中山肿瘤医院讲座2014

1、脑位于坚固的颅骨内，脑位于坚固的颅骨内，难以活检。难以活检。影像学检查是颅内病影像学检查是颅内病变定性诊断的主要手变定性诊断的主要手段。段。A: FLAIR; B:Ga-DTPA; C:DWI; D:ADC; E: rCBV; F&G: MRS 常规功能常规功能MRIn Sensitivity 97%, Specificity 67% 基本原理：放射性示踪技术基本原理：放射性示踪技术PET在脑肿瘤的临床应用在脑肿瘤的临床应用诊断和鉴别诊断诊断和鉴别诊断肿瘤累及范围肿瘤累及范围分级分级疗效预测和评估疗效预测和评估预后评估预后评估PET分子成像靶点：细胞膜分子成像靶点：细胞膜+细胞内细胞内

2、+细胞间质细胞间质右颞叶混合型神经胶质瘤（右颞叶混合型神经胶质瘤（级）。级）。FDG-PET延迟显像病灶浓聚增加延迟显像病灶浓聚增加肺癌脑转移肺癌脑转移FDG13N- NH3Resonfeld et al. J Nucl Med. 1992; 33:532-536淋巴瘤淋巴瘤化疗前化疗前 化疗后化疗后Resonfeld et al. J Nucl Med. 1992; 33:532-536真菌性肉芽肿真菌性肉芽肿FDG假阳性假阳性单纯疱疹病毒性脑炎单纯疱疹病毒性脑炎 18F-FDG PET 11C-MET PETGoldman et al. J Nucl Med 1997; 38:1459-1

3、462Tumor InfiltrationSolid TumorKracht et al. Clinical Cancer Research 2004; 10:7163-7170 Chen et al. J Nucl Med. 2006; 47:908-911Edema and AstrogliosisAstrocytomaGrade Pauleut et al. Brain 2005;125:678-687Chen. J Nucl Med. 2005; 46:948-952CONCLUSION: FLT was more sensitive than FDG to image recurre

4、nt high-grade tumors, correlated better with Ki-67 values, and was a more powerful predictor of tumor progression and survival. Thus, FLT appears to be a promising tracer as a surrogate marker of proliferation in high-grade gliomas.R=0.84R=0.51Chen. J Nucl Med. 2005; 46:948-952 11C-Choline PET 18F-F

5、DG PET18F-FDG11C-CHOLINE磷脂代谢磷脂代谢CHOBruehlmeier et al. J Nucl Med. 2004; 45:1851-1859CONCLUSION: FMISO provide a spatial description of hypoxia in brain tumors that is independent of BBB disruption and perfusion.HV: 129cm3, T/B: 3.0T0: 20cm3, T1Gd: 80cm3, T2: 169cm3HV: 5.3cm3, T/B: 1.6T0: 1cm3, T1Gd:

6、 7cm3, T2: 37cm3Alexander et al. Clin Cancer Res. 2008; 14: 2623-2630Alexander et al. Clin Cancer Res. 2008; 14: 2623-2630乏氧容积乏氧容积乏氧比值乏氧比值“In contrast to the relatively disappointing results with other targeted molecular therapies, there has been real progress with agents that inhibit angiogenesis.”

7、 “New developments in targeted molecular therapies for glioblastoma” Wen et al. Expert Rev. Anticancer Ther. 2009; 9:7-10Miller et al. J Natl Cancer Inst. 2005; 95：172-187Chen et al. J Nucl Med. 2008; 45:1176-1183 13N-NH3分子量：分子量： 547 17J Neuro-oncol. 2006; 78:141-151J Neuro-oncol. 2007; 82:305-311PE

8、T诊断：诊断： 小脑星形细胞瘤（小脑星形细胞瘤（级）级）18F-FDG13N-NH3 18F-FDG 13N-NH3 11C-MET 11C-CHO -脑肿瘤代谢显像剂脑肿瘤代谢显像剂 MRI增强增强FDGNH3MET-低级别星形细胞瘤典型代谢表型低级别星形细胞瘤典型代谢表型星形细胞瘤星形细胞瘤II级级星形细胞瘤星形细胞瘤II级级 CT/MRI18F-FDG13N-NH311C-MET脑脓肿脑脓肿星形细胞瘤星形细胞瘤III级级-颅内感染、炎症性病变代谢表型颅内感染、炎症性病变代谢表型MRI诊断海绵状血管瘤合并出血，诊断海绵状血管瘤合并出血，不除外星形细胞瘤不除外星形细胞瘤PET诊断低级别诊断低

9、级别星形细胞瘤星形细胞瘤手术病理：星形细胞瘤手术病理：星形细胞瘤II级级FDG13N-NH311C-METMRICTFDG13N-NH3MRI疑诊恶性脑疑诊恶性脑肿瘤肿瘤PET/CT诊断出诊断出血性脑梗死血性脑梗死诊断：诊断：右侧颞叶及海马病变，结合右侧颞叶及海马病变，结合MRI及及DWI表现及既往表现及既往影像资料，不支持肿瘤，考虑炎性病变可能性大影像资料，不支持肿瘤，考虑炎性病变可能性大麦润金麦润金 女女 55岁，岁，81512诊断：诊断：星形细胞瘤（星形细胞瘤（级）级）星形胶质瘤星形胶质瘤IIII级手术级手术并放化疗后并放化疗后7 7个月个月1818F-FDGF-FDG显示轻度摄取显示轻

10、度摄取1313N-N-NHNH3 3无摄取无摄取放射性坏死放射性坏死MRI诊断胶质瘤复发诊断胶质瘤复发胶质母细胞瘤胶质母细胞瘤手术加放化疗后三个月手术加放化疗后三个月 11C-MET 11C-MET假阳性表现假阳性表现( (二次手术证实为坏死二次手术证实为坏死) )-氨基酸类氨基酸类PET显像剂也有假阳性显像剂也有假阳性!胶质母细胞瘤术后胶质母细胞瘤术后2 2周周MRI增强增强18F-FDG13N-NH3胶质母细胞瘤胶质母细胞瘤淋巴瘤淋巴瘤-脑肿瘤代谢表型差异性脑肿瘤代谢表型差异性18F-FDG13N-NH3MRI？MRIFDG13N-NH3胶质母细胞瘤胶质母细胞瘤？MRIFDG13N-NH3淋巴瘤淋巴瘤-鞍区脑肿瘤代谢表型差异性鞍区脑肿瘤代谢表型差异性垂体瘤垂体瘤脑膜瘤脑膜瘤MRI增强增强18F-FDG13N-NH3中山一院院本部中山一院院本部MR诊断：脑膜瘤可能性大诊断：脑膜瘤可能性大黄埔院区黄埔院区MR诊断：鼻咽癌可能性大诊断：鼻咽癌可能性大MR增强增强18F-FDG13N-NH3手术病理：脑膜瘤手术病理：脑膜瘤I级级MR诊断：脑膜瘤诊断：脑膜瘤临床疑问：泌乳素升高，溴隐亭治疗有效，垂体瘤？海绵状血管瘤？临床疑问：泌乳素升高，溴隐亭治疗有效，垂体瘤？海绵状血管瘤？MR增强增强18F-FDG13N-NH3良性脑膜瘤良性脑膜瘤I级？级？Clin Nucl