PETCT在淋巴瘤中的应用-1.ppt

PET/CT在淋巴瘤中的应用 复旦大学附属肿瘤医院 肿瘤内科 郭 晔 指南更新 JCO 2007;25:579-586 JCO 2014;32:3048-3058 新的淋巴瘤分期 JCO 2014;32:3059-3067 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 Oncol 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：2分 Example of score 2: residual uptake of intensity mediastinal blood pool in lymph nodes in left axilla (arrow). Maximum standardized uptake value (SUVmax) in lymph nodes was 1.2; SUVmax in mediastinal blood pool was 1.7. 举例：治疗前 治疗后：3分 Example of score 3: residual uptake of intensity mediastinal blood pool but liver in residual mediastinal mass (arrow). Maximum standardized uptake value (SUVmax) in mass was 1.7; SUVmax in liver was 2.2. 举例：治疗前 治疗后：4分 Example of score 4: residual uptake of intensity 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 normal 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 established 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 CT CR：complet