^(18)F-FDG PET/CT在食管癌骨转移患者中的临床应用

Clinical Application of ^(18)F-FDG PET/CT in Diagnosis of Bone Metastases in Patients with Esophageal Carcinoma

目的探讨2-18 F-2-脱氧-β-D-葡萄糖(18 F-FDG)PET/CT在食管癌骨转移中的诊断价值,并分析18F-FDG PET/CT显像为阳性的食管癌骨转移患者临床特点及预后。方法回顾性分析2009年8月至2014年10月行18F-FDG PET/CT检查的148例食管癌住院患者的临床资料,其中骨转移病灶定义为FDG异常摄取灶在对应CT图像上存在形态学变化。结果 27例(18.24%)患者共计178个部位证实为骨转移病灶。基于患者分析,18F-FDG PET/CT诊断食管癌骨转移的灵敏度、特异度和准确度分别为96.30%(26/27)、98.35%(119/121)和97.97%(145/148),高于同机CT的66.67%(18/27)、76.03%(92/121)和74.32%(110/148),差异有统计学意义(P<0.05)。基于病灶分析,18F-FDG PET/CT鉴别食管癌骨转移病灶的灵敏度、特异度和准确度分别为94.94%(169/178)、97.92%(188/192)和96.49%(357/370),高于同机CT的82.02%(146/178),71.88%(138/192)和76.76%(284/370),差异有统计学意义(P<0.05)。22例骨质有异常改变和5例骨质无异常改变的食管癌骨转移患者半定量指标-标准摄取值最大值(SUVmax)分别为9.45±4.86和5.72±1.56,差异无统计学意义(t=1.673,P=0.107)。27例食管癌骨转移患者中位随访8个月,1和2年累计生存率分别为56.80%和23.30%。结论食管癌骨转移患者预后较差,在临床鉴别诊断中,18F-FDG PET/CT优于同机常规CT扫描,可早期发现食管癌骨转移,有利于制定个体化治疗方案及预后判断。

Objective To investigate the value of 18F-FDG PET/CT in diagnosing esophageal carcinoma patients with bone metastases and analyze the characteristics and prognosis of the patients with ^18F-FDG PET/CTpositive bone metastases.Methods One hundred and forty-eight inpatients with esophageal carcinoma detected by18F-FDG PET/CT from August 2009 to October 2014 were collected,and their clinical data and survival time were retrospectively analyzed.Results A total of 27patients（18.24%）with 178 lesions were diagnosed.In terms of patients,the sensitivity,specificity,and accuracy of hybrid CT for detecting bone metastases were 66.67%（18/27）,76.03%（92/121）,74.32%（110/148）and 18F-FDG PET/CT were 96.30%（26/27）,98.35%（119/121）,97.97%（145/148）,respectively（χ^2=4.90,16.69,5.03,all P〈0.05）.In terms of lesions,the sensitivity,specificity,and accuracy of hybrid CT for detecting bone metastases were 82.02%（146/178）,71.88%（138/192）,76.76%（284/370）and 18F-FDG PET/CT were 94.94%（169/178）,97.92%（188/192）,96.49%（357/370）,respectively（χ2=5.28,39.19,11.91,all P〈0.05）.The mean maximum standardized uptake values（SUVmax）of abnormal bone and normal bone in 22 cases with bone changes and 5cases without bone changes were 9.45±4.86 and 5.72±1.56,respectively（t=1.673,P=0.107）.The median follow-up time was 8 months,and the 1-and 2-year cumulative survival rates were 56.80% and 23.30%,respectively.Conclusion 18 F-FDG PET/CT can be used for diagnosing esophageal carcinoma with bone metastases,which is more sensitive than the routine CT for early detection of bone metastases and more useful for prognosis assessment and individual treatment placement.