18F-FDG PET-CT在食管癌放射治疗靶区勾画中的应用进展

放射治疗是食管癌的重要治疗方法,而精准的靶区勾画是决定放射治疗疗效的前提和基础,靶区勾画是以CT为基础的多种影像学信息资料,本文将对正电子发射断层显像(PET-CT)分子功能影像在食管癌及其转移淋巴结的靶区勾画中的应用进行综述,以充分发挥PET-CT在食管癌原发病灶及淋巴结转移靶区勾画方面的重要作用。     

FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes.

PURPOSE: The diagnostic role of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) in squamous cell carcinoma of the oral cavity is evaluated. PROCEDURES: In 38 patients, the results of FDG-PET, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were compared. The standard uptake values (SUV) of FDG-PET were correlated to histopathological grading and DNA-image cytometry. RESULTS: In the case of lymph node metastases, the sensitivity of FDG-PET (93%) was higher than the sensitivity for the compared methods. The specificity was best for CT. SUVs of diploid tumor cell lines seemed to be lower than in non-diploid tumor cell lines. CONCLUSIONS: The high sensitivity and the high negative predictive value of PET may lead to more restrictive therapeutic regimens regarding lymph node metastases. Studies are necessary regarding possible relationships between glucose metabolism and tumor grading.     

Metastatic Squamous Cell Carcinoma Presenting as Diffuse and Punctate Cervical Lymph Node Calcifications

Objective. The purpose of this series was to show the sonographic appearance of calcified cervical lymph nodes and the utility of sonographically guided fine-needle aspiration biopsy (FNAB) in the setting of metastatic squamous cell carcinoma (SCC). Methods. Two cases of confirmed metastatic SCC to cervical lymph nodes were identified. Sonography and sonographically guided FNAB were performed in both cases with positron emission tomography (PET)/computed tomography (CT) correlation. Results. In case 1, sonography identified a diffusely calcified, avascular cervical lymph node. Positron emission tomography/CT suggested granulomatous disease as a cause for hypermetabolism; however, sonographically guided FNAB identified metastatic SCC. In the second case, FNAB initially performed without sonographic guidance did not show malignancy. Subsequent FNAB with sonographic guidance identified an abnormal cervical lymph node with focal calcifications and internal color Doppler flow. Metastatic SCC was diagnosed on histopathologic examination. Subsequent PET/CT confirmed multiple punctate calcifications in a hypermetabolic lymph node. Conclusions. Calcifications in cervical lymph nodes from metastatic SCC are very rare. These 2 cases show the variable sonographic appearances and the utility of sonographically guided FNAB in establishing the correct diagnosis.     

18氟-脱氧葡萄糖PET/CT对原发灶不明的骨转移瘤的诊断作用

目的 探讨18氟-脱氧葡萄糖PET/CT在原发灶不明的骨转移瘤（BMUPT）患者中的应用价值,并总结BMUPT患者PET/CT图像特征。 方法 回顾性分析本院PET/CT中心检查的49例原发灶不明的骨转移瘤患者的影像资料,记录其原发灶部位、淋巴结转移、远处脏器转移、骨转移部位及骨转移性质,同时测定各骨转移灶最大标准化摄取值（SUV_max）,对不同骨转移性质及部位的SUV_max做统计学分析。 结果 PET/CT检查共正确检出48例原发灶, 有1例未正确检出,新发现42例合并淋巴结转移,26例合并器官转移。49例患者中成骨性转移9例,溶骨性转移33例,混合性转移7例。各部位骨转移发生率依次为:脊柱91.8%、骨盆85.7%、胸部77.5%、四肢57.1%、颅骨24.4%。溶骨性转移SUV_max大于成骨性转移（t=3.55,P<0.05）。成骨性转移、溶骨性转移各部位之间SUV_max差异均无统计学意义（P>0.05）。 结论 PET/CT在BMUPT的原发灶寻找中具有很高的准确性,且能发现新的淋巴结及远处转移灶,可以BMUPT患者病情评估及综合治疗提供更全面的价值。       

US和CT对甲状腺癌定性和淋巴结转移的比较

目的：评价超声（US）和CT检查对甲状腺癌的诊断价值。方法：我们回顾性分析42例甲状腺癌的US和CT表现。42例均行US和CT检查，CT都用对比增强扫描和多平面重建（MPR）来鉴别原发性肿瘤和颈部转移淋巴结。结果：US和CT诊断结果与病理结果进行对比分析。US诊断甲状腺癌的符合率为64．3％，CT为83．3％。对于颈部淋巴结转移诊断US的符合率为75．0％，CT为50．0％。结论：CT对甲状腺癌定性诊断正确率高于US检查，但是US对于怀疑颈部淋巴结转移的晚期病人评价要优于CT。US和CT结合可以提高诊断甲状腺癌的准确性。     

Laparoscopic pelvic lymph node dissection for malignant foot melanoma

A 39 year‐old woman with malignant foot melanoma underwent wide excision of the primary tumor with a safety margin and sentinel lymph node biopsy (SLNB) for the right inguinal lymph node. SLNB was positive and a computed tomography (CT) scan revealed right iliac lymph node swelling. Positron emission tomography computed tomography (PET–CT) scan of the lymph nodes revealed abnormal uptake of fluorodeoxyglucose (FDG). We performed a laparoscopic pelvic lymph node obturator, iliac lymph node) dissection. During the operation, several black lymph nodes were observed in the iliac lymph node. Pathologically, the iliac lymph node consisted of metastasized atypical melanocytes. This surgical method for pelvic lymph node dissection is not a standard procedure among institutions. There have been no reported cases of malignant melanoma with pelvic lymph node metastasis treated by laparoscopic surgery. However, due to the minimally invasive technique, this method is worth considering to be used for pelvic lymph node dissection in malignant melanoma as well as other cancers in the field of urology or gynecology.     

Isolated perfusion of extremities for metastatic melanoma from an unknown primary lesion

Since 1957, 822 patients with invasive malignant melanoma of the limbs were treated by regional perfusion at the Tulane Medical Center. Between 1958 and 1982, there were 32 patients with regional metastatic melanoma from an unknown primary site involving either the upper limb and axillary lymph nodes or lower limb and femoral or inguinal lymph nodes. This group represents 3.5% of patients with regional melanomas treated during this period. There were 16 patients with upper limb regional metastases and 14 patients with lower limb metastases. Sixteen patients had stage IIIB disease (ie, regional lymph node metastases), ten had stage IIIA disease (ie, satellitosis), and four had stage IIIAB disease. Six patients had a history of a suggestive limb lesion that had completely regressed and showed no residual tumor on biopsy. All 30 patients were treated by regional isolated perfusion and regional lymph node dissection, with surgical excision of in-transit disease when possible. The cumulative five-year survival for all patients is 50%. Interestingly, the patients with a history of a lesion that regressed had 85% cumulative five-year survival, and the patients with stage IIIB disease did almost as well, with 62% surviving for five years.     

Patlak联合不可逆两组织隔室模型动态18F-FDG PET/CT诊断肺原发肿瘤胸部高代谢转移性淋巴结

目的 观察Patlak联合不可逆两组织隔室模型（2TC-3k）动态¹⁸F-FDG PET/CT诊断肺原发肿瘤胸部高代谢转移性淋巴结的价值。方法 前瞻性纳入16例CT显示胸部存在可疑淋巴结转移且拟接受PET/CT检查的肺原发肿瘤患者,行胸部动态和全身静态¹⁸F-FDG PET/CT扫描;计算全身静态PET/CT图像中原发肿瘤及胸部高代谢淋巴结的最大标准摄取值（SUV_max）及平均标准摄取值（SUV_mean）,纳入淋巴结SUV_max>2.5者。采用Patlak图形分析和2TC-3k分析原发肿瘤和高代谢淋巴结动态数据,获取动力学参数的一阶特征参数,建立logistic模型;以病理学为金标准,分析模型诊断胸部高代谢淋巴结转移的效能。结果 共纳入11例患者、32枚胸部高代谢淋巴结,病理学示15枚为转移性、17枚非转移性。Ki_Kurtosis诊断胸部转移性高代谢淋巴结的曲线下面积（AUC）为0.81,以71 590.45为Ki_Kurtosis的截断值,其敏感度为70.60%,特异度为86.70%;V_B_Entropy的AUC为0.79,以6.16×10^－4为V_B_Entropy的截断值,其敏感度为80.00%,特异度为82.40%。肺原发肿瘤与胸部高代谢转移性淋巴结V_B_Kurtosis （r=0.67,P<0.05）和Ki_UPP （r=0.69,P<0.05）呈正相关。Patlak动态PET/CT模型诊断胸部转移性高代谢淋巴结的AUC为0.85[95%CI（0.71,0.99）],敏感度为76.50%,特异度为93.30%;2TC-3k动态PET/CT模型的AUC为0.87[95%CI（0.74,0.99）],敏感度为82.40%,特异度为80.00%;二者联合模型的AUC为0.91[95%CI（0.80,1.00）],敏感度为94.10%,特异度为80.00%;3个模型AUC两两比较差异均无统计学意义（P均>0.05）。结论 Patlak结合2TC-3k动态¹⁸F-FDG PET/CT对诊断肺原发肿瘤胸部高代谢转移性淋巴结具有一定价值。     

18F-FDG PET/CT在原发灶不明的淋巴结转移癌中的应用价值

目的 探讨¹⁸F-FDG PET/CT全身显像对诊断原发灶不明的淋巴结转移癌(LCUP)的临床价值。方法 回顾性分析以活检证实淋巴结转移为首发症状的34例LCUP患者资料,常规检查均未找到原发灶。对全部患者行¹⁸F-FDG PET/CT全身显像,与临床随访及组织病理学结果进行比较。结果 3例淋巴瘤患者被排除,¹⁸F-FDG PET/CT检出可疑原发灶25例,正确检测出原发灶13例,检出率为41.94%(13/31);其中8例经病理证实,5例为临床诊断,阳性预测值为52.00%(13/25)。未找到原发灶的6例患者中,3例经随访尚未明确诊断。结论 ¹⁸F-FDG PET/CT全身显像在寻找LCUP的原发灶中具有重要临床价值。     

Complementary role of positron emission tomography in merkel cell carcinoma

Merkel cell carcinoma is a rare type of neuroendocrine tumor of the skin with approximately 470 documented new cases annually in the United States. These tumors have high metastatic and recurrence rates, making them aggressive and difficult to treat. Diagnostic workup usually includes computed tomography, magnetic resonance imaging, and scintigraphy methods such as octreotide scans. More recently, positron emission tomographic scanning has been used to evaluate Merkel cell carcinomas. A case of Merkel cell carcinoma, in which positron emission tomography imaging with fluorodeoxyglucose played an important role in staging, re-staging, and identifying previously unknown distant metastatic disease, is presented in this article.     

胃癌淋巴结大小与转移的探讨

目的　本文通过胃癌淋巴结病理与CT对照 ,讨论根据淋巴结大小 (以 >10mm为标准 )判断淋巴结转移的可靠性。方法　 2 4例胃癌切除和D1或D2 淋巴结清除以及术前CT检查 ,分别记录淋巴结直径大小、数量和转移阳性率。结果　 2 4例胃癌手术摘取淋巴结 3 95个 ,病理证实 12 3个 (3 1% )淋巴结转移阳性。10mm以下的淋巴结占 76% ,其中 5 6%的淋巴结转移阳性 ,1～ 5mm和 6～ 9mm淋巴结转移率分别为 8%和 46% ;10mm或以上淋巴结转移阳性率分别为 5 4%和 68%。CT检出淋巴结 174个 ,病理证实 71个 (4 1% )淋巴结转移阳性。小于 10mm淋巴结占 3 8% ,1～ 5mm和 6～ 9mm淋巴结转移率分别为 17%和 3 1% ;10mm以上淋巴结转移阳性 5 0 %～ 76%。结论　胃癌小淋巴结转移率也较高 ,CT影像单纯依据淋巴结大小判断淋巴结转移是不可靠的。     

Clinical application of 18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography/computed tomography in breast cancer

Positron emission tomography (PET)/computed tomography (CT) is not suited for primary diagnostics of breast tumours and it cannot replace sentinel lymph node technique in determining metastases to the axilla. PET/CT has a high sensitivity and specificity regarding the detection of loco‐regional recurrence and metastases to mediastinal and internal mammary lymph nodes, as well as distant metastases. Whether the method can replace conventional methods, or be a supplement when this is non‐conclusive, remains unresolved. PET/CT cannot be recommended for routine follow‐up but is recommended in patients with suspected relapse when conventional imaging has given equivocal results. PET/CT can be applied to confirm isolated loco‐regional relapse or metastatic lesion detected by conventional imaging. PET/CT has a high sensitivity for detecting response to treatment, but a low specificity calls for cautions. Further investigations into the use of PET/CT to predict and monitor response are warranted, before this approach may find its way into a clinical setting. In the future, PET/CT will probably find increasing use in treatment planning and evaluation of patients with breast cancer.     

Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma

A comparison of transrectal ultrasound (TRUS) and computed tomography (CT) for staging of rectal carcinoma was performed. Thirty-two patients were examined by TRUS and 30 by CT. The results of these preoperative examinations were compared with postoperative histopathological findings. TRUS had an accuracy of 81% and it predicted perirectal tumor growth with a sensitivity of 90% and a specificity of 67%, whereas the corresponding figures for CT were 52%, 67%, and 27%. These findings indicate that TRUS is more efficient than CT in staging local tumor growth in rectal cancer. Neither technique, however, can reliably identify lymph node metastases, since no correlation was found between lymph node size as observed on CT and TRUS and tumor involvement as evaluated histopathologically.     

临床病理在颈淋巴结转移性癌原发病灶诊断中的价值——附36例报告

目的探讨临床病理在原发灶不明淋巴结转移癌原发部位诊断中的价值。方法分析本院36例初诊为颈淋巴结“原发灶不明”转移癌诊断过程中,病理形态学结合免疫酶标对指示可能原发部位的作用和准确性。结果36例中,病理明确指出原发部位或高度可能部位者7例,其中,甲状腺髓样癌4例,前列腺癌2例,卵巢癌1例;病理指示可能原发部位,而最终确诊的原发灶与之相符者26例,其中病理提示第一部位者17例;另有3例,病理未能正确指示原发部位。结论病理形态学结合免疫酶标能较准确地指示肿瘤可能的原发部位,从而为临床对转移癌原发病灶的寻找提供帮助。结合临床、放射、病理及其它影像学诊断,建立颈淋巴结转移癌原发部位临床诊断模式是可行的。     

^18F—FDG PET—CT显像在肾癌原发灶及转移灶诊断中的价值

[目的]探讨18F-FDG PET-CT显像在肾癌原发灶及转移病灶诊断中的价值.[方法]回顾性分析35例临床诊断为肾癌患者的全身18F-FDG PET-CT及病理结果,比较PET-CT与增强CT两者对肾癌及转移病灶的诊断价值.[结果]35例中,经原发灶手术病理证实为肾癌30例.其余5例因18F-FDG PET-CT显像发现远处转移未行原发灶手术治疗,仅取转移部位病检确诊,分别行DSA肿瘤栓塞术、免疫治疗及靶向药物治疗.18F-FDG PET-CT检查阳性29例,敏感度82.9% ,CT平扫加增强检查阳性33例,敏感度94.3%,转移病灶共16处, 腹膜后淋巴结转移3处,肺转移3处,肾静脉癌栓形成1处,骨转移2处,肝转移1处,肾上腺、右侧锁骨上淋巴结、纵隔淋巴结、双肺门淋巴结转移1处,右侧胸壁转移1处,软组织转移1处,而CT平扫加增强仅发现1处下腔静脉癌栓形成,1处肝转移.[结论]18F-FDG PET-CT对诊断原发性肾癌的敏感性不如CT,但对远处转移的诊断优于CT,对肾癌的分期及治疗方案的选择有重要意义.     

检测盆腔淋巴结HPV-DNA预测病理诊断淋巴结阴性宫颈癌的复发

目的探讨检测盆腔淋巴结的人乳头状瘤病毒DNA,以预测病理诊断淋巴结阴性宫颈癌的复发。方法对8例术后病理诊断淋巴结转移阳性患者的原发病灶和淋巴结转移病灶的石蜡包埋标本进行荧光定量PCR检测HPV-DNA,作为阳性对照。对20例病理诊断盆腔淋巴结转移阴性而临床上出现复发的患者进行荧光定量PCR检测其原发病灶和盆腔淋巴结石蜡包埋标本中的HPV-DNA。随机选择20例病理诊断无淋巴结转移临床上也无复发的患者,进行上述同样的原发灶和盆腔淋巴结的HPV-DNA检测。结果在8例病理诊断盆腔淋巴结转移阳性病灶中,均检测出与原发病灶型别完全相一致的HPV-DNA。在20例病理诊断无盆腔淋巴结转移而临床上复发的患者中,18例检测出与原发病灶型别完全相一致的HPV-DNA,占90％。在20例病理上无盆腔淋巴结转移、临床上也无复发者中,除了1个盆腔淋巴结检测出HPV—DNA外,其余19例均未检测出任何的HPV-DNA。结论在病理诊断盆腔淋巴结转移阴性的宫颈癌患者中,盆腔淋巴结HPV-DNA阳性提示可能存在早期微小淋巴结转移或同时存在不能发现的血性转移,因此,盆腔淋巴结HPV-DNA的检测结果可以作为一项诊断指标,以预测这部分宫颈癌患者的术后复发。     

18-F fluorodeoxyglucose positron emission tomography/computed tomography findings of bilateral primary fallopian tube carcinoma and metastasis to the uterus: a case report and literature review

Existing literature on primary carcinoma of the fallopian tube is limited because of the rarity of this disease. We report a patient with intermittent vaginal bleeding and vaginal discharge who underwent transvaginal ultrasound, magnetic resonance imaging, and 18-F-fluorodeoxyglucose positron emission tomography/computed tomography (18-F FDG PET/CT) in our hospital. Ultrasound showed a bilateral fallopian tube mass and a uterine lesion. Magnetic resonance imaging revealed typical sausage-shaped bilateral adnexal masses, but overlooked a small lesion in the uterus in the initial diagnosis. FDG PET/CT findings not only showed bilateral fallopian tube masses and uterine lesions, but also ruled out distant metastasis. Postoperative pathology confirmed bilateral primary high-grade serous adenocarcinoma of the fallopian tube with implants in the uterus. These findings suggest that 18-F FDG PET/CT imaging could be a good approach for the diagnosis and staging of primary carcinoma of the fallopian tube.     

Relative clinical utility of simultaneous 18F-fluorodeoxyglucose PET/MRI and PET/CT for preoperative cervical cancer diagnosis

ObjectiveTo investigate the utility of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) for the preoperative diagnosis of cervical cancer.MethodsWe retrospectively analyzed 114 patients who were diagnosed with cervical cancer and underwent PET/MRI (n = 59) or PET/computed tomography (PET/CT) (n = 65) before surgery. The maximal standardized uptake value (SUV_max) and mean SUV (SUV_mean) were determined for regions of interest in the resultant radiographic images.ResultsRelative to PET/CT, ¹⁸F-FDG PET/MRI exhibited higher specificity and sensitivity in defining the primary tumor bounds and higher sensitivity for detection of bladder involvement. The SUV_max and SUV_mean of PET/MRI were remarkably higher than those of PET/CT as a means of detecting primary tumors, bladder involvement, and the lymph node status. However, no significant differences in these values were detected when comparing the two imaging approaches as a means of detecting vaginal involvement or para-aortic lymph node metastasis.ConclusionsThese outcomes may demonstrate the capability of ¹⁸F-FDG PET/MRI to clarify preoperative cervical cancer diagnoses in the context of unclear PET/CT findings. However, studies directly comparing SUVs in different lesion types from patients who have undergone both PET/MRI and PET/CT scans are essential to validate and expand upon these findings.     

Imaging of the lymphatic system: new horizons

The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast‐enhanced MRI (DCE‐MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra‐lymphatic imaging methods have been developed. Direct lymphangiography is an all‐but‐extinct method of visualizing the lymphatic drainage from an extremity using oil‐based iodine contrast agents. More recently, interstitially injected intra‐lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide‐based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi‐modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy. Published in 2006 by John Wiley & Sons, Ltd.     

Primary hepatic follicular dendritic cell sarcoma: A case report

BACKGROUND Follicular dendritic cell sarcoma(FDCS) is an uncommon type of tumor with low incidence. To date,no standard treatment for the disease has been established.Surgery remains the main treatment. Adjuvant chemotherapy and radiotherapy are optional approaches. Metastatic cases require multidisciplinary collaborative treatments. However,the choice of chemotherapeutic drugs is controversial.CASE SUMMARY A 66-year-old Chinese woman presented to our hospital complaining of intermittent pain of right upper quadrant. An enhanced computed tomography(CT) scan of the abdomen revealed hepatocellular carcinoma. Subsequently,the patient underwent a radical partial hepatectomy. Primary FDCS of the liver was diagnosed pathologically. Except for regular follow-up examinations,the patient did not receive adjuvant chemotherapy or radiotherapy. However,fluorine-18-fluorodeoxyglucose positron emission tomography/CT(PET/CT) confirmed lymph node metastases in the space of ligamentum hepatogastricum and pancreatic head,as well as the portacaval space. The patient was given systemic chemotherapy with gemcitabine and docetaxel for she was unsuitable for surgery. Satisfactorily,the metastatic lymph nodes were significantly reduced to clinical complete remission after eight cycles of chemotherapy. Then,strengthened radiotherapy was followed when the patient rejected the opportunity of surgery. Eventually,the carcinoma got better control and the patient was free of progression.CONCLUSION This case highlights the importance of making suitable chemotherapy regimens for the rare tumor. The combination of gemcitabine,docetaxel,and consolidated radiotherapy may offer a new promising option for the treatment of metastatic hepatic FDCS in the future.