磁共振扩散加权成像鉴别良恶性软组织肿瘤的价值

目的 :探讨磁共振扩散加权成像(DWI)鉴别良恶性软组织肿瘤的价值。 方法 :采用扩散加权成像分析43例软组织肿瘤,其中恶性25例,良性18例。所有病例均经手术病理证实。扩散加权成像的扩散敏感因子(b值)为0,500s/mm²。选取肿瘤实体部分最大感兴趣区,尽量避开坏死、出血、瘢痕及钙化等不均质成分。分析各病灶的扩散加权图像特点,比较良、恶性肿瘤表观扩散系数(apparent diffusion coefficient,ADC)的差异。3例恶性肿瘤患者化疗前、后进行DWI检查,分析ADC值的变化特点。 结果 :恶性肿瘤的ADC值(0.96±0.31×10^-3)mm²/s明显低于良性肿瘤的ADC值(1.92±0.63×10^-3)mm²/s和肌肉组织(1.69±0.47×10^-3)mm²/s的ADC值,差异具有统计学意义(P<0.05),良性肿瘤与肌肉的ADC值无明显差异。ADC值为(1.38×10^-3)mm²/s时,鉴别良恶性肿瘤的敏感性为92%,特异性为83%。3例恶性肿瘤患者化疗前、后进行DWI检查,其中2例化疗后ADC值升高,1例无ADC值的明显变化。 结论 :ADC值在软组织良恶性肿瘤的鉴别诊断中具有重要价值,ADC值对于化疗效果评价的作用需要进一步研究并与组织学对照加以证实。     

软组织肉瘤保存肢体的新技术应用

应用广泛切除术及高剂量率后装内照射新技术（Ｂｒａｃｈｙｔｈｅｒａｐｙ），治疗累及重要血管及神经的软组织肉瘤，达到控制预防局部复发，保存肢体功能的目的。５例肢体软组织肉瘤经治疗后均生存，随访未见局部复发及远处转移。作者介绍了保存肢体手术及肿瘤床１９２铱置管内照射的技术，同时建议对以往截肢指征应慎重考虑，只有在各种综合治疗失败情况下才考虑截肢。     

放射性核素骨断层技术在肿瘤患者骨病变判断中的应用

目的探讨经单光子发射型计算机断层扫描（SPECT）对肿瘤患者骨断层的临床应用价值。方法在平面骨显像的基础上加作SPECT局部断层骨显像来分析患者骨病变情况。结果平面骨显像探测到病灶数为227个,断层骨显像探测发现病灶数为284个;SPECT断层较平面骨显像多探测到57个病变部位。20．1％（57／284）的病变在平面骨显像时漏诊。结论平面骨显像时一些隐匿性病灶或很难确定异常或正常的病变,通过断层显像后能更加肯定其性质和明显病变部分。应用SPECT断层显像技术区分肿瘤患者的骨病变情况有一定临床应用价值。     

基于双序列MRI的计算机辅助诊断鉴别软组织肿瘤良恶性的研究

目的:研究使用计算机辅助分析方法针对软组织肿瘤MRI影像进行肿瘤良恶性鉴别的价值。方法:回顾性收集了在辽宁省肿瘤医院就诊的72例软组织肿瘤患者的CE-T1和T1WI双序列MRI影像数据(2017年1月至2018年1月)。通过提取和筛选MRI影像特征,建立支持向量机(SVM)、K-最邻近(KNN)和随机森林(RF)三种机器学习分类器模型对肿瘤病灶进行二分类鉴别;提出一种新型集成学习分类器模型用于将两个序列MRI信息进行融合。通过绘制受试者工作特征曲线(ROC)并计算ROC曲线下面积(AUC值)以评估模型的分类鉴别能力。结果:三种机器学习分类器均取得较好的良恶性鉴别效果;提出的集成学习分类器的分类效果最佳,AUC值达到0.922(敏感性=0.965,特异性=0.783)。结论:本研究提出的计算机辅助模型能够利用MRI影像对软组织肿瘤良恶性进行有效的辅助鉴别,具有一定的潜在应用价值。     

放射性核素骨断层技术在肿瘤患者骨病变判断中的应用

目的 探讨经单光子发射型计算机断层扫描(SPECT)对肿瘤患者骨断层的临床应用价值.方法 在平面骨显像的基础上加作SPECT局部断层骨显像来分析患者骨病变情况.结果 平面骨显像探测到病灶数为227个,断层骨显像探测发现病灶数为284个;SPECT断层较平面骨显像多探测到57个病变部位.20.1%(57/284)的病变在平面骨显像时漏诊.结论 平面骨显像时一些隐匿性病灶或很难确定异常或正常的病变,通过断层显像后能更加肯定其性质和明显病变部分.应用SPECT断层显像技术区分肿瘤患者的骨病变情况有一定临床应用价值.     

正电子发射计算机断层显像在恶性淋巴瘤诊断及疗效评估中的应用

 目的　探讨正电子发射计算机断层显像（PET-CT）在恶性淋巴瘤诊断和疗效评估中的应用。方法　对经PET-CT检测的73例淋巴瘤患者的临床资料进行回顾分析。结果　PET-CT检测对初诊的淋巴瘤患者诊断敏感性高,有助于临床准确分期,对残留复发病灶监测的敏感性高达100 %。结论　PET-CT弥补了传统检测的不足,对淋巴瘤的诊断、分期和疗效评估有重要作用。     

18F-FDG PET-CT在肺部良、恶性病变中的诊断应用

目的探讨18-氟-2氟-2-脱氧-葡萄糖正电子发射断层扫描与CT扫描融合图像(18F-FDG PET-CT)在肺部病变中的诊断及应用价值。方法2004年12月~2006年12月,52例患者因肺部病变行螺旋CT及PET-CT检查,均得到临床或病理证实诊断。包括原发性肺癌35例,肝母细胞瘤肺转移1例,肺结核6例,肺炎5例,肺炎性假瘤1例,肺炎性肉芽肿4例。结果PET-CT及螺旋CT诊断结果与临床或病理诊断结果符合率分别为92.3%(48/52)和73.1%(38/52)。PET-CT对肺部恶性肿瘤诊断的灵敏度、特异度分别为100.0%(36/36)、81.3%(13/16)。PET-CT诊断为肺部恶性肿瘤患者中,94.4%(34/36)患者TNM分期与临床或病理分期相符合,而单独螺旋CT为72.2%(26/36)。35例原发性肺癌、1例肝母细胞瘤肺转移、4例肺炎性肉芽肿、1例机化性肺炎及2例肺结核显示高18F-FDG代谢改变。结论PET-CT提高了肺部病变的诊断水平,对肺癌的分期及指导临床治疗具有更大的实用价值。     

18F-FDG PET在消化道肿瘤疗效评估中的应用

肿瘤患者理想的治疗方案是疗效最好，同时毒副作用最少。化疗、放疗是现阶段最常用的辅助治疗手段，如何及时准确地评价其疗效已成为临床医师关注的焦点。传统的对实体瘤治疗响应的评估是根据治疗前后肿瘤大小、瘤体血供及病灶密度等因素的改变程度来判断的，主要有CT、MRI和B超等检查手段。但上述因素的改变是肿瘤治疗后细胞水平、亚细胞水平一系列复杂极链反应后的结果，常常需要几个疗程才能观察到，故传统的影像学检查不能及时评判疗效。     

磁共振成像新技术在乳腺良恶性病变鉴别诊断中的应用进展

乳腺癌已成为全球第一大癌症,严重威胁女性健康。磁共振成像技术以其多参数、高软组织分辨率及无电离辐射等优点,已越来越多地应用于乳腺病变的良恶性鉴别。随着近年来磁共振技术的飞速发展,新的成像方法不断涌现,为乳腺病变的良恶性检出提供了更有价值的参考依据。其中,超快速磁共振动态对比增强成像、合成磁共振成像、磁共振指纹打印技术及一系列高级扩散加权成像技术(体素内不相干运动成像、扩散峰度成像和拉伸指数模型成像)均可以从不同角度描述乳腺病变潜在的组织学或病理学特征,为良恶性鉴别提供有力支撑。本文将从成像原理、技术特点以及临床应用等多个层面,系统地阐述上述磁共振成像新技术对乳腺病变良恶性的鉴别诊断价值。     

^18F—FDGPET在食管癌诊断与治疗中的应用价值

早期诊断和准确分期是提高食管癌生存率的关键，传统的影像学检查对食管癌的诊断、分期、疗效评价及预后评估存在一定的局限性，作为生物影像，^18F-FDGPET现已广泛应用于临床，现综述其在食管癌诊断与治疗中的应用价值。     

Detection of recurrent or residual nasopharyngeal carcinomas after radiotherapy with technetium-99m tetrofosmin single photon emission computed tomography and comparison with computed tomography--a preliminary study

The effectiveness of technetium-99m tetrofosmin (Tc-TF) single photon emission computed tomography (SPECT) of the head and neck for detecting recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT). Both Tc-TF SPECT and CT of the head and neck were performed in 36 NPC patients 4 months after radiotherapy. All 36 then underwent histopathological examinations of nasopharyngeal biopsies. Based on the histopathological results, the sensitivity, specificity, and accuracy of visually interpreted Tc-TF SPECT images, to differentiation of recurrent NPC from benign lesions, were 64%, 96%, and 86%, respectively. The sensitivity, specificity, and accuracy of CT for detecting recurrent NPC were 73%, 88%, and 83%, respectively. The Tc-TF SPECT has a better specificity but a lower sensitivity to differentiate benign lesions and recurrent/residual NPC when compared with CT. Combined Tc-TF SPECT and CT sensitivity and specificity were 100% and 88%, respectively. There are much better either test alone. However, further studies, including a larger NPC patient population, are warranted to determine the exact role and clinical usefulness of Tc-TF SPECT to differentiate benign lesions and recurrent/residual NPC.     

Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic has made it more challenging for patients to undergo yttrium-90 (Y-90) radioembolization (RE). Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19, thus improving patient access. AIMTo describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography (SPECT/CT) in order to optimize therapy. METHODSAll patients were selected for Y-90 RE through a multidisciplinary tumor board, and were screened and tested for COVID-19 infection per institutional protocol. A same day procedure was developed, consisting of angiography, imaging, and Y-90 resin particle delivery. Routine SPECT/CT after technetium-99m macroaggregated albumin (Tc-99m MAA) administration was performed for assessment of arterial supply, personalized dosimetry, and extrahepatic activity. Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery, by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles. RESULTSA total of 14 patients underwent same day Y-90 RE between March and June 2020. Mean lung shunt fraction was 6.13% (range 3.5%-13.1%). Y-90 RE was performed for a single lesion in 7 patients, while the remaining 7 patients had treatment of multifocal lesions. The largest lesion measured 8.3 cm. All patients tolerated the procedure well and were discharged the same day. CONCLUSIONSame day Y-90 RE with resin-based microspheres is feasible, and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond. We recommend consideration of SPECT/CT, especially among patients with complex malignancies, for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.     

Detecting mediastinal lymph node metastases in non-small-cell lung cancer using a combination of technetium-99m tetrofosmin chest single photon emission computed tomography and chest computed tomography

The staging of non-small-cell lung cancer (NSCLC) to detect mediastinal lymph node (MLN) metastases is very important for determining the therapeutic strategy.

Methods: Thirty-four patients with proven NSCLC were enrolled in this study. All patients underwent chest computed tomography (CT) and technetium-99m (Tc-99m) tetrofosmin chest single photon emission computed tomography (SPECT) preoperative staging. Mediastinal lymph node metastases were determined on the basis of postoperative pathologic findings to compare the diagnostic accuracy of chest CT with that of Tc-99m tetrofosmin chest SPECT.

Results: Tc-99m tetrofosmin chest SPECT showed a diagnostic accuracy rate of 85.3% in detecting MLN metastases. Chest CT had an accuracy rate of 73.5%. If either Tc-99m tetrofosmin chest SPECT or chest CT with positive findings was considered as positive findings, the sensitivity was 94.7%. If either Tc-99m tetrofosmin chest SPECT or chest CT with negative findings was considered as negative, the specificity was 93.3%.

Conclusion: Tc-99m tetrofosmin chest SPECT was more accurate than chest CT in detecting MLN metastases in NSCLC patients. In addition, the combined use of Tc-99m tetrofosmin chest SPECT and chest CT could significantly increase the sensitivity and specificity compared with the single use of either Tc-99m tetrofosmin chest SPECT or chest CT.     

Detection of recurrent nasopharyngeal carcinomas after radiotherapy with technetium-99m tetrofosmin single photon emission computed tomography in patients with indeterminate magnetic resonance imaging findings

The aim of this study is to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of head and neck for detecting suspected recurrence of nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. MRI was performed 4 months after radiotherapy and 26 NPC patients with indeterminate MRI findings were included. MRI, Tc-99m TF SPECT, and biopsy were performed within 1 week. The final results were based on histopathologic findings and clinical follow-up for at least 6 months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m TF SPECT were 92.3%, 100.0%, and 96.2%, respectively. Based on this result, we can suggest Tc-99m TF SPECT is effective to detect recurrent NPC when MRI findings are indeterminate. However, further studies including a larger NPC patient population are warranted to determine the exact role and clinical usefulness of Tc-99m TF SPECT to differentiate benign lesions and recurrent NPC when MRI findings are indeterminate.     

^18F-FDG PET/CT诊断骨与软组织肉瘤术后复发及转移

目的 探讨18F-FDG PET/CT在诊断原发性骨与软组织肉瘤术后局部复发和（或）远处转移中的临床价值.方法 回顾性分析28例于2008年5月至2010年6月间,在我中心行手术切除的原发性骨与软组织肉瘤患者的病例资料,并随访其后续的诊治情况.以病理结果 或临床随访作为复发和转移灶的确认标准.随访至少3个月.结果 PET/CT提示局部复发16例,与临床、病理相符15例,假阳性1例.PET/CT监测肿瘤局部复发的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为100﹪、92﹪、96﹪、94﹪和100﹪.PET/CT提示远处转移17例,正确诊断14例,假阳性3例.PET/CT监测远处转移的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为100﹪、79﹪、89﹪、82﹪和100﹪.结论 PET/CT对于诊断原发性骨与软组织肉瘤术后复发及转移,表现为高度敏感性、中度特异性;可以更准确、更全面的发现肿瘤术后局部复发和（或）远处转移,为临床决策提供依据.     

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/...     

Usefulness of thallium-201 SPECT scintimammography to differentiate benign from malignant breast masses in mammographically dense breasts

The purpose of this study was to assess the usefulness of thallium-201 (Tl-201) single-photon emission-computed tomography (SPECT) scintimammography to differentiate benign from malignant breast masses in 32 female Taiwanese patients with indeterminate mammographic probability of malignancy because of mammographically dense breasts. All breast masses were removed, and final histopathological diagnoses were obtained in all cases. The results showed that thallium-201 SPECT scintimammography findings were true-positive in 22 cases, false-positive in 1 case, true-negative in 7 cases, and false-negative in 2 cases. The diagnostic sensitivity, specificity, and accuracy were 91.7%, 87.5%, and 90.6%, respectively, for detecting breast cancer in mammographically dense breasts. In conclusion, thallium-201 SPECT scintimammography is a useful tool for differentiating benign from malignant breast masses in patients with indeterminate mammograms because of mammographically dense breasts.     

全身PET/CT和VEGF-C检查对非小细胞肺癌诊治的应用价值

目的：探讨全身PET/CT和血浆血管内皮生长因子-C（VEGF-C）在非小细胞肺癌（NSCLC）诊断和治疗选择中的临床应用价值。方法：收集2005年1月17日～2007年1月17日86例病理确诊的NSCLC患者的PET/CT资料并留取血清样本备用。比较PET/CT、胸部CT、支气管镜活检及经皮肺穿刺切割活检4种不同方法对NSCLC的诊断敏感性;分析SUV值（standardized uptake value）和延迟相SUV对NSCLC的诊断价值;比较PET/CT与常规检查的TNM分期在淋巴结和远处转移中的检出率和检出分布上的差异。用双抗体夹心ELISA法试剂盒测定血清VEGF-C浓度辅助胸部CT评价N分期。结果：入组研究NSCLC患者86例,男性67例,女性19例;腺癌41例、鳞癌37例、混合型腺癌5例及大细胞癌3例。PET/CT和胸部CT、支气管镜活检、经皮肺穿切割活检术对NSCLC患者肺部原发病变的诊断敏感性分别为90.89%（78/86）、76.47%（60/86）、80%（36/45）和90%（45/50）,PET/CT与胸部CT在诊断敏感性上差异显著（P=0.02）。86例NSCLC患者PET/CT初始相SUV均值为8.27±4.90,其中46例患者延迟相SUV均值为8.35±5.29,高于其初始相SUV均值7.62±4.50（P=0.003）。PET/CT对N1、N2、N3分别检出10、24、26例,合计检出率为69.77%（60/86）;胸部CT/VEGF-C分别检出9、29、6例,合计53.88%（46/86）,PET/CT组与CT/VEGF-C组在阳性检出率和淋巴结分布上差异均非常显著（P=0.006和P=0.004）。本组PET/CT诊断Ⅳ期肺癌38例,与常规检查组诊断29例,两组在阳性发现率上无显著差异（P=0.211）,在分布上两组差异也不显著（P=0.712）。结论：PET/CT对NSCLC原发肿瘤的诊断敏感性显著优于胸部CT,延迟相SUV值对SUV初始值诊断NSCLC有重要参考价值。PET/CT对NSCLC的TNM分期比常规检查分期可能对治疗帮助更大。     

Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation: long-term results of a prospective trial (National Clinical Trial 00254683)

BACKGROUND:

Neoadjuvant chemoradiation (CRT) therapy may result in significant tumor regression in patients with rectal cancer. Patients who develop complete tumor regression have been managed by treatment strategies that are alternatives to standard total mesorectal excision. Therefore, assessment of tumor response with positron emission tomography/computed tomography (PET/CT) after neoadjuvant treatment may offer relevant information for the selection of patients to receive alternative treatment strategies.

METHODS:

Patients with clinical T2 (cT2) through cT4NxM0 rectal adenocarcinoma were included prospectively. Neoadjuvant therapy consisted of 54 grays of radiation and 5‐fluorouracil‐based chemotherapy. Baseline PET/CT studies were obtained before CRT followed by PET/CT studies at 6 weeks and 12 weeks after the completion of CRT. Clinical assessment was performed at 12 weeks after CRT completion. PET/CT results were compared with clinical and pathologic data.

RESULTS:

In total, 99 patients were included in the study. Twenty‐three patients were complete responders (16 had a complete clinical response, and 7 had a complete pathologic response). The PET/CT response evaluation at 12 weeks indicated that 18 patients had a complete response, and 81 patients had an incomplete response. There were 5 false‐negative and 10 false‐positive PET/CT results. PET/CT for the detection of residual cancer had 93% sensitivity, 53% specificity, a 73% negative predictive value, an 87% positive predictive value, and 85% accuracy. Clinical assessment alone resulted in an accuracy of 91%. PET/CT information may have detected misdiagnoses made by clinical assessment alone, improving overall accuracy to 96%.

CONCLUSIONS:

Assessment of tumor response at 12 weeks after CRT completion with PET/CT imaging may provide a useful additional tool with good overall accuracy for the selection of patients who may avoid unnecessary radical resection after achieving a complete clinical response. Cancer 2012;3501–3511. © 2011 American Cancer Society.