^(18)F-FDG PET对胆囊癌与胆管癌临床应用的价值

The evaluation of ^(18)F-FDG PET for clinical application of gallbladder carcinoma and cholangiocarci- noma

目的探讨^(18)F-FDG PET 在胆囊癌和胆管癌诊断、分期中的应用价值。方法回顾性分析65例胆囊及胆管病变患者^(18)F-FDG PET 或 PET/CT 显像资料。其中胆囊病变患者46例(术前7例,术后39例)、胆管病变患者19例(术前2例,术后17例)。通过目测和半定量方法(最大 SUV,SUV_(max))对图像进行分析。结果 (1)46例胆囊病变患者中,7例于术前行 PET 检查均诊断为胆囊癌,经术后病理检查证实3例为胆囊癌,2例假阳性(胆囊腺瘤、胆囊炎各1例),失访2例;其他39例为术后检查(PET 显像均为胆囊癌患者),其中21例病理检查示有残留、转移,15例阴性,失访3例,PET 诊断肿瘤残留、转移的灵敏度为91.3%,特异性为84.6%。转移灶的分布以腹腔及腹膜后淋巴结为多。(2)19例胆管癌患者,其中2例于术前行 PET 检查,1例诊断为胆管癌,另1例为阴性(后经病理检查证实为假阴性,患者为胆管腺癌);术后检查17例(PET 显像均为胆管癌患者),其中9例病理检查示有残留、转移,1例阴性,失访7例,PET 诊断肿瘤残留、转移的灵敏度为9/9,特异性为1/1。转移灶的分布以肝脏为主。结论 ^(18)F-FDG PET 显像诊断胆囊癌和胆管癌具有一定价值,但对术后再分期价值更加明显。

Objective The aim of this retrospective study was to investigate the value of PET with 18^F-FDG in the diagnosis, staging and restaging of gallbladder carcinoma and cholangiocarcinoma. Methods The results of 18^F-FDG PET or PET/CT over 65 patients with gallbladder and bile ductal diseases from four hospitals were retrospectively reviewed. Among them, 46 cases had gallbladder diseases （7 cases had PET before operation, 39 cases after） ; 19 cases had bile ductal diseases （2 before, 17 after operation）. All results were analyzed by visual inspection and semi-quantitative method （the maximum SUV, SUVmax, ）. Results In 46 cases suffered from gallbladder diseases, 7 cases with gallbladder carcinoma were diagnosed before surgery based on PET scans, and 3 of them were proved pathologically, 2 lost follow-up, and 2 were false positive（ 1 adenoma and 1 cholecystitis）. The other 39 gallbladder carcinoma underwent PET scan after operation, 21 had tumor residual and （or） metastases, while 15 were negative on PET scan, and 3 lost follow-up. The metastases were mainly confined in celiac lymph nodes and retroperitoneal lymph nodes. The sensitivity and specificity of PET in detecting gallbladder tumor residual and metastases were 91.3% and 84.6% respectively. In 19 cases with bile ductal diseases, 2 were scanned before operation, 1 cholangiocarcinoma was positive, 1 adenocarcinoma was false negative. Nine of seventeen cholangiocarcinoma studied after operation had residual and （or） metastases, 1 was negative, and 7 lost follow-up. The metastases were mainly confined in liver. The sensitivity and specificity of PET in detecting bile ductal tumor residual and metastases were 9/9 and 1/1. Conclusions 18^F-FDG PET is a useful tool in diagnosing gallbladder carcinoma and cholangiocarcinoma, and is of particular value in post-operation restaging.