结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Methods for Staging Non-small Cell Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Background Determining the stage of non–small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor. Methods We prospectively compared the ability of a standard approach to staging (computed tomography [CT], ultrasonography, bone scanning, and, when indicated, needle biopsies) and one involving PET to detect metastases in mediastinal lymph nodes and at distant sites in 102 patients with resectable non–small-cell lung cancer. The presence of mediastinal metastatic disease was confirmed histopathologically. Distant metastases that were detected by PET were further evaluated by standard imaging tests and biopsies. Patients were followed postoperatively for six months by standard methods to detect occult metastases. Logistic-regression analysis was used to evaluate the ability of PET and CT to identify malignant mediastinal lymph nodes. Results The sensitivity and sp...

Preoperative staging of non-small-cell lung cancer with positron-emission tomography.

https://www.heartrhythmjournal.com/article/S1547-5271(14)00335-X/pdf

HRS Expert Consensus Statement on the Diagnosis and Management of Arrhythmias Associated With Cardiac Sarcoidosis

The conundrum of modality selection in clinical diagnostic imaging is that modalities with the highest sensitivity have relatively poor resolution, while those with high resolution have relatively poor sensitivity In recent years, the idea of using multiple modalities in conjunction has gained in popularity and researchers have come to realize that the complementary abilities of different imaging modalities could be harnessed to great effect by using them in tandem The idea of combining imaging technologies moved to the mainstream with the advent of the first successful commercial fused instruments The first fused PET/CT instrument, developed in 1998 by Townsend and colleagues in collaboration with Siemens Medical, was available commercially in 2001 The “Biograph” was named as one of the “Inventions of the Year” in 2000 by Time magazine, and its success was such that by 2003 fused PET/CT instruments were available from all of the major clinical instrument manufacturers, GE, Philips, CTI, and Siemens1 Over the ensuing years, PET/CT sales increased with such vigor that by the year 2006 there were virtually no sales of standalone PET instruments; all PET sales were as part of multimodality systems2–4 The next wave of innovation has been in PET/MRI-fused instruments, which have generated much hope for improved patient safety and imaging capability over PET/CT Although research on PET/MRI instruments was initiated around the same time as PET/CT, the economic and engineering challenges of merging the two modalities slowed development, and the first commercial PET/MRI prototype for a human scale hybrid scanner was not unveiled until 20075,6 With hybrid technology clearly on the rise, the excitement over these new instruments has triggered a tumult of activity in probe design and development as investigators seek to boost the clinical benefits of hybrid instrument technology

As the preponderance of recent reviews and increase in attention at scientific meetings will attest, there has been a surge in research on multimodal contrast agent development over the past few years5,7–17 For molecular imaging, particularly, the rise in multimodal instrumentation has sparked hopes for new ways to track multiple molecular targets simultaneously, or to use different imaging methods in combination to more clearly delineate localization and expression of biochemical markers In the best of situations, the combined imaging methods and probes work synergistically to allow high-resolution, high-sensitivity investigation of biological activity For example, with dual function probes for PET/MRI, the high sensitivity of PET can be used as a whole body screen to identify regions of interest, thereby reducing the volume of tissue that needs to be scanned; this reduces scan time required for high-resolution imaging by MRI5,18 However, probe design and development has sometimes preceded the identification of clear applications that merit use of the multimodal principle There are many literature examples of probes that are “all dressed up with nowhere to go”; they possess unique physical properties that have yet to find a clear province in medicine or biology Nonetheless, it is not unusual for technology to sometimes presage the need, and it is these advances that can spur imaginative solutions to problems that had been intractable with the previously existing technology The goal of multimodal functionality has already reaped benefits by driving innovation in many areas of chemical synthesis, most notably in nanotechnology

While combining multimodal detectability in the same probe is not necessitated by all applications, there can be advantages to this arrangement A single probe helps to ensure the same pharmacokinetics and colocalization of signal for each modality if that is a concern It also can avoid putting the additional stress on the body’s blood clearance mechanisms that can accompany administration of multiple doses of agents The caveat is that because the sensitivities of different imaging modalities can vary by 3 orders of magnitude, it may not be practical to simply add all functionalities to one molecule, although we will see that is a common design, because the requirements for contrast agent concentrations can be vastly different between modalities In this review, we provide an overview of the many strategies that have been applied to achieve multimodal functionality in a single probe unit These span the range from small molecule to nanoparticulate systems and vary in complexity from facile encapsulation or conjugation of commercially available probes to de novo synthesis This review is limited to reports from the last approximately 5 years that deal with agents that carry two or more species of contrast enhancers Tables summarizing the physical properties from cited articles are included with each major category of probe to facilitate “browsing” by the reader

/pdf/multimodality-imaging-probes-design-and-challenges-2s9gb4o9ti.pdf

Multimodality Imaging Probes: Design and Challenges

Aims To evaluate the value of 18 F-fluoro-2-deoxyglucose positron emission tomography ( 18 F-FDG PET) in detecting cardiac sarcoidosis. Methods and results Thirty-two patients with sarcoidosis and thirty controls were recruited. All subjects underwent cardiac 18 F-FDG PET after a 6 h fasting period, and subjects with sarcoidosis underwent blood testing, ECG, echocardiography, and 67 Ga and 99m Tc-sestamibi (MIBI) scintigraphy. We classified 18 F-FDG PET images into four patterns ('none', 'diffuse', 'focal', and 'focal on diffuse') and found that all the control subjects exhibited either none (n = 16) or diffuse (n = 14) pattern. In contrast, fifteen subjects with sarcoidosis exhibited none, seven exhibited diffuse, eight exhibited focal, and two exhibited focal on diffuse patterns, with the prevalence of the focal and focal on diffuse patterns being significantly higher in the sarcoidosis group when compared with the control group (P < 0.001). None of the 32 subjects with sarcoidosis exhibited abnormal findings on 67 Ga scintigraphy, and 4 exhibited abnormal findings on 99m Tc-MIBI scintigraphy. Conclusion Focal uptake of the heart on 18 F-FDG PET images is a characteristic feature of patients with sarcoidosis. Furthermore, 18 F-FDG PET has the potential to detect cardiac sarcoidosis that cannot be diagnosed by 67 Ga or 99m Tc-MIBI scintigraphy.

/pdf/focal-uptake-on-18f-fluoro-2-deoxyglucose-positron-emission-2z8gwcuwjj.pdf

Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis

Purpose
Despite accumulating reports on the clinical value of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) and magnetic resonance imaging (MRI) in the assessment of cardiac sarcoidosis, no studies have systematically compared the images of these modalities.

Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis

Although FDG uptake is closely related to the expression of the glucose transporter (GLUT) in malignant tumors, such a relationship has not been fully investigated in inflammatory lesions. The aim of our study was to determine the expression of GLUT subtypes in experimental inflammatory lesions and to compare the results with those in malignant tumors in relation to FDG accumulation. Methods: Rats were inoculated with a suspension of Staphylococcus aureus or allogenic hepatoma cells (KDH-8) into the left calf muscle. Five days after S. aureus inoculation (n 5 9) and 14 d after KDH-8 inoculation (n 5 11), [14C]FDG was injected intravenously and its accumulation in the infectious and tumor tissues was determined as the percentage activity of the injected dose per gram of tissue (%ID/g). The expression of glucose transporters (GLUT-1 to GLUT-5) was investigated by immunostaining the infectious tissues (n 5 6) and the tumor tissues (n 5 6). Immunohistochemical grading was assessed semiquantitatively by 5 observers. Results: The [ 14 C]FDG uptake was significantly higher in the tumor lesion than in the inflammatory lesion (2.04 6 0.38 %ID/g vs. 0.72 6 0.15 %ID/g; P , 0.0001). The tumor and inflammatory tissues highly expressed GLUT-1 and GLUT-3. The GLUT-1 expression level was significantly higher in the tumor tissue than in the inflammatory tissue (P , 0.05). Conclusion: The results based on our models showed a high FDG uptake and high GLUT-1 expression level not only in the tumor lesion but also in the inflammatory lesion. The higher GLUT-1 expression level in the tumor lesion may partially explain the higher FDG accumulation in the tumor than in the inflammatory lesion.

https://jnm.snmjournals.org/content/jnumed/42/10/1551.full.pdf

FDG Uptake and Glucose Transporter Subtype Expressions in Experimental Tumor and Inflammation Models

F-FDG PET images intofour patterns (‘none’, ‘diffuse’, ‘focal’, and ‘focal on diffuse’) and found that allthe control subjects exhibited either none (n ¼ 16) or diffuse (n ¼ 14) pattern. In con-trast, ﬁfteen subjects with sarcoidosis exhibited none, seven exhibited diffuse, eightexhibited focal, and two exhibited focal on diffuse patterns, with the prevalence ofthe focal and focal on diffuse patterns being signiﬁcantly higher in the sarcoidosisgroup when compared with the control group (P , 0.001). None of the 32 subjectswith sarcoidosis exhibited abnormal ﬁndings on

emission tomography images indicates cardiac involvement of sarcoidosis

Purpose : Accurate diagnosis of tumor extent is important in three-dimensional conformal radiotherapy. This study reports the use of image fusion between (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) and magnetic resonance imaging/computed tomography (MRI/CT) for better targets delineation in radiotherapy planning of head-and-neck cancers. Methods and Materials : The subjects consisted of 12 patients with oropharyngeal carcinoma and 9 patients with nasopharyngeal carcinoma (NPC) who were treated with radical radiotherapy between July 1999 and February 2001. Image fusion between 18FDG-PET and MRI/CT was performed using an automatic multimodality image registration algorithm, which used the brain as an internal reference for registration. Gross tumor volume (GTV) was determined based on clinical examination and 18FDG uptake on the fusion images. Clinical target volume (CTV) was determined following the usual pattern of lymph node spread for each disease entity along with the clinical presentation of each patient. Results : Except for 3 cases with superficial tumors, all the other primary tumors were detected by 18FDG-PET. The GTV volumes for primary tumors were not changed by image fusion in 19 cases (89%), increased by 49% in one NPC, and decreased by 45% in another NPC. Normal tissue sparing was more easily performed based on clearer GTV and CTV determination on the fusion images. In particular, parotid sparing became possible in 15 patients (71%) whose upper neck areas near the parotid glands were tumor-free by 18FDG-PET. Within a mean follow-up period of 18 months, no recurrence occurred in the areas defined as CTV, which was treated prophylactically, except for 1 patient who experienced nodal recurrence in the CTV and simultaneous primary site recurrence. Conclusion : This preliminary study showed that image fusion between 18FDG-PET and MRI/CT was useful in GTV and CTV determination in conformal RT, thus sparing normal tissues.

Eriko Tsukamoto

Papers

Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis

Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis

FDG Uptake and Glucose Transporter Subtype Expressions in Experimental Tumor and Inflammation Models

emission tomography images indicates cardiac involvement of sarcoidosis

Image fusion between 18FDG-PET and MRI/CT for radiotherapy planning of oropharyngeal and nasopharyngeal carcinomas.