头颈癌 comparison of pet ct 课件

Positron Emission Tomography PET scanner FDG PET in Normal FDG accumulation in cancer cells Action of glucose transporter proteins. Highly active hexokinase bound to tumor mitochondria helps to trap FDG into cell. Relative hypoxia in tumor masses which activate the anaerobic glycolytic pathway. The increased glucose uptake is due to the need for nucleic acid synthesis and, therefore, is directly related to the tumors tendency to grow. FDG uptake is strongly related to the number of viable tumor cells, although not directly regulated by the need for DNA synthesis. Cancer 1988:1776, JNM 1991:1548, JNM 1993:414 PET in Oncology 顯影藥物：FDG, C-11 methionine, N-13 glutamate, F-18 FU, F-18 misonidazole, etc. 良性、惡性腫瘤鑑別 癌症病灶偵測定位 偵測癌症淋巴腺及轉移 病灶 精確的癌症分期 癌症復發、壞死鑑別 藥物、受體分析 癌症篩檢 Health Care Finance Administration 12/2000 臨床症狀 頭頸癌 黑色素瘤 結腸癌 淋巴瘤 食道癌 肺癌（非微小可疑點） 乳癌 給付類別 診斷、分期、再分期 診斷、分期、再分期（局部結點除外） 診斷、分期、再分期 診斷、分期、再分期 診斷、分期、再分期 診斷、分期、再分期 MCAC 研究中 Positron Emission Tomography in Head 200:135 TreatmentRepeat Bx or F/UMRI extent(-)(+) MRI (PET)F/UBiopsy (+)(-)(-)(+) BiopsyFDG PET Lesion suspicious RDNo identifiable lesion Physical examination Clinical symptoms PET in Recurrence (1) Head SUV = 6June, 2000; SUV = 3 CTFused PET/CTContrast CTFused PET/CT PET in Head 200:135 FDG PET should procede MRI/CT for possible residual or recurrence because MRI/CT is often inconclusive. PET: While negative PET, the patients might be clinically F/U without MRI/CT. 7+1&2+4 11&4+3 02&1+2 2&1+01 11+0 FDG PETCT/MRI12 pts grade Radioisotopes in PET 各種常用正子放射核種的特性： IsotopeT1/2 (min)Emax (MeV) FWHM (mm) F-18 109.70.6350.22 C-11 20.40.960.28 N-13 9.961.190.60 O-15 2.071.721.1 Ga-6868.31.901.35 Rb-821.253.352.6 Positron emitted Radiopharmaceuticals Health Care Finance Administration 12/2000 臨床症狀 肺癌（非微小可疑點） 黑色素瘤 結腸癌 淋巴瘤 食道癌 頭頸癌 腦疾發作（如癲癇） 心肌存活 乳癌 阿茲海默症 給付類別 診斷、分期、再分期 診斷、分期、再分期（局部結點除外） 診斷、分期、再分期 診斷、分期、再分期 診斷、分期、再分期 診斷、分期、再分期 手術前評估 SPECT 未有結論時之追蹤 MCAC 研究中 MCAC 研究中 PET/CT in Esophageal cancer PET in Neurology 顯影藥物：FDG, C-11 NMSP, F-18 L-dopa, C-11 benzodiazepine, C-11 carfentanil, etc. 老年癡呆症早期診斷 癲癇病灶偵測定位 腦瘤良性、惡性、壞死 腦血管疾病早期診斷 癌症復發、壞死鑑別 椎體外神經系統疾病 精神疾病 PET in Cardiology 顯影藥物：FDG, C-11 palmitate, C-11 acetate, N-13 NH3, F-18 misonidazole, etc. 存活心肌 PTCA, CABG 術前評估、術後追蹤 心肌梗塞範圍、預後 冠心症診斷、嚴重度 、側支循環 Dilated or Ischemic 心肌病變鑑別診斷 PET/CT or PET/MR : Clinical Benefits Improved oncological diagnosis improved localization of disease assista