正常心肌代谢显像18氟-脱氧葡萄糖摄取状况的初步探讨

目的探讨正确的18氟-脱氧葡萄糖(18F-Fluorodeoxyglucose,18F-FDG)心肌缺血显像方法。资料与方法两组各9名受试者分别于禁食状态下接受一日法、两日法静息、运动18F-FDG心肌代谢显像。定量分析两种显像方法在静息和运动状态下心肌18F-FDG摄取的差异。结果两日法运动状态下的正常心肌18F-FDG摄取不符合18F-FDG示踪动力学。而一日法运动状态下正常心肌18F-FDG的最大标准化摄取值(SUVheart)与肝实质的SUVliver比值及心肌与心血池的SUV比值(SUVheart/SUVliver;SUVheart/SUVblood pool)明显高于静息状态(2.07±1.44,1.31±0.81,P<0.05;2.61±0.80,1.75±0.52,P<0.05)。且三支冠脉血管区域之间18F-FDG摄取差异无统计学意义。一日法静息、运动18F-FDG心肌代谢显像,运动后各节段心肌18F-FDG摄取成比例明显增加,符合负荷心肌18F-FDG示踪动力学。结论本研究证实,一日法静息和运动18F-FDG心肌代谢显像可成为运动诱发冠心病心肌缺血的无创诊断方法。     

18F-氟脱氧葡萄糖正电子发射断层显像在妇科恶性肿瘤治疗后的随访价值

 目的 探讨18F-氟脱氧葡萄糖正电子发射断层显像(18F-FDG PET)在妇科恶性肿瘤治疗随访中的作用.方法 21例均经病理证实的妇科恶性肿瘤患者治疗后行18F-FDG PET检查.结果 21例中17例发现有残余或转移病灶,占80.9%,无假阳性病例;4例阴性显像患者中,3例提示未见明确复发和转移,1例为假阴性,为近期行化疗所致.FDG-PET对本组妇科肿瘤治疗后的复发或转移诊断的灵敏度、特异性和准确性分别为94.4%、100%和95.2%.结论 18F-FDG PET 对妇科恶性肿瘤治疗随访中有重要作用.     

18F-氟脱氧葡萄糖PET在恶性淋巴瘤中的应用

CT是诊断恶性淋巴瘤常规影像学手段,核医学显像也是非常重要的检查方法,如67Ga显像.18F-氟脱氧葡萄糖(18SF-FDG)PET以其在淋巴瘤中应用的显著优势逐步替代了67Ga显像.18F-FDG PET在淋巴瘤的早期诊断、准确分期、疗效的评价、复发和预后的估计等方面显示出了非常重要的价值.随着PET-CT的广泛应用使得敏感性和特异性都有了进一步的提高.主要综述了18F-FDG PET在淋巴瘤诊断、分期、疗效评价中的应用.     

呋塞米介入试验在泌尿生殖系统肿瘤18F-FDG PET/CT显像中的应用

目的提高^18F-脱氧葡萄糖（FDG）PET／CT显像对泌尿生殖系统肿瘤的检出。方法28例泌尿生殖系统肿瘤患者，行^18F—FDG PET／CT显像后30～60min，口服呋塞米（速尿）40mg或静脉注射呋塞米50mg，给药前后多饮水、多排尿，再过30min后憋尿下再次进行局部PET／CT显像。分析比较2次显像结果。以利尿^18F—FDG PET／CT显像中肝脏和软组织摄取^18F-FDG为标准，将正常肾组织和（或）膀胱放射性清除效果分为良好、一般、差。结果28例患者肾脏和膀胱促排良好率为85．7％（24／28例）。8例初诊原发肿瘤和8例术后肿瘤复发患者，常规PET／CT显像恶性肿瘤病灶难以辨认或显示不清，而利尿PET／CT显像病灶清楚显示；2例初诊肾透明细胞癌和1例错构瘤病灶内无^18F—FDG浓聚，呋塞米促排无助于提高病灶的检出。9例术后无肿瘤复发者常规和呋塞米介入PET／CT检查均为阴性。呋塞米促排后PET对泌尿生殖系统肿瘤的检出灵敏度为88％，与CT（83％）相近（x^2=0．232，P〉0．05），但38．8％患者因行PET／CT而提高分期。结论呋塞米介入能减少尿液高放射性水平对邻近肿瘤显示的影响，提高泌尿生殖系统肿瘤病灶的检出。     

18F-脱氧葡萄糖PET/CT显像在卵巢癌术后复发诊断及治疗中的价值

目的 探讨全身18F-脱氧葡萄糖(FDG) PET/CT显像在卵巢癌术后患者复发诊断和治疗中的价值.资料与方法 46例患者,行全身显像及局部延迟显像;以病灶最大标准摄取值(SUVmax)＞2.5伴密度异常为阳性,检测血清糖类抗原-125 (CA125).10个月内随访.结果 60例次全身显像,阳性48例次,30例次延迟显像SUVmax增加大于20％;CA125升高39例次.34例病灶在腹盆腔内,12例伴有其他部位转移.检查后化疗22例次,再手术12例次,放疗8例次,未治疗13例次.切除26处病灶中,25处肿瘤转移,准确率为96.2％.结论 PET/CT发现卵巢癌术后转移灶主要位于腹盆腔内;手术切除病例,CA125明显降低;多灶性病例行全身化疗或局部放疗;CA125正常病例,显像可提前发现转移病灶.     

氟代脱氧葡萄糖正电子发射断层扫描CT全身显像对喉癌病灶或淋巴结转移诊断效能的影响

目的 探讨氟代脱氧葡萄糖正电子发射断层扫描CT(¹⁸F-FDG PET-CT)全身显像对喉癌病灶或淋巴结转移术前诊断价值。方法 选取128例我院2019年8月至2021年8月就诊的高度疑似喉癌患者作为研究对象,入院后均行¹⁸F-FDG PET-CT检查及CT平扫+增强检查,以手术病理或喉镜活检结果为“金标准”,比较¹⁸F-FDG PET-CT检查及CT平扫+增强检查对喉癌病灶及淋巴结转移诊断结果,并比较2种方法对不同TNM分期喉癌病灶检出率。结果 经手术病理及喉镜活检结果显示,128例疑似喉癌患者中,阳性106例,淋巴结转移63例;经¹⁸F-FDG PET-CT检查,阳性104例,淋巴结转移61例;经CT平扫+增强检查,阳性92例,淋巴结转移52例;与CT平扫+增强扫描对喉癌病灶诊断灵敏度83.0%、准确度82.8%比较,¹⁸F-FDG PET-CT检查诊断灵敏度95.3%、准确度93.8%较高(P<0.05);与CT平扫+增强扫描对淋巴结转移诊断灵敏度73.0%、准确度...     

甲状腺良性病变的18氟-脱氧葡萄糖PET/CT表现探讨

目的探讨甲状腺良性病变的18氟-脱氧葡萄糖(18 F-fluorodexyoxyglucose,18F-FDG)PET/CT表现,以提高对该病变PET/CT影像的认识。方法回顾性分析经手术病理明确诊断的24例甲状腺良性病变的18 F-FDG PET/CT影像学资料,包括结节性甲状腺肿13例、甲状腺腺瘤10例、甲状腺局限性增生2例、桥本氏甲状腺炎4例、慢性甲状腺炎1例、亚急性甲状腺炎1例,其中10例患者甲状腺存在两个或多个病变。结果结节性甲状腺肿的异常PET/CT征象包括①甲状腺低密度结节或密度弥漫性减低;②甲状腺肿大;③钙化;④甲状腺局灶性或弥漫性FDG代谢增高。13例结节性甲状腺肿4例未见PET/CT异常征象,仅2例FDG代谢增高(局灶性、弥漫性)。甲状腺腺瘤的PET/CT异常征象包括①甲状腺低密度或略低密度结节;②囊变;③钙化;④甲状腺局灶性FDG代谢增高。10例甲状腺腺瘤仅2例局灶性FDG代谢增高。甲状腺局限性增生的PET/CT异常征象包括①甲状腺低密度结节;②甲状腺局灶性FDG代谢增高。2例甲状腺局限性增生1例局灶性FDG代谢增高。桥本氏甲状腺炎的PET/CT异常征象包括①甲状腺密度弥漫性减低;②甲状腺肿大;③甲状腺弥漫性FDG代谢增高。4例桥本氏甲状腺炎2例弥漫性FDG代谢增高。亚急性甲状腺炎和慢性甲状腺炎的PET/CT异常征象包括①甲状腺片状低密度灶;②甲状腺局灶性或弥漫性FDG代谢增高。结论甲状腺良性病变可出现FDG摄取增高,但在结节性甲状腺肿、甲状腺腺瘤、甲状腺局限性增生出现比例低,而在桥本氏甲状腺炎等炎性病变比例相对较高;甲状腺弥漫性FDG摄取多提示良性病变,而局灶性FDG摄取需作进一步的鉴别。     

18F-FDG PET/CT在多发性大动脉炎应用中的研究进展

多发性大动脉炎(TA)是一种累及主动脉及主动脉重要分支的慢性非特异度炎性疾病,主要依据患者的临床表现、实验室检查及相应的影像学检查进行诊断评估。近年来,¹⁸F-FDG PET/CT已逐渐应用于TA的临床工作中,并认为是评估该病活动性的相对金标准。就¹⁸F-FDG PET/CT在TA中的应用进行综述及展望,以期帮助临床医师更好地对TA进行诊断、治疗及评估。     

18氟-脱氧葡萄糖和11碳-乙酸PET/CT显像在原发性肝癌及肝脏肿瘤样病变诊断中的初步研究

目的探讨18氟-脱氧葡萄糖(18 F-fluorodexyoxyglucose,18F-FDG)和11碳-乙酸(11 C-acetate,11 C-ACT)PET/CT显像在原发性肝癌及肝脏肿瘤样病变诊断中的作用。方法回顾性分析9例患者资料,其中男性7例,女性2例,平均年龄70.2岁,所有患者均为肝内单发病灶。治疗前均先行18 F-FDG PET/CT,后行11 C-ACT PET/CT检查,两次检查间隔时间不超过1周。其中有7例肝细胞肝癌(hepatocelluar carcinoma,HCC)、1例胆管细胞癌(cholangiocarcinoma,CCC)、1例肝内感染性病灶,均经病理学或临床随访证实。结果 7例HCC患者18 F-FDG PET/CT显像均为阴性,11 C-ACT PET/CT显像有6例为阳性。18F-FDG PET/CT和11 C-ACT PET/CT显像均未发现1例高分化胆管细胞癌。对于1例肝内炎性病灶,18F-FDG PET/CT显像为阳性,而11 C-ACT PET/CT显像为阴性。结论①11 C-ACT PET/CT显像可以用来探测那些呈18 F-FDG等或低摄取的HCC病灶;②对于高分化的CCC,18 F-FDG PET/CT显像有可能会表现为假阴性结果;③11 C-ACT PET/CT显像可以用来诊断肝内感染性病灶。     

18F-FDG PET-CT在风湿免疫系统疾病中的应用

目的：探讨¹⁸F-FDG PET-CT在风湿免疫系统疾病诊断中的应用价值。方法：回顾性分析行PET-CT检查且经临床诊断标准证实的32例风湿免疫系统疾病患者的临床资料及¹⁸F-FDG PET-CT特征，观察病灶¹⁸F-FDG摄取情况。结果：32例中，痛风3例，类风湿关节炎（RA）5例，多发性大动脉炎（TA）6例，强直性脊柱炎（AS）4例，成人Still病（AOSD）9例（其中2例合并AS），皮肌炎2例，风湿性多肌痛（PMR）3例。PET-CT表现：痛风表现为患病关节邻近软组织肿胀、关节腔积液，伴FDG代谢升高；RA表现为双侧肩关节、肘关节、髋关节、腕关节及部分近端掌指关节FDG摄取升高；TA表现为主动脉及主要分支血管管壁不均匀增厚，伴FDG代谢弥漫性升高；AOSD表现为骨髓FDG弥漫性摄取升高，脾脏FDG代谢高于肝脏，全身部分淋巴结肿大伴FDG代谢升高，部分关节FDG代谢升高；皮肌炎表现为双侧肩部、双侧胸锁乳突肌、双侧臀部肌肉FDG代谢轻度升高；PMR表现为双侧肩、双髋、双膝、双踝关节、耻骨联合、坐骨结节周围FDG摄取升高；AS 4例中2例表现为骶髂关节FDG代谢升高，2例双髋FDG代谢升高。结论：¹⁸F-FDG PET-CT有助于风湿免疫系统疾病的早期诊断，可准确显示病变范围。     

18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究进展

18F-FDG PET/CT心肌代谢显像是目前被公认的监测患者存活心肌的"金标准",在冠心病的临床诊疗、血管再通术的预后评价等方面起指导作用。保证合格的图像质量是发挥其作用的关键。然而,18F-FDG PET/CT心肌代谢显像图像质量受到许多因素影响,其中血糖水平、胰岛素功能是主要的影响因素。通过调整显像前饮食结构、禁食时间、长期服用药物、检查日的血糖水平、调节血糖的方法以及注射显像剂的时间等可提高图像质量,并提升显像的成功率。为此,笔者对18F-FDG PET/CT心肌代谢显像图像质量影响因素的研究现状及最新进展进行综述。     

治疗前胃癌患者18F-FDG PET/CT显像特征分析

目的 探讨治疗前胃癌患者¹⁸F-FDG PET/CT显像特征,并分析影响胃癌原发灶最大标准摄取值(maximum standardized uptake value, SUVmax)的相关因素。方法 选取并分析2017年1月～2019年12月经病理学证实的70例胃癌患者临床资料,所有患者均于治疗前在本院行PET/CT全身显像,显像结果采用半定量分析及视觉分析。不同病理分型、性别、年龄、是否淋巴结转移、是否脏器转移组间原发灶SUVmax值比较采用t检验;不同原发灶部位组间SUVmax值比较采用方差分析;原发灶最大厚度值与原发灶SUVmax值相关性采用Pearson相关分析。结果 70例患者中66例原发灶¹⁸氟-氟代脱氧葡萄糖(¹⁸F-2-fluro-D-deoxy-glucose,¹⁸F-FDG)显像阳性,灵敏度94.3%,SUVmax9.6±4.9;PET显像灵敏度肠型胃癌高于非肠型胃癌[3 3/3 3 (1 0 0%) vs2 7/3 1 (8 7.1%)]、非粘液腺癌高于粘液腺癌[5 4/5 5...     

~(18)F-FDG PET/CT在食管癌的应用进展

食管癌恶性程度高、预后差,严重威胁了人类健康,18F-FDG PET/CT集功能和解剖信息于一身,这种医学影像技术在食管癌的应用优势日益受到广大医务工作者的关注。本文综述了18F-FDG PET/CT在食管癌的诊断、分期、复发、疗效和预后评估、放射治疗计划制定等方面的研究进展。     

PET/CT in oncology--a major advance

The concept of hardware fusion between positron emission tomography (PET) and computed tomography (CT) has only been introduced commercially in the last 4 years. The advantages of this combined technique over PET alone have become obvious. There is increasing evidence to suggest that PET/CT adds complementary information in staging, re-staging and follow-up in oncology patients, leading to changes in management plans. The present paper is a review of the strengths, weaknesses, current evidence and future directions of this technique.     

Evaluation of Dixon Sequence on Hybrid PET/MR Compared with Contrast-Enhanced PET/CT for PET-Positive Lesions

Purpose

Hybrid positron emission tomography and magnetic resonance (PET/MR) imaging performs a two-point Dixon MR sequence for attenuation correction. However, MR data in hybrid PET/MR should provide anatomic and morphologic information as well as an attenuation map. We evaluated the Dixon sequence of hybrid PET/MR for anatomic correlation of PET-positive lesions compared with contrast-enhanced PET/computed tomography (CT) in patients with oncologic diseases.

Methods

Twelve patients underwent a single injection, dual imaging protocol. PET/CT was performed with an intravenous contrast agent (85 ± 13 min after ¹⁸F-FDG injection of 403 ± 45 MBq) and then (125 ± 19 min after injection) PET/MR was performed. Attenuation correction and anatomic allocation of PET were performed using contrast-enhanced CT for PET/CT and Dixon MR sequence for hybrid PET/MR. The Dixon MR sequence and contrast-enhanced CT were compared for anatomic correlation of PET-positive lesions (scoring scale ranging from 0 to 3 for visual ratings). Additionally, standardized uptake values (SUVs) for the detected lesions were assessed for quantitative comparison.

Results

Both hybrid PET/MR and contrast-enhanced PET/CT identified 55 lesions with increased FDG uptake in ten patients. In total, 28 lymph nodes, 11 bone lesions, 3 dermal nodules, 3 pleural thickening lesions, 2 thyroid nodules, 1 pancreas, 1 liver, 1 ovary, 1 uterus, 1 breast, 1 soft tissue and 2 lung lesions were present. The best performance was observed for anatomic correlation of PET findings by the contrast-enhanced CT scans (contrast-enhanced CT, 2.64 ± 0.70; in-phase, 1.29 ± 1.01; opposed-phase, 1.29 ± 1.15; water-weighted, 1.71 ± 1.07; fat weighted, 0.56 ± 1.03). A significant difference was observed between the scores obtained from the contrast-enhanced CT and all four coregistered Dixon MR images. Quantitative evaluation revealed a high correlation between the SUVs measured with hybrid PET/MR (SUVmean, 2.63 ± 1.62; SUVmax, 4.30 ± 2.88) and contrast-enhanced PET/CT (SUVmean, 3.88 ± 2.30; SUVmax, 6.53 ± 4.04) in PET-positive lesions (SUVmean, ρ = 0.93; SUVmax, ρ = 0.95), although hybrid PET/MR presented a decrease of SUVs compared with contrast-enhanced PET/CT (mean reduction; SUVmean, 32.44 ± 15.64 %; SUVmax, 35.16 ± 12.59 %).

Conclusions

Despite different attenuation correction approaches, the SUV of PET-positive lesions correlated well between hybrid PET/MR and contrast-enhanced PET/CT. However Dixon MR images acquired for attenuation correction were insufficient to provide anatomic information of PET images because of low spatial resolution. Thus, additional MR sequence with fast and higher resolution may be necessary for anatomic information.     

Osteonecrosis Mimicking Bone Metastasis in Femoral Head on 18F-FDG PET/CT: A Case Report

A 77-year-old woman underwent chemotherapy, radiotherapy, and brachytherapy for cervical cancer 9 years ago. On a follow-up ¹⁸F-fluorodeoxyglucose (FDG) PET/CT image, focal FDG uptake was noted in a focal osteolytic lesion in the right femoral head. During magnetic resonance imaging, this lesion showed subchondral dark-signal-intensity rim on T1-weighted image and double line sign on T2-weighted image, suggestive of osteonecrosis. The lesion was pathologically confirmed as osteonecrosis after surgery. This case demonstrates that osteonecrosis of the femoral head may demonstrate focal FDG uptake mimicking bone metastasis.     

肝反应性淋巴样组织增生18F-FDG PET/CT双时相显像表现

目的 探讨肝反应性淋巴样组织增生（RLH）的18F-氟脱氧葡萄糖（FDG） PET/CT双时相显像表现。 方法 回顾性分析2016年9月至2021年7月于复旦大学附属中山医院行18F-FDG PET/CT双时相显像并经手术标本或穿刺组织病理学检查结果确诊为肝RLH的7例患者的临床资料和影像资料,其中男性2例、女性5例,年龄（60.4±3.7）岁。观察肝RLH的 18F-FDG PET/CT显像表现,分别测量及计算病灶长径、病灶与邻近肝脏的CT值、早期显像及延迟显像的最大标准化摄取值（SUVmax）、肝本底 SUVmax、滞留指数（RI）。符合正态分布的计量资料的比较采用两独立样本t检验。 结果 7例肝RLH患者中,71.4%（5/7）患者为单发病灶、28.6%（2/7）患者为多发病灶,共11个病灶,均位于肝包膜下,其形态呈类圆形或椭圆形,边界模糊,长径5.5~19.2（14.9±1.2） mm。CT平扫结果显示,11个病灶密度均匀,其中2个病灶呈等密度,9个病灶呈低密度,其CT值为（42.1±3.1） HU,低于邻近肝实质的CT值（55.9±1.5） HU,且二者的差异有统计学意义（t=−7.36,Ρ<0.001）。18F-FDG PET/CT显像结果显示,63.6%（7/11）病灶的18F-FDG摄取高于肝实质,其中85.7%（6/7）病灶延迟显像的SUVmax升高,14.3%（1/7）病灶延迟显像的SUVmax降低,早期、延迟显像病灶的SUVmax分别为6.2±0.4和6.8±0.7,RI为12.2%（8.9%,15.5%）;36.4%（4/11）病灶的18F-FDG 摄取低于或邻近肝实质,延迟显像病灶的SUVmax无明显变化,早期、延迟显像病灶的SUVmax分别为2.2±0.4和2.1±0.4。 结论 肝RLH病灶多位于肝包膜下,呈均匀稍低密度灶,边界模糊。18F-FDG PET/CT显像显示多数病灶18F-FDG高摄取,少数病灶呈等摄取或低摄取,延迟显像SUVmax多升高,多发病灶18F-FDG摄取相近或相差很大。     

FDG PET or PET/CT in Evaluation of Renal Angiomyolipoma

Objective

Angiomyolipoma is the most common benign kidney tumor. However, literature describing FDG PET findings on renal angiomyolipoma (AML) is limited. This study reports the FDG PET and PET/CT findings of 21 cases of renal AML.

Materials and Methods

The study reviews FDG PET and PET/CT images of 21 patients diagnosed with renal AML. The diagnosis is based on the classical appearance of an AML on CT scan with active surveillance for 6 months. The study is focused on the observation of clinical and radiographic features.

Results

Six men and 15 women were included in our study. The mean age of the patients was 57.14 ± 9.67 years old. The mean diameter of 21 renal AML on CT scans was 1.76 ± 1.00 cm (Min: 0.6 cm; Max: 4.4 cm). CT scans illustrated renal masses typical of AMLs, and the corresponding FDG PET scans showed minimal FDG activities in the area of the tumors. None of the 21 AMLs showed a maximum standardized uptake value (SUV_max) greater than 1.98. No statistically significant correlation was present between SUV_max and tumor size.

Conclusion

Renal AMLs demonstrate very low to low uptake on FDG PET and PET/CT imaging in this study. When a fat-containing tumor in the kidney is found on a CT scan, it is critical to differentiate an AML from a malignant tumor including an RCC, liposarcoma, and Wilms tumor. This study suggests that FDG PET or PET/CT imaging is useful for differentiating a renal AML from a fat-containing malignant tumor.     

18F-FDG PET/CT监测免疫相关不良反应的临床应用

免疫检查点抑制剂(ICIs)在国内外临床试验的多种恶性肿瘤治疗中表现出了显著的疗效,在我国已被批准进入临床应用。ICIs治疗引起的免疫相关不良反应(irAEs)可发生于任何器官,早期发现和临床干预能够改善患者预后。¹⁸F-FDG PET/CT有助于早期发现irAEs,为临床诊疗提供正确的指导。该文旨在对¹⁸F-FDG PET/CT在监测irAEs的临床应用进行综述,总结其典型影像学表现和研究进展。     

肾上腺淋巴瘤CT及18F-FDG PET/CT主要特征分析

 目的 探讨肾上腺淋巴瘤的CT及¹⁸F-FDG PET/CT影像学征象,以提高对该病的诊断水平。方法 回顾性分析经手术病理证实10例肾上腺淋巴瘤的临床、影像及病理资料,均行CT平扫及增强扫描及¹⁸F-FDG PET/CT检查,观察和比较肿瘤发生的一般资料(年龄、性别),MSCT表现(部位、最大径、形态、密度、边界、强化方式、腹膜后淋巴结等情况,并计算各期强化率)和计算病灶SUVmax。结果 原发性肾上腺淋巴瘤7例,继发性肾上腺淋巴瘤3例;双侧病灶者7例,单侧病灶者3例,共计17侧病灶;肿瘤最大径不等,平均5.6 cm;肿块呈椭圆形共13侧,三角形3侧,1侧呈结节状增生;13侧边界清晰,4侧边界模糊;病灶平扫CT值平均40.4 Hu;动脉期平均强化率为24.28%;静脉期平均强化率37.46%;大部分(14/17)CT平扫及(13/17)增强密度较均匀一致,动脉期呈轻中度强化,门脉期呈进行性强化;2例发现腹膜后淋巴结肿大。均表现为¹⁸F-FDG高摄取,SUVmax为8.7～23.5,平均值为12.5。结论 肾上腺淋巴瘤CT表现具有一定特征,PET/CT 可准确显示肿瘤累及的范围和淋巴结,在诊断和治疗中具有重要的价值。