Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

Background： The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery （VATS） combined with positron emitted tomography （PET）-computed tomography （CT） in the diagnosis of patients with early （Stage 1） sarcoidosis. Methods： From 1995 to 2006, seven patients （two males, five females）, with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis （mediastinal or hilar lymph nodes involvements without lung involvement） by histological examination of intrathoracic lymph nodes （LNs） and/or lung parenchyma taken＇from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results： All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satisfactory results. Conclusion： VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic altermative of transbronchial lung biopsy （TBLB）, and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.

Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography-computed tomography and the association with shoulder pain

BACKGROUND Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment.Positron emission tomography-computed tomography(PET-CT)is routinely performed as a follow-up study in cancer patients after therapy.Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.AIM To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.METHODS Our prospective study received Institutional Review Board approval.Written informed consent was obtained from all patients,who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study,between March 2015 and April 2019.Patients with advanced glenohumeral arthrosis,metastatic disease or other mass in the shoulder,or shoulder arthroplasty were excluded.Patterns of shoulder capsule 18F-fluorodeoxyglucose(FDG)uptake were noted.Standard Uptake Value(SUV)max and SUVmean values were measured at rotator interval(RI)and deltoid muscle in bilateral shoulders.Normalized SUV(SUV of RI/SUV of deltoid muscle)was also calculated.We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders.Covariates were age,gender,and therapy type(surgery,chemotherapy,radiation).Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age,SUV measurements between symptomatic and asymptomatic patients.Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status,after adjusting for covariates.Statistical significance level was set at P<0.05.RESULTS Of 252 patients initially enrolled for the study(mean age 66 years,67 symptomatic),shoulder PET-CT data were obtained in 200 patients(52 were excluded due to exclusion criteria above).The most common cancer types were lymphoma(n=61),lung(n=54)and breast(n=53).No significant difference was noted between symptomatic and asymptomatic patients in terms of age,gender,proportion of patients who had surgical therapy and radiation therapy.A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder(65%vs 48%,P=0.012).No such difference was seen for the left shoulder.In both shoulders,SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders(Left SUVmax 2.0 vs 1.6,SUVmean 1.6 vs 1.3,both P<0.002;Right SUVmax 2.2 vs 1.8,SUVmean 1.8 vs 1.5,both P<0.01).For lung cancer patients,bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders.For other cancer patients,symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.CONCLUSION In symptomatic patients metabolic activities in RI were higher than asymptomatic patients.Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.

Polyarteritis nodosa presenting as leg pain with resolution of positron emission tomography-images:A case report

BACKGROUND Although fluorodeoxyglucose-positron emission tomography/computed tomography(FDG-PET/CT)is widely used for diagnosis and follow-up of large sized vessel vasculitis,it is still not widely used for small to medium sized vessel vasculitis.CASE SUMMARY This is the case of a 68-year-old male who presented at the emergency department complaining of fever,myalgia,and bilateral leg pain of over two weeks duration,with elevated levels of C-reactive protein.He was subsequently admitted and despite the absence of clinically significant findings,the patient continued to exhibit recurrent fever.A fever of unknown origin workup,which included imaging studies using FDG-PET/CT,revealed vasculitis involving small to medium-sized vessels of both lower extremities,demonstrated by linear hypermetabolism throughout the leg muscles.The patient was treated with methylprednisolone and methotrexate after diagnosis leading to the gradual resolution of the patient’s symptoms.Three weeks later,a follow-up FDGPET/CT was performed.Previously hypermetabolic vessels were markedly improved.CONCLUSION Our case report demonstrated that FDG-PET/CT has tremendous potential to detect medium-sized vessel inflammation;it can also play a crucial role in prognosticating outcomes and monitoring therapeutic efficacy.

Rapid progress of an iris metastasis from esophageal cancer:a case report and review of literature

This case report details a rare instance of rapid iris metastasis from esophageal cancer in a 59-year-old man.A literature review was conducted to explore recent advances in detecting,diagnosing,and treating intraocular metastatic malignancies.Positron emission tomographycomputed tomography played a crucial role in identifying primary sites and systemic metastases.Local treatment combined with systemic therapy effectively reduced tumor size,preserved useful vision,and improved the patient’s survival rate.A comparison was made of the characteristics of iris metastases from esophageal cancer and lung cancer,including age,gender,tumor characteristics,and treatment.The challenges associated with diagnosis and treatment are discussed,highlighting the implications for clinical practice.

Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

Incidence of exclusive extrapelvic skeletal metastasis in prostate carcinoma on bone scintigraphy

BACKGROUND Bone is one of the common sites of metastasis from prostate carcinoma.Bone scintigraphy(BS)is one of the most sensitive imaging modalities currently used for bone metastatic work-up.Skeletal metastasis in prostate carcinoma commonly involves pelvic bones but rarely involves extrapelvic-extraspinal sites.AIM To retrospectively analyze the BS data to determine the pattern of skeletal metastases in the prostate carcinoma.METHODS This retrospective observational study involves patients with biopsy-proven prostate carcinoma referred for BS for staging assessment.Patients with abnormal BS were evaluated for the pattern of skeletal involvement and data were pre-sented in descriptive format in the form of percentages.RESULTS A total of 150 patients with biopsy-proven prostate cancer who were referred for staging were included in the study.Thirteen of 150 patients(8.67%)had no abnormal uptake on planar images,ruling out metastatic disease.Twenty-four patients(16%)had heterogeneous uptake in the spine with distribution charac-teristic of degenerative disease and no scan pattern of metastatic disease.Thirty patients(20%)had multifocal uptake involving both pelvic and extra pelvic bones on planar images typical for skeletal metastasis and were considered metastatic.Eighty-three out of 150 patients(55.3%)had increased tracer uptake,which was indeterminate,thus,single photon emission computed tomography-computed tomography(SPECT-CT)was acquired,which showed 51 with metastatic disease,31 benign lesions,and one indeterminate finding.Seven of 150 patients had exclusive pelvic bone uptake,which was found to be metastatic in 4/7 patients in SPECT-CT.Fifty six out of 150 patients showed exclusive extrapelvic tracer uptake,of which only 3 had vertebral metastatic disease.None of the patients with increased uptake exclusively in the extrapelvic-extraspinal location was metastatic.CONCLUSION The incidence of exclusive extrapelvic skeletal metastatic disease in prostate carcinoma is 2%(excluding one patient with indeterminate findings).Further,none of the patients in the current study had exclusive extrapelvic-extraspinal metastasis.Thus,exclusive extrapelvic-extraspinal focal abnormality on planar BS carries a very low probability of metastatic disease and hence,further imaging or SPECT-CT can be safely avoided in such cases.

脉络膜恶性黑色素瘤误诊误治分析

目的探讨以玻璃体积血为首发症状的脉络膜恶性黑色素瘤(CM)临床特征、误诊原因及防范措施。方法回顾性分析2023年12月收治的脉络膜黑色素瘤1例的临床资料。结果该例因双眼视物模糊,于外院诊断为玻璃体积血行玻璃体切割联合白内障超声乳化人工晶体植入术后7个月,术后视物不见,伴眼胀痛,加重7 d入院,考虑为继发性青光眼,完善术前检查后行“左眼球摘除术”,术中发现色素块,标本送病理检查确诊恶性黑色素瘤,行PETCT全身断层显像排除其他部位原发肿瘤或转移病灶。行“左眼眼眶内容物清除术”,术后予对症处理。随访半年未见明显异常。结论以玻璃体积血为首发症状的CM易误诊,医生在接诊此类病例时,应采取综合性的诊断策略,必要时活检,以降低误诊风险。

Role of molecular imaging in prognosis,diagnosis,and treatment of gastrointestinal cancers:An update on new therapeutic methods

One of the leading causes of cancer-related death is gastrointestinal cancer,which has a significant morbidity and mortality rate.Although preoperative risk assessment is essential for directing patient care,its biological behavior cannot be accurately predicted by conventional imaging investigations.Potential pathophysiological information in anatomical imaging that cannot be visually identified can now be converted into high-dimensional quantitative image features thanks to the developing discipline of molecular imaging.In order to enable molecular tissue profile in vivo,molecular imaging has most recently been utilized to phenotype the expression of single receptors and targets of biological therapy.It is expected that molecular imaging will become increasingly important in the near future,driven by the expanding range of biological therapies for cancer.With this live molecular fingerprinting,molecular imaging can be utilized to drive expression-tailored customized therapy.The technical aspects of molecular imaging are first briefly discussed in this review,followed by an examination of the most recent research on the diagnosis,prognosis,and potential future clinical methods of molecular imaging for GI tract malignancies.

Positron emission tomography/computer tomography:Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies

Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.

Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography

AIM: To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT) hybrid imaging for diagnosis of various endocrine disorders.METHODS: We performed MEDLINE and Pub Med searches using the terms: "SPECT/CT"; "functional anatomic mapping"; "transmission emission tomography"; "parathyroid adenoma"; "thyroid cancer"; "neuroendocrine tumor"; "adrenal"; "pheochromocytoma"; "paraganglioma"; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts(case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for ^(99m)Tc-sestamibi parathyroid scintigraphy and ^(99m)Tc-pertechnetate thyroid scintigraphy, ^(123)I- or ^(131)I-radioiodine for staging of differentiated thyroid carcinoma, ^(111)In- and ^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors, ^(131)I-norcholesterol(NP-59) scans for assessment of adrenal cortical hyperfunction, and ^(123)I- or ^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.

Mediastinal node staging by positron emission tomographycomputed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer:Results from a regional centre

AIM To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) and positron emission tomography-computed tomography(PET-CT) in the nodal staging of upper gastrointestinal(GI) cancer in a tertiary referral centre.METHODS We performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values(PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTS One hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma(Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients(10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients(65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients(34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen(51.9%) experienced clinical remission of a median of nine months(range three to forty two months). CONCLUSION EUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.

Ultrasound-guided intra-articular corticosteroid injection in a patient with manubriosternal joint involvement of ankylosing spondylitis:A case report

BACKGROUND Manubriosternal joint(MSJ)disease is a rare cause of anterior chest pain but can be a major sign of systemic arthritic involvement.In patients with ankylosing spondylitis(AS),a type of systemic arthritis,chest pain can be due to MSJ involvement and can be improved by ultrasound-guided corticosteroid injection into the joint.CASE SUMMARY A 64-year-old man visited our pain clinic complaining of anterior chest pain.There were no abnormal findings on lateral sternum X-ray,but arthritic changes in the MSJ were observed on single-photon emission computed tomography-computed tomography.We performed additional laboratory tests,and he was finally diagnosed with AS.For pain relief,we performed ultrasound-guided intra-articular(IA)corticosteroid injections into the MSJ.After the injections,his pain nearly resolved.CONCLUSION For patients complaining of anterior chest pain,AS should be considered,and single-photon emission computed tomography-computed tomography can be helpful in diagnosis.In addition,ultrasound-guided IA corticosteroid injections may be effective for pain relief.

Advancements of molecular imaging and radiomics in pancreatic carcinoma

Despite the recent progress of medical technology in the diagnosis and treatment of tumors,pancreatic carcinoma remains one of the most malignant tumors,with extremely poor prognosis partly due to the difficulty in early and accurate imaging evaluation.This paper focuses on the research progress of magnetic resonance imaging,nuclear medicine molecular imaging and radiomics in the diagnosis of pancreatic carcinoma.We also briefly described the achievements of our team in this field,to facilitate future research and explore new technologies to optimize diagnosis of pancreatic carcinoma.

电话随访在PET-CT检查中的应用

目的:探讨电话随访对PET-CT受检者及其家属依从性的影响。方法:对预约行PET-CT检查的患者按预约检查日期的单、双日随机分为随访组和对照组,两组患者在预约时均给予口头的注意事项告知及书面的“PET-CT检查知情同意书”。随访组在检查前一日的下午给予电话随访,确认到诊时间,告知禁食时间、检查流程等相关注意事项。对检查者通过随访及检查当日收集到的相关资料进行分析。结果:两组受检者在饮食依从性、就诊时间依从性、携带资料依从性、检查花费时间以及患者满意度调查的情况之间有显著差异,随访组依从性优于对照组。两组爽约例数有差异。结论:检查前的电话随访大大提高了患者检查的依从性,对顺利完成检查以及改善医患关系起到明显的促进作用。

Prognostic Value of Semi-Quantitative 18F-FDG PET/CT Parameters in Hodgkin’s Lymphoma

Objective:To assess the prognostic value of maximum standardized uptake value(SUVmax),metabolic tumor volume(MTV),and total lesion glycolysis(TLG)determined by 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)imaging in Hodgkin’s lymphoma patients.Methods:A total of 148 Hodgkin’s lymphoma patients diagnosed with lymph node biopsy from October 2014 to October 2015 were retrospectively analyzed followed by categorizing into good(125 cases)and poor(23 cases)prognosis groups.The chi-squared test was used to analyze the clinicopathological characteristics of Hodgkin’s lymphoma patients with the semi-quantitative 18F-FDG PET/CT parameters;the Spearman method was used to analyze the correlation between the semi-quantitative parameters and clinicopathological features of Hodgkin’s lymphoma;receiver operating characteristic curve was used to analyze the predictive value of the semi-quantitative parameters for poor prognosis of Hodgkin’s lymphoma patients.Results:Mean SUVmax,MTV,and TLG of the 148 cases of Hodgkin’s lymphoma were 7.26±2.38,12.46±3.14 cm3,and 76.83±18.56 g,respectively.Significant variations in the Ann Arbor stage and clinical classification were observed with different levels of semi-quantitative parameters(P<0.05).The semi-quantitative parameters were not correlated with age and gender(P>0.05)but positively correlated with Ann Arbor stage and clinical classification(P<0.05).These parameters in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The area under the curve(AUC)of SUVmax,MTV,and TLG in predicting the poor prognosis group was 0.881,0.875,and 0.838,with cut-off values of 7.264,12.898 cm3,and 74.580g,as well as specificity of 88.8%,84.0%,and 78.4%,and sensitivity of 87.0%,87.0%,and 78.3%,respectively;the AUC of the combined prediction was 0.986,with a specificity of 97.6%and sensitivity of 86.3%.Conclusion:The semi-quantitative 18F-FDG PET/CT parameters provide valuable insights for Hodgkin’s lymphoma prognosis assessment.

结直肠癌影像学诊断的研究进展

影像诊断技术对筛查和诊断结直肠癌具有重要意义。近年来CT虚拟结肠镜、相控阵线圈、氟代脱氧葡萄糖正电子发射断层显像(18F-FDG PET)和相关新型对比增强剂等技术的出现为结直肠癌的诊断带来了革新。该文比较各项影像学技术的优劣,对近年来结直肠癌影像学诊断研究的新进展进行综述。

18F-FDG PET/CT显像对宫颈癌放疗后骶骨不全骨折与转移瘤的鉴别诊断

目的探讨18F-FDG PET/CT显像鉴别诊断宫颈癌放疗后骶骨不全骨折(SIF)与骶骨转移瘤的价值。资料与方法回顾性分析经临床或病理确诊的29例宫颈癌放疗后SIF患者(SIF组)及28例单发骶骨转移瘤患者(转移瘤组)的PET/CT资料,观察放疗区域内、外椎体CT值、骨折类型、最大标准化摄取值(SUVmax)、FDG摄取模式、骨质破坏模式、有无骨折线、有无软组织肿块。采用受试者工作特征(ROC)曲线分析SIF与骶骨转移瘤的最佳SUVmax临界值。结果SIF组放疗区域内、外椎体CT值分别为(25.1±26.6)Hu和(90.3±32.5)Hu,差异有统计学意义(t=8.354,P<0.001);SIF组骨折类型为B1型9例,B2型2例,A1型11例,A2型7例,合并骶骨外骨折11例。SIF组与转移瘤组SUVmax分别为3.0±1.2和9.1±4.2,差异有统计学意义(t=7.390,P<0.001);FDG摄取模式、骨质破坏模式、折线及软组织肿块差异均有统计学意义(P均<0.01)。ROC分析显示诊断转移瘤的SUVmax最佳阈值为5.0,敏感度为83.2%,特异度为98.5%。结论SIF的典型18F-FDG PET/CT表现为平行于骶髂关节的骨折线伴轻中度FDG摄取,PET/CT显示病变的FDG摄取特征及形态学改变与转移瘤的鉴别诊断有重要价值。

^(13)N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验对单侧大脑中动脉或颈内动脉狭窄患者脑血管储备的评定

目的探讨^(13)N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病脑血管储备评定中的应用价值。方法 2014年1月~2015年12月,10名正常人和53例单侧大脑中动脉或颈内动脉狭窄患者在基态和醋甲唑胺负荷后分别行^(13)N-ammonia PET/CT脑血流灌注显像成像。在双侧额叶、顶叶、颞叶、枕叶、基底节和丘脑勾画相应的感兴趣区,计算两侧的平均放射性计数和血流变化率。结果正常人基态和负荷后,双侧额叶、顶叶、颞叶、枕叶、基底节和丘脑放射性分布均大致对称。基底节、丘脑放射性分布高于皮质,白质放射性分布最低。负荷后双侧放射性计数均较基态时增高,双侧增高幅度基本一致(t=1.552,P=0.132)。基态显像时,39例患者呈现126个血流灌注减低区。负荷后,49例患者呈现183个血流灌注减低区。基态时已有血流灌注减低区的39例患者中,16例负荷后出现新的血流灌注减低区,13例29个病灶血流灌注较基态时改善。血流灌注减低区的负荷血流变化率与基态血流变化率有显著性差异(t=2.466,P<0.05)。结论^(13)N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验能够很好评估单侧大脑中动脉或颈内动脉狭窄患者脑血管储备的变化,对缺血性脑血管病的病情评估和早期干预有重要临床意义。

18F-FDG PET/CT中不同部位SUVmax对预测初治转移鼻咽癌预后的价值

目的探讨18F-FDGPET/CT的最大标准化摄取值(SUVmax)预测初诊转移鼻咽癌预后的价值。资料与方法回顾性分析治疗前行病理活检及全身PET/CT检查,并确诊为初治远处转移的鼻咽癌患者159例。所有患者均行电话及门诊随访,中位随访时间17.95个月。评估18F-FDG PET/CT不同部位的SUVmax与总体生存期(OS)的相关性。通过Kaplan-Meier法计算患者6个月、1年、2年OS;应用Cox模型分析预后影响因素。结果159例患者中,单纯骨转移64例;未行化疗34例、疗程<4周期63例、>4周期62例;73例未行放疗、16例鼻咽部放疗剂量<68 Gy、70例>68 Gy。鼻咽部SUVmax(NP-SUVmax)7.00-15.00,中位数11.75;颈部SUVmax(NK-SUVmax)7.00-16.00,中位数11.72;转移灶SUVmax(M-SUVmax)5.00-11.25,中位数5.33。单因素分析发现,转移部位、化疗周期、放疗剂量及M?SUVmax是OS的影响因素;多因素分析发现,单纯骨转移、化疗>4周期以及低M-SUVmax患者OS更长。结论18F-FDGPET/CT转移灶的SUVmax对预测初诊转移的鼻咽癌患者的预后具有一定的价值。

13N-Ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验在缺血性脑血管病中的应用

目的探讨13N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验评估缺血性脑血管病患者脑血管储备(CVR)的应用价值。方法2014年1月至2016年12月,单侧大脑中动脉或颈内动脉重度狭窄患者56例,在基态和醋甲唑胺负荷后分别行13N-ammonia PET/CT脑血流灌注显像,评估CVR情况;治疗后6个月再次行基态脑血流灌注显像。根据CVR将患者分为CVR正常组(n=29)和CVR下降组(n=27),随访24个月,观察两组脑缺血事件发生率和治疗前后基态脑血流(CBF)的变化。结果CVR下降组短暂性脑缺血发作的发生率高于CVR正常组(χ2=4.389,P<0.05),缺血性脑卒中的发生率略高于CVR正常组,但无显著性差异(P>0.05)。CVR正常组治疗后基态CBF改善(t=2.409,P<0.05);CVR下降组治疗后基态CBF与治疗前无显著性差异(t=0.648,P>0.05)。结论13N-ammonia PET/CT脑血流灌注显像结合醋甲唑胺负荷试验能很好评估缺血性脑血管病患者CVR变化,并估计预后,对早期干预有指导意义。