PET/CT与钼靶X线鉴别乳腺癌的比较研究

目的评价PET/CT诊断乳腺癌的真实性,初步探讨其临床意义。方法33例乳房肿块患者行钼靶X线和PET/CT检查,分别采用半定量和定性方法分析肿瘤病灶摄取氟脱氧葡萄糖(FDG)的程度和血流灌注情况,比较PET/CT和钼靶X线诊断乳腺癌的差异。结果PET/CT诊断乳腺癌的敏感度、特异度和精确度分别为92.6%,100%和93.9%;钼靶X线的敏感度、特异度、精确度分别为81.5%,80.0%和78.8%;但两种方法的诊断效能无显著性差异(P>0.05)。结论PET/CT诊断乳腺癌的敏感度、特异度和阳性预测值较高,并可提供更多方面的活体诊断信息,为治疗策略提供参考,弥补了钼靶X线之不足。     

PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价

目的：评价PET／CT诊断乳腺癌和腋窝淋巴结转移的临床价值。方法：对33例疑似乳腺癌病人进行PET／CT检查，定性分析肿瘤病灶、淋巴结摄取氟脱氧葡萄糖（FDG）的程度，半定量测量标准摄取值（SUV），根据乳腺和淋巴结的FDG摄取强度诊断乳腺癌和淋巴结转移，检验SUV与乳腺癌分化程度、有丝分裂计数的关联性。结果：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度和精确度分别为92．6％、100％、93．9％和82．3％、90％、85．2％；SUV与乳腺癌分化程度、有丝分裂计数显著相关（P〈0．05）；诊断乳腺癌的Kappa指数=0．835，μ=8．48，（P〈0．01）。结论：PET／CT诊断乳腺癌和腋窝淋巴结转移的敏感度、特异度较高，作为一种非侵袭性检查方法，可提供乳腺癌在活体内的多方面生物学信息，为选择合理的手术方式及新辅助化疗提供参考，弥补传统检查方法的不足。     

磁共振成像与多层螺旋CT检查用于成人外伤性膝关节损伤诊断研究

目的 探讨磁共振成像与多层螺旋CT检查用于成人外伤性膝关节损伤诊断临床价值差异，旨在为膝关节损伤影像学辅助诊断方法选择提供更多参考。方法 回顾性纳入本院2020年1月至2022年12月共收治可疑外伤性膝关节损伤成人患者90例，均行磁共振成像和多层螺旋CT检查，并以关节镜作为金标准，分析外伤性膝关节损伤检查结果，比较两组诊断效能指标及损伤类型诊断准确率。结果90例患者经关节镜检查显示确诊膝关节损伤78例，多层螺旋CT检查提示膝关节损伤60例，磁共振检查提示膝关节损伤75例。多层螺旋CT检查用于外伤性膝关节损伤诊断敏感度、特异度及总准确度分别为70.51%(55/78),53.33%(7/12),68.89%(62/90)；磁共振检查用于外伤性膝关节损伤诊断敏感度、特异度及总准确度分别为93.59%(73/78),83.33%(10/12),92.22%(83/90)。磁共振组用于外伤性膝关节损伤诊断总准确度和敏感度显著高于多层螺旋CT组（P<0.05）。多层螺旋CT组和磁共振组用于外伤性膝关节损伤诊断特异度比较差异无统计学意义（P>0.05）。多层螺旋CT检查用于外伤性膝关节...     

对比基于PET/CT的不同方法定性诊断孤立性肺结节的效能

目的对比观察基于PET/CT的不同方法定性诊断孤立性肺结节(SPN)的效能。方法收集161接受PET/CT检查的SPN患者,比较良恶性SPN患者间临床表现、高分辨率CT(HRCT)征象及SUV max值的差异;通过二元Logistic回归构建SPN的数学诊断模型,比较诊断模型、PET/CT及HRCT的诊断效能。结果161例SPN中,经病理诊断恶性131例,良性30例。PET/CT诊断恶性SPN的灵敏度、特异度及准确率分别为98.47%(129/131)、76.67%(23/30)及94.41%(152/161),HRCT分别为59.54%(78/131)、83.33%(25/30)及63.98%(103/161)。经单因素及多因素分析后,将SUV max、年龄、钙化及气管血管集束纳入回归方程并建立模型,模型诊断恶性SPN的敏感度、特异度及准确率分别为82.44%(108/131)、86.67%(26/30)及83.23%(134/161)。ROC曲线结果显示,模型、PET/CT及HRCT诊断恶性SPN的AUC分别为0.909、0.876及0.714,PET/CT及模型的AUC均高于HRCT(P均<0.001),模型与PET/CT差异无统计学意义(P=0.468)。结论基于PET/CT的Logistic回归模型及PET/CT定性诊断SPN的效能优于HRCT,且特异度高于PET/CT。     

MSCT间接血管成像诊断髂静脉受压综合征

目的探讨MSCT间接血管成像诊断髂静脉受压综合征(IVCS)的价值。方法对25例临床疑诊IVCS患者行髂静脉MSCT间接血管成像,测量左髂总静脉受压处前后内径,计算受压程度,≥50%诊断为IVCS;以DSA作为金标准,计算MSCT间接血管成像诊断IVCS的敏感度、特异度及准确率。结果 MSCT间接血管成像中,25例髂静脉均显示清晰。MSCT间接血管成像诊断IVCS的敏感度为90.91%(20/22),特异度为100%(3/3),准确率为92.00%(23/25)。经DSA确诊的22例IVCS中,MSCT间接血管成像显示7例(7/22,31.82%)左髂总静脉受压程度70%,13例(13/22,59.09%)50%~70%,2例(2/22,9.09%)50%。结论髂静脉MSCT间接血管成像可准确评价髂静脉受压程度,诊断IVCS敏感度和特异度较高,具有重要的临床意义。     

超声弹性成像对乳腺癌患者腋窝淋巴结良恶性诊断的Meta分析

目的采用Meta分析评价超声弹性成像在乳腺癌患者腋窝淋巴结良恶性鉴别诊断中的临床价值。方法检索PubMed、the Cochrane Library、万方数据库、中国知网(CNKI)、Embase数据库,收集采用超声弹性成像技术诊断乳腺癌患者腋窝淋巴结的临床研究。对符合纳入标准的文献进行质量评价和异质性检测。计算合并敏感度、特异度、诊断比值比,绘制合并受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。结果共纳入10篇文献,其中英文3篇,中文7篇。合并敏感度、特异度、诊断比值比及其95%可信区间分别为0.84(0.80,0.87)、0.79(0.74,0.83)、18.71(13.11,26.70)。SROC曲线的AUC为0.88。结论超声弹性成像对乳腺癌患者腋窝淋巴结良恶性诊断效能高。     

门诊应用CT引导下经皮肺穿刺活检术的安全性

目的评价CT引导下经皮肺穿刺活检术的价值及其应用于门诊患者的安全性。方法回顾性分析CT引导下经皮肺部切割针穿刺活检的门诊患者782例。穿刺后即刻CT复查,患者留院观察1h后无症状者出院。计算诊断准确率、敏感度、特异度和并发症发生率。结果 782例全部穿刺成功。诊断准确率、敏感度、特异度分别为95.65%、94.54%、100%。气胸、咯血发生率分别为19.31%（151/782）和6.52%（51/782）。6例（6/782,0.77%）患者穿刺后需入院治疗,其中2例接受胸腔闭式引流,2例出现血胸,另2例离院后出现呼吸困难再次入院治疗。结论 CT引导下经皮肺穿刺活检术是一种安全有效的检查手段,可安全应用于门诊患者。     

简易乳腺磁共振序列筛选乳腺癌临床可行性研究

目的 探讨乳腺磁共振简易序列（BMRI-AP）筛选乳腺癌的临床可行性。方法 收集2010年5月至2014年12月北京大学人民医院214例经钼靶或超声怀疑乳腺单发结节的女性病人行BMRI检查。以术后病理学检查为金标准,比较BMRI-AP和全扫描序列（BMRI-FDP）筛选乳腺癌的敏感度、特异度、阳性预测值及阴性预测值。结果 BMRI-AP及BMRI-FDP检查及阅读时间分别为5 min,45s及25min,1200s,均检出全部119例乳腺癌。BMRI-AP诊断乳腺癌敏感度（97.5%）及阴性预测值（95.9%）高于BMRI-FDPF （95.8%和94.0%）,但差异无统计学意义（P=0.72和P=0.72）。尽管BMRI-AP诊断乳腺癌特异度（73.7%）和阳性预测值（82.3%）低于BMRI-FDP（82.1%和87.0%）,但同样差异无统计学意义（P=0.22和P=0.32）。结论 BMRI-AP与BMRI-FDP相比,诊断乳腺癌的敏感度及特异度相似,但检查和阅片时间却显著缩短。BMRI-AP是临床可行筛选乳腺癌的影像学方法。     

超声造影监测原发性肝癌射频消融术的疗效

目的 观察对比剂超声造影（contrast-enhanced ultrasound,CEUS）成像技术对原发性肝癌的诊断价值,以及对肝癌射频消融术治疗效果的评价.方法 适合行射频消融治疗的46例原发性肝癌患者,观察射频消融术前普通超声、CT与CEUS的差别;同时以CT作为标准,对比射频消融术后行CEUS的价值.结果 CEUS与CT检查对原发性肝癌术前诊断价值基本相同,两者的阳性似然比分别为1.26和1.31,敏感度、特异度分别为97%、91%和23%、31%,而灰阶超声检查诊断原发性肝癌的阳性似然比为0.99,敏感度、特异度分别为76%和23%与前两者相比较稍差.射频消融术后CEUS对残存病灶诊断的敏感度和特异度分别为60%和90%,阳性似然比6.18,阴性似然比为0.44,与CT相比差异有统计学意义（P=0.012）.所有患者随访1～9个月,平均5个月,目前均存活;术后1个月射频消融灶周围肿瘤残留3例（6.5%）;术后3、6、9个月复发率分别为8.7%（4/46）、11%（5/46）、11%（5/46）.结论 CEUS与CT结合对诊断原发性肝癌和射频消融术后的复查具有实际应用价值.     

16层CT与导管法造影在显示冠状动脉狭窄中的对照研究

目的探讨16层CT冠状动脉成像在显示冠状动脉狭窄中的应用价值和限度。方法回顾性分析52例临床诊断或可疑冠心病患者的16层CT冠状动脉成像检查结果,并将16层CT检查结果与导管法冠状动脉造影结果进行对照。结果在52例患者的冠状动脉直径≥2 mm的580节段中,CT图像能满足管腔评价为507节段(占87.41%)。在CT图像能满足管腔评价的冠状动脉节段中,16层CT显示中度或中度以上狭窄(≥50%)的敏感度、特异度和阳性、阴性预测值分别为87.88%、98.17%和76.32%、95.96%,若将CT图像不能满足管腔评价的中度或中度以上狭窄的5个节段包括在内,其敏感度为81.69%;16层CT显示高度狭窄(≥75%)的敏感度、特异度和阳性、阴性预测值分别为83.78%、99.35%和91.18%、98.7%,若将CT图像不能满足管腔评价的高度狭窄的2个节段包括在内,其敏感度为79.49%。结论16层CT在对冠状动脉中、高度狭窄的初步诊断及介入治疗的筛选方面,可部分取代导管法冠状动脉造影。     

Bone Scan or 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography; Which Modality Better Shows Bone Metastases of Breast Cancer?

Background

In this multicenter study, we aimed to compare concurrent ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and bone scan results of breast cancer patient.

Patients and Methods

162 patients with breast cancer (158 female, 4 male; mean age 50.6 years) were included in the study. FDG PET/CT examination was performed in all patients, and concurrent bone scintigraphy in 68 patients. The results of FDG PET/CT and bone scan were compared.

Results

132 of the 162 patients were operated on because of breast cancer. 89 patients had metastasis, and 4 had recurrent disease according to FDG PET/CT results. Metastatic sites in order of frequency were lymph nodes, bone, lung, liver, adrenal gland, local skin or muscle, brain, and peritoneum (peritonitis carcinomatosa). The sensitivity, specificity, accuracy, and negative and positive predictive value of bone scintigraphy versus FDG PET/CT were 96 vs. 100%, 100 vs. 98%, 100 vs. 83%, 100 vs. 100%, and 90 vs. 100%, respectively.

Conclusion

Although the 2 modalities were in concordance with each other, in 5 (21%) cases, FDG PET/CT could not show bone metastasis which were detected on bone scintigraphy. Hence, bone scintigraphy was superior to FDG PET/CT in the determination of bone metastasis derived from breast cancer. However, FDG PET/CT should be considered for soft tissue metastasis.     

FDG PET/CT during neoadjuvant chemotherapy may predict response in ER-positive/HER2-negative and triple negative,but not in HER2-positive breast cancer

BackgroundResponse monitoring with MRI during neoadjuvant chemotherapy (NAC) in breast cancer is promising, but knowledge of breast cancer subtype is essential. The aim of the present study was to evaluate the relevance of breast cancer subtypes for monitoring of therapy response during NAC with 18F-FDG PET/CT.MethodsEvaluation included 98 women with stages II and III breast cancer. PET/CTs were performed before and after six or eight weeks of NAC. FDG uptake was quantified using maximum standardized uptake values (SUVmax). Tumors were divided into three subtypes: HER2-positive, ER-positive/HER2-negative, and triple negative. Tumor response at surgery was assessed dichotomously (presence or absence of residual disease) and ordinally (breast response index, representing relative change in tumor stage). Multivariate regression and receiver operating characteristic (ROC) analyses were employed to determine associations with pathological response.ResultsA (near) complete pathological response was seen in 19 (76%) of 25 HER2-positive, 7 (16%) of 45 ER-positive/HER2-negative, and 20 (71%) of 28 triple negative tumors. Multivariate regression of pathological response indicated a significant interaction between change in FDG uptake and breast cancer subtype. The area under the ROC curve was 0.35 (0.12–0.64) for HER2-positive, 0.90 (0.76–1.00) for ER-positive/HER2-negative, and 0.96 (0.86–1.00) for triple negative tumors. We found no association between age, stage, histology, or baseline SUVmax and pathological response.ConclusionResponse monitoring with PET/CT during NAC in breast cancer seems feasible, but is dependent on the breast cancer subtype. PET/CT may predict response in ER-positive/HER2-negative and triple negative tumors, but seems less accurate in HER2-positive tumors.     

The predictive value of incidental PET/CT findings suspicious for breast cancer in women with non-breast malignancies

Background

On occasion, patients followed with positron emission tomographic (PET)/computed tomographic (CT) imaging for nonbreast malignancies will have incidental breast findings concerning for second primary breast cancers. The aim of this study was to determine the predictive value of PET/CT imaging to identify breast cancers in these patients.

Methods

Patients with primary nonbreast malignancies and findings concerning for second primary breast cancers were identified from a prospectively acquired nuclear medicine database from January 2005 to July 2008. Chart reviews were then performed.

Results

Nine hundred two women underwent PET/CT imaging to evaluate nonbreast malignancies. Nine women (1%) had concerning breast findings, and 5 (56%) had subsequent breast cancer diagnoses. The positive predictive value of PET/CT imaging in these patients was 63%. Evidence of compliance with current screening guidelines was present in only 22% of these patients.

Conclusions

The data suggest that findings concerning for an additional primary breast cancer should be evaluated and that age-appropriate screening tools should not be abandoned.     

11C-胆碱PET/CT显像在前列腺癌诊断中的应用价值

目的探讨11C-胆碱PET/CT显像在前列腺癌诊断中的临床价值。方法42例PSA升高的可疑前列腺癌患者为研究组,5例浸润性膀胱癌患者为阴性对照组,静脉注射7.4 MBq/kg 11C-胆碱5 min后行仰卧位盆腔PET/CT显像,可疑转移者行全身显像。测量最高标准化摄取值(SUVmax)并计算前列腺病灶与肌肉组织SUVmax的比值T/B。结果经病理证实为前列腺癌者22例,良性前列腺增生(BPH)者25例(含对照组),两者的T/B值分别为4.32±1.35和1.68±1.23.差异有统计学意义(P<0.01)。11C-胆碱PET/CT显像诊断前列腺癌的敏感性为81.8%(18/22),特异性为84.0%(21/25)。PET/CT显示9例前列腺癌患者伴骨和(或)淋巴结及肺转移。22例前列腺癌者SUVmax与PSA值、Gleason评分值无相关性(P>0.05)。结论11C-胆碱PET/CT显像对前列腺癌的诊断有重要价值。     

PET—CT在前列腺癌诊断与临床分期的应用

目的探讨PET—CT应用于前列腺癌诊断及分期的临床价值。方法2008年1月至2011年1月新疆自治区人民医院泌尿外科收治前列腺肿瘤病例中,病理类型最终确诊为前列腺癌者有47例接受了全身PET—CT检查。检查范围包括前列腺原发肿瘤、区域淋巴结及全身脏器,将PET—CT结果参照手术／病理结果进行评价分析。结果47例患者中1例未发现原发病灶,此外PET—CT与常规检查各有1例假阴性,准确性均高达95．7％,差异无统计学意义。35例I、Ⅱ期患者中18例髂血管淋巴结转移,PET-CT检查的敏感性59．6％、特异性81％、准确性70．3％,优于B超、磁共振检查;PET—CT发现4例患者合并远处转移并经穿刺证实,准确性100％。结论PET—CT对于发现前列腺癌原发肿瘤、区域淋巴结转移均优于B超、磁共振检查,且对于远处转移具有较精确的检测能力,对于前列腺癌术前诊断及分期有较好的临床价值。     

Role of positron emission tomography in urological oncology

??Positron emission tomography (PET) is a diagnostic tool using radiotracers to show changes in metabolic activities in tissues. We analysed the role of PET and PET/computed tomography (CT) in the diagnosis, staging, and follow-up of urological tumours. ??A critical, non-structured review of the literature of the role of PET and PET/CT in urological oncology was conducted. ??PET and PET/CT can play a role in the management of urological malignancies. For prostate cancer, the advances in radiotracers seems promising, with novel radiotracers yielding better diagnostic and staging results than 18F-fluorodeoxyglucose (18F-FDG). In kidney cancer, PET and PET/CT allow a proper diagnosis before the pathological examination of the surgical specimen. For testis cancer, PET and PET/CT have been shown to be useful in the management of seminoma tumours. In bladder cancer, these scans allow a better initial diagnosis for invasive cancer, while detecting occult metastases. ??PET and its combined modality PET/CT have shown their potential in the diagnosis of urological malignancies. However, further studies are needed to establish the role of PET in the management of these diseases. Future applications of PET may involve fusion techniques such as magnetic resonance imaging with PET.     

Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver?

OBJECTIVE: To compare the diagnostic value of contrast-enhanced CT (ceCT) and 2-[18-F]-fluoro-2-deoxyglucose-PET/CT in patients with metastatic colorectal cancer to the liver. BACKGROUND: Despite preoperative evaluation with ceCT, the tumor load in patients with metastatic colorectal cancer to the liver is often underestimated. Positron emission tomography (PET) has been used in combination with the ceCT to improve identification of intra- and extrahepatic tumors in these patients. We compared ceCT and a novel fused PET/CT technique in patients evaluated for liver resection for metastatic colorectal cancer. METHODS: Patients evaluated for resection of liver metastases from colorectal cancer were entered into a prospective database. Each patient received a ceCT and a PET/CT, and both examinations were evaluated independently by a radiologist/nuclear medicine physician without the knowledge of the results of other diagnostic techniques. The sensitivity and the specificity of both tests regarding the detection of intrahepatic tumor load, extra/hepatic metastases, and local recurrence at the colorectal site were determined. The main end point of the study was to assess the impact of the PET/CT findings on the therapeutic strategy. RESULTS: Seventy-six patients with a median age of 63 years were included in the study. ceCT and PET/CT provided comparable findings for the detection of intrahepatic metastases with a sensitivity of 95% and 91%, respectively. However, PET/CT was superior in establishing the diagnosis of intrahepatic recurrences in patients with prior hepatectomy (specificity 50% vs. 100%, P = 0.04). Local recurrences at the primary colo-rectal resection site were detected by ceCT and PET/CT with a sensitivity of 53% and 93%, respectively (P = 0.03). Extrahepatic disease was missed in the ceCT in one third of the cases (sensitivity 64%), whereas PET/CT failed to detect extrahepatic lesions in only 11% of the cases (sensitivity 89%) (P = 0.02). New findings in the PET/CT resulted in a change in the therapeutic strategy in 21% of the patients. CONCLUSION: PET/CT and ceCT provide similar information regarding hepatic metastases of colorectal cancer, whereas PET/CT is superior to ceCT for the detection of recurrent intrahepatic tumors after hepatectomy, extrahepatic metastases, and local recurrence at the site of the initial colorectal surgery. We now routinely perform PET/CT on all patients being evaluated for liver resection for metastatic colorectal cancer.