PET在肺癌诊断及治疗中的应用

随着肿瘤放射治疗研究的日益深入，对肿瘤的正确诊断和对治疗反应的检测成为研究热点。正电子发射体层摄影术(PET)做为一种功能影像已被广泛应用于肺癌的诊断和治疗。现就PET在肺部原发灶的诊断、纵隔淋巴结分期、评价患者治疗反应和预后以及与其他检查手段的比较进行综述。     

18F-FDG PET在非小细胞肺癌诊断和分期中的应用价值

早期诊断和准确的临床分期是提高非小细胞肺癌(NSCLC)生存率的关键,传统的影像学检查在判断胸部病灶性质和病变范围时存在很大局限性,已不能满足临床对肺癌精确分期的需要.以18F-FDG为示踪剂的正电子发射体层显像(PET)在NSCLC中的应用已受到广泛的关注.现综述PET对肺内孤立性结节或局灶性病变的定性诊断价值以及对NSCLC纵隔淋巴结和远处转移检出的精确性.     

18^F—FDG PET在非小细胞肺癌诊断和分期中的应用价值

早期诊断和准确的临床分期是提高非小细胞肺癌(NSCLC)生存率的关键，传统的影像学检查在判断胸部病灶性质和病变范围时存在很大局限性，已不能满足临床对肺癌精确分期的需要。以18^F-FDG为示踪剂的正电子发射体层显像(PET)在NSCLC中的应用已受到广泛的关注。现综述PET对肺内孤立性结节或局灶性病变的定性诊断价值以及对NSCLC纵隔淋巴结和远处转移检出的精确性。     

PET在肺癌诊断中的应用进展

正电子发射计算机断层 ( positron emissiontomography,简称 PET)是目前最新的显像诊断技术之一 ,能够无创性探测正电子放射性核素在机体内分布状况。其重要性在于研究人体生理生化代谢及受体等方面起重要作用。正电子核素衰变产生的正电子与体内的负电子结合 ,产生一对能量相同( 5 1 1 ke V)但方向相反的γ光子 ,PET采用符合探测技术 ,探测到这一对光子 ,得到人体内不同脏器的核素分布信息 ,通过计算机进行图像重建处理 ,得到人体内标记化合物的分布图像。正电子核素主要依靠回旋加速器生产 ,如 11C、13 N、15O、18F,它们的半衰期极短…     

CT在肺癌临床分期中的应用和评价

为使肺癌得到正确的诊断和治疗，应用新的肺癌国际TNM分期标准是十分重要的。由于CT有助于在肺癌诊断和分期过程中对于原发肿瘤和纵隔淋巴结的评估，同时也有助于搜寻远处转移灶。因此，CT是肺癌最重要的辅助影像检查，而且也可进一步明确观察大气管、大血管、淋巴结及胸膜受侵犯的情况，从而为肺癌的TNM分期提供更有价值的信息和资料。PET-CT的图像融合可使肺癌的定位更加准确，使解剖位置和病灶代谢两者关系更为完善。PET／CT的联合检查和图像融合可改进肺癌的术前TNM分期，可能成为肺癌无创性分期中最为优良的方法。     

PET在肺癌诊断及治疗中的应用

随着肿瘤放射治疗研究的日益深入,对肿瘤的正确诊断和对治疗反应的检测成为研究热点.正电子发射体层摄影术(PET)做为一种功能影像已被广泛应用于肺癌的诊断和治疗.现就PET在肺部原发灶的诊断、纵隔淋巴结分期、评价患者治疗反应和预后以及与其他检查手段的比较进行综述.     

磁共振成像在肺癌诊断和分期中的作用

磁共振成像(MRI)是常用的影像学检查技术,其在肺癌诊断和分期中的作用备受关注.研究表明,MRI可用于肺部良恶性结节的鉴别及肺癌的筛查,并可用于非小细胞肺癌(NSCLC)的TNM分期,其敏感性和特异性与18氟-脱氧葡萄糖(18F-FDG) PET-CT相当,可作为NSCLC诊断和分期的替代影像学检查手段.     

FDG PET显像结合增强CT扫描在肺癌术前分期中的价值

目的研究18 F-脱氧葡萄糖(FDG)PET显像结合胸部CT在原发性肺癌术前分期中的价值.方法回顾性分析32例原发性肺癌患者,对术前CT分期、FDG PET结合CT分期与术后病理分期的符合率进行比较.结果4例全身PET显像发现远处有18 F-FDG摄取增高者放弃手术,28例开胸手术中,FDG PET诊断肺门、纵隔恶性淋巴结的灵敏度与准确度显著优于CT检查,P＜0.05;FDG PET结合CT检查术前分期与术后病理分期的符合率(92.9%)较CT检查有显著意义的提高,P＜0.05.结论FDG PET结合CT检查能提高术前肺癌分期的准确率,有助于改进对治疗方案的选择并指导手术操作的进行.     

纵隔镜检查在纵隔疾病诊断和肺癌分期中的应用

背景与目的:CT、纤维支气管镜等检查对某些纵隔疾病确诊仍十分困难;而准确地判定肺癌是否有纵隔淋巴结转移并对肺癌进行合理分期,对制定治疗方案和初步预测预后具有重要意义.本研究旨在探讨纵隔镜检查在纵隔疾病诊断和合并纵隔淋巴结肿大的肺癌分期中的应用价值和经验.方法:对16例CT等影像学检查发现有纵隔疾病的患者和14例术前经CT或PET、纤维支气管镜等检查诊断肺癌合并纵隔淋巴结肿大的患者进行纵隔镜检查和活检,行病理诊断.根据病理结果对肺癌进行分期.结果:未能确诊的纵隔疾病16例,经纵隔镜检查活检后获得病理确诊,分别为结节病5例,纵隔淋巴结结核3例,纵隔淋巴结炎性改变2例,淋巴瘤2例,胃肠道外胃肠道型恶性间质瘤1例,胸腺瘤1例,转移性小细胞癌1例,转移性腺癌1例;术前诊断肺癌并有纵隔淋巴结肿大的14例患者,经纵隔镜淋巴结活检,发现6例有纵隔淋巴结转移,8例无转移,后者经开胸手术,病理确诊为肺癌无纵隔淋巴结转移.14例患者经纵隔镜淋巴结活检均获得准确的肺癌分期;手术无严重并发症发生.结论:在纵隔疾病诊断和肺癌分期的应用方面纵隔镜检查是一种安全、准确的有效方法.     

Characteristics of advantages of positron emission tomography over computed tomography for N-staging in lung cancer patients

OBJECTIVE: We analyzed the characteristics of advantages of positron emission tomography (PET) over computed tomography (CT) for N-staging in lung cancer patients. METHODS: Preoperative PET and CT scans were performed for 2057 lymph node stations in 205 patients with peripheral-type lung cancer. The advantages of PET over CT for N-staging were analyzed among lymph node locations and histological subtypes. RESULTS: The pathological N-stages were N0 in 143 patients, N1 in 31, N2 in 24 and N3 in 7. PET was able to diagnose N0, N2 and N3 diseases more accurately than CT (P=0.03, 0.01 and 0.02, respectively), but there was no significant difference between the two modalities for N1 disease. In the upper mediastinal lymph node stations, both false-negative and false-positive were significantly less frequent with PET than with CT (P=0.001). In the lower mediastinal and supra clavicle lymph nodes, PET showed a lower frequency of false-negative than CT (P=0.04 and 0.003, respectively), but there was no significant difference in the frequency of false-positive between the two modalities. Among histological types, PET could stage adenocarcinoma with less frequent false-negative and squamous cell carcinoma with less frequent false-positive than CT (P=0.02 and 0.005, respectively). CONCLUSION: For N-staging, PET was superior to CT for the following: (1) more accurate for N0, N2 and N3 diseases but not for N1; (2) lower frequency of false-positive in the upper mediastinal nodes; and (3) lower frequencies of false-negative in adenocarcinoma and false-positive in squamous cell carcinoma. Recognizing these advantages of PET could make the N-staging of lung cancer more accurate.     

Coregistered whole body magnetic resonance imaging‐positron emission tomography (MRI‐PET) versus PET‐computed tomography plus brain MRI in staging resectable lung cancer

BACKGROUND:

The objective of this study was to assess whether coregistered whole brain (WB) magnetic resonance imaging‐positron emission tomography (MRI‐PET) would increase the number of correctly upstaged patients compared with WB PET‐computed tomography (PET‐CT) plus dedicated brain MRI in patients with nonsmall cell lung cancer (NSCLC).

METHODS:

From January 2010 through November 2011, patients with NSCLC who had resectable disease based on conventional staging were assigned randomly either to coregistered MRI‐PET or WB PET‐CT plus brain MRI (ClinicalTrials.gov trial NCT01065415). The primary endpoint was correct upstaging (the identification of lesions with higher tumor, lymph node, or metastasis classification, verified with biopsy or other diagnostic test) to have the advantage of avoiding unnecessary thoracotomy, to determine appropriate treatment, and to accurately predict patient prognosis. The secondary endpoints were over staging and under staging compared with pathologic staging.

RESULTS:

Lung cancer was correctly upstaged in 37 of 143 patients (25.9%) in the MRI‐PET group and in 26 of 120 patients (21.7%) in the PET‐CT plus brain MRI group (4.2% difference; 95% confidence interval, ?6.1% to 14.5%; P = .426). Lung cancer was over staged in 26 of 143 patients (18.2%) in the MRI‐PET group and in 7 of 120 patients (5.8%) in the PET‐CT plus brain MRI group (12.4% difference; 95% confidence interval, 4.8%‐20%; P = .003), whereas lung cancer was under staged in 18 of 143 patients (12.6%) and in 28 of 120 patients (23.3%), respectively (?10.7% difference; 95% confidence interval, ?20.1% to ?1.4%; P = .022).

CONCLUSIONS:

Although both staging tools allowed greater than 20% correct upstaging compared with conventional staging methods, coregistered MRI‐PET did not appear to help identify significantly more correctly upstaged patients than PET‐CT plus brain MRI in patients with NSCLC. Cancer 2013. © 2013 American Cancer Society.     

正电子发射断层显像在心脏恶性肿瘤诊断中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在心脏肿瘤诊断中的临床应用价值.方法:回顾性分析2011年1月-2018年12月,在我中心行PET/CT检查的23例心脏肿瘤患者的全身PET/CT的诊断结果,确诊依据为术后病理结果、临床随诊结果证实,评价PET/CT对心脏肿瘤诊断效能.结合影像学特征及SUVmax得到PET/...     

Diagnostic performance of positron emission tomography in the staging of pseudomyxoma peritonei

BackgroundPseudomyxoma peritonei (PMP) is a rare clinical entity, commonly derived from a mucin-producing tumour of the appendix. International consensus is unclear on the role of positron emission tomography (PET) in preoperative staging. This study aimed to assess the ability of preoperative PET in predicting the histological grade of PMP.MethodsAll patients scheduled for cytoreductive surgery (CRS) +/? hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP who underwent preoperative PET at a single centre between June 2007 and June 2020 were included. A nuclear medicine physician, blinded to patient outcomes, retrospectively reviewed imaging studies to assess for maximum tumour standardised uptake value (SUV) to mean liver SUV ratio (SUV_TLR) and maximum porta hepatis SUV to mean liver SUV ratio (SUV_PLR).ResultsBetween April 2007 and December 2020, a total of 204 patients underwent surgical intervention for PMP. Of these, 124 (60.8%) met the inclusion criteria. Median peritoneal carcinomatosis index for the entire cohort was 9 and complete cytoreduction (CC0/1) was achieved in 109 (88%) patients. Patients with high-grade PMP were more likely to have diffuse peritoneal disease (p < 0.001) and higher SUV_TLR (p<0.001). The area under the ROC curve (AUC) of SUV_TLR in predicting high-grade pathology was 71% (p = 0.003). Patients with a SUV_TLR ≤ 0.78 had improved disease-free survival (p = 0.042).ConclusionPreoperative PET showed positive correlation with high-grade PMP and acceptable sensitivity and specificity as a diagnostic tool. PET should be considered a useful adjunct to standard imaging for predicting histological grade in the staging of patients with PMP.     

PET对非小细胞肺癌三维适形放疗计划的影响

正电子发射计算机断层显像(posi-tron emission tomography, PET)作为一种先进的功能影像技术,通过影响非小细胞肺癌(non small cell lung cancer, NSCLC)的临床分期,而影响其三维适形放疗(3 dimensionaconformal radiation therapy, 3D CRT)计划的制定与实施。对于伴阻塞性肺炎、肺不张、胸膜受侵和胸腔积液者,CT确定肿瘤边界有一定困难,但PET却能较好地鉴别肿瘤组织与正常组织,因而能更精确地进行T分期并可明显缩小照射野,减少正常组织受量;对于受呼吸运动、心脏搏动影响较大的肿瘤,PET能提供精确的三维模拟图象,从而能据以制定出个体化的放疗计划。PET检测纵隔淋巴结的敏感性比 CT高,对直径≤1 cm的淋巴结的检出率尤其高,从而可发现 CT阴性的转移淋巴结,也可排除 CT阳性的正常淋巴结而修正常规的 N分期。PET诊断远处转移的优势也比其他影像学手段明显,尤其对Ⅲ期患者更为有益。PET 可改变 20% ~30% NSCLC患者的整体治疗策略,使不同的靶区勾画者之间的差异性明显减小,趋同性明显增大。PET可减少对周围正常组织的放射性肺损伤,更严格地执行根治性放疗的指征,降低与放疗有关的死亡率而大大增加治疗收益。但图象融合方式的选择、靶区运动的控制、结果判断标准的选取仍是未来研究的重要课题。     

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

BACKGROUND:

The malignant biological behavior of small‐sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose‐positron emission tomography/computed tomography (PET/CT) in addition to high‐resolution CT (HRCT) and pathological analysis in a multicenter setting.

METHODS:

A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground‐glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study.

RESULTS:

The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease‐free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R²] = 0.1699) was much weaker than that reported with the GGO ratio (R² = 0.5860) or TDR (R² = 0.5082).

CONCLUSIONS:

Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010. © 2010 American Cancer Society.     

Detection of occult bone metastases of lung cancer with Fluorine‐18 fluorodeoxyglucose positron emission tomography

Accurate staging of cancer has a critical role in optimal patient management. Fluorine‐18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with non‐small cell lung cancer. Although Tc‐99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X‐rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans.     

The role of positron emission tomography in management of small cell lung cancer

Accurate radiological staging of small-cell lung cancer (SCLC) is of paramount importance in selection of individual patients with limited stage disease for potentially curative treatment while avoiding toxic treatment in those with distant metastatic disease. [¹⁸F] flurodeoxy-d-glucose (FDG) positron emission tomography (PET) is an attractive tool for this purpose but there is limited evidence to support its use in the routine staging of SCLC. Whether therapeutic decisions based on FDG-PET imaging should be made remains uncertain. There is only preliminary evidence for use of FDG-PET as a prognostic biomarker, in the assessment of response to treatment and delineation of disease in conformal radiation planning.     

Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine-18-labeled fluoro-deoxyglucose (FDG-PET)

BACKGROUND AND OBJECTIVES: The purpose of this paper is to evaluate the utility of positron emission tomography (PET) with fluorine-18-labeled fluoro-deoxyglucose (FDG) in the preoperative differential diagnosis of gallbladder tumors. We performed PET studies of gallbladder tumors in order to predict the malignancy of these tumors preoperatively. METHODS: Sixteen patients who had protuberant lesions in the gallbladder and who were scheduled to undergo surgery were studied with PET using FDG. Focally increased FDG uptake in the gallbladder region was considered malignant. The FDG-PET findings were compared with the histological findings of surgical pathology. RESULTS: Sensitivity of FDG-PET was 75% (6/8 patients). One of two false-negative cases suffered from diabetes mellitus, and in the other case, the lesion was small. Specificity was 87.5% (7/8 patients). A case with xanthogranulomatous cholecystitis (XGC) was the only false-positive case. CONCLUSIONS: FDG-PET may be able to provide important information for evaluating the malignancy of gallbladder tumors.