^18F-FDG PET／CT在黑色素瘤中的应用价值

Clinical value of ^18F-FDG PET/CT in detection of malignant melanoma

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像在黑色素瘤诊断、临床分期及监测治疗后肿瘤复发与转移灶中的应用价值。方法黑色素瘤患者61例，均进行^18F-FDG PET／CT全身显像。所有PET、CT及PET／CT融合图像均通过融合软件进行帧对帧对比分析。肿瘤病灶根据病理学检查、多种影像学检查及临床随访结果诊断。结果^18F-FDG PET／CT显像对黑色素瘤病灶检出的灵敏度、特异性和准确性分别为90，9％（40／44）、88．2％（15／17）和90．2％（55／61）。其中12例治疗前患者中，^18F-FDG PET／CT显像诊断的灵敏度为83．3％（10／12）。在黑色素瘤病灶局部切除、尚未进行其他治疗的9例患者中，5例残余病灶^18F-FDG PET／CT显像检出3例；4例远处转移灶患者全被检出，提高了临床分期，改变了治疗方案。首先发现转移性黑色素瘤病灶并且手术切除后，寻找原发灶的7例患者中，^18F-FDG PET／CT检出原发灶2例，4例其他转移灶全被检出。黑色素瘤患者根治术后监测肿瘤复发或转移患者33例，^18F-FDG PET／CT显像灵敏度、特异性和准确性分别为100．0％（19／19）、85．7％（12／14）和93．9％（31／33）。与同期临床其他影像学检查比较，^18F-FDG PET／CT显像发现更多，33例患者中，16例（48．5％）病灶提高临床分期；7例（21．2％）排除可疑病灶，降低临床分期；10例（30．3％）检出病灶与临床一致。结论^18F-FDG PET／CT显像对于黑色素瘤的诊断，残余病灶、复发病灶及转移灶的检出，临床分期的明确具有重要价值。

Objective The aim of this study was to evaluate the clinical role of ^18F-fluorodeoxyglueose （FDG） PET/CT in detection of malignant melanoma. Methods The whole body ^18F-FDG PET/CT scans were performed on 61 patients with malignant melanoma. All PET and CT images of one patient were fused by the specific software on workstation. PET images, CT images and PET/CT fused images were analyzed by frame to frame. All patients were followed up for at least six months or last to the patient death. The final diagnosis was obtained by pathologic finding from surgery or biopsy, and （or） muhi-modalities of imaging and clinical follow-up. Results The overall sensitivity, specificity and accuracy of ^18F-FDG PET/ CT for detecting primary malignant melanoma was 90.9% （40/44） , 88.2% （15/17） and 90.2% （55/61） , respectively. In 9 patients post local surgery and proven histologically malignant melanoma, ^18F-FDG PET/ CT detected the residual and metastatic tumor in 3/5 and 4/4 cases, respectively. In 7 patients with metastastic melanoma, ^18F-FDG PET/CT found primary tumors in 2 cases and metastatic loci in 4 cases. In 33 patients after the radical operation, the sensitivity, specificity and accuracy of ^18F-FDG PET/CT for detecting recurrence or metastasis was 100.0% （ 19/19 ）, 85.7% （12/14） and 93.9% （31/33）, respectively. Of these 33 patients, 16 （48.5%） were up-staged and 7 （21.2%） were down-staged by ^18F-FDG PET/ CT. Conclusion ^18F-FDG PET/CT is a valuable imaging tool to detect the residual, recurrent and metastatic tumor in patients with malignant melanoma.