^18F—FDG PET—CT显像在肾癌原发灶及转移灶诊断中的价值

Comparison Study of ^18F-FDG PET-CT and Enhanced-CT in the Diagnosis of Primary Lesion and Metastatic Lesion of Renal Carcinoma

[目的]探讨18F-FDG PET-CT显像在肾癌原发灶及转移病灶诊断中的价值.[方法]回顾性分析35例临床诊断为肾癌患者的全身18F-FDG PET-CT及病理结果,比较PET-CT与增强CT两者对肾癌及转移病灶的诊断价值.[结果]35例中,经原发灶手术病理证实为肾癌30例.其余5例因18F-FDG PET-CT显像发现远处转移未行原发灶手术治疗,仅取转移部位病检确诊,分别行DSA肿瘤栓塞术、免疫治疗及靶向药物治疗.18F-FDG PET-CT检查阳性29例,敏感度82.9% ,CT平扫加增强检查阳性33例,敏感度94.3%,转移病灶共16处, 腹膜后淋巴结转移3处,肺转移3处,肾静脉癌栓形成1处,骨转移2处,肝转移1处,肾上腺、右侧锁骨上淋巴结、纵隔淋巴结、双肺门淋巴结转移1处,右侧胸壁转移1处,软组织转移1处,而CT平扫加增强仅发现1处下腔静脉癌栓形成,1处肝转移.[结论]18F-FDG PET-CT对诊断原发性肾癌的敏感性不如CT,但对远处转移的诊断优于CT,对肾癌的分期及治疗方案的选择有重要意义.

[Objective] To evaluate the role of ^18F - FDG PET/CT imaging in the diagnosis of primary le sion and metastatic lesion of renal carcinoma. [Methods] The ＇SF FDG PET CT and pathological results of 35 patients diagnosed as renal carcinoma were reviewed. The diagnostic values of PET-CT and enhanced CT were compared. [Results] Among 35 cases, 30 patients undergoing operation were confirmed as renal carcinoma by pathological results. The other 5 cases with metastasis shown by ^18F-FDG PET-CT imaging were not per formed operation of primary lesion, and were confirmed only by pathological examination of metastatic lesion, and underwent DSA tumor embolism, immunotherapy and targeted drug therapy. Twenty nine cases were positive by ^18F-FDG PET CT, and its sensitivity was 82.9%. Thirty three cases were positive by enhanced-CT plain scan, and its sensitivity was 94. 3%. There were 16 metastatic lesions including 3 in retroperitoneal lymph, 3 in lung, 1 in kidney vein, 2 in bones, each in liver, adrenal gland, right supraclavicular lymph node, mediastinal lymph nodes, both lungs lymph nodes, left chest and soft tissue. Enhanced-CT plain, scan showed only one metastatic lesion in inferior vena and liver, respectively. [Conclusion] In the diagnosis of primary lesion of renal carcinoma , ^18F-FDG PET-CT is not as sensitive as CT enhance, however ,^18F-FDG PET-CT ima ging is better in the diagnosis of metastatic lesion. Therefore ^18F-FDG PET-CT is import for the staging and choice of therapeutic regimen of real carcinoma.