- 學位論文
癌症患者在[氟-18]去氧葡萄糖正子電腦斷層造影中呈現的中心靜脈植入式導管的植入率和異常發生率研究
The Incidence of Central Venous Catheter Implantation and the Associated Abnormalities in Cancer Patients Revealed in 18F-FDG PET/CT Imaging
摘要
本研究是回溯性評估癌症患者在接受[氟-18]去氧葡萄糖(2-[Fluorine-18]fluoro-2-deoxy-D-glucose, FDG) 正子電腦斷層造影(integrated Positron Emission Tomography-Computer Tomography, PET/CT)時中心靜脈植入式導管(central venous catheter implantation)的異常發生機率和種類，並統計原報告紀錄異常的比率。 本研究回溯式檢視過去三年間各種癌症患者在接受 [氟-18]去氧葡萄糖正子電腦斷層造影時，裝設有中心靜脈植入式導管的比率，紀錄中心靜脈植入式導管發生各種異常的機率和種類，並與放射影像作比對，並整理臨床治療結果與追蹤統計原報告紀錄異常的比率。 本院過去三年間共有2442人次各種癌症患者接受 [氟-18]去氧葡萄糖正子電腦斷層造影，共有 897 (897/2442, 36.7%)造影人次中裝設有中心靜脈植入式導管。其中有22造影人次發現有中心靜脈植入式導管折斷(Port-A fractures, 22/897, 2.45%)， 14人次中心靜脈植入式導管位置異常(malposition, 1.56%)，1人次感染(infection, 0.11%)，和1人次中心靜脈植入式導管被腫瘤包埋(embraced by a tumor, 0.11%)。所有異常中只有感染的1例有臨床症狀。22人次中心靜脈植入式導管折斷案例中，8例完全斷裂並移位到遠端血管。所有位置異常中有兩例進入對側鎖骨下靜脈(subclavian vein)其餘都進入同側的頸靜脈(jugular vein)。中心靜脈植入式導管感染和被腫瘤包埋的案例，都發生在導管尖端，呈現在胸部縱膈腔內。在原有正子電腦斷層造影報告中只有7例 (7/38, 18.42%)紀錄中心靜脈植入式導管的異常。 根據本研究結果，研究人員建立並推薦判讀[氟-18]去氧葡萄糖正子電腦斷層造影的項目清單，包括記錄所有金屬植入物，並判讀全身X-光透視圖(topography)，作為正子電腦斷層造影報告標準的一部分。
並列摘要
The purpose of this retrospective study was to evaluate the incidence of totally implantable venous access devices, also called ports, implantation and the associated abnormalities in 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography-computed tomography (PET-CT) images for patients with cancer, and to determine the percentage of abnormalities identified in the original reports. The study aimed to perform a retrospective review of all FDG PET-CT imaging in a 3-year period. Cases of port-associated abnormalities found on the FDG PET-CT images were identified and then correlated with X-ray reports and clinical treatment or follow-up. In total, 2442 FDG PET-CT scans were retrospectively reviewed. Among them, 897 (897 of 2442, 36.7%) demonstrated port implantation. Abnormalities, including 22 port fractures (22 of 897, 2.45%), 14 malposition (1.56%), one infection (0.11%), and one embraced by a fibrin sheath or tumor (0.11%) were found. Only the infectious one had clinical symptoms. Among the 22 fractured ports, eight fractured catheters migrated and became dislodged. All of the malpositioned ports, except two in the contralateral subclavian vein, were found in the ipsilateral jugular vein. Both the port infection and the port embraced by a fibrin sheath or tumor occurred at the tips of the devices, which demonstrated FDG uptake in the mediastinal region. Only seven of the 38 (18.42%) images of port abnormalities had been identified in the original reports. Based on this study, we recommend that the interpretation of FDG PET-CT scans should include a checklist to record all metallic device implantations and to interpret the whole-body X-ray topography as a standard part of PET-CT image report.
參考文獻
延伸閱讀
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