直肠癌的CT分期与病理对照分析

目的 回顾性分析直肠癌的CT表现和手术病理结果,探讨直肠癌CT分期的价值。方法 CT诊断94例直肠癌并进行分期,均经手术和病理检查。结果 CT在Tis-T2、T3和T4的准确率分别为73．3％、80％和92．9％,T分期的准确率为79．8％。本采用大于5mm作为淋巴结转移的诊断标准,其准确率为84．1％、敏感性为80％、特异性为75．6％。结论 直肠癌的术前CT扫描对临床选择最佳治疗方案有重要意义。     

Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT

Accurate preoperative staging is essential in determining the optimal therapeutic planning for individual patients. The computed tomography (CT) in the preoperative staging of colorectal cancer, even if controversial, may be useful for planning surgery and/or neoadjuvant therapy, particularly when local tumor extension into adjacent organs or distant metastases are detected. There have been significant changes in the CT technology with the advent of multi-detector row CT (MDCT) scanner. Advances in CT technology have raised interest in the potential role of CT for detection and staging of colorectal cancer. In recent studies, MDCT with MPR images has shown promising accuracy in the evaluation of local extent and nodal involvement of colorectal cancer. Combined PET/CT images have significant advantages over either alone because it provides both functional and anatomical data. Therefore, it is natural to expect that PET/CT would improve the accuracy of preoperative staging of colorectal cancer. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. For the evaluation of patients with colorectal cancer, CT has relative advantages over PET/CT in regard to the depth of tumor invasion through the wall, extramural extension, and regional lymph node metastases. PET/CT should be performed on selected patients with suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrast-enhanced PET/CT and PET/CT colonography, may replace the diagnostic CT for the preoperative staging of colorectal cancer.     

PET/CT检查在乳腺癌患者复发中的作用

目的研究乳腺癌患者血清肿瘤标志物出现异常后,PET/CT对早期发现乳腺癌复发的部位,及早进行治疗的价值。方法 82位乳癌患者,术后行常规复查时,出现1项或多项肿瘤标志物增高,常规行CT检查,检查后1-3个月内行PET/CT检查。当影像学检查提示阳性结节后,结果的最终判定是通过组织病理学诊断及随访。结果 PET/CT检查提示异常结节368个。真阳性：310个,假阳性：11个,真阴性：41个,假阴性：6个。在82名患者中,确诊为复发的真阳性患者：38名,假阳性：11名,真阴性：28名,假阴性：5名。结论乳腺癌患者血清肿瘤标志物异常后,PET/CT诊断复发的敏感性、特异性、准确性指标均高于CT。     

血清CA125联合PET/CT对早期卵巢癌的诊断效果

目的 探讨血清CA125联合PET/CT对早期卵巢癌的诊断效果.方法 选择2018年6月至2019年10月在我院接受治疗的80例卵巢病变患者,所有患者进行组织病理学、血清CA125水平、PET/CT显像检查.比较卵巢癌患者与良性病变患者的血清CA125水平与SUVmax;分析血清CA125、PET/CT显像以及二者联合...     

Imaging Uterine Cervical Cancer with FDG-PET/CT: Direct Comparison with PET

Purpose  To compare 2-deoxy-2-[F-18]fluoro-d-glucose–positron emission tomography (FDG-PET) and PET/computed tomography (CT) for certainty of image interpretation and for diagnostic accuracy in patients with primary and metastatic uterine cervical cancer. Materials and Methods  Images of 13 patients with cervical cancer having PET/CT examinations were reviewed retrospectively. PET and PET/CT images of all cases were read blindly and randomly by two readers. Foci of increased FDG uptake on PET or PET/CT were classified using a scoring system regarding lesion localization and characterization. PET and PET/CT findings were assessed with all clinical information available, and diagnostic accuracy was determined on a per-lesion and on a per-patient basis. Results  For both readers, PET/CT provided significantly higher frequencies of definite lesion localization (>30% higher) and definite lesion characterization (>20% higher) compared to the findings on PET alone. The improvement in lesion localization to the definite level by PET/CT provided the definite lesion characterization in at least 50% of cases. PET/CT tended to exhibit higher diagnostic accuracy than PET alone on a lesion-based analysis (92% vs. 78% in reader 1 and 92% vs. 82% in reader 2, respectively). Metastatic disease spread was, however, almost equally evaluated between PET and PET/CT. Conclusion  PET/CT was demonstrated to be useful in the definite localization and characterization of foci of increased FDG uptake, which provided its higher diagnostic accuracy than PET alone. PET/CT appears preferable to PET in the evaluation of cervical cancer, although additional study is needed.     

PET/CT无创检测实验性动脉粥样硬化斑块的初步研究

目的 探讨PET/CT无创检测动脉粥样斑块的可行性.方法 6只新西兰大白兔随机分成实验组和对照组.实验组通过球囊拉伤膈下降主动脉内膜,并饲喂含2%胆固醇的高脂饲料20周,制造动脉粥样硬化模型;对照组仅饲喂普通饮食20周.静脉注射FDG(1 mCi/kg)180 min后,将对照组和实验组动物置于PET/CT设备下进行降主动脉活体成像,之后处死实验组动物,进行降主动脉标本游离,数码照相,降主动脉标本分段,测定其放射强度和靶非靶比值.结果 注药180 min后18F-FDG PET/CT活体显像显示:所有实验性动脉粥样硬化兔均可见沿降主动脉分布的放射性浓集显像.离体大体标本数码照相病变斑块与活体显像相一致.活体SUV以及离体标本放射性技术显示靶-非靶比值均相对较高.结论 18F-FDG PET/CT无创检测动脉粥样斑块具有一定的可行性,有可能发展成为一种临床无创评价斑块稳定性的方法.     

PET/CT在肺癌诊断中的应用

目的探讨PEC/CT多种示踪剂及诊断性CT的应用对肺癌的诊断价值。方法对62例资料完整的肺癌患者PET/CT检查结果进行分析。结果62例肺癌患者中,中央型肺癌7例,周围型肺癌55例,明确诊断59例,诊断率95.16%。18F-FDG PET/CT检查见病灶有不同程度放射性异常浓聚,最大SUV1.0～22.3;11C-MET PET/CT检查的病灶均见不同程度放射性摄取,SUV0.5～4.9;CT增强扫描病灶边界清晰,明显强化,可见血管"集束征",HRCT检查见病灶有分叶、毛刺征、胸膜凹陷征及支气管阻断。结论18F-FDG PET/CT能较准确地对肺癌做出明确诊断,多种示踪剂及诊断性CT的联合应用能极大地提高肺癌尤其是小肺癌的诊断准确率。     

~(18)F-NaF PET/CT对前列腺癌骨转移的诊断价值

目的探讨18F-Na F PET/CT在前列腺癌骨转移中的诊断价值及影像学特征。方法回顾性分析42例经病理证实为前列腺癌的患者的临床资料,均行18F-Na F PET/CT骨显像。比较18F-Na F PET/CT、18F-Na F PET和单独CT诊断前列腺癌骨转移灶的灵敏性、准确性。结果18F-Na F PET/CT、18F-Na F PET、单独CT诊断前列腺癌骨转移瘤的灵敏度分别为100%、94.4%、77.8%,准确性分别为95.2%、87.0%、71.4%。18F-Na F PET/CT骨显像的准确性显著高于18F-Na F PET和单独CT(P0.05)。结论18F-Na F PET/CT对前列腺癌骨转移诊断的灵敏度、特异性、准确性较高。     

18F-FDG PET/CT features of ureteral metastases from breast cancer: a case report

Breast cancer metastasis to the ureter is rare. Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) is widely used to identify primary lesions of metastatic tumours, however, 18F-FDG PET/CT imaging features of ureteral metastasis from breast cancer are rarely reported. Herein, the case of a 46-year-old woman with recurrent left flank pain for 5 months, who was admitted to the Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, is described. She had undergone right radical mastectomy 5 years previously and had received tamoxifen treatment for 5 years. Assessment by 18F-FDG PET/CT revealed tumours on the ureter presenting as a long segmental lesion, radioactive concentrations, and a low maximum standardized uptake value (SUVmax), with no radioactive concentrations in the urine and no significant change in the ureteral contour. The severity of the ureteral lesion was not consistent with the severity of hydronephrosis. A tumour biopsy was performed laparoscopically, and postoperative pathological examination confirmed a primary breast cancer tumour. The patient did not consent to treatment and was lost to follow-up.     

Detecting recurrence of gastric cancer: the value of FDG PET/CT

Purpose  In order to assess the diagnostic performance of Positron emission tomography/Computed tomography (PET/CT) for detecting recurrence in gastric cancer patients with clinical or radiologic suspicion of recurrence after surgical resection. Materials and methods  Over a 4-year period, 105 post-operative patients with gastric cancer, who underwent PET/CT due to clinical or radiologic suspicion of recurrence during follow-up, were collected after confirming their PET/CT findings. The number and site of positive FDG uptake were retrospectively analyzed, and were correlated with the final diagnosis, by calculating the diagnostic values and assessing the causes of misdiagnosis. Results  Of all 105 patients, 75 patients were confirmed to have true recurrence with 108 recurrence sites. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for diagnosing true recurrence on a per-person basis were 75%, 77%, 89%, 55%, and 75%, respectively. On a per-lesion basis, 75 (69%) of 108 true recurrences showed positive FDG uptake, while 75 (89%) of 84 positive FDG uptake was confirmed to have true recurrence. Conclusion  PET/CT was relatively accurate in detecting recurrence in post-operative patients with gastric cancer. Moreover, PET/CT might be helpful in confirming the presence of recurrence particularly in patients who were highly suspicious of recurrence, because of its high positive predictability.     

Staging rectal cancer: MRI compared to MDCT

PURPOSE: To audit the accuracy with which pre-operative MRI and multi-detector row CT determine the relationship between rectal tumour and the circumferential resection margin (CRM). MATERIALS AND METHODS: The MR and CT scans of 72 patients with rectal adenocarcinoma were retrieved. The relationship between tumour and the mesorectal fascia was determined by two observers, who classified appearances into three categories: no tumour within 5 mm of the mesorectal fascia; tumour within 5 mm of the mesorectal fascia ('threatened' margin); tumour at the mesorectal fascia ('involved' margin). Agreement with post-operative histopathology was assessed by Kappa statistics. RESULTS: There was poor agreement between both MRI and CT, and post-operative histology, both in all 72 patients and in the 42 who had received no pre-operative therapy or short-course radiotherapy only. Both imaging modalities had a tendency to overstage patients whose CRM was uninvolved subsequently. However, the negative predictive value for an uninvolved margin was 81.8% by MRI and 84.6% by CT. There was no patient with an involved margin by histopathology whose imaging had suggested the margin was uninvolved. CONCLUSION: Both pre-operative MRI and multi-detector row CT have high negative predictive values for a subsequently uninvolved resection margin.     

PET／CT对头颈部癌放射治疗计划的临床价值

目的前瞻性研究以评估PET／CT对头颈部癌患者CT放射治疗计划和治疗模式的临床价值。方法24例头颈部癌患者（鼻咽癌6例、上颌窦癌5例、舌癌8例、牙龈癌5例）进入本研究。每例患者先在治疗体位下作CT平扫和增强扫描，然后行FDG-PET／CT检查。由同一放疗医师和物理师作CT和PET／CT放射治疗计划。每例患者的二个计划作对比，以评估PE丁／CT对CT放疗计划肿瘤区（GTV）体积、放疗野和治疗模式的影响。结果PET／CT检查后54．2％（13／24）的患者GTV体积变化≥15％。125％（3／24）的患者发生放射野改变：2例患者增加下颈部放射野（原CT扫描颈部阴性，PET／CT显示下颈部淋巴结阳性浓聚）；1例鼻咽癌放疗后复发患者原计划放射鼻咽部和颈部，PET／CT显示鼻咽部阴性和颈部阳性，取消鼻咽部放射野仅放疗颈部。该患者随访1年以上未发现肿瘤病灶。另2例患者PET／CT检查确定有远处转移（1例肺转移，1例骨转移），从而改变治疗方案为始息放疗和化疗。结论PET／CT检查使本组头颈部放疗患者的CT放疗计划和治疗模式产生明显改变，增加PET／CT检查具有很大的临床价值。     

The additional diagnostic value of contemporary evaluation of FDG PET/CT scan and contrast enhanced CT imaging both acquired by a last generation PET/CT system in oncologic patients

Last generation PET tomographs are equipped with a state-of-the-art CT scanner. Normally, CT images are acquired with suboptimal parameters and without intravenous contrast media, being used for attenuation correction and localization only. For this reason, no CT report is usually provided. Most of the patients who are referred for an FDG PET/CT scan, however, present with a diagnostic CT indicating that a PET/CT is required to characterize otherwise equivocal findings and, in the end, undergo both the techniques to reach a final diagnosis. The aim of this study was to evaluate the impact of the contemporary execution of both the techniques employing a PET/CT scanner on the conclusiveness of the final report. Secondary aim was to verify the concordance of the two reports.     

新型PET/CT显像剂在原发性肝癌诊断中的作用

原发性肝癌早期发病隐匿、诊断困难,大部分肝癌患者在确诊时已处于肝癌中晚期,治疗后易复发且生存率低。近期研究发现,肝癌的发生发展并非由上皮细胞或间质细胞单方面作用所决定,而是由两者交互作用所形成的肿瘤微环境来决定。肿瘤微环境主要由肿瘤相关成纤维细胞构成,其通过分泌各种细胞因子、蛋白酶类等对肿瘤细胞产生重要的调控作用,成纤维细胞活化蛋白是肿瘤微环境产物之一,成纤维细胞活化蛋白过表达与肿瘤的生长、侵袭及转移有一定关联。放射性核素标记成纤维活化蛋白抑制剂（⁶⁸Ga-FAPI）作为一种新型PET/CT显像剂,已在多种恶性肿瘤中表现出良好的敏感性及特异性,特别是在原发性肝癌中,因肝脏本底摄取较低,在早期原发性肝癌的诊断、原发性肝癌的分期、肝脏结节良恶性的鉴别都表现出更高的敏感性及特异性。本文主要通过阐述新型PET/CT显像剂⁶⁸Ga-FAPI在早期原发性肝癌的诊断中、原发性肝癌的分期、原发性肝癌治疗后复发及肝结节良恶性的鉴别中的研究进展,以期对临床原发性肝癌诊治有所裨益。     

18F-FDG PET/CT在健康体检中的应用价值

目的 探讨18F-FDG PET/CT显像在健康体检中的应用价值.方法 对1301例以健康体检为目的的受检者行全身18F-FDG PET/CT显像检查资料进行回顾性分析.结果 18F-FDG PET/CT检查阳性1275例(98%),仅26例(2%)检查为阴性,放射性分布异常565例(43.43%),其中发现恶性肿瘤32例(2.46%),良性肿瘤241例(18.52%),炎性病变292例(22.44%).结论 18F-FDG PET/CT显像应用于健康人群体检,尤其是在肿瘤筛查中具有积极意义.     

PET/CT-Guided Interventions in Oncology Patients: A Nursing Perspective

In the past 5 years, the utilization of positron emission tomography/computerized tomography (PET/CT) guidance is more commonly used for cancer patients undergoing biopsy and ablations at this National Cancer Institute-designated cancer center. The interventional use of PET/CT imaging requires nurses to have a thorough understanding of the mechanisms involved to provide the best care in an environment that is safe for patients and staff. Evidence suggests cohesive care, and safe practice measures are achieved when patients actively participate and understand their care. This article will discuss how a collaborative patient-centered approach in caring for oncologic patients undergoing PET/CT interventions is necessary for achieving quality patient outcomes.     

Performance of FDG PET/ceCT in the evaluation of patients with lung cancer

Aim

The aim of this study was to assess the performance of FDG PET/ceCT simultaneously acquired, contemporary read and finally discussed by the radiologist and the nuclear medicine physician for staging and restaging lung cancer patients.

Methods

We analysed 17 consecutive patients (7F; 10M; mean age 68). Six patients were in staging, 8 patients were in restaging (1 during therapy, 2 after therapy and 5 during the follow-up) and 2 patients needed to characterise a suspect pulmonary mass. All the patients underwent combined FDG PET/CT and ceCT acquired simultaneously on the same tomograph. The images were read and reported together by the nuclear medicine physician and the radiologist.

Results

None of the patients had adverse reactions nor complained about the procedure. Thirteen FDG PET/ceCT turned out positive, while 4 were completely negative. Among positive patients, a significant SUV max was detected in all the cases (range 1.8–17.5). In the end, 9 patients had a true positive result, 4 true negative, 3 false positive and 1 false negative. Sensitivity, specificity and accuracy of the combined procedure were 90%, 57% and 76% respectively. In 7/17 patients FDG PET/CT and ceCT were completely concordant. FDG PET/CT provided a significant impact on the final interpretation in 7/17 patients while ceCT had a major impact in 3/17 patients.

Discussion

This preliminary study shows that FDG PET/ceCT is a feasible technique for lung cancer patients, providing an optimal sensitivity (90%). From our results it is advisable not to include patients without an histological diagnosis of cancer due to possible false positivity of the two methods, significantly reducing specificity. However, a proper patient selection is not easy and the future of this combined test relies essentially on the capacity to early identify only the subjects who would really benefit from both the procedures.     

PET/CT、头部增强CT和头部增强MRI对肺癌脑转移瘤检出价值的对比

目的  分析与探讨¹⁸F-FDG PET/CT+头部增强CT、¹⁸F-FDG PET/CT+头部增强MRI几种检查方法对肺癌脑转移瘤的诊断价值与差异。方法  回顾分析327例肺癌患者的临床资料,对比其¹⁸F-FDG PET/CT、头部增强CT及头部增强MRI影像资料,分析¹⁸F-FDG PET/CT联合头部增强CT、¹⁸F-FDG PET/CT联合头部增强MRI对肺癌分期的影响;比较¹⁸F-FDG PET/CT、头部增强CT、头部增强MRI 3种检查方法对肺癌脑转移瘤检出价值;比较¹⁸F-FDG PET/CT与头部增强MRI,肺癌脑转移瘤漏诊组与未漏诊组囊变、水肿表现的差异。结果  ¹⁸F-FDG PET/CT+头部增强CT、¹⁸F-FDG PET/CT+头部增强MRI这两种组合检查方法在检出肺癌脑转移瘤方面,对肺癌分期的影响差异有统计学意义（χ²=305.58,P < 0.01）;¹⁸F-FDG PET/CT、头部增强CT、头部增强MRI三种检查方法对肺癌脑转移瘤检出率分别为7.34%、12.23%、19.88%;3种检查方法对肺癌脑转移瘤检出情况比较差异具有统计学意义（χ²=22.867,P < 0.01）;肺癌脑转移瘤¹⁸F-FDG PET/CT与MRI比较漏诊组与未漏诊组发生囊变、水肿情况的差异无统计学意义（χ²=0.657,P > 0.05;χ²=0.023,P > 0.05）;漏诊组、未漏诊组出现囊变率为31.70%（13/41）、41.67%（10/24）;漏诊组、未漏诊组出现水肿率为56.09%（23/41）、54.17%（13/24）。结论  ¹⁸F-FDG PET/CT+头部增强CT、¹⁸F-FDG PET/CT+头部增强MRI检查均能够提高肺癌脑转移瘤的检出率,对精确判断肺癌分期,掌握脑转移瘤详细情况,降低脑转移瘤的漏诊率有重要作用,检出价值最高的是¹⁸F-FDG PET/CT+头部增强MRI联合。