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18F-FDG PET/CT在胆囊癌鉴别诊断及分期中的应用价值 被引量:12

Utility of 18F-FDG PET/CT for the diagnosis and staging of gallbladder carcinoma
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摘要 目的 探讨如何将18F-FDG PET/CT和临床资料相结合,以更好地诊断胆囊癌,并评价全身PET/CT在胆囊癌分期中的应用价值.方法 回顾性分析2009年3月至2014年3月54例疑似胆囊癌患者(男28例,女26例,年龄18~82岁)的PET/CT显像结果及相关临床资料,以组织病理学及临床随访为“金标准”,分析PET/CT定性法、定量法对胆囊癌的诊断效能,并研究血清CEA、CA19-9和外周血WBC计数在进一步区分18F-FDG代谢增高的胆囊良、恶性病变中的作用.以临床分期为基准,研究全身PET/CT在胆囊癌分期中的价值.采用两样本t检验x2检验和McNemar检验对数据进行分析.结果 (1)54例患者中27例为胆囊癌,另27例为胆囊良性病变.18F-FDG PET/CT显像阳性者42例(真阳性27例,假阳性15例).以胆囊病灶代谢增高为定性诊断标准,PET/CT诊断胆囊癌的灵敏度、特异性和准确性分别为100%(27/27)、44.4%(12/27)和72.2% (39/54);以SUVmax 6.6为定量诊断标准时的相应值分别为81.5%(22/27)、70.4% (19/27)和75.9%(41/54),与定性方法间差异无统计学意义(x2=3.711和0.193,均P>0.05).早期胆囊癌和代谢增高胆囊良性病变患者的CEA和CA19-9阳性率差异无统计学意义(x2=0.529和0.045,均P>0.05).然而代谢增高胆囊良性病变患者的外周血WBC计数增高异常率明显高于早期胆囊癌患者(14/15和1/6;x2=12.343,P<0.05).(2)18 F-FDG PET/CT全身显像提高了59.3% (16/27)患者的临床分期.18F-FDGPET/CT全身显像诊断胆囊癌淋巴结转移灶的灵敏度和特异性分别为18/19和7/8,诊断胆囊癌远处转移灶的灵敏度和特异性分别为17/17和9/10.结论 无论是定性法还是定量法,18F-FDG PET/CT均难以特异性鉴别诊断早期胆囊癌和代谢增高胆囊良性病变(急性炎性病变为主),PET/CT显像结合外周血WBC计数有助于两者的鉴别.全身18F-FDG PET/CT显像有助于胆囊癌准确分期. Objective To investigate the value of 18 F-FDG PET/CT combined with clinical data in the diagnosis of gallbladder carcinoma and to assess the role of 18F-FDG PET/CT in tumor staging.Methods 18F-FDG PET/CT and clinical data of 54 patients (28 males,26 females,age range 18-82 years) with suspected gallbladder carcinoma from March 2009 to March 2014 were retrospectively analyzed.The results of histopathology and clinical follow-up were taken as golden standard.The diagnostic value of 18F-FDG PET/CT for gallbladder carcinoma was determined by the qualitative and quantitative methods.Serum CEA,CA19-9 and WBC count were evaluated for discriminating 18F-FDG-avid malignant and benign diseases.According to the final clinical staging,the role of 18F-FDG PET/CT for tumor staging was assessed.Data were analyzed by two-sample t test,x2 test and McNemar test.Results (1) Gallbladder carcinoma was diagnosed in 27 cases and the gallbladder benign diseases in other 27 cases.18F-FDG PET/CT showed positive results in 42 patients including true positive in 27 patients and false positive in other ones.When focal high uptake of 18F-FDG in the gallbladder and SUVmax of 6.6 in the lesions were used as the qualitative and quantitative standards,the diagnostic sensitivity,specificity,and accuracy of the two methods for gallbladder carcinoma were 100%(27/27) vs 81.5%(22/27),44.4%(12/27) vs 70.4%(19/27),72.2%(39/54) vs 75.9% (41/54),respectively (x2=3.711 and 0.193,both P〉0.05).There were no much difference for the positive rate of serum CEA and CA19-9 levels between the patients with early staged gallbladder carcinoma and those with 18F-FDG-avid benign diseases(x2 =0.529 and 0.045,both P〉0.05).However,the rate of increased WBC count in patients with 18F-FDG-avid benign diseases was significantly higher than that in patients with early staged gallbladder carcinoma (14/15 vs 1/6,x2 =12.343,P〈0.05).(2) Nearly 59.3% (16/27) patients with gallbladder carcinoma were upstaged due to the findings by whole body 18F-FDG PET/CT.The sensitivity,specificity of 18F-FDG PET/CT for diagnosing lymph node metastases and distant metastases were 18/19,7/8 and 17/17,9/10,respectively.Conclusions 18F-FDG PET/CT has low specificity for differentiating 18F-FDG-avid gallbladder benign disease and early staged gallbladder carcinoma,but it may be beneficial to the diagnosis that combining PET/CT with WBC count.18F-FDG PET/CT is helpful for the staging of gallbladder carcinoma.
出处 《中华核医学与分子影像杂志》 CAS 北大核心 2016年第5期402-407,共6页 Chinese Journal of Nuclear Medicine and Molecular Imaging
基金 国家自然科学基金(81371591)
关键词 胆囊肿瘤 体层摄影术 发射型计算机 体层摄影术 X线计算机 诊断 鉴别 肿瘤分期 脱氧葡萄糖 Gallbladder neoplasms Tomography,emission-computed Tomography,X-ray computed Diagnosis,differential Neoplasm staging Deoxyglucose
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