18F-FDG PET显像在肺癌中的应用

18F-FDG(18F-氟代脱氧葡萄糖)PET可以反映正常机体组织和肿瘤细胞的功能状态,在对肺部病变的定性诊断、肺癌的临床分期、疗效评价、复发监测以及预后估计上都明显优于CT、MRI等形态解剖学检查,而且能间接提供瘤组织细胞分化程度和增殖潜能的判断依据,具有重要的临床应用价值。由于PET在空间分辨率上存在不足,应与其他影像学检查相结合,以提高其准确性。     

~(18)F-FDG PET/CT显像在霍奇金淋巴瘤分期及疗效评价的应用

目的探讨18F-FDG PET/CT显像对霍奇金淋巴瘤(hodgkin’s lymphoma,HD)的临床分期、疗效评价、监测复发及提示预后方面的应用价值。方法回顾性分析我院2005年~2011年病理活检和免疫组化确诊的51例HD患者的18F-FDG PET/CT显像结果,应用无进展生存(progression-free survival,PFS)期及总体生存(overall survival,OS)期作为随访指标,进行疗效评价。组间PFS率及OS率的比较采用X2检验;患者的生存分析采用Kaplan-Meier方法。结果23例HD患者于治疗前行18 F-FDG PET/CT显像,17.4%(4/23)患者分期上调。51例患者在完成全部治疗后行18 FFDG PET/CT显像,PET/CT显像结果阳性患者19例,阴性患者32例。阳性者及阴性者的中位PFS期分别为10个月和38个月,2年PFS率分别为5.2%(1/19)和64.5%(20/31),差异有统计学意义(X2=16.978,P=0.000);中位OS期分别为19个月和39个月,3年OS率分别为10.5%(2/19)和51.6%(16/31),差异有统计学意义(X2=8.631,P=0.003)。治疗后PET/CT显像的阳性预测值及阴性预测值分别为94.7%(18/19)、90.6%(29/32)。结论18 F-FDG PET/CT是HD患者明确分期、评价疗效、监测复发及提示预后方面的可靠方法,有助于临床早期判断疗效及制定个体化治疗方案。     

18F-FDG PET/CT显像用于肺癌诊疗的研究进展

常规¹⁸F-FDG PET/CT静态显像在肺癌的诊断、分期、疗效评估等方面发挥了重要作用,并能通过标准化摄取值等代谢参数进行半定量分析,但静态显像无法提供病变的示踪动力学信息。近年出现的动态显像技术能够连续评估某一时间段内病变的代谢变化过程,并可应用净摄取速率常数等动力学参数进行定量分析,与静态显像相互补充,为肺癌的诊断提供更丰富的信息。就 ¹⁸F-FDG PET/CT静态及动态显像在肺癌诊疗中的研究进展进行综述。     

18F-FDG PET显像在肝癌中的应用

18F-FDG PET在肝脏的原发肿瘤和转移性肿瘤的诊断中有重要价值,特别是在肝肿瘤的诊断、分期和治疗方案的选择方面.结合CT、MRI和超声可以提高诊断的准确性,同时,在对肝肿瘤疗效监测以及评价手术效果方面也有重要作用.     

18F-FDG PET/CT显像在非小细胞肺癌分期中的价值

目的 探讨非小细胞肺癌开展¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像/计算机断层扫描(PET/CT)的作用。方法 选取非小细胞肺癌患者25例,均开展¹⁸F-FDG PET/CT显像检查,并采集病理组织标本开展病理检查,依据病理检查结果为患者实施临床分期,其中早期包含Ⅰ期和Ⅱ期患者,中晚期包含Ⅲ期和Ⅳ期患者。分析患者病理学检查情况;对比早期组与中晚期组患者临床资料、¹⁸F-FDG PET/CT显像参数;分析¹⁸F-FDG PET/CT显像参数诊断非小细胞肺癌临床分期情况。结果 在25例非小细胞肺癌患者中,病理学检查提示Ⅰ期4例、Ⅱ期5例、Ⅲ期3例、Ⅳ期13例。9例属于早期组,16例属于中晚期组。中晚期组患者鳞状细胞癌抗原或癌胚抗原水平相较高于早期组,差异有统计学意义(P<0.05)。中晚期组肿瘤标准摄取值的最大值以及肿瘤代谢体积相较高于早期组,差异有统计学意义(P<0.05)。¹⁸F-FDG PET/CT显像参数联合检测诊断...     

18F-FDG PET显像在恶性淋巴瘤中的应用

18F-FDG(18F-氟代脱氧葡萄糖)PET显像作为一种功能显像技术,能反映肿瘤组织中的生化变化和代谢状态,对淋巴瘤的准确分期、恶性程度评价、治疗疗效评价、治疗后复发的诊断以及预后估计等方面均具有重要作用.     

腹膜后异位脾^(18)F-FDG PET/CT显像1例

患者男,74岁。因“双侧腰背部胀痛,伴尿频、尿急不适20+天”。实验室检查:WBC 6.83×10^(9)/L;Neut 5.2×10^(9)/L;Lymph 0.94×10^(9)/L;Ig42970 g/L;CRP、ESR等无明显异常,全腹CT平扫见腹膜后团片状等密度影,形态不规则,边界欠清,腹主动脉下段及双侧髂总动脉与病灶间无明显分界,邻近双侧输尿管腹段受累,近段输尿管扩张,双侧肾盂、肾盏扩张。18 F-FDG PET/CT全身显像见腹膜后条片状软组织密度影,伴FDG摄取增高,最大SUV为4.2,倾向腹膜后纤维化。     

~(18)F-FDG PET/CT在肺部肿瘤诊治中的作用

正电子发射型断层屁像以及计算机断层扫描的结合是当代最先进的检测仪器之一，它能够将解剖和功能的图像融合在一起．在分子水平上对疾病进行诊断。随着计算机软硬件的发展和正电子药物的问世，正电子发射型断层显像以及计算机断层扫描已经在多种疾病的诊断、分期及观察疗效等方面发挥更大作用。本文主要介绍^18F-氯代脱氧葡萄糖正电子发射型断层显像以及计算机断层扫描在肺部肿瘤诊断、治疗中的作用和进展。     

喉癌18F-FDG PET/CT显像的临床应用价值

目的探讨18F-脱氧葡萄糖(FDG)PET/CT显像相对于单独的18F-FDG PET显像在喉癌诊断中的临床价值以及评价平均标准化摄取值(SUVmean)在喉癌和喉生理性显像鉴别中的作用。方法疑似喉癌患者23例。男19例,女4例,年龄30～70岁。空腹6H以上,静脉注射7.4MBq/kg 18F-FDG后40min后仰卧位行头颈部或全身扫描。分别评价18F-FDG PET和18F-FDG PET/CT显像对病灶诊断的灵敏度和特异性。19例病理为鳞癌的喉癌患者与15例喉生理性显像患者作为对照,测定显像部位的SUVmean,试用受试者工作曲线特征(Receivrer Operation Characteristic,ROC)及阳性似然比(positive likelihood ratio,+LR)确定SUVmean阈值。结果 23例喉癌患者,108处病灶。18 F-FDGPET显像和18F-FDG PET/CT显像对病灶诊断的灵敏度分别为85.1%(40/47)和89.4%(42/47),差异无统计学意义(P>0.05),特异性分别为和72.1%(44/61)和91.8%(56/61),差异有统计学意义(P<0.05)。19例病理为鳞癌的喉癌患者SUVmean均数为7.3±2.9,15例喉生理性显像SUVmean均数为4.9±1.1,差异有统计学意义(P<0.05)。SU-Vmean阈值选定为6.1,18 F-FDG PET/CT显像喉癌诊断的灵敏性为63.2%,特异性为86.7%。结论 18 F-FDG PET/CT显像明显改善18F-FDG PET显像的特异性。SUVmean阈值选定为6.1,有利于喉癌和喉生理性显像的鉴别。     

18 F-FDG PET/CT在三阴性乳腺癌分子分型诊断中的价值

目的 探究¹⁸F-氟脱氧葡萄糖-正电子体层扫描成像(¹⁸F-FDG PET/CT)在三阴性乳腺癌分子分型诊断中的价值。方法 回顾性分析2010年1月1日至2022年12月31日在天津医科大学肿瘤医院行¹⁸F-FDG PET/CT检查的227例乳腺癌患者的临床和影像学资料,根据乳腺癌原发灶雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子受体2(HER-2)表达状态将患者分为三阴性乳腺癌和非三阴性乳腺癌两组;基于PET图像和CT图像,提取影像组学特征,构建影像组学模型用于预测三阴性乳腺癌的分子分型;并比较两组患者的临床资料、CT形态学特征和PET代谢参数的差异,筛选出差异有统计学意义的指标,建立联合临床特征的综合性影像组学模型。结果 与非三阴性乳腺癌相比,三阴性乳腺癌在肿瘤直径、边缘、合并同侧腋下淋巴结转移、累犯邻近皮肤乳头及PET代谢参数等方面表现出更显著的侵袭性(t=-3.19,χ²=7.30、8.10、5.34,t=3.80、3.30、3.42,P＜ 0.05)。构建的¹⁸F-FDG PET/CT影像组学模型能够有效预测三阴性乳腺癌的分子分型,受试者工作特征(ROC)曲线分析显示,曲线下面积(AUC)为0.83(95%CI 0.78~0.88),预测准确度为75.9%,灵敏度为74.5%,特异度为77.2%。构建的综合性影像组学模型AUC为0.86(95%CI 0.81~0.90),预测准确度为77.2%,灵敏度为78.6%,特异度为75.9%。结论 ¹⁸F-FDG PET/CT在三阴性乳腺癌分子分型诊断中发挥重要价值,构建的影像组学模型和综合性影像组学模型进一步提高了PET代谢参数的预测效能,有助于临床上尽早制定准确的治疗方案,从而改善患者预后。     

18F-FDG PET/CT对非小细胞肺癌EGFR基因突变诊断价值的Meta分析

 目的 采用Meta分析系统评价¹⁸F-FDG PET/CT对非小细胞肺癌EGFR基因突变的诊断价值。方法 计算机检索PubMed、EMbase、The Cochrane Library、中国期刊全文数据库、万方数据库、中文科技期刊数据库,查找有关¹⁸F-FDG PET/CT对非小细胞肺癌EGFR基因突变的诊断性试验。由 2 位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Meta DiSc1.4软件进行Meta分析。结果 最终纳入16篇文献,非小细胞肺癌3308例。病理确诊为肺腺癌2914例(88.09%),其他病理类型394例(11.91%)。Meta分析结果示,SEN合并=0.57[95%CI(0.55,0.60)],SPE合并=0.65[95%CI(0.62,0.67)],+LR合并=1.82[95%CI(1.49,2.23)],-LR合并=0.67[95%CI(0.59,0.76)],DOR合并=2.93[95%CI(2.08,4.15)],AUC=0.6678。结论 ¹⁸F-FDG PET/CT的SUV_max对NSCLC患者的EGFR突变有一定的预测能力,其特异度优于敏感度,可以用于EGFR突变的诊断。     

18F-FDG PET/CT引导局部晚期非小细胞肺癌靶区剂量提升的可行性研究

目的 研究基于放疗前正电子发射计算机断层显像（PET/CT）的标准摄取值（SUV）梯度引导局部晚期非小细胞肺癌（NSCLC）患者靶向剂量提升的可行性及剂量学特点。方法 收集29例NSCLC患者的放疗前PET/CT图像,在PET/CT图像上勾画大体肿瘤靶区（GTV）,以最大SUV值（SUV_max）的50%和75%为阈值将GTV分割为3个代谢活性亚区域,低于50%SUV_max的区域为GTV1,50%SUV_max到75%SUV_max的区域为GTV2,高于75%SUV_max的区域为GTV3。计划靶区（PTV）、PTV1、PTV2、PTV3分别由GTV、GTV1、GTV2及GTV3外放适当边界得到。计划1：在PTV上照射均匀60 Gy处方剂量。计划2：将PTV1、PTV2和PTV3的处方剂量分别设置为60~66 Gy、66~72 Gy和≥72 Gy。比较两种治疗计划靶区和危及器官（OAR）的剂量学差异。结果 相对于计划1,计划2将2%的PTV体积接受的剂量（D₂）由66.5 Gy提升至78.5 Gy,剂量提升约20%;PTV的平均剂量提升了8.9%（63.2~68.8 Gy）、PTV1,PTV2、PTV3的平均剂量分别提升了2.8%（62.7~64.4 Gy）、10.3%（63.5~70.0 Gy）、18.7%（63.8~75.8 Gy）。各亚区域剂量均得到有效提升。计划1与计划2 中PTV的60 Gy剂量线靶区覆盖度基本相当,差异无统计学意义（P>0.05）,均匀性指数（HI）的差异有统计学意义（t=23.3, P<0.05）,计划2中随着最大剂量的提升,HI下降显著。肺、心脏和脊髓的受照剂量在两个治疗计划中基本相当,差异均无统计学意义（P>0.05）。结论 对不同代谢活性梯度实施差异化的放疗剂量,在不增加危及器官辐射剂量的前提下,可对代谢活性高的亚区域进行靶向剂量提升,具有提高肿瘤局部控制的潜能。     

(18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients.

OBJECTIVE: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.     

PET/CT imaging in different types of lung cancer: an overview

Lung cancer (LC) still represents one of the most common tumours in both women and men. PET/CT is a whole-body non-invasive imaging procedure that has been increasingly used for the assessment of LC patients. In particular, PET/CT added value to CT is mainly related to a more accurate staging of nodal and metastatic sites and to the evaluation of the response to therapy. Although the most common PET tracer for LC evaluation is 18F-FDG, new tracers have been proposed for the evaluation of lung neuroendocrine tumours (68Ga-DOTA-peptides, 18F-DOPA) and for the assessment of central nervous system metastasis (11C-methionine). This review focuses on the main clinical applications and accuracy of PET/CT for the detection of non-small cells lung cancer (NSCLC), broncho-alveolar carcinoma (BAC), small cells lung cancer (SCLC), lung neuroendocrine tumours (NET) and solitary pulmonary nodules (SPN).     

18F-FDG PET/CT代谢参数与晚期非小细胞肺癌一线免疫治疗联合化疗预后的关系

目的探讨基线氟-18-氟代脱氧葡萄糖(18F-FDG)正电子发射计算机断层扫描(PET/CT)代谢参数与晚期非小细胞肺癌(NSCLC)一线免疫检查点抑制剂(ICI)联合化疗预后的关系。方法回顾性分析2019至2021年于郑州大学附属肿瘤医院接受基线PET/CT检查且行一线ICI联合化疗的晚期NSCLC患者。采用受试者工作特征曲线(ROC)获得总肿瘤代谢体积(TMTV)、糖酵解总量(TLG)和最大标准摄取值(SUVmax)与一线ICI联合化疗预后的最佳临界值, 并收集患者外周血指标, 采用Kaplan-Meier法、Log-rank法及Cox回归计算总生存(OS)及无进展生存(PFS)。结果共入组44例患者。单因素分析显示, TMTV>119.5 cm3及转移灶数量>3个与较差的PFS有关(χ2=4.19、11.28, P<0.05);TMTV>119.5 cm3及TLG>424.3与较差的OS有关(χ2=14.96、6.05, P<0.05)。多因素分析显示, 转移灶数量是PFS的独立预后因素(P=0.011), TMTV是OS的独立预后因素(P=0...     

呋塞米介入对18 F-脱氧葡萄糖正电子发射计算机断层显像的放射防护作用

目的 探讨呋塞米介入¹⁸F-脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像(PET/CT)的放射防护作用。方法 146例患者按随机数表法随机分为两组,实验组74例,对照组72例。试验组注射前口服呋塞米40 mg,正常对照组未行特殊处理,¹⁸F-FDG注射60、120 min后,分别在其正面前胸、腹水平测量0.5 m处周围剂量当量率。结果 试验组注射¹⁸F-FDG后60 min胸部及腹部、120 min胸部及腹部的周围剂量当量率分别为(30.80±8.61)、(41.38±11.06)、(18.26±4.85)和(24.66±6.50)μSv/h,均低于对照组,差异有统计学意义(t=15.36、13.13、18.73、17.29,P＜0.05)。试验组和对照组的纵隔SUV_max、肝脏SUV_max差异无统计学意义(P＞0.05)。多因素分析显示,是否服用速尿、体表面积是影响周围剂量当量率的主要影响因素(t=-13.52、2.96,P＜0.05),年龄、性别对周围剂量当量率的影响不明显(P＞0.05)。结论 呋塞米介入可促进排尿,在不影响影像质量的前提下有效降低了受检者的体内辐射,有较好的放射防护作用。     

18F-FDGPET/CT勾画鼻咽癌原发肿瘤体积最适阈值的研究

目的 寻找¹⁸F-FDG PET/CT勾画鼻咽癌大体肿瘤体积（GTV）的最适阈值。 方法 16例初诊鼻咽癌患者在治疗前接受¹⁸F-FDG PET/CT及MRI检查,将MRI/CT融合图像上勾画的肿瘤GTV定义为GTV_f,¹⁸F-FDG PET/CT勾画肿瘤范围为BTV。不同阈值条件下的BTV通过调整最大标准摄取值（SUV_max）的比例得到。将不同阈值条件下的BTV和GTV_f进行比较,当二者在体积及形态学上达到最佳匹配时对应的阈值水平为最适阈值（sTL）。sTL×SUV_max得到相应的最适标准摄取值（sSUV）。 结果 16例患者最适阈值sTL（%）为20.93±6.51, 相应的最适标准摄取值sSUV为2.27±0.48。 sTL与SUV_max呈负相关（R²=0.85,F=78.57,P<0.05）;sSUV与SUV_max呈正相关（R²=0.75,F=41.88,P<0.05）;sTL与GTV_f无相关性。 结论 利用SUV_max阈值法勾画鼻咽癌GTV是可行的,最适阈值不是一个固定数值,与SUV_max相关,与肿瘤体积没有明显相关性。     

Evaluation of gross tumor size using CT, 18F-FDG PET, integrated 18F-FDG PET/CT and pathological analysis in non-small cell lung cancer

Purpose

The correlation of gross tumor sizes between combined ¹⁸F-FDG PET/CT images and macroscopic surgical samples has not yet been studied in detail. In the present study, we compared CT, ¹⁸F-FDG PET and combined ¹⁸F-FDG PET/CT for the delineation of gross tumor volume (GTV) and validated the results through examination of the macroscopic surgical specimen.

Methods

Fifty-two operable non-small cell lung cancer (NSCLC) patients had integrated ¹⁸F-FDG PET/CT scans preoperatively and pathological examination post-operation. Four separate maximal tumor sizes at X (lateral direction), Y (ventro-dorsal direction) and Z (cranio-caudal direction) axis were measured on ¹⁸F-FDG PET, CT, combined ¹⁸F-FDG PET/CT and surgical specimen, respectively. Linear regression was calculated for each of the three imaging measurements versus pathological measurement.

Results

No significant differences were observed among the tumor sizes measured by three images and pathological method. Compared with pathological measurement, CT size at X, Y, Z axis was larger, whereas combined ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET size were smaller. Combined ¹⁸F-FDG PET/CT size was more similar to the pathological size than that of ¹⁸F-FDG PET or CT. Results of linear regressions showed that integrated ¹⁸F-FDG PET/CT was the most accurate modality in measuring the size of cancer.

Conclusions

¹⁸F-FDG PET/CT correlates more faithfully with pathological findings than ¹⁸F-FDG PET or CT. Integrated ¹⁸F-FDG PET/CT is an effective tool to define the target of GTV in radiotherapy.     

Performance of integrated FDG PET/contrast-enhanced CT in the diagnosis of recurrent colorectal cancer: Comparison with integrated FDG PET/non-contrast-enhanced CT and enhanced CT

Purpose  The aim of our study was to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using ¹⁸F-fluorodeoxyglucose (FDG) with IV contrast for depiction of suspected recurrent colorectal cancer and to assess the impact of PET/contrast-enhanced CT findings on clinical management compared with PET/non-contrast-enhanced CT and CT component. Methods  One hundred seventy patients previously treated for colorectal cancer underwent PET/CT consisting of non-enhanced and contrast-enhanced CT for suspected recurrence. PET/contrast-enhanced CT, PET/non-contrast-enhanced CT and enhanced CT were interpreted by two experienced radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months. Results  Patient-based analysis showed that the sensitivity, specificity and accuracy of PET/contrast-enhanced CT were 93.2 (69/74), 95.8 (92/96) and 94.7% (161/170), respectively, whereas those of PET/non-contrast-enhanced CT were 89.2 (66/74), 94.8 (91/96) and 92.4% (157/170), respectively, and those of enhanced CT were 79.7 (59/74), 93.8 (90/96) and 87.6% (149/170), respectively. Sensitivity and accuracy differed significantly among the three modalities (Cochran’s Q test: p = 0.0004 and p = 0.0001, respectively).The findings of PET/contrast-enhanced CT resulted in a change of management for 64 of the 170 patients (38%) and had an effect on patient management in 12 patients (7%) diagnosed by enhanced CT alone and 4 patients (2%) diagnosed by PET/non-contrast-enhanced CT. Conclusion  Integrated PET/contrast-enhanced CT is an accurate modality for assessing colorectal cancer recurrence and led to changes in the subsequent appropriate therapy.