正电子发射断层显像中子宫和卵巢生理性摄取的特点

Characteristics of Physiological Uptake of Uterus and Ovaries on ^(18)F-fluorodeoxyglucose Positron Emission Tomography

目的了解正电子发射断层显像(PET)中女性子宫和卵巢生理性摄取的特点和规律。方法对247例女性受试者共进行了288次PET检查,其中恶性肿瘤164例,良性病变44例,正常39例,均无盆腔病变。分析比较子宫和卵巢摄取18F-脱氧葡萄糖(FDG)的高低与所处月经周期时段的关系。结果月经规律患者116例,共行131次PET检查,其高、中度子宫内膜摄取多出现在月经早期或中期,呈倒置椎形,尖端指向膀胱后方;一侧或双侧卵巢摄取常在月经中期出现,多呈卵圆形,位于膀胱后上方两侧;月经来潮后期和增殖早期无明显子宫或卵巢摄取的可能性最大,分别为86%和80%。17例(19次PET)月经明显不规律、112例(136次PET)停经和2例尚未开始来月经者均无子宫、卵巢高摄取。结论子宫和卵巢对18F-FDG的生理性摄取随月经周期而变化,正确认识可避免误诊,通过选择检查时机可减少其影响。

Objective To observe the characteristics of the physiological uptake of uterus and ovaries on ^18 F-fluorodeoxyglucose positron emission tomography （FDG PET）. Methods A total of 288 PET examinations performed in 247 women （164 with malignancies, 44 with benign diseases, and 39 without remarkable abnormality） were included for analysis, and clinical follow-ups were applied for at least 10 months to exclude pelvic diseases. The menstrual statuses, menstrual cycles, and related pelvic examinations with other modalities were inquired before each PET examination. PET scanning was performed from pelvis to neck with a Siemens ECAT EXACT HR ＋ system. The uptake levels of uterus and ovaries were set as intense, moderate, and mild endometrial uptake, usually in inverted cone shape surrounded by relatively low-uptake uterine wall, was observed with two peaks in the early menstrual flow phase and in the mid-cycle respectively; the ovarian uptake was more prominent in the mid-cycle, with the foci of uptake in ovoidal shape and located at the left and/or right side superior-posterior to the bladder. From the early menstrual flow phase to the late secretory phase of the menstrual cycles, the probabilities of mild uptake in both endometrium and ovaries were 7%, 86%, 80%, 58%, 20%, 40%, 64%, and 59%, respectively, indicating that the late menstrual flow phase and the early proliferative phase had the least probability of intense or moderate uptake. No intense uptake was observed in the 17 patients （ 19 examinations） presenting remarkably irregular menstrual cycle, 112 patients （ 136 studies） in menopause for 3 months to 39 years, and 2 patients without menstruation yet. Only one patient within 1 year of menopause and a 14-year-old girl expected to start menstruation showed mild to moderate uptake in the endometrium. Conclusion The physiological endometrial and ovarian uptakes have specific shapes and positions on ^18 F-FDG PET images, which correlates well with the menstrual phases.