18F-FDG符合探测正电子显像对淋巴瘤的临床应用研究

目的 探讨氟[^18F]—氟代脱氧葡萄糖(^18F—FDG)符合探测正电子代谢显像(SPECT／PET)对淋巴瘤的临床应用价值。方法 经确诊的18例非霍奇金淋巴瘤(NHL)患者在治疗前后进行^18F—FDG符合线路显像，对显像结果用定性和半定量方法分析，并与B超和CT检查结果进行比较。结果 18例患者共进行30例次检查，真阳性21例次，真阴性6例次，假阳性2例次，假阴性1例次，其准确率90．0％，灵敏度95．5％，特异性75．0％，阳性预测值91．3％，阴性预测值85．7％。^18F—FDG显像改变了16．7％(3／18)临床分期和46．7％(14／30)的治疗方案。治疗后^18F—FDG对复发的阳性预测值100％，阴性预测值为80．0％。CT的阳性预测值50．0％，阴性预测值25．0％。治疗后阴性^18F—FDG显像患者无疾病进展生存期为16～47个月，平均28．7个月，治疗后阳性^18F—FDG显像的患者无疾病进展生存期为3～46个月，平均8．3个月。结论 ^18F—FDG SPECT／PET在NHL中具有重要的临床价值。     

^18F-FDG符合线路显像在恶性胸膜间皮瘤诊断中的价值

目的探讨^18F-FDG符合线路显像在恶性胸膜间皮瘤（MPM）诊断中的价值。方法回顾性分析26例病理确诊为胸膜间皮瘤患者的^18F—FDG符合线路（以下简称符合线路）显像结果。结果病理诊断为MPM22例,其中符合线路阳性20例;病理示良性问皮瘤4例,符合线路假阳性1例;符合线路诊断MPM的灵敏度、特异度、准确度分别为90．9％（20／22）、75．0％（3／4）、88．5％（23／26）;20例MPM中17例表现为弥漫性和（或）多结节状浓聚灶,3例表现为单个局限性胸膜浓聚灶。符合线路未能确切区分纵隔胸膜和转移的淋巴结;共发现3例远处转移灶。结论符合线路显像有利于鉴别胸膜间皮瘤的病变性质,易于发现远处转移灶。     

^18F-FDG PET／CT显像监测卵巢癌患者术后复发／转移的临床价值分析

目的 探讨18-氟代脱氧葡萄糖（^18F-FDG）PET／CT显像在卵巢癌术后监测中的价值。方法回顾性分析19例卵巢癌术后患者的全身PET／CT显像结果,并以病理和随访诊断结果为标准计算其诊断卵巢癌复发／转移的灵敏度、特异性等。结果 “F-FDGPET／CT显像预测卵巢癌术后复发／转移的灵敏度为100．O％（14／14）、特异性为60．0％（3／5）、阳性预测值为87．5％（14／16）、阴性预测值为100．O％（3／3）。结论”F-FDGPET／CT显像对监测卵巢癌术后复发／转移的价值优于传统影像学方法,与血清癌胚抗原（CAl25）联合检查可早期检出复发／转移灶。     

符合线路18F-脱氧葡萄糖代谢显像在卵巢癌复发中的应用

目的：探讨符合线路18F-脱氧葡萄糖代谢显像（符合线路18F—FDG）在卵巢癌复发中的诊断价值。方法：对40例在核医学科接受符合线路18F-FDG显像的卵巢癌术后患者进行分析，并与CA125进行比较。结果：40例临床疑有复发的卵巢癌患者中，经临床或病理证实复发28例，24／28例符合线路18F—FDG显示阳性；22／28例血清CA125升高。符合线路18F-FDG显像，CA125监测卵巢癌复发和转移的灵敏度、特异性和准确性分别为85．7％、66．7％和80％；78．6%、83．3％和80％。结论：符合线路18F-FDG显像作为无创伤性检查技术，能及时探测到复发或扩散肿瘤的代谢变化，可以为卵巢癌术后随访，特别是CA125升高的患者提供一种有效的非侵入性影像学诊断方法。     

符合线路断层显像对肺部肿块的诊断价值

目的:探讨以18F-FDG为代谢示踪剂的单光子发射型计算机断层(single photon emission computer tomographic,SPECT)进行符合线路显像(符合线路断层显像)对肺部肿块的诊断价值。方法:106例患者全部取得病理诊断,恶性肿瘤84例,良性肿块22例。将患者的胸部符合线路断层显像和CT的检查结论与病理结果进行比较。结果:符合线路断层显像诊断恶性肿瘤90例,良性肿块16例,其中假阳性9例,假阴性3例;胸部CT诊断恶性肿瘤86例,良性肿块20例,其中假阳性13例,假阴性11例。统计分析显示,对于诊断的敏感性、准确率和阴性预测值,二者间的差异有显著性,前者优于后者。结核是引起假阳性的主要病种,符合线路断层显像误判的9例中,6例为结核。引起误判的结核的病理形态通常表现为以增生为主的结节样病灶。结论:符合线路断层显像对肺部肿块的定性诊断具有较高的实用价值,对治疗方案的制订有指导意义。     

99Tcm-生长抑素受体显像对肺癌的诊断价值

目的探讨^99Tc^m-生长抑素受体(^99Tc^m-奥曲肽)显像对肺部肿瘤的诊断价值。方法56例胸部cT检查疑诊为肺癌的患者，行^99Tc^m-奥曲肽显像检查，其中23例行氟脱氧葡萄糖F18(^18F—FDG)双探头符合线路显像(DHC)，并将影像学结果与病理检查结果进行对比分析。结果病理检查证实，56例患者中，肺癌46例，肺良性病变10例。^99Tc^m-奥曲肽显像：53例结果与病理结果相同(44例肺癌、9例肺良性病变)；2例病理检查为肺腺癌，^99Tc^m-奥曲肽显像为肺良性病变，1例病理证实为肺结核球，^99Tc^m-奥曲肽显像为肺癌。^18F—FDG DHC：19例结果与病理结果相同(13例肺癌、6例肺良性病变)；4例病理证实为肺良性病变，^18F—FDG DHC检查为肺癌。以病理结果为诊断标准，^99Tc^m-奥曲肽显像诊断肺癌的敏感性、特异性和准确性分别为95．7％、90．0％和94．6％，阳性预测值(PPR)为97．8％，阴性预测值(NPR)为81．8％；^18F—FDG DHC诊断肺癌的敏感性、特异性、准确性分别为100％、60．0％、82．6％，PPR为76．5％，NPR为100％。^18F—FDG DHC诊断为肺癌的13例患者，6例有淋巴结转移，^18F—FDG DHC共检出10枚转移淋巴结，^99Tc^m-奥曲肽显像仅检出2枚。2例肺癌脑转移，两种显像方法均清晰显示脑部转移灶。结论^99Tc^m-奥曲肽显像是一种无创、安全、经济的检查方法，对肺癌原发病灶有较好的诊断价值，但对淋巴结转移诊断价值有限，它是^18F—FDG DHC的有效补充。     

锝-氮-氮欧乙替心肌灌注显像对冠心病的诊断评价

目的评价锝-氮-氮欧乙替（^99mTc-N—NOET）心肌灌注显像检测冠心病的价值。方法对42例临床疑诊冠心病患者,行^99mTc-N-NOET运动负荷和再分布心肌灌注显像,所有患者行冠状动脉造影检查。结果在42例患者中,26例冠状动脉造影显示有冠状动脉狭窄病变,其中单支病变10例,二支病变7例,三支病变9例.^99mTc-N-NOET心肌显像检出心肌缺血或心肌梗死21例,未检出异常5例;16例冠状动脉造影正常患者,^99mTc-N-NOET心肌显像正常14例,异常2例.^99mTc-N-NOET心肌灌注显像诊断冠心病的敏感性为81％、特异性为88％、阳性预测值91％,阴性预测值74％,预测准确性为83％。诊断单支、二支和三支冠状动脉病变的敏感性分别为60％（6／10）、86％（6／7）、100％（9／9）。42例均无干扰心肌分辨的肺、肝重度摄取增高者。15min运动负荷显像肺脏摄取高,尤以冠状动脉狭窄患者增高明显。结论 ^99mTc-N-NOET心肌灌注显像检测冠心病敏感性、特异性较高,早期显像肺摄取增加与有意义的冠状动脉病变有关。     

~(18)F-FDG符合线路SPECT/CT融合显像对肺癌的临床诊断价值

目的分析18氟-脱氧葡萄糖(~(18)F-FDG)符合线路单光子发射计算机断层成像术(SPECT)/CT融合显像应用于肺癌诊断的临床价值。方法选取2014年10月-2016年10月达州市中心医院收治的疑似肺癌患者65例,术后病理检查结果作为诊断的金标准,对~(18)F-FDG符合线路SPECT/CT诊断肺癌的特异性、敏感性及阴性预测值准确性进行分析。结果病理检查与符合线路SPECT/CT显像的灵敏度为91.07%(51/56),特异度为100%(9/9),阳性预测值100%(51/51),阴性预测值为64.29(9/15),准确度92.31%(60/65);经病理检查发现有34例患者淋巴结、脏器及骨骼转移,符合线路SPECT/CT显像发现39例出现淋巴结、脏器及骨骼转移。符合线路SPECT/CT显像对淋巴结、脏器及骨骼转移的灵敏度为94.12%(32/34),特异度为58.82%(10/17)。结论~(18)F-FDG符合线路SPECT/CT融合应用于肺癌的诊断具有较高的敏感性、特异性,与病理检查结果的准确度较高,并有效的探查出淋巴结、脏器及全身骨骼转移情况,值得应用推广。     

99mTc-MIBI心肌灌注断层显像与心电图对冠心病的诊断价值

目的评估^99mTc—MIBI心肌灌注断层显像与心电图（ECG）在冠心病（CAD）诊断的价值。方法对28例冠心病和可疑冠心病患者进行心电图检查和^99mTc—MIBI心肌灌注断层显像（同时采用半定量方法分析患者左心室心肌血流灌注情况），其中13例患者行冠状动脉造影术（CAG）。结果心肌灌注断层显像与ECG阳性率分别为42．9％、53．6％，两者阳性率间差异无显著性意义（P〉0．05）。ECG诊断冠心病的敏感性为3／3，特异性为3／10，阳性预测值为3／10，阴性预测值为3／3，准确度为6／13。心肌灌注显像诊断冠心病的敏感性为3／3，特异性为8／10，阳性预测值为3／5，阴性预测值为8／8，准确度为11／13。心肌灌注断层显像和ECG与CAG阳性率间差异均无显著性意义（P〉0．05）。结论^99mTc—MIBI心肌灌注层显像与心电图是安全、无创伤、方便及费用低的检查方法，临床联合应用对冠心病的诊断、治疗和预后判断有重要的价值。     

18F-FDG PET/CT显像联合血清CA125检测诊断卵巢癌术后复发、转移的价值

目的探讨18F-脱氧葡萄糖（18F-FDG）PET/CT显像联合血清CA125检测对卵巢癌术后复发、转移的诊断价值。方法对56例卵巢癌患者行18F-FDG PET/CT显像联合血清CA125检测随访复发转移灶,并以病理检查结果为金标准计算其敏感性及准确性。结果 18F-FDG PET/CT显像对卵巢癌复发、转移定性诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为95.7%（45/47）、100%（9/9）、96.4%（54/56）、100%（45/45）、81.8%（9/11）,血清CA125检测分别为93.6%（44/47）、100%（9/9）、94.6%（53/56）1、00%（44/44）和75.0%（9/12）。PET/CT显像联合血清CA125检测对卵巢癌复发、转移定性诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值均为100%。与术后病理对照,PET/CT对于复发、转移病灶数目诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为80.0%（24/30）9、0.9%（20/22）8、4.6%（44/52）、92.3%（24/26）和76.9%（20/26）。血清CA125≤70 U/ml者单发病灶者（14/23）高于CA125〉70 U/ml者（7/24）,P=0.029。结论 18F-FDG PET/CT显像联合血清CA125检测对卵巢癌术后复发、转移的诊断具有重要临床价值。     

Early detection of cardiac sarcoid lesions with (18)F-fluoro-2-deoxyglucose positron emission tomography

In April 2005, a 72-year-old woman with pulmonary sarcoidosis exhibited focal (18)F-fluoro-2-deoxyglucose ((18)F-FDG) uptake in her heart on (18)F-FDG positron emission tomography (PET). Although Japanese guidelines for diagnosing cardiac sarcoidosis were not met at this point, electrocardiography, echocardiography, and magnetic resonance imaging became diagnostic for cardiac sarcoidosis 1 year later. In the present case report, the potential of (18)F-FDG PET in the early recognition of cardiac sarcoidosis in comparison with other imaging modalities is discussed.     

Incidental detection of thoracic sarcoidosis on whole-body 18fluorine-2- fluoro-2-deoxy-D-glucose positron emission tomography

18 Fluorine-2- Fluoro-2-Deoxy-D-Glucose positron emission tomography (18FDG PET) allows imaging of sites with increased metabolic activity. Increased metabolic activity in mediastinal nodes in sarcoidosis has been described. We report the prospective diagnosis of thoracic sarcoidosis on 18FDG PET based on extensive, peripheral, upper lobe parenchymal, and mediastinal nodal tracer uptake.     

Scintigraphy with J001 macrophage targeting glycolipopeptide. A new approach for sarcoidosis imaging.

Scintigraphy with radiolabeled J001 as a ligand for macrophage targeting is a new approach for sarcoidosis imaging. J001 is a fully characterized acylated peptido-poly (1,3) galactoside isolated from Klebsiella membrane proteoglycans and able to bind electively recruited macrophages. Its physiochemical properties allow rapid absorption by the respiratory tract when this agent, labeled by 99m technetium, is administered as an aerosol. Images are obtained within 3 to 5 h after inhalation. In the present study, we determined the ability of J001 scintigraphy to localize areas of sarcoidosis involvement in 22 patients compared with gallium scanning in ten of them. Nineteen patients underwent bronchoalveolar lavage (BAL) and serum angiotensin-converting enzyme (ACE) assay. J001 scintigraphy was also performed on a control group of six patients with extrathoracic melanoma, in whom J001 scintigraphy was used to evaluate the cutaneous extent of the tumor and the lymph node involvement. In this control group, no fixation appeared in the thoracic area. In the sarcoidosis group, 18 positive results were observed. One stage 0 patient had a mediastinal fixation. Five of the six stage 1 patients had a fixation located in the mediastinum, the lungs, and the wrists. Five of the six stage 2 patients had positive foci located in the mediastinum or the lung areas and in the myocardium in one of them. Six of the nine stage 3 patients had positive J001 scintigraphy occurring in the lungs and/or the mediastinum. One patient had a fixation on the main bronchi. J001 scintigraphy and gallium scanning, performed in ten patients, were positive in seven of them. There were discrepancies between the BAL results and J001 scintigraphy, as well as between the ACE results and J001 scintigraphy. In conclusion, 99mTc-J001 scintigraphy appears to be a sensitive and rapid technique for the imaging of thoracic sarcoidosis at the three stages of the disease.     

Dysfonction sinusale au cours de la sarcoïdose cardiaque: à propos d’un cas

IntroductionSarcoidosis is a multisystemic granulomatous disease of unknown cause occurring in young adults. Cardiac sarcoidosis patients are at increased risk for atrioventricular blocks and ventricular arrhythmias. Sinus node dysfunction is scarcely reported.ObservationWe report a case of cardiac sarcoidosis revealed by a sinus node dysfunction and focus on cardiac and thoracic imaging to guide diagnosis.ConclusionSinus node dysfunction may be the first manifestation of cardiac sarcoidosis. In unexplained sinus node dysfunction in young patients, advanced cardiac imaging is a key to cardiac sarcoidosis diagnostic. Early recognition of cardiac sarcoidosis enables to start immunosuppressive treatment and discuss implantable cardioverter defibrillator implantation.     

Depreotide scanning in sarcoidosis: a pilot study

STUDY OBJECTIVES: To determine whether sarcoidosis results in uptake on (99m)Tc-labeled depreotide (DP) scintigraphy and to generate preliminary data to guide the development of future trials exploring this imaging modality in sarcoidosis patients. DESIGN: Prospective cohort trial among a convenience sample of patients with sarcoidosis. SETTING: Tertiary care medical center pulmonary clinic. PATIENTS: Subjects in whom sarcoidosis has been diagnosed based on a biopsy revealing nonnecrotizing granulomas. INTERVENTIONS: Two hours after IV administration of (99m)Tc-DP, all patients underwent whole-body anterior and posterior planar imaging, followed by thoracic single-photon emission CT scanning. Images were interpreted by two nuclear medicine physicians who were blinded to the patient's clinical status. MEASUREMENTS AND RESULTS: The study cohort included 22 subjects (mean [+/- SD] age, 41.3 +/- 9.3 years; 40% female). Approximately half of the cohort had stage I disease determined by chest radiographs (CXRs). The results of (99m)Tc-DP scintigraphy were positive for sarcoidosis in 18 individuals (81.8%; 95% confidence interval, 59.7 to 94.8%). Of the four persons lacking (99m)Tc-DP uptake, all had normalized their CXRs since the time of presentation. In the entire sample, the intraclass correlation between radiographic stage determined by CXR vs that determined by (99m)Tc-DP scintigraphy was robust (kappa = 0.79; p = 0.0005). Among patients with positive (99m)Tc-DP scan findings, the correlation was stronger (kappa = 0.94; p < 0.0001). Flow rates and lung volumes were lower in patients with parenchymal activity on (99m)Tc-DP scintigraphy (mean FEV(1), 68.6 +/- 13.9% predicted vs 84.5 +/- 10.7% predicted, respectively [p = 0.012]; mean FVC, 74.0 +/- 16.0% predicted vs 88.4 +/- 12.7% predicted [p = 0.041]). (99m)Tc-DP scintigraphy correctly identified all sites of known nonpulmonary visceral involvement with sarcoidosis. CONCLUSIONS: The results of (99m)Tc-DP imaging are often positive in sarcoidosis patients, and correlate with disease stage determined by CXR and pulmonary function. (99m)Tc-DP scintigraphy does not preclude the need for biopsy if this is indicated to confirm the diagnosis of sarcoidosis or to exclude the possibility of malignancy. (99m)Tc-DP scintigraphy merits further study in the evaluation and management of sarcoidosis.     

Sarcoidosis and the occurrence of malignant diseases

Whereas the association between sarcoidosis and malignant diseases has been well described, it remains controversial whether this association is merely a coincidence or the consequence of a common pathophysiologic mechanism. We investigated the incidence of malignancies in a large cohort of patients with sarcoidosis from a German University Hospital. Patients with a malignant disease were identified in a retrospective analysis of a cohort of 425 patients with sarcoidosis at the Medical Center of the University of Heidelberg. The type of malignancies and the onset before, concomitant or after sarcoidosis were analyzed. Sixty-one patients with a malignant disease were identified in our cohort of 425 patients with sarcoidosis. Among them, there were 18 patients with malignant lymphoma, 13 with breast cancer and 5 with cervical cancer. Malignant lymphoma was diagnosed up to 30 years after sarcoidosis with a median of 6.9 years. Breast or cervical cancers were diagnosed up to 20 years before or after sarcoidosis, and the median was 0.0 years. A high prevalence of B-cell lymphoma, breast and cervical cancers was found in our sarcoidosis cohort. In most patients, B-cell lymphoma was diagnosed many years after chronic sarcoidosis. In contrast, the diagnosis of breast or cervical cancer was evenly distributed before, around and after the diagnosis of sarcoidosis. Our hypothesis is that the immune dysregulation which persists during or after chronic sarcoidosis might represent a contributing factor for the development of B-cell lymphoma.     

The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis

OBJECTIVES: Cardiac involvement is an important prognostic factor in patients with sarcoidosis. We evaluated the usefulness of delayed enhancement MRI (DE-MRI) for diagnosing cardiac sarcoidosis by comparing with nuclear imaging and studying the correlation between DE area and left ventricular (LV) function. METHODS: Twelve patients (male:female 3:9) diagnosed as having sarcoidosis underwent Gd-MRI, myocardial perfusion SPECT (Tl-201, Tc-99m sestamibi), Ga-67 scintigraphy, and/or F-18 FDG-PET. RESULTS: DE was observed in 5 patients, and was positive in 39 (39%) of 100 LV segments. The corresponding perfusion defects in myocardial perfusion SPECT were undetectable in 14 (36%) segments. DE distributed mainly in mid- to epi-myocardium, and the lack of perfusion defects in myocardial perfusion SPECT was more prominent in less transmural DE segments. Two patients with diffuse DE and 1 case with focal DE exhibited positive cardiac uptake in Ga-67 scintigraphy, and 2 other cases with focal DE showed cardiac uptake in F-18 FDG-PET. In 7 patients without DE, there were no significant findings in nuclear imaging. Both LV end-diastolic and end-systolic volume were positively and LV ejection fraction was negatively correlated with the extent of DE area. Four patients treated with corticosteroid showed improvement in nuclear imaging and slight decreases in DE area but no recovery in LV function. CONCLUSIONS: DE-MRI is useful to diagnose the cardiac involvement of sarcoidosis and to evaluate cardiac function. It is likely that the distribution of DE in mid- to epi-myocardium is the characteristic of cardiac sarcoidosis, and the larger DE area may be correlated with poor LV function.     

~(18)F-FDG符合线路SPECT显像在非霍奇金淋巴瘤预后评估中的作用

目的:探讨18F-脱氧葡萄糖(18F-FDG)符合线路单光子发射计算机断层显像(SPECT)在淋巴瘤预后评估中的应用价值。方法:回顾分析52例非霍奇金淋巴瘤(NHL)患者治疗前和4程化疗后18F-FDG符合线路SPECT显像结果,治疗后18F-FDG符合线路SPECT显像反应按照完全缓解(CR)、部分缓解(PR)或无反应(NR)评分。联合使用国际预后指数(IPI)和治疗后18F-FDG符合线路显像SPECT反应评估患者的无失败生存率(FFS)。结果:4程化疗后,18F-FDG符合线路显像反应CR的患者34例,2年FFS是75%;PR患者12例,2年FFS是41%,未缓解6例,2年FFS是0,23例患者疾病进展或复发。18F-FDG符合线路显像反应CR、PR和NR的患者之间的FFS明显不同(P<0.01)。将18F-FDG符合线路SPECT显像反应与IPI相联合,至少分为明显不同的4组,联合危险度评分(CRS)0～1(14例患者)2年FFS77%,CRS2～3(26例患者)2年FFS64%,CRS4(8例患者)2年FFS25%和CRS5～6(5例患者)2年FFS为0,4组患者的2年FFS明显不同(P<0.01)...     

老年前期及老年人胸部结节病的CT表现

目的：总结老年前期及老年胸部结节病患者的CT表现。方法：回顾性分析25例确诊的老年前期及老年胸部结节病患者的CT图像。结果：9例CT呈典型表现，16例CT呈不典型表现，其中纵隔和一侧肺门淋巴结肿大者3例（3／25），无肺门淋巴结肿大的单纯纵隔淋巴结肿在者7例（7／25），无纵隔淋巴结肿大的单侧肺门淋巴肿大者1例（1／25），仅有肺部改变而无胸部淋巴结肿大者5例（5／25）。后者在首诊时全部误诊。结论：老年人胸部结节病的CT表现多不典型，认识此种表现在诊断中很重要。