PET/CT对胰腺癌诊断现状及进展

胰腺癌是一种常见的消化系统恶性肿瘤,其预后差,早期诊断具有重要的意义。18F-FDG PET/CT集功能影像与解剖成像于一体,能够反映肿瘤组织的代谢和细胞增生水平,以及肿瘤组织与周围结构的毗邻关系,因此在胰腺癌患者的诊断、分期、指导治疗、疗效监控和预后评价等方面具有较为明显的优势。本文就18F-FDG PET/CT在胰腺癌临床应用中的价值进行综述。     

18F-FDG PET显像在胰腺癌诊断中的临床应用

目的：探讨^18F-FDG PET显像在胰腺癌诊断中的应用价值。方法：54例临床怀疑为胰腺癌的患者均行^18F-FDG PET显像,对显像结果进行目测法及半定量分析,并与CT、手术、腹腔镜取病理等进行对比研究。结果：^18F-FDG PET显像对胰腺癌诊断的敏感度为93％(38／41),特异度为85g(11／13)。CT对胰腺癌诊断的敏感度为76N(31／41),特异度为69％(9／13)。^18F-FDG PET显像发现7例CT检查未能确定的肝、肺及淋巴结转移,同时PET诊断结果使15例(28％)患者的临床治疗方案得到修正。结论：^18F-FDG PET显像对胰腺癌的诊断及临床分期具有较好的临床应用价值。     

18F-氟脱氧葡萄糖PET在原发性肝细胞癌中的应用

肝细胞癌(HCC)的早期诊断是获得临床治愈的关键,准确分期是制定合理治疗方案的基础.尽管18F-氟脱氧葡萄糖(18F-FDG)PET诊断HCC的总体敏感性不高,但其阳性显像与肿瘤分化程度、肝内外转移、门静脉癌栓及血清甲胎蛋白水平等许多因素相关.因此,18F-FDG PET在中、低分化的HCC诊断、分期与再分期、监测治疗反应、评价疗效、判断预后以及鉴别肝脏良性疾病等方面具有独特的价值.     

18F-FDG PET/CT在甲状腺癌中的临床应用

甲状腺癌是最常见的内分泌肿瘤,其显像方法很多,但由于甲状腺癌生物学行为的多重性,不同的显像方法对其的诊断价值及生物学行为判断价值各有不同.目前,18F-FDG PET/CT显像对不同进展期的甲状腺癌临床判断价值显著,其最重要的临床应用在于病灶诊断、分期和再分期及对各种治疗的评价和预后判断.笔者主要就18F-FDG PET/CT显像在甲状腺癌中的临床应用进行综述.     

18F-FDG PET/CT在前列腺癌中的应用进展

前列腺癌是临床常见的恶性肿瘤之一,在我国的发病率呈逐年上升趋势。18F-FDG是一种广谱的肿瘤非特异性显像剂,在多数肿瘤的临床应用中都具有重要价值。但临床实践表明,18F-FDG PET/CT显像在前列腺癌早期诊断中的价值是有限的。随着认识的深入,人们发现其在前列腺癌临床分期、疗效评价、预后评估等方面仍具有重要价值。笔者将对18F-FDG PET/CT在前列腺癌中的应用进展予以综述。     

^18F-FDG PET／CT在诊断转移性肝肿瘤中的应用

目的：探讨^18F-FDG PEF／CT在诊断转移性肝肿瘤中的应用。方法：回顾性分析49例转移性肝肿瘤患者的PET／CT影像资料,探讨^18F-FDG PET／CT诊断转移性肝肿瘤的影像表现及应用价值。结果：49例转移性肝肿瘤患者中45例^18F-FDG PET／CT表现为病灶^18F-FDG摄取明显高于周围正常肝组织;其中25例进行了延迟显像,22例表现为SUVmax及T／N值明显升高;发现肝转移同时伴有肝外转移患者38例。结论：^18F-FDG PET／CT诊断转移性肝肿瘤灵敏度高,准确,并可以同时对全身情况加以评价,对肿瘤患者肝转移的评价及治疗具有重要指导作用。     

18F-FDG PET/CT显像在宫颈癌术后复发和转移中的应用价值

目的 探讨18F-FDG PET/CT显像在宫颈癌术后复发和转移中的应用价值.方法 搜集临床可疑宫颈癌术后复发和转移患者65例,年龄23～77岁,平均48.7岁.所有宫颈癌患者均经手术病理确诊并行根治性治疗,其中鳞癌47例,腺癌12例,腺鳞癌4例,透明细胞癌1例,小细胞癌1例.患者均行18F-FDG PET/CT全身显像检查,采用目测法和半定量法判断结果,并与组织病理或临床随访结果比较其诊断的准确性,以及评价其诊断的真实性和可靠性.结果 65例患者经组织病理或临床随访证实50例复发和转移.18F-FDG PET/CT显像诊断肿瘤局部复发18例,肿瘤转移33例,复发和转移病灶的SUVmax 2.91 ～ 16.70,平均SUVmax 9.81,18F-FDG PET/CT显像诊断宫颈癌术后复发和转移的灵敏度为98.00％,特异性为86.67％,准确性为95.38％,阳性预测值为96.08％,阴性预测值为92.86％;18F-FDG PET/CT显像诊断结果与组织病理或临床随访结果比较差异无统计学意义(经x2检验,P＞0.05);二者结果的吻合度有统计学意义且吻合度较强(系数k=0.867,P=0.000).结论 18F-FDG PET/CT显像能够准确、直观地显示宫颈癌术后复发和转移,且真实性和可靠性好;同时18F-FDG PET/CT全身显像检查是肿瘤远处转移探测最有效的方法,可较全面评估患者病情,对协助临床确定个体化治疗方案具有重要价值.     

18F-氟脱氧葡萄糖PET及PET-CT早期诊断肿瘤复发

早期探测肿瘤复发可以改善患者的预后,延长其生存期。18F-氟脱氧葡萄糖(18F-FDG)PET能在组织结构变化之前早期探测代谢变化,PET-CT中同机CT提供的融合图像能够对病灶进行精确定位,在早期诊断肿瘤复发方面显示功能与解剖信息互补的作用。除能准确诊断和确定肿瘤复发程度外,18F-FDGPET及PET-CT还能进一步影响患者的治疗。     

18F-氟脱氧葡萄糖PET/CT在胰腺癌放疗中的应用

18F-氟脱氧葡萄糖PET/CT在胰腺癌的放疗中具有重要的应用价值。PET/CT较常规影像学检查能提高胰腺癌放疗前的诊断及分期准确性。在放疗过程中,以PET/CT检查为基础的靶区勾画能够准确地覆盖肿瘤组织及保护周围正常组织,同时可以按照其所提示的肿瘤代谢活性调整放疗计划。PET/CT还能够进行放疗的疗效评估及预后评判。相信随着研究的进展,18F-氟脱氧葡萄糖PET/CT将在胰腺癌放疗中发挥越来越重要的作用。     

18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术的临床应用

目的 评价一日法18F-脱氧葡萄糖(FIX;)PET/CT全身扫描联合18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术用于恶性实体肿瘤分期与定性诊断的临床价值.方法 16例实体占位病变患者,全部行一日内全身18F-FDG PET/CT扫描结合18F-FDG PET/CT影像辅助CY引导下经皮穿刺活组织检查术.每例患者的2种检查均在同一台PET/CT扫描仪上完成.共获18份适合病理分析的标本.分别以活组织检查标本结合外科术后病理检查,或临床随访结果为依据,建立最后诊断.采用SPSS 13.0软件,对2种检查结果进行比较(Fisher精确概率法).结果 16例患者中,最后诊断恶性12例,良性4例.有10例18F-FDG;PET/CT影像诊断与穿刺活组织病理检查结果一致.10例18F-FDG PET/CT诊断为恶性病变者中,最终诊断为恶性8例,良性2例.6例18F-FDGPET/CT诊断为良性者中,最终诊断为良性2例,恶性4例.穿刺活组织检查结果与最后手术病理检查和随访诊断结果全部符合.PET/CT影像诊断与穿刺活组织检查结果之间差异无统计学意义(P=0.604).所有最后诊断为恶性实体肿瘤的患者,定性与分期在一日内完成;诊断为良性者则规定门诊长期随访,排除假阴性.穿刺获取组织学标本时间为平均每例15 min.该组病例均无严重并发症发生.结论 全身18F-FDG PET/CT扫描联合18F-FDG PET/CT影像辅助CT引导下经皮穿刺活组织检查术,有助于提高PET/CT诊断效能与穿刺活组织检查的成功率与准确性.当18F-FDG PET/CT影像诊断出现定性困难时,其价值尤为明显.     

18F-FDG PET-CT诊断前列腺癌复发与转移的价值

目的 探讨18F-FDG PET-CT在前列腺癌复发、转移诊断中的价值.方法 回顾性分析23例前列腺癌治疗后随访期间临床怀疑复发、转移患者的18F-FDG显像资料,同期常规显像检查结果,病理及临床随访结果.结果 经病理及临床随访结果证实前列腺癌复发、转移者19例.PET-CT诊断为阳性者20例,其中1例盆腔脓肿、5例前...     

(18)F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis

Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose ((18)F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. (18)F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented.     

晚期乳腺癌18F-FDG PET-CT显像标准摄取值与预后的相关性

目的 探讨晚期乳腺癌18 F-FDG PET-CT显像标准摄取值与预后的相关性.方法 选择68例晚期乳腺癌患者,记录诊断时PET-CT的SUV值,均给予全身静脉化疗,以SUV值8为分界点,将本组患者分为两组,随访5年,观察SUV值与5年生存率的关系.结果 本组观察的68例患者,SUV值越小,生存期相对越长,反之,生存期则相对较短.结论 18F-FDG PET-CT显像标准摄取值(SUV值)对乳腺癌的预后有一定价值,值得临床进一步研究.     

Role of 18F-FDG PET–CT imaging for the detection of an unknown primary tumour: preliminary results in 21 patients

Purpose Metastatic cancer of unknown primary origin is a syndrome characterised by a poor prognosis, with a typical survival rate from diagnosis of no longer than 1 year. Only 20–27% of primary tumours are identified by conventional radiological imaging. By contrast, it has been reported that ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) allows the identification of 24–40% of otherwise unrecognised primary tumours. To our knowledge, the studies on this topic have been conducted using ¹⁸F-FDG PET imaging alone. The aim of this study was to evaluate the potential additional diagnostic role of fused ¹⁸F-FDG PET-CT imaging for the detection of metastatic occult primary tumours.Methods The study population consisted of 21 consecutive patients with biopsy-proven metastatic disease and negative conventional diagnostic procedures. Each patient underwent a PET scan, carried out according to a standard procedure (6 h of fasting, i.v. injection of 370 MBq of ¹⁸F-FDG and image acquisition with a dedicated PET-CT scanner for 4 min per bed position).Results ¹⁸F-FDG PET-CT detected the occult primary tumour in 12 patients (57% of cases), providing a detection rate higher than that reported with any other imaging modality, including conventional ¹⁸F-FDG PET.Conclusion The favourable results of this study need to be confirmed in larger patient populations with long-term follow-up.     

PET-CT在乳腺癌诊断中的应用价值

乳腺癌是当今大多数国家妇女最常见的恶性肿瘤。在过去的数十年中,正电子发射体层显像(PET)的应用极大地提高了乳腺肿瘤的临床诊治率。然而由于PET对肿瘤病灶缺乏准确的解剖定位而使18F-氟代脱氧葡萄糖(18F-FDG) PET临床应用的准确性受到限制。PET-CT的完美结合使对肿瘤的解剖定位和诊断的敏感性及特异性得到了明显的提高。本文着重介绍PET-CT在乳腺癌治疗后再分期、疗效观察、术前分期和放疗计划拟定中的应用价值。     

兔VX2肺肿瘤PET-CT与血管生成的相关性研究

目的 探讨11C-胆碱和18F-FDG PET-CT反映兔VX2肺肿瘤血管生成的效能.方法 新西兰大白兔54只,右肺接种VX2肿瘤10～11 d后,行11C-胆碱和18F-FDG PET-CT,测量肿瘤11C-胆碱和18F-FDG最大标准化摄取值(SUVmax).同时,测量肿瘤标本大小,用免疫组化方法评价肿瘤微血管密度(MVD).然后对肿瘤胆碱SUVmax、18F-FDG SUVmax与肿瘤大小、MVD进行相关性分析.结果 33只实验兔成功完成所有检查,得到Vχ2肺肿瘤的11C-胆碱SUVmax平均值为4.02±3.07(1.4～12.2),对18F-FDG的SUVmax平均值为5.70±3.45(1.0～13.0),肿瘤大小平均值为(1.68±1.61)cm3(0.13～8.00 cm3).高倍镜(200倍,0.739 mm2)视野下,肿瘤MVD平均值为(35.8±13.6)个(13～64个).经统计学分析,11C-胆碱SUVmax与肿瘤大小及MVD之间均不具有相关性;18F-FDG SUVmax与MVD(r=0.525,P=0.002)之间存在正相关关系,与肿瘤大小(r=0.335,P=0.057)之间呈临界正相关关系.结论 18F-FDG PET-CT可反映兔VX2肺肿瘤血管生成,11C-胆碱PET-CT不能反映肿瘤血管生成.     

18F-FDG PET/CT在ⅠA期非小细胞肺癌患者诊疗中的研究进展

肺癌是目前世界上最常见的癌症之一,随着低剂量CT肺癌筛查的普及,ⅠA期非小细胞肺癌（NSCLC）的检出率逐年增高。18F-氟脱氧葡萄糖（FDG）PET/CT作为一种可从分子水平上反映肿瘤细胞代谢状态的显像方法,已成为NSCLC诊断、分期和预后预测的重要工具。PET/CT在ⅠA期NSCLC中的临床应用逐年增多,笔者就近年来涉及到18F-FDG PET/CT在ⅠA期NSCLC患者中应用的研究以及这些研究结果对临床决策及预后的价值进行综述。     

Radiologische Diagnostik des CUP-Syndroms

Clinical/methodical issue

Imaging plays an essential role in the therapeutic management of cancer of unknown primary (CUP) patients for localizing the primary tumor, for the identification of tumor entities for which a dedicated therapy regimen is available and for the characterization of clinicopathological subentities that direct the subsequent diagnostic and therapeutic strategy.

Standard radiological methods

Modalities include conventional x-ray, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound as well as positron emission tomography (PET)-CT and MRI-PET.

Performance

In whole body imaging CT has a high sensitivity for tumor entities which frequently present as a metastasized cancer illness. According to the current literature CT is diagnostic in 86% of patients with pancreatic carcinoma, in 36% of patients with colon carcinoma and in 74% of patients with lung carcinoma. Additionally a meta-analysis showed that for patients with squamous cell carcinoma and cervical lymph node metastases a positive diagnosis was possible in 22% of the cases using CT, in 36% using MRI and in 28-57% using 18F-fluorodeoxyglucose PET-CT (¹⁸F-FDG PET-CT). In addition, MRI plays an important role in the localization of primary occult tumors (e.g. breast and prostate) because of its high soft tissue contrast and options for functional imaging.

Achievements

At the beginning of the diagnostic algorithm stands the search for a possible primary tumor and CT of the neck, thorax and abdomen is most frequently used for whole body staging. Subsequent organ-specific imaging examinations follow, e.g. mammography in women with axillary lymphadenopathy. For histological and immunohistochemical characterization of tumor tissue, imaging is also applied to identify the most accessible and representative tumor manifestation for biopsy. Tumor biopsy may be guided by CT, MRI or ultrasound and MRI also plays a central role in the localization of primary occult tumors because of superior soft tissue contrast and options for functional imaging (perfusion, diffusion), e.g. investigation of breast carcinoma or prostate carcinoma.

Practical recommendations

Whole body staging stands at the beginning of the diagnostic algorithm in CUP syndrome to localize a potential primary tumor. Clinically, contrast-enhanced CT of the neck, thorax and abdomen is frequently applied; however, many studies have demonstrated augmented sensitivity of ¹⁸F-FDG PET-CT for the detection of primary tumors and metastatic tumor manifestations.     

PET-CT与钼靶X线、B超定性诊断乳腺癌的临床对比研究

目的 探讨18F-氟代脱氧葡萄糖(18F-FDG)PET-CT诊断乳腺癌的临床应用价值。方法 60例临床怀疑乳腺癌的患者分别行B超、钼靶X线乳腺摄影和PET-CT检查。结合术后病理,比较PET-CT、B超、钼靶X线乳腺摄影诊断乳腺癌的结果。结果 手术病理证实乳腺癌48例,良性病变12例。PET-CT目测法诊断乳腺癌的灵敏度、特异度、准确率及阳性预测值分别为93.8%、83.3%、91.7%及95.7%,钼靶X线法分别为81.3%、83.3%、81.7%及95.1%,B超法分别为85.4%、83.3%、85.0%及95.3%。三种方法对乳腺癌的诊断效能无显著差异性(χ2=3.40,P>0.5)。结论 18F-FDGPET-CT诊断乳腺癌具有很好的临床应用价值,并能对乳腺癌的分期提供更多的信息。