18F-FDG PET/CT 在宫颈癌诊断及分期中的临床价值

目的:探讨氟代脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像/X线计算机体层成像仪(PET/CT)检查在局灶早期宫颈癌中的临床应用价值。方法:53例病理确诊为早期宫颈癌的患者行全身~(18)F-FDG PET/CT检查,并在检查结束10日内行广泛性全子宫切除术+双附件切除术+盆腔淋巴结清扫术,计算~(18)F-FDG PET/CT诊断宫颈原发部位肿瘤及盆腔淋巴结转移的敏感度,特异度与准确度。结果:~(18)F-FDG PET/CT检查诊断的宫颈原发部位肿瘤的敏感度为79.25%,特异度为86.79%,准确度为84.9%;以病人为单位诊断盆腔淋巴结转移的准确度为85.71%,特异度为97.87%;以淋巴结为单位诊断盆腔淋巴结转移的准确度为84.61%,特异度为99.00%。结论:PET/CT显像对宫颈癌诊断,分期诊断及盆腔淋巴结转移的检出具有重要临床意义。     

早期动态18F-FDG PET/CT成像在实体肿瘤评估中的应用

~(18)F-FDG PET/CT常规代谢成像反应肿瘤的葡萄糖代谢及乏氧情况,而~(18)F-FDG PET/CT早期动态成像能反映PET/CT成像早期肿瘤的灌注情况。由于肿瘤的异质性,在早期动态~(18)F-FDG PET/CT成像,即~(18)F-FDG PET/CT灌注成像中,存在独立于常规60 min~(18)F-FDG PET/CT代谢成像的SUVmax(最大标准摄取值)高摄取区。因此,在临床工作中应用~(18)F-FDG PET/CT早期动态成像,能够进一步对实体肿瘤的活性区域进行评估,能够更好评价患者预后、完善治疗方案。当前~(18)F-FDG早期动态成像已经应用在肝癌、肾癌以及膀胱癌等实体肿瘤诊断中。早期动态~(18)F-FDG PET/CT成像结合常规标准~(18)F-FDG PET/CT代谢成像,对实体肿块进行一站式成像方法,能够更好的对肿瘤进行评估。     

肿瘤自身抗体检测对早期肺癌的诊断价值

目的探讨肺癌自身抗体P53、PGP9.5、SOX2、GAGE7、GBU4-5、MAGEA1和CAGE对早期肺癌的诊断价值。方法采用ELISA法检测肺癌组(46例首次确诊的肺癌患者)和对照组(包含22名肺部良性疾病患者及23例健康体检者)血清中肺癌自身抗体P53、PGP9.5、SOX2、GAGE7、GBU4-5、MAGEA1和CAGE表达水平,分析评价7种肺癌自身抗体单独检测和联合检测对肺癌的临床诊断价值。结果肺癌组患者血清中7种自身抗体的水平明显高于对照组(均P<0.05)。肺癌组患者7种抗体联合检测的阳性率明显高于对照组(65.22%vs 15.56%,χ²=23.252,P<0.001)。单一肺癌自身抗体检测的敏感性为4.35%~36.96%,特异性为93.30%~100.00%,AUC为0.695~0.832。7种肺癌抗体联合检测的敏感性为65.22%,特异性为84.44%,AUC为0.897。结论早期肺癌患者血清中7种肺癌自身抗体水平均较高。单一肺癌自身抗体检测的特异性较高,但敏感性较低。7种肺癌自身抗体联合检测具有较高的敏感性,可成为临床早期肺癌新的辅助诊断指标。     

肺癌早期诊断的研究进展

大多数肺癌患者在确诊时已属中晚期,5年生存率极低,早期诊断是改善其预后和提高生存率的关键。目前常用的肺癌早期诊断方法包括影像学、内镜和分子生物学技术等。除传统的X线胸片、磁共振（Magnetic Resonance Imaging,MRI）、正电子发射断层显像（Positron Emission Tomography-Computed Tomography,PET-CT）等方法外,近年来逐步应用的高分辨CT（High-ResolutionComputed Tomography,HRCT）、低剂量CT（Low Dose Computed Tomography,LDCT）、自荧光纤维支气管镜（AutomaticFluorescence Bronchoscopy,AFB）、超声支气管内镜（Endo-Bronchial Ultra-Sound,EBUS）、荧光共聚焦显微镜支气管镜（FiberedConfocal Fluorescence Microscopy,FCFM）、细胞内镜（Endocytoscopy,EC）、电磁导航支气管镜（Electromagnetic NavigationBronchoscopy,ENB）、经支气管针吸活检术（Transbronchial Needle Aspiration,TBNA）、呼出气体分析和肿瘤标记物联合检测等,对于肺癌的早期诊断起到了重要作用,明显改善预后。本文就肺癌早期诊断的研究进展进行综述。     

PET/CT和超声弹性成像在乳腺癌诊断中的价值对比分析

目的:探讨PET/CT和超声弹性成像(UE)在乳腺癌诊断中的价值。方法:回顾性分析2011年1月至2012年5月在我院确诊的173例乳腺患者的临床资料,所有患者均行PET/CT和UE检查。依据病理组织活检和临床随访分别评价PET/CT和UE对乳腺癌诊断的灵敏性、特异性、准确性,并比较两者的结果。结果:PET/CT和UE诊断乳腺癌的灵敏性分别为98.8%和81.3%;特异性分别为84.3%和97.2%;准确性分别为90.7%和90.2%;两种方法联合检测诊断乳腺癌的灵敏性、特异性、准确性分别为98.8%、98.1%、98.4%,UE检测乳腺癌的敏感性明显低于PET/CT及PET/CT+UE,PET/CT检测乳腺癌的特异性明显低于UE及PET/CT+UE,PET/CT+UE诊断乳腺癌的准确性显著提高(P0.05)。结论:PET/CT和超声弹性成像在乳腺癌诊断中均有较高的应用价值,各有优缺点,二者联合检测可提高乳腺癌诊断的准确率。     

多层螺旋CT对肺结核合并肺癌患者的诊断价值

目的:研究多层螺旋CT对肺结核合并肺癌的鉴别诊断价值。方法:选择2013年3月至2015年9月在我院确诊的肺结核合并肺癌患者32例和单纯肺结核患者39例应用多层螺旋CT扫描患者肺部病变情况。结果:肺结核合并肺癌组:陈旧性肺结核28例、活动性肺结核4例;病灶位置经典部位29例、非经典部位3例,合并鳞癌11例、腺癌13例、小细胞癌5例、未分化癌3例;10例结核病灶与肺癌病灶不同侧、13例结核病灶与肺癌病灶同侧不同叶、9例结核病灶于肺癌病灶同侧同叶。单纯性肺结核组胨旧性肺结核36例、活动性肺结核3例;病灶位置经典部位34例(上叶尖段11例、后段9例、下叶背段14例)、非经典部位5例。肺结核合并肺癌组患者分叶征、毛刺征、胸膜凹陷征、阻塞性肺炎及肺不张以及棘状突起比例高于单纯肺结核组,而空泡影比例低于单纯肺结核组,差异具有统计学意义(P0.05);两组钙化、斑片条索影、结节影以及空洞或空腔比较,差异无统计学意义(P0.05)。结论:多层螺旋CT对肺结核合并肺癌具有较高的临床鉴别诊断价值。     

利用血液诊断早期发现肺癌

日本奥林巴斯公司开发的一项高精度基因诊断技术，为早期发现肺癌提供了可能。     

肺癌的综合影像诊断进展

肺癌的患病率及死亡率呈逐年增长趋势,影像学对肺癌的诊断及疗效监测至关重要。随着影像学的飞速发展和分子影像的崛起,临床用于肺癌诊断的成像方式日趋丰富,其中功能成像及分子成像的重要性日益增加。本文就各种成像方式关于肺癌检测、筛查、分期及疗效监测的进展进行综述。     

~(18)F-FDGPET/CT显像对淋巴瘤诊断、分期及疗效评价价值探讨

目的:探讨18氟-氟代脱氧葡萄糖(18F-FDG)PET/CT对淋巴瘤诊断、分期和疗效的评价价值。方法:入选我院2008年1月至2013年1月收治的52例经手术病理证实为淋巴瘤的患者,均进行18F-FDG PET/CT检查,并与病理结果进行比较,评价诊断价值,治疗前后对比分期改变,评价疗效和改变治疗方案。结果:PET/CT诊断发现异常高代谢情况51例(98.1%),其对淋巴瘤检查的灵敏度为98.1%(51/52),诊断率与病理结果比较相当,差异无统计学意义(P0.05),治疗后,11例(21.2%)完全恢复,PET/CT未见高代谢或肿大情况,3例(5.8%)临床分期上调,15例(28.8%)分期下调,其中15例(28.8%)改变治疗方案。结论:18F-FDG PET/CT对淋巴瘤诊断准确性高,在分期和疗效评价中具有重要意义,有助于准确分期并鉴别残余病变性质。     

基于多孔小波融合的PET/CT 图像增强及其评价

目的:为解决融合图像视觉效果增强与量化信息损失之间的矛盾,本文提出一种基于非降采样的多孔小波(àtrous wavelet)分解的PET/CT图像融合方法,使得融合图像既有利于肿瘤诊断又能用于放疗靶区勾画和放射性定量分析。方法:对PET和CT图像分别进行多孔小波分解,以包含肿瘤目标的适当大小的感兴趣区域的清晰度为目标函数,采用Nelder-Mead算法对PET和CT图像高频分解系数之比进行优化获得最终的融合系数,使融合图像充分增加解剖学信息的同时又尽量保持PET图像原有的局部和整体灰度信息。结果:融合图像质量评价表明,本文方法能将有价值的PET功能信息与精确的CT解剖信息结合在一起,并克服传统小波融合损失图像量化信息的不足。结论:基于多孔小波融合的PET/CT图像既能用于肿瘤诊断,又能同时用于肿瘤学放射性计算和适形放疗计划制定等量化研究。     

Dual-time-point PET/CT study protocol can improve the larynx cancer diagnosis

AimTo evaluate whether the sequential dual-time-point fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (DTP 18F-FDG PET/CT) study improves the differential diagnosis in the larynx.BackgroundIn some cases, the clinical and metabolic similarity of laryngitis and larynx cancer make differential diagnostics difficult when performing standard 18F-FDG PET/CT examinations; therefore, an additional study protocol performance seems to be of reasonable value.Materials and methods90 patients (mean age: 61 ± 11 years, range: 41–84 years): 23 women (mean age: 63 ± 10 years, range: 51–84 years) and 67 men (mean age: 61 ± 11 years, range: 41–80 years) underwent delayed 18F-FDG PET/CT examinations at 60 and 90 min post intravenous injection (p.i.) of the radiopharmaceutical 18F-FDG. We compared the metabolic activity of 90 structures divided into following groups: normal larynx (30 patients), laryngitis (30 lesions) and larynx cancer (30 tumors) with maximal and mean standardized uptake value (SUVmax, SUVmean) and the retention index (RI-SUVmax). We used the receiver operating characteristics (ROC) curve to evaluate the SUVmax cut-off values.ResultsThe SUVmax cut-off value at 60 and 90 min p.i. of 2.3 (sensitivity/specificity: 96.4%/100%) and 2.4 (94.2%/100%), respectively, distinguished normal and abnormal metabolic activity in the larynx. When laryngitis and tumors were compared, the SUVmax cut-off values obtained after initial and delayed imaging were 3.6 (87.5%/52.0%) and 6.1 (58.3%/84%), respectively. The RI-SUVmax of 1.3% (71.4%/88.1%) suggested abnormality, while RI-SUVmax of 6.6%, malignant etiology (75.0%/80.0%).ConclusionsIn this study, the sequential DTP scanning protocol improved the sensitivity and specificity of the PET/CT method in terms of differential diagnosis within the larynx.     

The use of PET/CT in radiotherapy of patients with non-small cell lung cancer

The goal of this paper was to investigate the influence of FDG-PET/CT scan on the modification of staging and irradiation planning in patients suffering from non-small cell lung cancer (NSCLC). Fifteen patients suffering from NSCLC were analyzed by the authors from January, 2008 to July, 2009. The aim of the analysis was to examine the influence of FDG-PET/CT on irradiation planning and on decision-making of the complex oncologic therapy. The FDG-PET/CT scan was carried out in the position of irradiation performed later. For irradiation planning, planning target volumes (PTV) and the organs of risk were contoured on the patients' topometric CT slides as well as on the fused FDG-PET/CT slides. We evaluated how the application of PET/CT modified the stage of the illness, the complex oncologic therapeutic plan, the volume and the localization of the PTV, and the irradiation doses of the organs at risk. The mean and maximum dose of the spinal cord, the mean and V20 dose load of the lungs and the mean dose loads of the heart as well as of the left ventricle were measured. In 8 of 15 cases the stage of the disease and the treatment strategy was modified, since distant metastases were detected by the PET/CT. We evaluated the modification of the PTV and dose load of the organs at risk in 7 cases. According to the PET/CT the PTV was reduced in 5 cases (mean: 393.6 cm3) and was increased in 2 cases (mean: 250.8 cm3). Concerning the risk organs we found that the average (8.8 Gy/9.5 Gy) and maximum (33.4 Gy/36.4 Gy) dose load of the spinal cord increased, while the average (24.5 Gy/13.8 Gy) and V20 (33.7%/22.1%) dose load of the lungs decreased. We likewise found a decrease in the mean dose load of the heart (17.3 Gy/16.8 Gy) and left ventricle (12.9 Gy/9.6 Gy). In the majority of the cases the FDG-PET/CT scan modified the therapeutic decision, the size of the irradiated volume, and the dose load of the lung, the organ at risk causing the most difficulties at irradiation planning, was also reduced. The PET/CT scan plays an essential role in the complex oncologic treatment and irradiation therapy of NSCLC.     

Application of CT images in the diagnosis of lung cancer based on finite mixed model

ObjectiveInvestigating the application of CT images when diagnosing lung cancer based on finite mixture model is the objective. Method: 120 clean healthy rats were taken as the research objects to establish lung cancer rat model and carry out lung CT image examination. After the successful CT image data preprocessing, the image is segmented by different methods, which include lung nodule segmentation on the basis of Adaptive Particle Swarm Optimization – Gaussian mixture model (APSO-GMM), lung nodule segmentation on the basis of Adaptive Particle Swarm Optimization – gamma mixture model (APSO-GaMM), lung nodule segmentation based on statistical information and self-selected mixed distribution model, and lung nodule segmentation based on neighborhood information and self-selected mixed distribution model. The segmentation effect is evaluated. Results: Compared with the results of lung nodule segmentation based on statistical information and self-selected mixed distribution model, the Dice coefficient of lung nodule segmentation based on neighborhood information and self-selected mixed distribution model is higher, the relative final measurement accuracy is smaller, the segmentation is more accurate, but the running time is longer. Compared with APSO-GMM and APSO-GaMM, the dice value of self-selected mixed distribution model segmentation method is larger, and the final measurement accuracy is smaller. Conclusion: Among the five methods, the dice value of the self-selected mixed distribution model based on neighborhood information is the largest, and the relative accuracy of the final measurement is the smallest, indicating that the segmentation effect of the self-selected mixed distribution model based on neighborhood information is the best.     

The utility of 18F-FDG PET/CT in brain tumours diagnosis

BackgroundThe purpose of the study was to discuss whether 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) study protocol should include brain imaging.Materials and methodsAnalysis of international societies recommendations compared with the original data obtained in over 1000 consecutive torso and brain ¹⁸F-FDG PET/CT studies collected in 2010.ResultsAccording to the international societies recommendations, the ¹⁸F-FDG should not be the radiotracer of choice considering the brain region PET/CT study. However, it can be performed as an additional brain imaging tool. Based on at least a 3-year follow-up, we detected 8 cases of suspicious brain findings and no primary lesion among over 1000 consecutive torso and brain 18F-FDG PET/CT scans performed in 2010. However, in 5 out of 8 patients, the brain lesion was the only metastasis detected, affecting further therapy.ConclusionsThe ¹⁸F-FDG PET/CT study may help detect malignant brain lesions and, therefore, including brain region imaging into the study protocol should be considered.     

Clinical value of whole-body PET/CT in patients with active rheumatic diseases

Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in pre-clinical stages, requiring highly sensitive detection techniques. Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This review provides an overview of the current utility of ¹⁸ F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still’s disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener’s granulomatosis, polymyositis, and dermatomyositis. We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.     

Clinical value of whole-body PET/CT in patients with active rheumatic diseases

Advanced imaging techniques may enable early diagnosis and monitoring of therapy in various rheumatic diseases. To prevent irreversible tissue damage, inflammatory rheumatic disease must be diagnosed and treated in pre-clinical stages, requiring highly sensitive detection techniques. Positron emission tomography (PET) provides highly sensitive, quantitative imaging at a molecular level, revealing the important pathophysiological processes underlying inflammation. This review provides an overview of the current utility of ¹⁸?F-fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in patients with active rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, polymyalgia rheumatica, adult-onset Still’s disease, relapsing polychondritis, immunoglobulin G4-related disease, large-vessel vasculitis, Wegener’s granulomatosis, polymyositis, and dermatomyositis. We also discuss the role of FDG-PET/CT in the diagnosis and monitoring of these diseases.     

血清肿瘤标志物在肺癌辅助诊断中的应用

目的 探讨血清肿瘤标志物在肺癌诊断中的临床价值。方法 收集40例健康人、45例肺部良性疾病患者和90例肺癌患者,采用电化学发光分析检测患者血清中肿瘤标志物细胞角蛋白19（CYFRA21-1）、鳞状细胞癌相关抗原（SCC）和癌胚抗原（CEA）,以及胃泌素释放肽前体（pro-GRP）和神经元特异性烯醇化酶（NSE）的含量。结果 健康人组和肺部良性疾病患者组血清NSE、pro-GRP、CYFRA21-1、SCC和CEA水平较肺癌患者组水平低,差异有统计学意义（P<0.01）。NSE和pro-GRP在小细胞肺癌患者中的水平均明显高于其他类型的肺癌患者（P<0.01）,CYFRA21-1和SCC在鳞癌患者中的含量比其他类型肺癌患者高（P<0.01）。联合检测此5种血清肿瘤标志物敏感性高于单独的肿瘤标志物（P<0.01）。结论 联合检测NSE、pro-GRP、CYFRA21-1、SCC和CEA可以提高肺癌诊断的灵敏度。     

Radiation dosimetry of 18F-flurocholine PET/CT studies in prostate cancer patients

PurposeWe aimed to evaluate the Equivalent Doses (H_Ts) to highly exposed organs as well as the Effective Dose (ED) for ¹⁸F-fluorocholine PET/CT scan in the follow-up of prostate cancer patients.MethodsFifty patients were administered with ¹⁸F-fluorocholine. The activities in organs with the highest uptake were derived by region-of-interest (ROI) analysis. OLINDA/EXM1.0 and Impact software were used to assess ED for the administered ¹⁸F-fluorocholine and CT scan, respectively, and the ¹⁸F-fluorocholine and CT-scan EDs summed to yield the total ED for the PET/CT procedure.ResultsThe calculated ¹⁸F-fluorocholine and CT scans EDs based on ICRP Publication 103 were 5.2 mSv/300 MBq and 6.7 mSv, respectively. The ¹⁸F-fluorocholine H_Ts to the liver, kidneys, spleen and pancreas were about threefold higher than those from the CT, which contributed a greater proportion of the total ED than the ¹⁸F-fluorocholine did.ConclusionsFor ¹⁸F-fluorocholine PET/CT procedures, about 40% of the ED is contributed by administered ¹⁸F-fluorocholine and 60% by the CT scan. The kidneys and liver were the highly exposed organs. Considering the large number of diagnostic procedures oncology patients undergo, radiation dosimetry is important in relation to the stochastic risk of such procedures.