肿瘤非手术治疗后FDG PET随访临床价值

目的：探讨FDG PET影像诊断在肿瘤非手术治疗后临床随访中的价值。方法：选择实质性肿瘤强度聚焦超声（HIFU）治疗后21例，鼻咽癌患者放射治疗后14例，共35例，随访中同期行FDG PET和CT、MRI检查，并将结果进行双盲比较。结果：21例实质性肿瘤HIFU治疗后2－3个月复查，19例CT、MRI表现密度和信号有变化，但形态、大小未见明显改变，另2例CT、MRI密度和信号变化不明显；PET示17例肿瘤中心大部分放射性分布缺损，但以肿瘤边缘部分分为主仍有FDG代谢活跃现象，提示部分肿瘤存活，其中6例在FDG代谢活跃局部经穿刺活检证实肿瘤存活；4例PET表现为FDG摄取缺损，其中1例局部穿刺活检证实为坏死组织。14例鼻咽癌放疗后12－18个月复查,CT和MRI提示11例未见局部肿瘤复发，PET显示其中3例有局灶性FDG浓聚病变，其中1例局部穿刺活检证实为局部肿瘤复发，2例CT和MRI提示肿瘤复发，FDG显像病变处理有明显的放射性浓聚，余1例放射治疗后脑损伤FDG PET显示为放射性分布缺损区。结论：FDG显像在实质性肿瘤HIFU治疗后疗效判断和鼻咽癌放射治疗后肿瘤复发诊断上较CT和MRI准确，两者结合分析在临床随访中更具有明显的优势。     

18F-FDG PET显像在头颈部肿瘤中的应用

目的 探讨^18F-脱氧葡萄糖（FDG）PET显像在头颈部肿瘤中的应用.方法 39例头颈部肿瘤患者,共行56次^18F-FDG PET检查.图像分析采用视觉和半定量（标准摄取值,SUV）方法.结果 ①5例治疗前患者,PET显像使3例改变了分期;34例治疗后患者中,PET显像发现6例头颈部有残存或复发灶,11例淋巴结转移,4例肺部转移,3例骨转移.②22例PET显像阳性患者中,20例经手术病理检查或随访证实,2例假阳性;17例PET显像为阴性的患者均得到随访证实.PET显像用于头颈部肿瘤病情监测的灵敏度为100%,特异性为89.5%,准确性为94.9%.③21例患者有近期CT或MRI检查结果,其中6例PET显像发现了CT或MRI未发现的局部复发病灶和转移淋巴结.6例患者CT或MRI提示有肿瘤复发或转移,但PET显像结果阴性,并经随访证实.④9例患者多次进行PET检查随访,其中5例病灶消失,3例病情进展,1例无变化.结论 ^18F-FDG PET显像可较准确地发现头颈部肿瘤的残存、转移和复发病灶,并为肿瘤分期提供重要依据,但应与炎症鉴别.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

肝癌经导管肝动脉化疗栓塞后PET/CT显像的临床价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检查评估肝细胞肝癌(HCC)经导管肝动脉化疗栓塞(TACE)治疗后肿瘤活性及对转移灶的检出能力.方法 22例HCC患者TACE后进行18F-FDG PET/CT检查,以临床随访及部分病理结果为标准进行对照分析.结果 22例患者中,18例复发或转移,其余4例全身未见明显FDG代谢异常增高灶.16例患者肝内有1个或多个18F-FDG放射性增高灶,其中5例碘油沉积区和非碘油沉积区均有FDG浓聚灶,13例并发肝外转移病灶;2例肝内FDG显像阴性但腹膜后淋巴结放射性浓聚.转移灶分布:肺和淋巴结转移各9例,骨转移2例,门静脉瘤栓和膈脚转移各1例.经随访证实2例肝内18F-FDG显像为假阴性,18F-FDG PET/CT检查对肝内肿瘤复发或转移灶的探测灵敏度为88.9%(16/18),特异性为4/4,准确性为90.9%(20/22);全身显像对肿瘤复发或转移检测的灵敏度为94.7%(18/19),特异性为3/3,准确性为95.5%(21/22).结论 18F-FDG PET/CT显像对HCC介入治疗后的残留或复发灶探测有较高的灵敏度,对肝外转移病灶的检出具有独特的优势.     

PET在颅内胶质瘤术后放射治疗后随访中的应用价值

目的：探讨PET在颅内胶质瘤术后,放射治疗后随诊中的作用。方法：对16例颅内胶质瘤术事并放射治疗后的病例采用双盲法将PET与CT／或MRI结果进行比较。结果：16例中14例（占87．5％）CT和／或MRI表现不规则环形或结节状明显强化,不能准确作出手术后改变和／或放射治疗后脑损伤,残存肿瘤或神经复发的诊断;其中9例残存肿瘤或肿瘤复发病灶^18F-FDG PET影像均表现为葡萄糖代谢率明显增高,另5例术后放射治疗后脑损伤病例和2例术后软化灶^18F-FDG PET影像均显示局部病变区为放射性分布缺损或明显低下。结论：与CT和MRI相比,PET在胶质瘤术后放射治疗后的脑损伤和肿瘤复发的定性诊断上具有明显的优势,若结合CT和MRI多种影像结果分析,更能提供病变解剖结构和功能改变的综合信息,尤其是对胶质瘤术后放射治疗后的临床随访非常重要。     

16例颅内胶质瘤术后并放射治疗后的18F-FDG PET显像

目的　探讨18F 脱氧葡萄糖 (FDG)PET在颅内胶质瘤术后并放射治疗后随诊中的临床价值。方法　对 16例颅内胶质瘤术后并放射治疗后的患者同期行18F FDGPET和CT、MRI检查 ,采用双盲法对结果进行比较。结果　 16例中 87 5 % (14例 )CT和 (或 )MRI表现不规则环形或结节状明显强化 ,不能准确作出手术后改变和 (或 )放射治疗后脑损伤、残存肿瘤或肿瘤复发的诊断 ;其中 9例残存肿瘤或肿瘤复发病灶18F FDGPET影像表现为葡萄糖代谢明显增高 ,有 5例得到手术病理证实 ;另 5例术后放射治疗后脑损伤患者和 2例术后软化灶18F FDGPET影像均显示局部病变区为放射性分布缺损或明显低下。结论　18F FDGPET在胶质瘤术后放射治疗后的脑损伤和肿瘤复发的定性诊断上具有明显的优势 ,结合CT和MRI更能提供病变解剖结构和功能改变的综合信息。     

CT与MRI对鼻咽癌放疗后局部复发或残留的诊断

目的 探讨CT与MRI对鼻咽癌放疗后局部复发或残留的诊断价值。方法 收集125例放疗后4月～2年CT和/或MRI检查出现异常块影的鼻咽癌患者。73例行鼻咽部活检,活检阴性及未活检患者继续行CT或MRI随访。将CT、MRI结果与病理对比。结果 病理活检或CT、MRI随访复查证实55例(55/125,44.4％)为放疗后局部复发或残留,70例(70/125,55.6％)为放疗后改变。CT诊断鼻咽癌放疗后局部复发或残留的敏感性、特异性、准确性分别为54.8％、73.8％、65.8％;MRI诊断的敏感性、特异性、准确性分别为61.8％、83.7％、74.0％。结论 CT和MRI诊断鼻咽癌放疗后局部复发或残留的准确性相对均较低,MRI稍优于CT。     

PET/CT for staging and follow-up of pediatric nasopharyngeal carcinoma

Purpose

While FDG PET/CT for the evaluation of nasopharyngeal carcinoma (NPC) in adult patients has documented advantages and disadvantages compared with conventional imaging, to our knowledge, no studies of FDG PET/CT for the evaluation of NPC in pediatric patients have been performed. In this investigation, we studied the utility of FDG PET/CT in children with NPC.

Methods

The study group comprised 18 children with biopsy-proven NPC who underwent FDG PET/CT and MRI (total 38 pairs of images). All baseline and follow-up FDG PET/CT and MRI studies were independently reviewed for restaging of disease.

Results

The concordance between FDG PET/CT and MRI in T, N, and overall staging was 29%, 64%, and 43%, respectively. Compared with MRI, FDG PET/CT yielded lower T and overall staging and showed less cervical and retropharyngeal lymphadenopathy. The concordance between follow-up FDG PET/CT and MRI was 79% overall and 100% 9?months after therapy. In patients who achieved complete remission, FDG PET/CT showed disease clearance 3–6?months earlier than MRI. There were no false-positive or false-negative FDG PET/CT scans during follow-up.

Conclusion

FDG PET/CT may underestimate tumor extent and regional lymphadenopathy compared with MRI at the time of diagnosis, but it helps to detect metastases and clarify ambiguous findings. FDG PET/CT is sensitive and specific for follow-up and enables earlier determination of disease remission. FDG PET/CT is a valuable imaging modality for the evaluation and monitoring of NPC in pediatric patients.     

False positive fluorine-18 fluorodeoxy-D-glucose positron emission tomography finding caused by osteoradionecrosis in a nasopharyngeal carcinoma patient

Nasopharyngeal carcinoma (NPC) is treated by radiotherapy with or without chemotherapy. It is not uncommon to find the residual/recurrent lesion in the skull base area. For patients who had received radiotherapy, it is difficult to differentiate the skull base tumour from post-treatment change in the CT or MRI. (18)F-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) provides an alternative diagnostic choice in this situation for head and neck cancer including NPC especially when there is inconclusive CT/MRI finding. This report of an NPC patient who received radiotherapy 18 months previously, describes the misdiagnosis of tumour recurrence at the skull base found in both MRI and FDG PET scan. Histopathological studies showed osteoradionecrosis of the debrided tissue and follow-up PET showed complete regression of the skull base lesion. Therefore, a false positive result in FDG PET caused by osteoradionecrosis was confirmed. To the best of our knowledge, this is the first case report in the literature.     

Extraordinarily high F-18 FDG uptake caused by radiation necrosis in a patient with nasopharyngeal carcinoma

A false-positive F-18 FDG PET scan caused by osteoradionecrosis and inflammation in patients with nasopharyngeal carcinoma (NPC) has been reported. The standard uptake values (SUVs) in these false-positive cases are always below 6 and decrease with time. This report is concerned with a false-positive result with extraordinarily high F-18 FDG uptake, which increased on the delayed 3-hour image. A 63-year-old man with NPC underwent surgical removal and radiotherapy (7400 cGy) in July 2003. In October 2003, the CT scan showed a large soft tissue mass over the nasopharynx. Tumor recurrence was suspected. F-18 FDG PET scan showed an FDG-avid lesion over the nasopharyngeal region with a maximum SUV of 28.8 at 1 hour that increased to 30.4 at 3 hours. Biopsy was performed and the histopathologic examination showed only necrotic tissue and no evidence of tumor cells. Radiation necrosis was diagnosed. No evidence of tumor recurrence was noted during the 10-month follow-up period.     

18F-FDG PET/CT在鼻咽癌综合治疗后患者随访及预后评估中的价值

鼻咽癌是一类发病率较高、早期发现困难、误诊误治率较高的头颈部恶性肿瘤。多数鼻咽癌患者对放疗敏感, 但仍有部分患者出现残留、复发或转移。PET/CT作为现代医学影像重要组成部分之一, 将PET的功能显像与CT的解剖成像有机结合, 不仅能有效显示肿瘤的增生、代谢、乏氧及细胞的凋亡状态, 而且能精确显示肿瘤与其周围脏器组织的解剖结构, 在鼻咽癌患者的临床诊断、分期、治疗及预后评估等方面具有重要价值。该文重点就PET/CT对鼻咽癌综合治疗后患者局部残留、复发或转移的诊断价值及预后评估效能进行综述。     

18F—FDGPET／CT在鼻咽癌综合治疗后患者随访及预后评估中的价值

鼻咽癌是一类发病率较高、早期发现困难、误诊误治率较高的头颈部恶性肿瘤。多数鼻咽癌患者对放疗敏感,但仍有部分患者出现残留、复发或转移。PET／CT作为现代医学影像重要组成部分之一,将PET的功能显像与CT的解剖成像有机结合,不仅能有效显示肿瘤的增生、代谢、乏氧及细胞的凋亡状态,而且能精确显示肿瘤与其周围脏器组织的解剖结构,在鼻咽癌患者的临床诊断、分期、治疗及预后评估等方面具有重要价值。该文重点就PET／CT对鼻咽癌综合治疗后患者局部残留、复发或转移的诊断价值及预后评估效能进行综述。     

^18F-FDG PET／CT在鼻咽癌临床分期和疗效监测中的应用

目的探讨^18F-FDGPET／CT显像在鼻咽癌首次分期、再分期及疗效监测中的临床应用价值。方法通过分析86例鼻咽癌患者^18F-FDGPET／CT扫描结果,结合其他临床资料和随访结果,计算^18F-FDGPET／CT显像的准确性、特异性、灵敏度、阳性预测值与阴性预测值,并与CT、MRI进行比较。结果^18F-FDGPET／CT与CT、MRI诊断鼻咽癌的准确率、敏感性、特异性、阳性预测值与阴性预测值的差异均有统计学意义（P〈0．05）。依据^18F-FDGPET／CT结果,改变了4例首次分期、14例再分期的临床诊断和22例患者的治疗方案。结论与CT、MRI相比,^18F-FDGPET／CT显像对鼻咽癌的临床分期及疗效监测具有更重要价值。     

FDG positron emission tomography in the surveillance of hepatic tumors treated with radiofrequency ablation

PURPOSE: Radiofrequency thermal ablation (RFA) is an emerging technique in the treatment of focal hepatic tumors. Magnetic resonance imaging (MRI) and computed tomography (CT) are currently used to monitor hepatic tumors after RFA for residual disease and recurrence. Fluorodeoxyglucose (FDG) positron emission tomography (PET) is an excellent imaging method for the detection of liver metastases, but it has not been thoroughly evaluated as an alternative to anatomic imaging in the surveillance of liver tumors treated with RFA. The purpose of this investigation was to determine the role of FDG-PET imaging in the surveillance of liver tumors treated with RFA. METHODS: Thirteen patients with histories of malignant tumors of the liver treated with RFA and who had received post-treatment FDG-PET scans were assessed retrospectively. One patient had two post-RFA FDG-PET scans, eight patients had concurrent MRI scans, and six patients had concurrent CT scans. Imaging findings were compared with the results of clinical follow-up. RESULTS: There were either recurrent tumors at the ablation site (8 patients) or new metastases (3 patients) in 11 patients. FDG-PET identified all 11 cases and did not misidentify any cases. Of the seven patients with positive PET findings who received an MRI scan, three were also positive on MRI (42.9%); the other four cases were either negative or equivocal. Of the four patients with positive PET findings who received a CT scan, only two had positive CT scan findings (50%). All recurrences diagnosed by PET were confirmed on clinical follow-up. CONCLUSION: In this preliminary study, FDG-PET was superior to anatomic imaging in the surveillance of patients treated with RFA for malignant hepatic tumors.