Value of dual-phase 2-fluoro-2-deoxy-d-glucose positron emission tomography in cervical cancer.

PURPOSE: The role of positron emission tomography (PET) with fluorine-18-labeled fluoro-2-deoxy-d-glucose (FDG) in cervical cancer has not yet been well defined. We conducted a prospective study to investigate its efficacy in comparison with magnetic resonance imaging and/or computed tomography (MRI-CT). Materials and METHODS: Patients with untreated locally advanced (35%) or recurrent (65%) cervical cancer were enrolled onto this study. In the first part of this study, 41 patients had a conventional FDG-PET (40 minutes after injection), and in the second part, 94 patients received dual-phase PET (at both 40 minutes and 3 hours after injection). The overall results of PET scans were compared with MRI-CT, and the two protocols of PET were also compared with each other. Lesion status was determined by pathology results or clinical follow-up. The receiver operating characteristic curve method with area under the curve (AUC) calculation was used to evaluate the discriminative power. RESULTS: Overall (N = 135), FDG-PET was significantly superior to MRI-CT in identifying metastatic lesions (AUC, 0.971 v 0.879; P =.039), although the diagnostic accuracy was similar for local tumors. Dual-phase PET was also significantly better than the 40-minute PET (n = 94). The latter accurately recognized 70% of metastatic lesions and the former detected 90% (AUC, 0.943 v 0.951; P =.007). Dual-phase FDG-PET changed treatment of 29 patients (31%; upstaging 27% and downstaging 4%). CONCLUSION: This study shows that dual-phase FDG-PET is superior to conventional FDG-PET or MRI-CT in the evaluation of metastatic lesions in locally advanced or recurrent cervical cancer.     

18F-FDG PET/CT显像在鼻咽癌分期与疗效监测中的临床应用价值

背景与目的:18F-脱氧葡萄糖(fluorine-18 fluorodeoxyglucose,18F-FDG)PET/CT显像可明显提高肺癌、食管癌等多种肿瘤的诊断、分期与疗效监测的准确性,有助于更准确地制定治疗方案.本研究探讨全身18F-FDG PET/CT显像在鼻咽癌首次分期、再分期及疗效监测中的临床应用价值.方法:回顾性分析澳大利亚Peter MacCallum肿瘤中心2002年2月至2005年12月43例鼻咽癌患者的18F-FDG PET/CT全身扫描报告,根据临床资料、病理结果及临床随访结果,计算18F-FDG PET/CT与传统影像学检查CT、MRI的准确性、特异性、灵敏度、阳性预测值与阴性预测值,并对结果进行比较和分析.结果:18F-FDGPET/CT诊断鼻咽癌总的准确率、敏感性、特异性、阳性预测值与阴性预测值分别为95.3%、100.0%、85.7%、93.8%、100.0%,传统影像学检查CT、MRI分别为65.5%、79.4%、64.7%、81.8%、57.9%. 18F-FDG PET/CT诊断结果使2例首次分期、7例再分期患者治疗方案得到改变,并影响1例首次分期和3例再分期患者治疗方案的制定;在疗效监测组中,指导医生修改治疗方案共11例(其中5例为原则性的修改).18F-FDG PET/CT检测到2例第二原发肿瘤,1例是甲状腺癌,1例是低度恶性胃癌.结论:18F-FDG PET/CT全身显像对鼻咽癌N、M分期与疗效监测的临床作用可能优于CT、MR检查.     

Clinical value of F-FDG PET/CT in assessing suspicious relapse after rectal cancer resection

AIM: To evaluate the value of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in the restaging of resected rectal cancer.METHODS: From January 2007 to Sep 2008, 21 patients who had undergone curative surgery resection for rectal carcinoma with suspicious relapse in conventional imaging or clinical findings were retrospectively enrolled in our study. The patients underwent 28 PET/CT scans (two patients had two scans, one patient had three and one had four scans). Locoregional recurrences and/or distant metastases were confirmed by histological analysis or clinical and imaging follow-up.RESULTS: Final diagnosis was confirmed by histopathological diagnosis in 12 patients (57.1%) and by clinical and imaging follow-up in nine patients (42.9%). Eight patients had extrapelvic metastases with no evidence of pelvic recurrence. Seven patients had both pelvic recurrence and extrapelvic metastases, and two patients had pelvic recurrence only. ¹⁸F-FDG PET/CT was negative in two patients and positive in 19 patients. ¹⁸F-FDG PET/CT was true positive in 17 patients and false positive in two. The accuracy of ¹⁸F-FDG PET/CT was 90.5%, negative predictive value was 100%, and positive predictive value was 89.5%. Five patients with perirectal recurrence underwent ¹⁸F-FDG PET/CT image guided tissue core biopsy. ¹⁸F-FDG PET/CT also guided surgical resection of pulmonary metastases in three patients and monitored the response to salvage chemotherapy and/or radiotherapy in four patients.CONCLUSION: ¹⁸F-FDG PET/CT is useful for evaluating suspicious locoregional recurrence and distant metastases in the restaging of rectal cancer after curative resection.     

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.     

鼻咽癌放射治疗后FDG PET显像的临床价值

目的 探讨核医学影像诊断技术--FDG PET在鼻咽癌放射治疗后随诊中的临床价值。方法 12例鼻咽癌患者放射治疗后12～18个月同期行FDG PET和CT、MRI检查,并采用双盲法将PDG PET与CT和MRI结果进行比较,其中6例经活检病理证实,余6例经CT动态观察10个月后确诊。结果 9例CT和MRI未见肿瘤复发,PET显示其中3例有局灶性FDG代谢明显增高病变,2例CT和MRI提示肿瘤复发,FDG PET均显示局部病变有放射性摄取浓聚;该5例FDG摄取浓聚的病变处均经活检病理证实为肿瘤复发。另1例MRI提示鼻咽癌颅内转移,而FDG PET诊断为放射治疗后脑损伤,后经CT随访证实。结论 与CT和MRI检查相比,FDG PET在鼻咽癌放射治疗后肿瘤复发的早期定性诊断上具有明显的优势,若结合CT和MRI多种影像结果分析,更能提供局部病变结构与代谢改变的复合信息,尤其对局部复发病灶精确的适形放射治疗非常重要。     

Comparison of (18)F Flurodeoxyglucose PET with Ga-67 scintigraphy and conventional imaging modalities in pediatric lymphoma

Flurodeoxyglucose PET (FDG PET) is very useful for staging and restaging adult lymphomas. Its effectiveness in childhood lymphomas is less established. To evaluate the potential utility of FDG PET in the care of pediatric patients with lymphomas, we examined the clinical data and imaging findings of 26 patients, 8 - 19 years of age (14 HD, 12 NHL) who underwent 55 FDG PET studies. Results were compared with CT/MRI and gallium scans. FDG PET provided incremental, clinically important information in 21% of HD cases and 33% of NHL cases. It was especially useful in distinguishing scar tissue from residual disease at the end of therapy. In both HD and NHL, FDG PET had higher sensitivity (94%, 90%) and specificity (100%, 88%) than CT/MRI and gallium scanning. These results indicate that FDG PET is useful in the management of pediatric lymphomas.     

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.     

The role of positron emission tomography in occult primary head and neck cancers.

PURPOSE: To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors. METHODS: Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings. RESULTS: PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET. DISCUSSION: A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.     

18F-FDG PET/CT在探测卵巢癌术后复发和转移中的价值

[目的]评价^18F-FDG PET/CT显像在探测卵巢癌术后复发病灶中的应用价值。[方法]采用仪器为Siemens Biograph Sensation 16 PET/CT，43例卵巢癌术后患者禁食4～6h，静脉注射^18F-FDG60min后进行PET/CT检查，采集方式为3D模式。PET/CT图像结果与血清CA125、B超及CT或MRI影像学资料进行比较。并与手术病理或临床随访结果比较判断其诊断的准确性。[结果]FDG PET/CT诊断卵巢癌复发的灵敏度、特异性和准确性分别为92.3%、100%和93.0%。血清CA125水平与FDG PET结果有一定相关性，33例CA125升高患者中31例PET显像阳性，10例CA125正常水平患者中仅有5例PET显像阳性。[结论]当常规影像学检查阴性或可疑时，PET/CT显像对卵巢癌复发的检测具有较高的灵敏度和准确性，特别术后患者CA125升高的情况下，FDG PET/CT有助于探测隐匿性复发或转移病灶，指导进一步的治疗。     

The integration of 18-fluoro-deoxy-glucose positron emission tomography and endoscopic ultrasound in the treatment-planning process for esophageal carcinoma

PURPOSE: Accurate delineation of the gross tumor volume (GTV) is important in radiation therapy treatment planning. We evaluated the impact of PET and endoscopic ultrasound (EUS) compared with CT simulation in the planning of radiation fields for patients with esophageal carcinoma. MATERIAL AND METHODS: Twenty-five patients presenting with esophageal carcinoma for radiation therapy underwent PET scans in the treatment position after conventional CT simulation. Patients underwent PET/CT scanning after being injected with 10 to 20 mCi of [F-18]-2-deoxy-2-fluro-D-glucose. The length of the abnormality seen on the CT portion of the PET/CT scan vs. the PET scan alone was determined independently by 2 separate investigators. The length of the GTV and detection of regional adenopathy by PET was also correlated with EUS in 18 patients. Of the 18 patients who had EUS, 2 had T2 tumors and 16 had T3 tumors. Eighteen patients had adenocarcinoma and 7 had squamous cell carcinoma. Nine tumors were located at the gastroesophageal junction, 8 at the lower esophagus, 7 in the middle esophagus, and 1 in the cervical esophagus. The PET scans were reviewed to determine the length of the abnormality by use of a standard uptake value (SUV) of 2.5 to delineate the tumor extent. RESULTS: The mean length of the cancer was 5.4 cm (95% CI 4.4-6.4 cm) as determined by PET scan, 6.77 cm (95% CI, 5.6-7.9 cm) as determined by CT scan, and 5.1 cm (95% CI, 4.0-6.1 cm) for the 22 patients who had endoscopy. The length of the tumors was significantly longer as measured by CT scans compared with PET scans (p = 0.0063). EUS detected significantly more patients with periesophageal and celiac lymphadenopathy compared to PET and CT. The SUV of the esophageal tumors was higher in patients with peri-esophageal lymphadenopathy identified on PET scans. CONCLUSION: Endoscopic ultrasound and PET scans can add additional information to aid the radiation oncologist's ability to precisely identify the GTV in patients with esophageal carcinoma.     

Impact of 18F-fluorodeoxyglucose positron emission tomography in the staging and treatment response assessment of extra-pulmonary small-cell cancer

The aim of this study was to retrospectively evaluate the value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in extrapulmonary small-cell cancer (EPSCC). Patients with EPSCC who underwent PET for staging or response assessment between 1996 and 2007 were identified from a database. Patient records were reviewed. PET-based, and conventional staging and restaging results were compared. The binary staging classification of limited disease (LD) versus extensive disease (ED) was used. Patients with LD had tumours that could be encompassed within a tolerable radiation therapy (RT) volume. Of 33 eligible patients, 12 had staging PET scans, 11 had restaging scans and 10 had both. All known gross disease sites were FDG-avid. PET and conventional stage groupings were concordant in 21 of 22 cases. One patient was appropriately upstaged from LD to ED by PET. PET detected additional disease sites, without causing upstaging in three further patients. Restaging PET scans identified previously unrecognised persistent or progressive disease in 4 of 21 cases. In four further cases, persistent FDG uptake after treatment was either false positive (n = 2) or of uncertain (n = 2) aetiology. PPV was 100% for staging and 82% for restaging. In 8 of 43 imaging episodes (19%), PET appropriately influenced management in five cases by changing treatment intent from radical to palliative, and in three cases by altering the RT volume. PET has incremental value compared to conventional imaging for staging EPSCC, and may also be useful for restaging after therapy. PET influenced patient management in 19% of 43 imaging episodes.     

Significant value of 18F-FDG-PET/CT in diagnosing small cervical lymph node metastases in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

Background: Little is known about the nature of metastasis to small cervical lymph nodes (SCLNs) in the patients with nasopharyngeal carcinoma (NPC) examined by using 18-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients. Methods: Magnetic resonance images (MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage. Results: In total, 2082 SCLNs were identified, with 808 (38.8%) ≥ 5 and < 6 mm in diameter (group A), 526 (25.3%)≥ 6 and < 7 mm in diameter (group B), 374 (18.0%) ≥ 7 and < 8 mm in diameter (group C), 237 (11.4%) ≥ 8 and< 9 mm in diameter (group D), and 137 (6.5%) ≥ 9 and < 10 mm in diameter (group E). The overall metastatic rates examined by using PET/CT for groups A, B, C, D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively (P < 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modifica-tion of N category and overall stage for 135 (28.7%) and 46 (9.8%) patients, respectively. The areas under curve of MRI-determined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival. Conclusions: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.     

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.     

Whole Body 18F-FDG PET/CT Imaging in the Detection of Primary Tumours in Patients with a Metastatic Carcinoma of Unknown Origin

Purpose: The aim of this study was to evaluate the role of whole body 18F-FDG PET/CT imaging in thedetection of primary tumors in patients with a metastatic cancer from an unknown primary site. Methods: Thestudy population consisted of 43 patients with a biopsy proven metastatic disease, negative conventional diagnosticprocedures (including CT/MRI/endoscopic procedures) and a whole body 18F-FDG PET/CT examination.Patients’ records were retrospectively analyzed. According to the final pathologic diagnoses, rate of detection ofthe primary tumor site was determined. Additionally, overall patient survival was calculated to evaluate theprognostic value of 18F-FDG PET/CT findings. Results: A primary tumor site was shown by 18F-FDG PET/CTin 24 patients (24/43; 55.8%). In 18 patients 18F-FDG PET/CT scans were negative (18/43; 41.8%). In a patientwith an adenocarcinoma metastasis 18F-FDG PET/CT was falsely positive for an inflammatory lesion in thelung. Among the 18F-FDG PET/CT positive and negative groups median overall survival was not significantlydifferent (log-rank p=0.573). Conclusion: Whole body 18F-FDG PET/CT imaging has a high rate of detectionof a primary tumor in patients with a carcinoma of unknown origin.     

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.     

Impact of positron emission tomography on the management of patients with small-cell lung cancer: preliminary experience

Accurate staging is important in small-cell lung cancer (SCLC). Patients with limited stage may benefit from chemoradiation, whereas those with extensive stage conventionally receive chemotherapy. Prophylactic cranial irradiation may benefit those attaining complete remission (CR). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) enhances accuracy of staging in non-SCLC. Its role in SCLC remains unclear. We reviewed 36 consecutive SCLC patients who underwent 47 PET studies between December 1996 and January 2001, for either staging (n = 11), restaging after therapy (n = 21), or both (n = 4). Conventional imaging was also performed. Of 15 patients who had PET for staging, 5 (33%) were upstaged from limited to extensive disease and treated without thoracic radiotherapy. Twenty-five patients underwent 32 restaging PET scans, of which 20 (63%) were discordant with conventional imaging. In 8 cases PET showed more extensive disease than conventional imaging, and in 12 cases PET-apparent disease appeared less extensive. In 13 patients, 14 untreated discordant lesions were evaluable; PET was confirmed accurate in 11 (79%) sites by last follow-up. Restaging PET influenced management in 13 cases (52%). PET-CR conferred longer median time to progression (13.7 months) than no CR (9.7 months). FDG-PET for SCLC was often discordant with conventional assessment and frequently influenced management.     

Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients

18-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) has previously been used successfully to image primary and metastatic breast cancer. In this pilot study, 19 breast cancer patients with symptoms/signs referrable to the brachial plexus were evaluated with 18FDG-PET. In 11 cases computerized tomography (CT) scanning was also performed. Of the 19 patients referred for PET study, 14 had abnormal uptake of 18FDG in the region of the symptomatic plexus. Four patients had normal PET studies and one had increased FDG uptake in the chest wall that accounted for her axillary pain. CT scans were performed in 9 of the 14 patients who had positive brachial plexus PET studies; six of these were either normal or showed no clear evidence of recurrent disease, while three CTs demonstrated clear brachial plexus involvement. Of two of the four patients with normal PET studies, one has had complete resolution of symptoms untreated while the other was found to have cervical disc herniation on magnetic resonance imaging (MRI) scan. The remaining two patients almost certainly had radiation-induced plexopathy and had normal CT, MRI and PET study. These data suggest that 18FDG-PET scanning is a useful tool in evaluation of patients with suspected metastatic plexopathy, particularly if other imaging studies are normal. It may also be useful in distinguishing between radiation-induced and metastatic plexopathy.     

^18F-FDG PET/CT在结直肠癌诊断和治疗中的价值

结直肠癌在我国是常见的恶性肿瘤,发病率逐年上升,但近30年的治疗效果进步不大,因而,术前早期正确的诊断和分期、术后检测复发转移以及判断治疗效果,对于个体化的治疗意义重大.集解剖和功能显像优势于一身的^18F-FDG PET/CT显像在结直肠癌诊断和治疗上具有广泛的应用前景和价值.大多数结直肠癌病变在PET上表现为高度的浓聚灶,^18F-FDG PET/CT对于结直肠原发灶诊断准确率一般在92.7%～95%之间,其敏感度高,假阴性率低.18F-FDG PET/CT可以早期发现转移病灶,是目前最好的术前分期手段;对结直肠癌复发及转移诊断的灵敏度、特异性及准确性分别为89%～94.6%、83.3%～100%、90%～98.3%,显著优于传统的检查方式,可以发现更多微小或隐匿的复发和转移灶.此外,PET/CT可以通过病灶代谢的变化先于超声、CT、MRI等形态学手段早期判定化疗效果,指导临床及时更改治疗方案以及进行术前再分期.总之,PET/CT为结直肠癌的诊断、术前分期、监测术后复发转移、评估疗效提供了一种安全无创的功能影像方法.     

18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值及优势

  目的   探讨18F-FDG PET/CT显像在原发性胆囊癌诊断中的价值, 并与增强CT、B超及MRI进行比较。   方法   收集2006年3月至2011年12月期间38例临床疑似胆囊癌而在本院行PET/CT检查的患者, 其中男26例, 女12例; 年龄46~82岁, 中位年龄69岁。患者均行PET/CT、增强CT、B超及MRI检查。全部病例均经手术病理及临床随访证实, 其中35例为原发胆囊癌, 3例为胆囊炎。分别统计4种影像诊断方法的真阳性率、假阳性率、真阴性率、假阴性率及诊断正确率。   结果   PET/CT、增强CT、B超及MRI检查的真阳性率分别为100.0%、74.3%、60.0%、71.4%;假阴性率分别为0、25.7%、40.0%、28.6%;增强CT、B超及MRI检查真阴性率分别为66.7%、33.3%、66.7%;假阳性率分别为33.3%、66.7%、33.3%。诊断正确率分别为92.1%、71.1%、60.5%、68.4%。PET/CT与增强CT、B超及MRI结果比较, P值分别为0.036、0.002、0.019, 均P < 0.05。   结论   在原发性胆囊癌诊断中, PET/CT较其他3种传统影像诊断方法准确率高。如将PET/CT结合增强CT检查, 可使诊断正确率提高2.6%。故18F-FDG PET/CT显像对原发性胆囊癌的诊断具有重要的临床应用价值。