| 张雯杰,吴宁,周纯武,郑容,刘瑛,梁颖,赵平.18FDG PET/CT与增强CT对胰腺癌分期的价值[J].中国医学影像技术,2012,28(4):727~730 |
| 18FDG PET/CT与增强CT对胰腺癌分期的价值 |
| Value of 18FDG PET/CT and contrast-enhanced CT in staging of pancreatic cancer |
| 投稿时间：2011-10-16 修订日期：2011-11-04 |
| DOI： |
| 中文关键词: 胰腺肿瘤 18F 氟脱氧葡萄糖 正电子发射型体层摄影术 体层摄影术,X线计算机 肿瘤分期 |
| 英文关键词:Pancreatic neoplasms Fluorodeoxyglucose F18 Positron-emission tomography Tomography, X-ray computed Neoplasm staging |
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| 中文摘要: |
| 目的 比较PET/CT与增强CT(CECT)对胰腺癌T和N分期的准确性;探讨PET/CT对胰腺癌治疗前M分期的影响以及最大标准摄取(SUVmax)值与远处转移的关系。 方法 收集经病理或临床、影像学随诊证实的胰腺癌患者46例,术前全部患者接受PET/CT检查,43例并接受CECT检查,中位间隔时间为6天;对接受手术切除或探查的19例患者以手术所见为参照,比较PET/CT与CECT检查对胰腺癌T和N分期的准确率。 结果 19例胰腺癌患者术中发现肿瘤与周围血管粘连或侵犯周围血管/器官,术前CECT明确诊断17例(17/18,94.44%),PET/CT明确诊断3例(3/19,15.79%),CECT对T分期的准确率高于PET/CT。对于N分期,CECT和PET/CT的敏感度、特异度和准确率分别为66.67%(8/12)、100%(7/7)、78.95%(15/19)和75.00%(9/12)、100%(7/7)和84.21%(16/19),二者诊断区域淋巴结转移差异无统计学意义(P=1.00)。46例胰腺癌患者中,PET/CT发现28例血行转移及远隔淋巴结转移,常规影像学分期检出其中的15例。PET/CT明确诊断了5例CT不能肯定的肝脏病灶,并发现2例患者同时存在第二原发癌;ROC曲线分析表明,SUVmax越高,发生血行转移的可能越大,其曲线下面积为0.68,诊断界值为4.80。 结论 PET/CT对胰腺癌T分期的准确率远低于CECT;PET/CT和CECT对N分期的敏感度、特异度、准确率相似;PET/CT对M分期和远隔淋巴结转移具有明显优势,并可同时发现第二原发癌灶,SUVmax越高,发生血行转移的可能越大。 |
| 英文摘要: |
| Objective To compare the accuracy of 18FDG PET/CT and contrast-enhanced CT (CECT) in T and N staging of pancreatic cancer, and to explore the value of PET/CT in pre-operation M staging of pancreatic cancer and the correlation between SUVmax and distant metastasis. Methods Forty-six patients with pancreatic cancer confirmed with pathology, clinical or radiological follow-up were enrolled.All patients underwent PET/CT, while 43 of them underwent CECT before surgical operation, the median time interval was 6 days. For patients underwent surgical resection or exploratory operation, the operational findings were used to assess the accuracy of PET/CT and CECT in T and regional N staging of pancreatic cancer. Results Surgical resection or exploratory operation was performed in 19 patients, and peripancreatic organic involvement and (or) vascular invasion were found in all the patients. Among them 18 underwent both PET/CT and CECT. The diagnostic accuracy of CECT and PET/CT for preoperative T staging was 94.44% (17/18) and 15.79% (3/19), respectively. For the staging of regional lymph nodes, the sensitivity, specificity, and accuracy of CECT was 66.67% (8/12), 100% (7/7) and 78.95% (15/19), while of PET/CT was 75.00% (9/12), 100% (7/7) and 84.21% (16/19), respectively. There was no significant difference between the two methods (P=1.00). PET/CT detected hematogenous metastases and distant lymph node metastases in 28 patients, while routine imaging staging detected only 15 of them. PET/CT proved or excluded malignancy when CT was equivocal in 5 patients, PET/CT detected additional synchronous rectal cancer and lung cancer in 2 patients. ROC curve analysis showed that distant metastasis had positive correlation with higher SUVmax. When the cut-off value of SUVmax was 4.80, the area under the curve of ROC was 0.68. Conclusion The accuracy of PET/CT is far lower than that of CECT in T staging for pancreatic cancer. PET/CT is similar to CECT in sensitivity, specificity and accuracy rate for regional lymph N staging. However, PET/CT has significant advantage for M staging, being able to detect synchronous second primary cancer. Hematogenous metastasis has positive correlation with higher SUVmax. |
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