单光子发射计算机断层扫描在颅脑创伤后的临床研究

目的 探索单光子发射计算机断层扫描（SPECF）在脑外伤评估及预后方面的价值的依据。方法 28例中、重度颅脑损伤患者分别于伤后3天、10天及3～4周接受SPECF、CT检查及临床评定。3个月后所有患者行脑外伤综合征的临床测试，对首检SPECF显像阳性者复查SPECF，分析首检SPECF显像阳性者与损伤程度的关系，动态观察SPECF显像与预后的关系。结果 SPECF显像阳性与脑损伤程度有关，首检SPECF显像阳性提示预后良好，复查SPECF显像阳性提示多出现脑外伤综合征。对幕上损伤患者表现的小脑症状、体征可以做出合理的解释。结论 在中至重度颅脑损伤后SPECF显像与CT扫描比较更敏感，脑SPECF具有无创性、功能性及灵敏性高等特点，是脑外伤后功能评估、预后判断及临床研究的可靠方法。     

前列腺癌分子影像学的PET研究进展

前列腺癌是男性泌尿系统中最常见的恶性肿瘤。它的生物学行为与临床情况有很大的异质性,这一特点使前列腺癌的早期诊断、鉴别诊断、治疗及预后评价面临挑战。PET是反映肿瘤生物学的一种理想的非侵入性的功能显像方法,目前已有多种分子影像途径及药物用于前列腺癌的定位诊断及疗效监测。本文综述国内外有关前列腺癌分子影像学的最新PET研究进展并展望其发展前景。     

Rectal malignant melanoma diagnosed by N-isopropyl- p-123I-iodoamphetamine single photon emission computed tomography and 5-S-cysteinyl dopa: report of a case

Malignant melanoma in the anorectal region is a rare disease associated with a very poor prognosis. Taking a biopsy of malignant melanoma is generally contraindicated because of the high risk of inducing metastasis. Although clinical examination and imaging findings are important for the preoperative diagnosis, conventional imaging techniques sometimes fail to provide information from which an accurate diagnosis can be made. We recently treated an 84-year-old woman with rectal malignant melanoma, in whom magnetic resonance imaging showed atypical findings. On the other hand, N-isopropyl-p-¹²³I-iodoamphetamine single photon emission computed tomography and 5-S-cysteinyl dopa in blood serum, as a tumor marker of malignant melanoma, proved very effective for establishing the preoperative diagnosis. Despite radical abdominoperineal resection, the patient died of multiple liver and lung metastases about 5 months after surgery. Received: April 8, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: S. Sato     

Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions

BackgroundTo date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged.MethodsArticles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: ⁶⁸Ga-prostate specific membrane antibody (⁶⁸Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS.ResultsUltimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for ⁶⁸Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of ⁶⁸Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034.DiscussionThe meta-analysis showed that ⁶⁸Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.     

Functional imaging in schizencephaly using [18F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) and single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime (HMPAO-SPECT)

We analyzed interictal [¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography (FGD-PET) and single photon emission computed tomography with technetium-99m-hexamethyl-propyleneamine oxime (HMPAO-SPECT) in a 23-year-old female with schizencephaly. She had epilepsy and mild left hemiparesis, but was otherwise developmentally normal. We found the glucose metabolism and perfusion of the wall of the schizencephalic cleft to be identical to those of normal cerebral cortex. The wall of the transcerebral clefts, which were observed to be lined by abnormally organized gray matter as a result of a migration disorder, demonstrated gray matter metabolic activity and perfusion. FDG-PET and HMPAO-SPECT were thus found to be a useful complement to magnetic resonance imaging for evaluating schizencephaly. Received: 26 June 1998 / Accepted: 19 August 1998     

18F-FDGPET/CT与传统影像检查寻找骨转移瘤原发灶的比较

[目的]比较18F-FDG PET/CT与传统影像检查(胸片、彩超、CT及MRI等)为骨转移瘤患者寻找原发灶的临床价值.[方法]回顾性分析37例于2008年5月～2010年6月间本中心收治的经病理证实的骨转移瘤患者的病例资料,并随访其后续的诊治情况.以病理结果或临床随访作为原发灶确认标准.并将PET/CT与传统影像检查对原发灶的检出情况进行比较.且对治疗方案的调整进行汇总.[结果]37例患者中,PET/CT提示原发灶28例,其中正确检出原发灶27例(73％),1例为假阳性;传统影像检查正确检出原发灶17例(46％),两者原发灶正确检出率的差异有显著性(x2=5.61,P=0.018).27例经PET/CT正确检出原发灶的病例中,17例(63％)采取了针对原发灶的治疗措施.此外9例PET/CT未提示原发灶的患者中,3例经病理证实为假阴性.[结论]与传统影像检查相比,18F-FDG PET/CT可更有效、更便捷的找出骨转移瘤患者原发灶,进而为制定更合理的治疗方案提供依据.     

Clinical value of whole body fluorine‐18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of metastatic bladder cancer

Objectives: To investigate the value of whole‐body fluorine‐18 2‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography/computed tomography for the detection of metastatic bladder cancer. Methods: From December 2006 to August 2010, 60 bladder cancer patients (median age 60.5 years old, range 32–96) underwent whole body positron emission tomography/computed tomography positron emission tomography/computed tomography. The diagnostic accuracy was assessed by performing both organ‐based and patient‐based analyses. Identified lesions were further studied by biopsy or clinically followed for at least 6 months. Results: One hundred and thirty‐four suspicious lesions were identified. Among them, 4 primary cancers (2 pancreatic cancers, 1 colonic and 1 nasopharyngeal cancer) were incidentally detected, and the patients could be treated on time. For the remaining 130 lesions, positron emission tomography/computed tomography detected 118 true positive lesions (sensitivity = 95.9%). On the patient‐based analysis, the overall sensitivity and specificity resulted to be 87.1% and 89.7%, respectively. There was no difference of sensitivity and specificity in patients with or without adjuvant treatment in terms of detection of metastatic sites by positron emission tomography/computed tomography. Compared with conventional imaging modality, positron emission tomography/computed tomography correctly changed the management in 15 patients (25.0%). Conclusions: Positron emission tomography/computed tomography has excellent sensitivity and specificity in the detection of metastatic bladder cancer and it provides additional diagnostic information compared to standard imaging techniques.     

SPECT与PSA联合检测诊断前列腺癌的临床意义

目的：探讨放射性核素骨显像与血清前列腺特异抗原联合检测在前列腺癌诊断中的临床意义。方法;采用单光子发射型计算机断层摄影术骨显像及血清ＰＳＡ浓度检测诊断ＰＣａ患者６３例。结果：６３例ＰＣａ患者中,血清ＰＳＡ测定阳性率为９６．８３％,ＳＰＥＣＴ骨显像转移率为５７．１４％。结论：ＳＰＥＣＴ骨显像与血清ＰＳＡ浓度联合检测对于ＰＣａ患者的临床诊断及治疗具有重要的指导意义。     

The value of combining single photon emission computerised tomography and computerised tomography in the investigation of spondylolysis

The aim of this study was to assess the diagnostic value of combining single photon emission computerised tomography (SPECT) with reverse gantry computerised tomography (rg-CT) in the investigation of spondylolysis. Patient characteristics and imaging results in 118 patients, aged 8–44 years, with low back pain (LBP) were analysed. SPECT showed increased scintigraphic uptake in 80 patients, and spondylolysis was identified on rg-CT in 53. The Cohen Kappa ratio of 0.362 (95% CI: 0.198–0.526) suggests only fair agreement for the result of increased scintigraphic activity with the finding of spondylolysis on rg-CT. We conclude that these investigations give mutually exclusive information, which leads to four diagnostic categories. When there was increased scintigraphic activity on SPECT, 58.8% (95% CI: 48.0–69.5%) of patients had spondylolysis on rg-CT. With rest from provoking activities, these lesions may heal. We interpret the findings of increased scintigraphic activity, but no spondylolysis demonstrated on rg-CT as indicating a bone stress response. These also require rest from provoking activity to prevent a stress fracture developing. In this study, 84.2% (95% CI: 72.67–95.8%) of those patients without increased activity on SPECT had no spondylolysis identified on rg-CT. These patients may need further investigations such as magnetic resonance imaging (MRI) to diagnose pathology, which typically does not involve the posterior elements—but rest from sport may not be so important. There were five patients in our study, without increased scintigraphic activity, but in whom bilateral chronic-appearing (wide separation, smooth sclerotic bone margins) spondylolyses were identified at L5. These all were anticipated from previous plain radiographs or MRI. This group will almost certainly not heal, and if the spondylolyses are the cause of pain these vertebrae will need stabilisation by surgery if physiotherapy fails.     

Update on positron emission tomography for imaging of prostate cancer

Prostate cancer is the most common non‐cutaneous malignancy among men in the Western world, and continues to be a major health problem. Imaging has recently become more important in the clinical management of prostate cancer patients, including diagnosis, staging, choice of optimal treatment strategy, treatment follow up and restaging. Positron emission tomography, a functional and molecular imaging technique, has opened a new field in clinical oncological imaging. The most common positron emission tomography radiotracer, ¹⁸F‐fluorodeoxyglucose, has been limited in imaging of prostate cancer. Recently, however, other positron emission tomography tracers, such as ¹¹C‐acetate and ¹¹C‐ or ¹⁸F‐choline, have shown promising results. In the present review article, we overview the potential and current use of positron emission tomography or positron emission tomography/computed tomography imaging employing the four most commonly used positron emission tomography radiotracers, ¹⁸F‐fluorodeoxyglucose, ¹¹C‐acetate and ¹¹C‐ or ¹⁸F‐choline, for imaging evaluation of prostate cancer.     

正电子发射型断层显像在结直肠癌肝转移诊断中的应用

目的 评价正电子发射型断层显像(PET)在结直肠癌术后肝转移诊断中的作用。方法 对18例怀疑结直肠癌术后肝转移的患者和3例怀疑其他疾病的患者进行PET检查，通过与CT比较及手术探查，评价PET在结直肠癌肝转移诊断中的作用。结果 怀疑术后肝转移的18例患者，经PET显像确诊17例，其中14例同时伴有肝脏以外的其他脏器转移(肺转移2例、腹壁转移2例、骨转移1例、腹腔淋巴结转移6例、纵隔淋巴结转移2例、锁骨上淋巴结转移1例)；PET诊断阴性的1例患者，随访1年后仍无瘤存活。3例怀疑其他疾病的患者经PET检查发现有结肠癌伴肝转移。结论 与CT相比，PET对结直肠癌术后肝脏及其他部位转移的敏感度更高，对术后肝转移患者是否选择再次手术具有更好的指导意义。     

Magnetic resonance imaging of the axial skeleton enables objective measurement of tumor response on prostate cancer bone metastases

BACKGROUND: There is currently no technique to image quantitatively bone metastases. Here, we assessed the value of MRI of the axial skeleton (AS-MRI) as a single step technique to quantify bone metastases and measure tumor response. METHODS: AS-MRI was performed in 38 patients before receiving chemotherapy for metastatic HRPCa, in addition to PSA, computed tomography of the thorax, abdomen, and pelvis [CT-TAP]; and Tc-99m bone scintigraphy. A second AS-MRI was performed in 20 patients who completed 6 months of chemotherapy. Evaluation of tumor response was performed using RECIST. RESULTS: Only 11 patients (29%) had RECIST measurable metastases in soft-tissues or lymph nodes on baseline CT-TAP. AS-MRI identified a diffuse infiltration of the bone marrow in 8 patients and focal measurable metastatic lesions in 25 patients (65%), therefore, doubling the proportion of patients with measurable lesions. Transposing RECIST on AS-MRI in 20 patients who completed 6 months of treatment, allows the accurate estimation of complete response (n = 2), partial response (n = 2), stable disease (n = 5), or tumor progression (n = 11), as it is done using CT-TAP in soft tissue solid metastases. CONCLUSIONS: MRI of axial skeleton enables precise measurement and follow-up of bone metastases as it is for other soft-tissue metastasis.     

Combined 18F‐fluorocholine and 18F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

Study Type – Diagnosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Positron emission tomography/computed tomography (PET/CT) with choline and fluoride for the detection of metastases in patients with prostate cancer have each been evaluated, with mixed results. Choline PET/CT has been evaluated against pelvic lymphadenectomy, generally with a low sensitivity but a high specificity; however, the study populations have been heterogenous. Fluoride PET/CT has been evaluated against other imaging methods, such as bone scan, single photon emission CT and MRI, and has been shown to have high specificity as well as sensitivity for bone metastases, but there are no studies with biopsy verification. This is the first study that evaluates the clinical use of both choline and fluoride PET/CT on the same patients in a well‐defined population of patients with high‐risk prostate cancer.

OBJECTIVE

• ? To investigate how often positron emission tomography/computed tomography (PET/CT) scans, with both ¹⁸F‐fluorocholine and ¹⁸F‐fluoride as markers, add clinically relevant information for patients with prostate cancer who have high‐risk tumours and a normal or inconclusive planar bone scan.

PATIENTS AND METHODS

• ? Patients with prostate cancer with prostate specific antigen (PSA) levels between 20 and 99 ng/mL and/or Gleason score 8–10 tumours, planned for treatment with curative intent based on routine staging with a negative or inconclusive bone scan, were further investigated with a ¹⁸F‐fluorocholine and a ¹⁸F‐fluoride PET/CT.
• ? None of the patients received hormonal therapy before the staging procedures were completed.

RESULTS

• ? For 50 of the 90 included patients (56%) one or both PET/CT scans indicated metastases.
• ? ¹⁸F‐fluorocholine PET/CT indicated lymph node metastases and/or bone metastases in 35 patients (39%).
• ? ¹⁸F‐fluoride PET/CT was suggestive for bone metastases in 37 patients (41%).
• ? In 18 patients (20%) the PET/CT scans indicated widespread metastases, leading to a change in therapy intent from curative to non‐curative.
• ? Of the patients with positive scans, 74% had Gleason score 8–10 tumours. Of the patients with Gleason score 8–10 tumours, 64% had positive scans.

CONCLUSIONS

• ? PET/CT scans with ¹⁸F‐fluorocholine and ¹⁸F‐fluoride commonly detect metastases in patients with high‐risk prostate cancer and a negative or inconclusive bone scan.
• ? For 20% of the patients the results of the PET/CT scans changed the treatment plan.

     

Combined contrast-enhanced computed tomography and 18-fluoro-2-deoxy-D-glucose-positron emission tomography in the diagnosis and staging of non-small cell lung cancer

We present the current optimal uses and limitations of positron emission tomography/computed tomography (PET/CT) as it relates to the diagnosis and staging of non-small cell lung cancer (NSCLC). PET/CT demonstrates increased accuracy in the workup of solitary pulmonary nodules for malignancy compared with CT alone, and we discuss its benefits and limitations. We review pitfalls in measured standardized uptake values of lung lesions caused by respiratory artifacts, the lower sensitivity for detection of small lung nodules on non-breath-hold CT, and the benefits of obtaining an additional diagnostic CT for the maximum sensitivity of lung nodule detection. There are limitations of quantitatively comparing separate PET/CT examinations from different facilities with standardized uptake values. As for staging, we describe how PET/CT supplements clinical tumor-nodes-metastases (ie, TNM) staging, as well as mediastinoscopy, endobronchial ultrasound, and endoscopic ultrasound, which are the gold standard pathologic staging methods. We touch on the 7th edition TNM staging system based on the work by the International Association for the Study of Lung Cancer, an anatomically based staging method.