Hain S F, O'Doherty M J, Bingham J, Chinyama C, Smith M A
The Clinical PET Centre, Guy's, King's and St Thomas' School of Medicine, Guy's and St Thomas' Hospital, London, UK.
Nucl Med Commun. 2003 Nov;24(11):1139-43. doi: 10.1097/00006231-200311000-00003.
Magnetic resonance imaging (MRI) has been the most useful tool in the anatomical definition of soft tissue sarcoma, although there remains the problem of defining the lesions as benign or malignant. The management of such lesions requires biopsy prior to surgical resection. If the most malignant area could be defined more accurately, then this area could be targeted for biopsy. Fluorodeoxyglucose positron emission tomography (FDG PET) has been found to be useful in identifying malignancy and variations in grade in soft tissue masses. The aim of this study was to assess the use of FDG PET scanning with or without co-registered MRI to indicate the most appropriate biopsy site. Twenty consecutive patients presented with soft tissue masses with clinical signs of malignancy. All patients underwent MRI and FDG PET scanning and the two images were co-registered. A biopsy site that was the most likely to be malignant was defined on the PET scan. All patients underwent an initial biopsy and then complete surgical resection of the mass. The histological results from the mass were compared with those from the biopsy specimen obtained from the site suggested by the PET scan. In malignant masses the biopsy site suggested by the FDG PET scan was found to be representative of the most malignant site on the whole mass histology. Benign lesions had low or no FDG uptake. In no case did the co-registered image add significantly to the appropriate biopsy site. FDG PET can be used to appropriately direct biopsy in soft tissue sarcoma and potentially may lead to computed tomography/MRI directed outpatient biopsy prior to definitive treatment.
磁共振成像（MRI）一直是软组织肉瘤解剖学定义中最有用的工具，尽管在将病变定义为良性或恶性方面仍然存在问题。对于此类病变的处理需要在手术切除前进行活检。如果能够更准确地定义最恶性的区域，那么该区域就可以作为活检的目标。已发现氟脱氧葡萄糖正电子发射断层扫描（FDG PET）在识别软组织肿块中的恶性程度及分级差异方面很有用。本研究的目的是评估使用FDG PET扫描（有无联合配准MRI）来指示最合适的活检部位。连续20例患有具有恶性临床体征的软组织肿块的患者。所有患者均接受了MRI和FDG PET扫描，且这两种图像进行了联合配准。在PET扫描上定义了最可能为恶性的活检部位。所有患者均先进行了初步活检，然后对肿块进行了完整的手术切除。将肿块的组织学结果与从PET扫描所建议部位获取的活检标本的结果进行比较。在恶性肿块中，发现FDG PET扫描所建议的活检部位代表了整个肿块组织学上最恶性的部位。良性病变的FDG摄取较低或无摄取。在任何情况下，联合配准图像都没有显著增加对合适活检部位的指示。FDG PET可用于在软组织肉瘤中适当地指导活检，并且可能会在确定性治疗之前实现计算机断层扫描/ MRI引导的门诊活检。
