PET-CT在淋巴瘤中的应用.pptx
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1、内容背景介绍PET/CT用于淋巴瘤的分期评估PET/CT用于淋巴瘤治疗后评估PET/CT用于淋巴瘤治疗中期评估背景知识PET:正电子发射型计算机断层显象,是以人体解剖结构为基础,利用正电子核素标记药物的示踪作用,显示人体内物质代谢,细胞增殖,血流灌注及脏器功能状态。缺点是不能准确测量肿瘤大小CT:显示人体解剖结构及形态学改变,有较强的空间分辨率PET/CT:PET和CT图像同机融合,一次成象获得全身PET和CT的图象,将功能影象与解剖形态学优化组合,两者结合取长补短18FDG在肿瘤细胞中的摄取FDG在常见淋巴瘤中的摄取进行FDG-PET的要求Juweid ME,et al.J Clin Onc
2、ol 2007;25:571-578.PET图像的解读标准(视觉判断法)Juweid ME,et al.J Clin Oncol 2007;25:571-578.5分类法(Deauville 标准)Barrington S,et al.J Clin Oncol 2014;32:3048举例:治疗前治疗后:1分Example of score 1:complete metabolic response with no uptake in normal-size lymph nodes at site of initial disease in left neck(arrow).举例:治疗前治疗后
3、:2分Example of score 2:residual uptake of intensity mediastinal blood pool but liver in residual mediastinal mass(arrow).Maximum standardized uptake value(SUVmax)in mass was 4.5;SUVmax in liver was 3.2.举例:治疗前治疗后:5分Example of score 5:residual uptake in mediastinum with intensity markedly higher than n
4、ormal liver.Maximum standardized uptake value(SUVmax)in mass was 13.0;SUVmax in liver was 2.3.新的指南推荐级别Experts in nuclear medicine and radiology applied to lymphoma undertook a literature review and shared knowledge about research in progress.Recommendations were formulated as follows:Based on establ
5、ished current knowledge(type 1)To identify emerging applications(type 2)To highlight key areas requiring further research(type 3)Barrington S,et al.J Clin Oncol 2014;32:3048肿瘤缓解术语CTCR:complete responseCRu:complete response unconfirmedPR:partial responseSD:stable diseasePD:progressive diseasePET/CTCM
6、R:complete metabolic responsePMR:partial metabolic responseNMR:no metabolic responsePMR:progressive metabolic diseaseCheson BD,et al.J Clin Oncol 1999;17:1244.Cheson BD,et al.J Clin Oncol 2014;32:3059Interpretation of PET-CT scans1.Staging of FDG-avid lymphomas is recommended using visual assessment
7、,with PET-CT images scaled to fixed SUV display and color table;focal uptakein HL and aggressive NHL is sensitive for bone marrow involvement and may obviate need for biopsy;MRI is modality of choice for suspected CNS lymphoma(type 1)2.Five-point scale is recommended for reporting PET-CT;results sho
8、uld be interpreted in context of anticipated prognosis,clinical findings,and othermarkers of response;scores 1 and 2 represent CMR;score 3 also probably represents CMR in patients receiving standard treatment(type 1)3.Score 4 or 5 with reduced uptake from baseline likely represents partial metabolic
9、 response,but at end of treatment represents residual metabolicdisease;increase in FDG uptake to score 5,score 5 with no decrease in uptake,and new FDG-avid foci consistent with lymphoma represent treatment failure and/or progression(type 2)Barrington S,et al.J Clin Oncol 2014;32:3048PET结果假阳性产生的原因化疗
10、/放疗后的坏死/炎症反应化疗间隔:至少3周(最佳6-8周)放疗间隔:8-12周造血因子的骨髓刺激增生的胸腺组织某些摄取FDG的良性疾病免疫细胞的影响不规范的操作和图像的解读内容背景介绍PET/CT用于淋巴瘤的分期评估PET/CT用于淋巴瘤治疗后评估PET/CT用于淋巴瘤治疗中期评估传统CT分期评估的缺点仅根据病变/淋巴结的形态和大小决定临床意义对于结外病变的判断能力不足评估能力受扫描区域或部位的限制需要增强扫描,无法用于碘过敏的患者PET与CT用于分期评估的比较PET分期评估的结果Role of PET-CT for staging1.PET-CT should be used for sta
11、ging in clinical practice and clinical trials but is not routinely recommended in lymphomas with low FDG avidity;PET-CT may be used to select best site to biopsy(type 1)2.Contrast-enhanced CT when used at staging or restaging should ideally occur during single visit combined with PET-CT,if not alrea
12、dy performed;baseline findings will determine whether contrast-enhanced PET-CT or lower-dose unenhanced PET-CT will suffice for additional imaging examinations(type 2)3.Bulk remains an important prognostic factor in some lymphomas;volumetric measurement of tumor bulk and total tumor burden,including
13、 methods combining metabolic activity and anatomical size or volume,should be explored as potential prognosticators(type 3)Barrington S,et al.J Clin Oncol 2014;32:3048内容背景介绍PET/CT用于淋巴瘤的分期评估PET/CT用于淋巴瘤治疗后评估PET/CT用于淋巴瘤治疗中期评估基于CT的IWG标准1999年IWG制定了淋巴瘤疗效评价和预后评估指南IWG指南统一了原本各异的疗效评估标准该指南得到了临床医生和监管机构的广泛认可,并用于
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