤的诊断及鉴别具有较大价值.     

Ga-67 scintigraphy for the localization and staging of malignant lymphoma

Thirty-eight Ga-67 scintigraphies have been evaluated in regard to patients with an untreated malignant lymphoma or a recurrent lymphoma after a complete remission. Thirty-four studies (89%) showed positive findings. Waldeyer's ring and lymph node involvement were detected in 66% of the cases. The recurrent type was detected less often than the untreated malignant lymphoma, and there was no significant difference in detectability between Hodgkin's disease and non-Hodgkin's lymphoma. Although the malignancy grade for NHL did not affect the detectability, the intermediate and high grade NHLs tended to show a greater uptake than the low grade NHLs. The detectability was particularly good for neck and intrathoracic lymph nodes. Ga-67 scintigraphy tended to downgrade a malignant lymphoma to a lower stage, especially if in recurrence.     

飞利浦64排增强CT扫描在胃癌术前分期中的应用

目的:分析飞利浦64排增强CT扫描在胃癌术前分期中的应用价值。方法:选取我院2016年1月至2018年1月收治的450例经胃镜检查证实的胃癌患者纳入研究,术前采取飞利浦64排增强CT扫描方式评估TNM分期,以术后病理检查结果作为“金标准”,分析飞利浦64排增强CT扫描在胃癌术前分期中的准确性。结果:飞利浦64排增强扫描T1期灵敏度为64.00%,特异度99.06%,准确性97.11%,Kappa值0.70;T2期灵敏度为70.65%,特异度94.97%,准确性90.00%,Kappa值0.68;T3期灵敏度为83.93%,特异度81.42%,准确性82.67%,Kappa值0.65;T4期灵敏度为70.64%,特异度88.27%,准确性84.00%,Kappa值0.57;飞利浦64排增强扫描N0期灵敏度为80.25%,特异度85.85%,准确性82.89%,Kappa值0.66;N1期灵敏度为77.16%,特异度92.36%,准确性86.89%,Kappa值0.71;N2期灵敏度为84.00%,特异度90.00%,准确性89.33%,Kappa值0.58;飞利浦64排增强扫描M分期检查灵敏度为96.62%,特异度93.85%,准确性96.22%,Kappa值0.86。结论:依据飞利浦64排增强CT扫描结果进行胃癌术前TNM分期,与术后病理检查一致,其中M分期检查准确性最高,与术后病理一致性极好,可为患者治疗方案的合理选择提供重要参考。     

胃间质瘤多层螺旋CT双期扫描的诊断价值

目的探讨多排螺旋CT对胃间质瘤的诊断价值。方法回顾性分析经手术及病理免疫组织化学证实的25例胃间质瘤的CT平扫和增强表现。结果肿瘤均单发,呈均匀或不均匀软组织密度,其内可见出血、坏死、囊变及钙化。腔内型4例,腔外型14例,哑铃型7例。良性19例,直径均〈5 cm,密度均匀,强化较均匀;恶性6例,直径均〉5 cm,密度多不均匀,见囊变、坏死,且强化不均匀。静脉期病变强化程度高于动脉期。瘤内见点状钙化灶1例。结论多排螺旋CT可同时观察肿瘤本身、周围脏器及有无转移等重要征象,对鉴别良、恶性肿瘤,临床早期诊断和治疗以及评估预后有重要价值。     

多层螺旋CT在直肠癌术前分期中的诊断价值

背景与目的:直肠癌术前分期对选择合理治疗方案和判断预后至关重要。传统的计算机断层扫描(computed tomography,CT)对直肠癌术前分期存在争议,本研究旨在探讨多层螺旋CT(multislice spiral CT,MSCT)对直肠癌术前分期的诊断价值。方法:中山大学肿瘤防治中心2006年3月至2007年2月,经病理证实的直肠癌患者87例,所有患者术前行MSCT平扫及增强扫描,由两位放射科医生独立评价肿瘤的部位、大小、侵犯范围(T)、淋巴结转移(N)及远处转移(M)情况,做出诊断及TNM分期,并与术后病理对照,评价准确性、灵敏度及特异度。结果:MSCT检出了全部87例直肠癌,对直肠癌TNM分期总的准确性为81.6%(71/87)。T、N、M期准确性分别为94.3%(82/87)、82.8%(72/87)、98.9%(86/87)。≤T2、T3、T4期灵敏度分别为90.5%、91.3%、97.7%,特异度分别为98.5%、94.2%、97.7%。N0、N1、N2期灵敏度分别为92.9%、72.0%、82.4%,特异度分别为88.9%、88.5%、91.7%。远处转移的患者仅1例因肝脏转移灶<5mm而漏诊。结论:MSCT能较准确地判断直肠癌的侵犯范围、淋巴结转移及远处转移,是非常有价值的术前分期方法。     

螺旋CT对直肠癌术后复发的诊断价值

目的探讨螺旋CT对直肠癌术后复发的诊断价值.方法采用螺旋CT结合三维重建,对48例直肠癌术后复发的患者进行检查.结果 48例患者中,37例局部复发的CT表现为吻合口区肠壁不规则结节状、新月状软组织密度影,向腔内或肌层生长;其中16例伴侵犯邻近组织器官,(6例侵犯膀胱、前列腺、一侧或两侧精囊腺,3例侵犯子宫、阴道,7例侵犯骶骨及骶骨前软组织、直肠浆膜外脂肪层).19例为远处转移(伴局部复发8例),多见于肝脏.结论螺旋CT扫描结合三维重建,对诊断直肠癌术后复发具有重要的临床应用价值.     

原发性胃淋巴瘤的X线和CT诊断

目的:提高原发性胃淋巴瘤(PGML)的X线和CT诊断水平。方法:收集21例经胃镜活检和手术证实为原发性胃淋巴瘤。其中行胃肠气钡双对比造影(GI)检查7例,CT检查17例,两者均行检查3例。分析其GI和CT表现。结果:21例PGML中,GI表现为多发结节状充盈缺损5例,胃底、体多发肿块1例,胃腔扩张及收缩良好5例。CT表现为胃壁增厚17例,伴有肿块4例,形成直径2.5cm以上大溃疡4例。17例胃壁均增厚为0.6cm～4cm,14例(82.3%)增厚胃壁增强幅度为14HU～25HU的轻、中度强化。增厚胃壁强化均匀15例,见小片状坏死2例。肝脏均未见转移性病灶。结论:原发性胃淋巴瘤主要位于胃窦和胃体,GI主要表现为多发结节状充盈缺损或多发肿块,CT主要表现为浸润型,密度均匀,呈轻、中度均匀强化,可伴有大溃疡形成,在GI检查或CT三期扫描中胃的形态可变。     

摇篮体位技术在结肠癌术前CT分期的价值

为了评价摇篮体位技术结肠灌注CT扫描在结肠癌术前分期的价值,将130例结肠癌患者根据病变部位采取不同的摇篮体位,检查前低张肠道自肛门注入800～1 200mL的温水,增强CT扫描。右半结肠肿瘤取右侧卧位,左半结肠取左侧卧位。根据肿瘤的浸润程度和淋巴结情况进行CT分期,并与术后病理分期对照。术前CT分期T1低估3例,T2分别高估1例和低估4例,T3高估3例和低估3例,T4高估1例。T1分期准确率76.9%(10/13),T2准确率85.7%(30/35),T3准确率90.6%(58/64),T4准确率94.4%(17/18)。切除送检910个淋巴结中,CT检出581个,敏感性63.8%。送检淋巴结中确诊转移390个,CT诊断转移341例,特异性为87.4%。初步研究结果提示,摇篮体位技术结肠灌注CT扫描能够对结肠癌进行术前准确分期,为临床决策治疗提供有价值的信息。     

Laparoscopy in the abdominal staging of melanoma

A retrospective study on laparoscopic results in the abdominal staging of 297 patients with melanoma, is reported.In 195 (99.3%) of patients, laparoscopy was technically feasible, and in 10% the clinical stage was changed on the basis of the findings.In 34% of patients with metastasis of the liver and peritoneum, the tumor had a diameter of under 1 cm and therefore was not detectable with non-invasive techniques.In the light of these results laparoscopy is advisable in patients with Stage I melanoma at a high risk of metastatization (Clark IV–V; Breslow 0.76 mm) and in Stage II patients. In Stage III patients, laparoscopy seems indicated for an evaluation of the efficacy of systemic treatment.     

恶性淋巴瘤受累淋巴结的全身螺旋计算机层析成像表现

目的探讨恶性淋巴瘤累及淋巴结的全身螺旋计算机层析成像（CT）表现及其解剖分布。方法回顾性分析89例诊治的淋巴瘤患者,其中霍奇金淋巴瘤（HL）12例,非霍奇金淋巴瘤（NHL）77例。所有患者均行颈部、胸部及全腹部CT直接增强扫描,记录所有病例肿大淋巴结分布、大小、密度及强化程度。结果HL组患者中普遍均匀强化9例（75．0％）,均匀强化伴坏死3例（25．0％）;NHL组中普遍均匀强化64例（83．1％）,均匀强化伴坏死13例（16．9％）,两组均匀强化情况比较差异无统计学意义（Fisher精确概率法,P=0．4461）。HL组中淋巴结呈融合状6例（50．0％）,不融合6例（50．0％）;NHL组中淋巴结呈融合状8例（10．4％）,不融合69例（89．6％）,两组比较差异有统计学意义（Fisher精确概率法,P=0．0028）。HL组患者常优势累及颈部及纵隔淋巴结,NHL组患者常优势累及颈部、纵隔及腹腔淋巴结,两组全身淋巴结累及优势分布差异无统计学意义（Fisher精确概率法,P=0．110）。结论全身螺旋CT扫描能很好的显示淋巴瘤患者全身淋巴结肿大的形态、部位及分布。     

CT和MRI在鼻咽癌临床分期中的价值

鼻咽癌(NPC)分期以CT为标准,但MRI多参数成像和高软组织分辨力可更早诊断及更细致了解肿瘤侵犯范围,从而指导个体化治疗.现综述CT和MRI在临床分期中的诊断作用及其价值比较.     

PET scan in the staging of non-small cell lung cancer

Imaging techniques play an essential role in the diagnosis, staging, and follow-up of patients with lung cancer. Positron emission tomography (PET) has become an important innovation in lung cancer imaging. In this report, a comprehensive overview is given of the important number of prospective performance studies, looking at the value of PET in locoregional and distant staging of NSCLC, and at its potential impact on patient management. In the assessment of locoregional lymph node spread, PET has a high negative predictive value in the exclusion of N2 or N3 disease, so that mediastinoscopy can be omitted in most patients with negative mediastinal PET-images. False negative mediastinal PET findings may occur in patients with minimal N2 disease. Because of possible false positive findings in patients with inflammatory nodes or granulomatous disorders, confirmation and lymph node mapping by mediastinoscopy remains mandatory in these situations. In the extrathoracic staging, PET is a useful adjunct to conventional imaging, because it is able to detect unexpected metastatic lesions. An isolated positive finding that determines the possibility for radical treatment requires pathological verification, because of the possibility of a false positive result. PET is also able to exclude malignancy in equivocal lesions, but caution is needed in case of small lesions. There are currently insufficient data to state that PET could replace standard imaging. The use of PET as described in the performance studies, now undergoes further validation in large-scale randomised patient outcome studies. In the meanwhile, a current recommendation for the use of PET in contemporary lung cancer staging is provided.     

腹部增强CT扫描对结肠肿瘤性肠梗阻的诊断价值

目的探讨结肠肿瘤性肠梗阻采用腹部增强CT扫描的诊断价值。方法选取2017年1月至2018年12月间宝鸡市人民医院收治的120例结肠肿瘤性患者,采用随机数表法分为观察组和对照组患者,每组60例。对照组患者采用腹部X线检查,观察组患者采用腹部增强CT扫描,比较两组患者诊断效果。结果观察组患者梗阻诊断率、梗阻部位确定率、图像清晰度和患者舒适度均高于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者肠粘连、腹腔感染和肠道肿瘤检出率均高于对照组,差异均有统计学意义(均P <0. 05);两组患者供血不足和疝气发生率比较,差异无统计学意义(P> 0. 05)。结论腹部增强CT用于结肠肿瘤性肠梗阻患者诊断中,可有效提高诊断准确率,提高病情检测,值得应用。     

多层螺旋CT在胃肠道淋巴瘤中的鉴别价值及与TNM分期的相关性研究

目的探讨多层螺旋CT(MSCT)在胃肠道淋巴瘤中的鉴别价值及与TNM分期的相关性。方法选取2017年1月至2020年5月间上海市普陀区人民医院收治的58例胃肠道淋巴瘤患者为A组,另选取同期52例进展性胃癌患者为B组,均接受MSCT扫描检查。比较两组患者及A组内不同TNM分期患者MSCT扫描参数差异,采用受试者工作特征曲线(ROC)分析MSCT扫描参数对胃肠道淋巴瘤的鉴别诊断价值,采用Spearman相关分析MSCT扫描参数与TNM分期的相关性。结果两组患者肿瘤部位、黏膜破坏、胃腔狭窄、密度分布和强化程度比较,差异均有统计学意义(均P <0.05)。A组患者图像客观噪声小于B组,信噪比大于B组,差异均有统计学意义(均P <0.05)。A组患者图像客观噪声随TNM分期升高而降低,信噪比随TNM分期升高而升高;Ⅲ期和Ⅳ期患者的图像客观噪声和信噪比均与Ⅰ期存在差异,差异均有统计学意义(均P <0.05)。ROC曲线分析显示,图像客观噪声和信噪比鉴别诊断胃肠道淋巴瘤与进展性胃癌的AUC分别为0.822和0.823,具有一定准确性。以ROC曲线靠左上方约登指数最大切点为最佳临界值,该点图像客观噪声为67.2%和90.4%,信噪比为63.8%和92.3%,具有一定鉴别诊断价值。进一步ROC曲线显示,联合检查鉴别诊断AUC为0.865,敏感度和特异度为81.0%和93.5%,均高于单项检查,提示联合鉴别诊断价值较高。Spearman相关分析显示,图像客观噪声与胃肠道淋巴瘤TNM分期呈负相关,信噪比与胃肠道淋巴瘤TNM分期呈正相关,差异均有统计学意义(P <0.05)。结论多层螺旋CT用于胃肠道淋巴瘤的辅助鉴别诊断效果较好,且CT扫描参数对判断TNM分期具有重要意义。     

Value of liver scintigraphy in pretreatment staging and in follow-up of patients with malignant melanoma

Liver scintigraphy (99Tcm sulphur colloid) was performed in 118 patients with malignant melanoma. In 73 patients diagnosed as stage I, the pretreatment evaluation showed one false-negative and one false-positive examination. During follow-up there were ten abnormal liver scintigraphies; one was later correlated to liver metastases. In 46 patients diagnosed as stage II-IV, the pretreatment liver scintigraphy yielded false-negative results in 36% and false-positive results in 15%. The predictive values of positive and negative tests were 44% and 81%, respectively. The yields of liver tests (S-alkaline phosphatase, S-gamma-glutamyl-transferase) in patients with liver metastases were low. This study demonstrated the limitations of liver scintigraphy for diagnosis of liver metastases in patients with malignant melanoma.