18 F-脱氧葡萄糖PET显像在原发灶不明转移癌中的应用

目的：探讨^18F-脱氧葡萄糖（FDG）正电子发射型体层摄影术（PET）全身显像在原发灶不明转移癌中的作用。方法：对29例原发灶不明转移癌患者行EDG PET全身显像，并与临床随诊、组织活检和手术病理结果对照。结果：29例原发灶不明转移癌患者，FDG PET发现可疑原发灶15例，其中13例为病理结果所证实，2例病理结果为阴性，FDG PET对原发灶的检出率为44．8％（13／29）。FDG PET全身显像另外检检出淋巴结转移和远地转移灶26个，CT和MRI只检出13个。14例FDG PET未确定原发灶者，经随访3－13个月,死亡率42．9％（6／14）。13例FDG PET确定原发灶者，经过有针对性的治疗，经随访2－13个月，死亡率为15．4％（2／13）。结论：FDG PET全身显像对原发灶不明转移癌原发灶的确定、临床分期、治疗方案的制定以及预后的改善均有一定的价值。     

双探头18F-FDG符合线路显像在不明原发转移癌中的临床价值

目的评价双探头^18F-FDG符合线路显像在探查不明原发转移癌（CUP）中的临床应用价值。方法对CUP患者40例进行^18F-FDG显像,以FDG浓聚程度作为异常判断标准探查可疑原发灶,并结合病理学、影像诊断方法及随访加以证实。结果双探头^18F-FDG符合线路显像对原发灶的检出率为30.0%（12/40）。结论双探头^18F-FDG符合线路显像是寻找CUP原发灶的一种有用方法。     

18F-FDG PET/CT全身显像在寻找肿瘤原发灶中的临床价值

目的：回顾性探讨了^18F-FDG PET/CT显像在寻找肿瘤原发灶中的临床价值。方法：对33例原发灶不明转移癌（CUP）患者行^18F-FDG PET/CT全身显像,通过视觉判断和SUV测定对原发灶和转移灶进行判断,并经随访观察、综合诊断证实。结果：33个病例中找到原发灶者25例（75.8%,25/33）,其中肺癌9例,肝癌2例,鼻咽癌2例,甲状腺癌2例,乳腺癌、食管癌、胃癌、胰腺癌、肠癌、肾癌、前列腺癌、脑胶质瘤、淋巴瘤和腹膜后肌母细胞瘤各1例。结论：^18F-FDG PET/CT全身显像能有效地发现CUP患者的原发灶,一次扫描能了解全身各脏器病灶分布情况,这对选择正确的治疗方案、评价患者预后有着重要的临床意义。     

1818F-FDG PET显像在胃肠道恶性肿瘤术后监测的应用价值

目的:探讨18F-双脱氧葡萄糖(FDG)PET显像探察胃肠道恶性肿瘤患者术后肿瘤复发和远处转移的应用价值。方法:40例胃肠道恶性肿瘤术后患者,其中食管癌8例,胃癌8例,结肠癌15例,直肠癌9例;进行18F-FDG显像。结果:18F-FDGPET显像诊断胃肠道恶性肿瘤术后复发和或转移的灵敏度93.8%、特异性87.5%、准确性92.5%;在18F-FDGPET显像真阳性30例中,4例为局部复发,9例为局部复发伴转移;17例为远处转移。在有复发的13例中,9例18F-FDGPET显像结果与X-CT结果一致,4例X-CT检查未见异常。在有转移的26例患者中,18F-FDGPET显像共捡出转移灶109处。结论:18F-FDGPET显像是检测胃肠道恶性肿瘤术后复发和转移的灵敏而有效的方法,值得推广应用。     

18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值

背景与目的:颈部淋巴结转移瘤在颈部恶性肿瘤中最常见,原发灶检出与否直接影响患者的生存期和生活质量.本研究旨在评估18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中的应用价值;另外,设定不同的PET/CT原发灶诊断标准,分别评价其阳性预测价值.方法:对93例病理学诊断为颈淋巴结转移瘤的患者行18F-FDG PET/CT显像,根据不同的PET/CT原发灶诊断标准寻找原发灶,即明确诊断、可疑诊断及未见原发灶征象;所有PET/CT诊断均与病理或其它影像检查相对照.结果:PET/CT明确诊断原发灶40例,均经病理或临床证实,阳性预测值100%;PET/CT可疑诊断28例,经病理证实为原发灶16例.其阳性预测值57.1%;2例患者经PET/CT提示为纵隔淋巴结转移但未见原发灶征象.最终临床诊断为原发纵隔型肺癌;2例患者PET/CT未见原发征象,经内窥镜检出原发灶;PET/CT原发灶检出率为60.2%(56/93).结论:18F-FDG PET/CT在寻找颈淋巴结转移瘤原发灶中有较大的临床价值.     

^18F-FDG PET、PET/CT显像在肝脏占位病变鉴别诊断中的价值

[目的]探讨18F-脱氧葡萄糖（18FDG）PET、PET/CT显像在肝占位病变诊断中的价值。[方法]回顾性分析111例肝占位患者临床资料及PET、PET/CT图像,PET图像计算靶/本比值（T/B）反映代谢活性,T/B〉1为PET诊断恶性标准。[结果]18FFDGPET、PET/CT的诊断灵敏度、特异性和准确率分别为67.0%、58.8%和65.8%。18F-FDGPET、PET/CT对于肝恶性病灶〈1.0cm均未检出,对肝细胞肝癌（HCC）的诊断准确率为54.0%。肿瘤大小、数量和分化程度影响PET对HCC诊断准确率。[结论]PET显像对肝占位性病变鉴别诊断能力差,不适合作为首选诊断方法,病史及其他影像学检查结果可能对提高PET、PET/CT诊断准确率有帮助。     

^18氟-脱氧葡萄糖正电子发射计算机断层显像寻找未知原发灶肿瘤原发灶的临床价值

目的研究”氟一脱氧葡萄糖正电子发射计算机断层显像（^18F－FDGPET－CT）在寻找原发灶不明转移癌（CUP）患者原发灶中的临床价值。方法回顾性分析为寻找原发灶而行^18F-FDGPET．CT扫描的CUP患者48例,其中男28例,女20例;年龄41-82岁,平均（57±16）岁。依据转移癌部位不同将患者分为颈部淋巴结转移组（28例）及非颈部淋巴结转移组（20例）,计算并比较^18F-FDGPET-CT诊断各组原发灶的灵敏度。结果^18F-FDGPET-CT寻找CUP患者原发病灶的灵敏度为66．7％（32／48）,寻找颈部淋巴结转移CUP患者的灵敏度为78．6％（22／28）,非颈部淋巴结转移CUP患者的灵敏度为50．0％（10／20）;^18F-FDGPET-CT诊断颈部淋巴结转移组CUP患者原发灶的灵敏度与非颈部淋巴结转移组相比,差异有统计学意义（x。4．286,P〈0．05）。结论^18F-FDGPET-CT诊断CUP患者原发灶灵敏度较高,尤其适用于颈部淋巴结转移的CUP患者。、     

18F-FDG PET-CT在肾癌诊断中的应用价值

目的评价~(18)F-FDG PET-CT在肾癌诊断中的应用价值。方法回顾性分析了2006年至2011年间27例其他影像学方法发现肾脏肿物患者的~(18)F-FDG PET-CT检查,并与手术/穿刺病理或长期随访结果进行对照。结果对于肾脏肿瘤,~(18)F-FDG PET-CT诊断良恶性的敏感性为60%,特异性为50%,准确率为59.3%。肾癌病灶的常规扫描与延迟扫描的SUV_(max)没有显著差异[(4.0±3.0)vs(4.6±4.4)]。FDG阳性肾癌病灶的最大径显著大于FDG阴性肾癌病灶[(5.6±2.0)cm vs(2.5±1.0)cm]。FDG阳性肾癌病灶的病理分级显著高于FDG阴性肾癌病灶[(3.1±0.8)vs(1.9±0.6)]。合并转移的肾癌原发病灶的SUV_(max)显著高于未合并转移的肾癌原发病灶[(7.7±3.7)vs(3.0±2.3)]。结论 ~(18)F-FDG PET-CT对鉴别肾脏肿物的良恶性作用有限。由于最大径越大、分化越差、存在转移的肾癌越容易被~(18)F-FDG PET-CT发现,因此对于肾脏肿物患者其仍是一项有意义的检查,可以作为常规影像学方法的有效补充。     

18F-FDG PET判断头颈部癌复发的作用

目的：探讨^18F-氟脱氧葡萄糖（^18F-fluoro-deoxyglucose,^18F-FDG）正电子发射断层显像术（positron emission tomography,PET）在头颈部癌复发诊断中的作用。方法：54例临床上怀疑复发的头颈部癌患者同期均行^18F-FDGPET显像（25例全身显像,29例局部显像）和CT或MR检查,最后诊断依靠病理检查或临床随访。结果：54例患者中^18F-FDGPET显像阳性39例,其中假阳性2例;阴性15例,其中假阴性3例。^18F-FDGPET显像和CT或MR的敏感性分别为92.5%（37/40）和55.0%（22/40）,差异有统计学意义,χ^2=14.528,P〈0.05;特异性分别为85.7%（12/14）和85.7%（12/14）,差异无统计学意义,χ^2=1.875,P=0.483;阳性预测值、阴性预测值分别为94.9%（37/39）、80.0%（12/15）和100.0%（22/22）、52.2%（12/23）;准确率分别为90.7%（49/54）和63.0%（34/54）,差异有统计学意义,χ^2=11.711,P=0.001。在25例18F-FDGPET全身显像中,16例除头颈^18F-FDG异常浓聚外,9例还发现有远处转移。结论：判断头颈部癌治疗后复发,^18F-FDGPET比CT或MR更敏感和有更高的准确性,并且在临床分期上有一定价值。     

Localised disease in cancer of unknown primary (CUP): The value of positron emission tomography (PET) for individual therapeutic management

Background:Two to four percent of cancer patients presentwith CUP syndrome. Median survival for localised disease is 20 and fordisseminated disease, seven months. For localised disease, curativetreatment is more likely and individual therapeutic strategies becomemore important. After conservative diagnostic procedures including MRI,the primary is detected in less than 25%. The diagnostic value ofPET and its influence on therapeutic strategies was evaluated. Patients and methods:Forty-two patients with localised CUPwere investigated from 5 of 98 to 10 of 2000. The presenting site waslymph node metastasis in 34 and visceral metastasis in 8 patients. Aftera median of 7 (3–11) diagnostic procedures without detection ofthe primary, but evidence of localised disease, PET was performed withfluorine-18-fluorodeoxyglucose. Results:In 26 of 42patients (62%), a primary was suggested by PET and confirmed in18 (43%). In 5 of 18 patients beyond localised disease,additional dissemination, not detected by previous diagnostic measures,was diagnosed by PET. Overall, dissemination was only detected only byPET in 16 of 42 patients (38%). In 29 of 42 patients(69%), the PET result influenced selection of the definitivetreatment. Conclusion:In CUP patients, PET has acertain impact on detection of the primary as well as of thedisseminated disease, and may also have a certain impact on therapeuticmanagement.     

The usefulness of F-18 FDG PET/CT-mammography for preoperative staging of breast cancer: comparison with conventional PET/CT and MR-mammography

Background

The objective of the study was to compare the diagnostic efficacy of an integrated Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT-mammography (mammo-PET/CT) with conventional torso PET/CT (supine-PET/CT) and MR-mammography for initial assessment of breast cancer patients.

Patients and methods

Forty women (52.0 ± 12.0 years) with breast cancer who underwent supine-PET/CT, mammo-PET/CT, and MR-mammography from April 2009 to August 2009 were enrolled in the study. We compared the size of the tumour, tumour to chest wall distance, tumour to skin distance, volume of axillary fossa, and number of meta-static axillary lymph nodes between supine-PET/CT and mammo-PET/CT. Next, we assessed the difference of focality of primary breast tumour and tumour size in mammo-PET/CT and MR-mammography. Histopathologic findings served as the standard of reference.

Results

In the comparison between supine-PET/CT and mammo-PET/CT, significant differences were found in the tumour size (supine-PET/CT: 1.3 ± 0.6 cm, mammo-PET/CT: 1.5 ± 0.6 cm, p < 0.001), tumour to thoracic wall distance (1.8 ± 0.9 cm, 2.2 ± 2.1 cm, p < 0.001), and tumour to skin distance (1.5 ± 0.8 cm, 2.1 ± 1.4 cm, p < 0.001). The volume of axillary fossa was significantly wider in mammo-PET/CT than supine-PET/CT (21.7 ± 8.7 cm³ vs. 23.4 ± 10.4 cm³, p = 0.03). Mammo-PET/CT provided more correct definition of the T-stage of the primary tumour than did supine-PET/CT (72.5% vs. 67.5%). No significant difference was found in the number of metastatic axillary lymph nodes. Compared with MR-mammography, mammo-PET/CT provided more correct classification of the focality of lesion than did MR-mammography (95% vs. 90%). In the T-stage, 72.5% of cases with mammo-PET/CT and 70% of cases with MR-mammography showed correspondence with pathologic results.

Conclusions

Mammo-PET/CT provided more correct definition of the T-stage and evaluation of axillary fossa may also be delineated more clearly than with supine-PET/CT. The initial assessment of mammo-PET/CT would be more useful than MR-mammography because the mammo-PET/CT indicates similar accuracy with MR-mammography for decision of T-stage of primary breast tumour and more correct than MR-mammography for defining focality of lesion.     

Carcinoma of unknown primary and paraneoplastic dermatomyositis

Dermatomyositis is known to be associated with neoplastic disorders, however the presentation of carcinoma of unknown primary as dermatomyositis is rare. We describe a case index of 50-year-old female who presented with enlarged inguinal lymph nodes accompanied with symmetric proximal muscle weakness and erythematous plaques. Conventional basic work-up did not reveal the diagnosis, however, positron emission tomography-computed tomography and re-staining of the pathology specimen suggested the ovaries as the primary site. Chemotherapy including carboplatin paclitaxel and bevacizumab led to complete response of disease and improvement in the dermatomyositis. The present case emphasizes the importance of a thorough directed evaluation for the underlying cancer in patients with carcinoma of unknown primary presenting as dermatomyositis. We further provide an up-to-date detailed review of published data describing these clinical entities.     

PICTORIAL ESSAY: Role of FDG PET/CT in imaging of renal lesions

Focal incidental renal lesions are commonly encountered on positron emission tomography (PET)/computed tomography (CT) imaging. The vast majority of these lesions are benign. However, the interpretation of renal lesions can be problematic if the imaging criteria of simple cysts are not met. Limited literature exists on the characterisation of renal masses with metabolic imaging. The purpose of this article is to focus on the imaging features of benign and malignant renal masses with PET/CT. The lesions discussed include renal cyst, angiomyolipoma, oncocytoma, renal cell carcinoma, renal metastases and other infiltrating neoplastic processes affecting the kidney. Both the anatomical and metabolic features which characterise these benign and malignant entities are described. We emphasise the importance of viewing the CT component to identify the typical morphological features and discuss how to best use hybrid imaging for management of renal lesions. Metabolic imaging has a promising role in the imaging of renal lesions and can help prevent unnecessary biopsies and ensure optimal management of suspicious lesions.     

FDG PET/CT在精确放疗中应用的初步研究

目的：研究FDG PET/CT在肿瘤病例中的成像特点和对精确放疗的影响.方法：2009年8月至2011年5月,72例肿瘤患者在放疗前接受GE Discovery PET/CT定位扫描.图像资料传至Varian Eclipse 8.6治疗计划系统.将FDG在各组织器官及肿瘤病灶中的聚积水平分为四个等级（＋-＋＋＋＋）,分析PET成像特点并探讨PET/CT图像融合对放疗的影响.结果：通常情况下,肿瘤病灶和正常脑组织、膀胱肾盏肾盂FDG聚积水平最高（＋＋＋＋）;肝脏、脾脏、椎体次之（＋＋＋）;大部分肌肉和胃肠道、胰腺FDG稍低（＋＋）;肺和皮肤最低（＋）.非肿瘤性FDG高聚积多见于左心室、咽喉周围、局部肠道内以及创伤或炎症病变等部位.PET/CT图像融合使肿瘤病灶更易被发现,因此约22％病例病灶数增加.此外,约62.5％放疗靶区受PET/CT融合图像影响发生了较明显改变.结论：FDG PET/CT在放疗的应用有利于复杂解剖部位肿瘤的边界确定及早期肿瘤病灶的发现和治疗,而非肿瘤性FDG高聚积是最主要的不良影响因素.     

兔VX2移植瘤PET—CT的显像研究

目的：研究兔VX2移植瘤的PET／CT显像及其应用前景。方法：48只日本大白兔种植VX2肿瘤,随机分为4组,分别于2、4、6和8周进行PET／CT显像,获得注射^18F-FDG后不同时间（20、40、60、80、100和120min）PET／CT图像,以及肿瘤组织和正常组织的SUV值。显像后处死大白兔,进行病理检查,观察肿瘤细胞的核分裂像及平均肿瘤微血管密度。结果：VX2移植瘤总成活率为80％;注射^18F-FDG后40～100min的SUV值与20和120min的SUV值相比,差异有统计学意义,P≤0．001。种植VX2肿瘤细胞后2、4、6和8周的肿瘤组织和正常组织的SUV值差异均有统计学意义,P均〈0．05。肿瘤大小的增殖、病理性核分裂像和平均肿瘤微血管密度与注射^18F-FDG后60min的SUV值密切相关。结论：PET／CT还可以清楚地显示肿瘤的解剖部位、形态、大小和肿瘤细胞的代谢状况,及时发现转移,是一项可靠和有价值的检查手段。     

Intra-individual comparison of 18F-FET and 18F-DOPA in PET imaging of recurrent brain tumors

Background

Both ¹⁸F-fluorodihydroxyphenylalanine (¹⁸F-DOPA) and ¹⁸F-fluoroethyltyrosine (¹⁸F-FET) have already been used successfully for imaging of brain tumors. The aim of this study was to evaluate differences between these 2 promising tracers to determine the consequences for imaging protocols and the interpretation of findings.

Methods

Forty minutes of dynamic PET imaging were performed on 2 consecutive days with both ¹⁸F-DOPA and ¹⁸F-FET in patients with recurrent low-grade astrocytoma (n = 8) or high-grade glioblastoma (n = 8). Time-activity-curves (TACs), standardized uptake values (SUVs) and compartment modeling of both tracers were analyzed, respectively.

Results

The TAC of DOPA-PET peaked at 8 minutes p.i. with SUV 5.23 in high-grade gliomas and 10 minutes p.i. with SUV 4.92 in low-grade gliomas. FET-PET peaked at 9 minutes p.i. with SUV 3.17 in high-grade gliomas and 40 minutes p.i. with SUV 3.24 in low-grade gliomas. Neglecting the specific uptake of DOPA into the striatum, the tumor-to-brain and tumor-to-blood ratios were higher for DOPA-PET. Kinetic modeling demonstrated a high flow constant k1 (mL/ccm/min), representing cellular internalization through AS-transporters, for DOPA in both high-grade (k1 = 0.59) and low-grade (k1 = 0.55) tumors, while lower absolute values and a relevant dependency from tumor-grading (high-grade k1 = 0.43; low-grade k1 = 0.33) were observed with FET.

Conclusions

DOPA-PET demonstrates superior contrast ratios for lesions outside the striatum, but SUVs do not correlate with grading. FET-PET can provide additional information on tumor grading and benefits from lower striatal uptake but presents lower contrast ratios and requires prolonged imaging if histology is not available in advance due to a more variable time-to-peak.     

淋巴瘤单发骨病变的18F－FDGPET／CT影像学分析

目的：研究原发性骨淋巴瘤与单发继发性淋巴瘤骨髓浸润的18 F －FDG PET／CT 影像学表现,探讨18 F－FDG PET／CT 对原发性骨淋巴瘤的诊断及鉴别诊断价值。方法：回顾性分析经病理证实的25例单发骨淋巴瘤的18 F －FDG PET／CT 影像学资料。结果：25例骨淋巴瘤均为单发,其中14例位于脊柱骨,10例位于附肢骨,1例位于肋骨。15例为原发性骨淋巴瘤,10例为继发性淋巴瘤骨髓浸润。原发性骨淋巴瘤15例中非霍奇金淋巴瘤11例,霍奇金淋巴瘤4例;继发性淋巴瘤骨髓浸润10例中非霍奇金淋巴瘤7例,霍奇金淋巴瘤3例。25例骨淋巴瘤中23例 CT 表现为骨质密度异常改变,2例病变骨质密度未见明显异常改变。病变 FDG摄取不同程度增高,SUVmax范围为2．6～24．5。原发性骨淋巴瘤及继发性淋巴瘤骨髓浸润病变 SUVmax经 Mann－Whitney U 检验提示原发性骨淋巴瘤与继发性淋巴瘤骨髓浸润病变 SUVmax有差异（P ＝0．007）。结论：原发性骨淋巴瘤18 F －FDG PET／CT 影像学表现有一定的特征性,分析其表现对原发性和继发性骨淋巴瘤的诊断及鉴别诊断有一定的临床价值。     

Role of F-18 FDG PET/CT imaging in the diagnosis of paraneoplastic neurological syndromes

Paraneoplastic neurological syndromes （PNS） is a series of rare neurologic disorders which happen with an underlying malignancy. It has various clinical symptoms proceding to the diagnosis of tumors. Although the abnormality of anti-neuronal antibodies is suggestive of PNS and tumors, there exist many false positive and false negative cases. The diagnosis of PNS is usually a challenge in clinic. Positron emission tomography/computed tomography （PET/CT） imaging is an anatomical and functional fusion imaging method, which provides the whole-body information by single scan. Fluorodeoxy- glucose （FDG） PET/CT imaging can not only detect potential malignant lesions in the whole body, but also assess functional abnormality in the brain. In this review, the mechanism, clinical manifestation, diagnostic procedure and the recent progress of the utility of FDG PET/CT in PNS are introduced respectively.