胰腺癌^(18)F-FDG PET/CT显像及诊断方法

^(18)F-FDG PET/CT imaging and diagnosis method of pancreatic carcinoma

目的评价18F-FDG PET/CT诊断胰腺癌的价值及分析方法。方法 回顾性分析88例接受18F-PET/CT检查的胰腺原发疾病患者资料,其中恶性65例,良性23例,采用目测和半定量方法分析胰腺疾病的PET/CT特点。目测法分别根据病变CT特征、PET摄取程度和PET/CT特点制定CT、PET和PET/CT五级分析方法;定量分析方法主要在PET图像上测量病变的最大标准化摄取值(SUVmax),并与最后诊断结果进行诊断学试验评价。结果 CT、PET及PET/CT目视五分法诊断胰腺癌的灵敏度、特异度和准确率分别为92.31%(60/65)、69.57%(16/23)、86.36%(76/88);90.77%(59/65)、78.26%(18/23)、87.50%(77/88);98.46%(64/65)、91.30%(21/23)、96.59%(85/88)。三种方法的ROC曲线下面积(ROC-AUC)均大于0.90。胰腺癌SUVmax平均值为8.06±2.96,胰腺良性病变SUVmax平均值为3.13±2.09(t=7.344,P<0.01)。胰腺癌转移组与非转移组SUVmax分别为8.06±3.01和7.23±2.96(t=0.693,P=0.38),以SUVmax=4.65为判断良恶性的阈值,PET诊断胰腺癌的灵敏度和特异度为87.69%和86.96%。结论 18F-FDG PET/CT在胰腺癌的诊断上具有较大价值;PET/CT目视五分法是鉴别胰腺良恶性病变较好的方法。

Objective To explore the value of 18F-FDG PET/CT in the diagnosis of pancreatic carcinoma,and to analyze the method of diagnosis.Methods 18F-FDG PET/CT was performed in 88 patients with primary pancreatic lesions（65 malignant,23 benign）.The visual assessment and semiquantitative analysis were used to analyze the lesions＇ PET/CT characteristics.A 5-point rank scale was used for visual assessment according to the CT features,the degree of 18F-FDG uptake and the PET/CT characteristics.The maximum standardized uptake value（SUV_max） was measured for semiquantitative analysis.Results The sensitivity,specificity,accuracy with visual assessment was 92.31%（60/65）,69.57%（16/23）,86.36%（76/88） for CT;90.77%（59/65）,78.26%（18/23）,87.50%（77/88） for PET visual analysis;98.46%（64/65）,91.30%（21/23）,96.59%（85/88） for PET/CT visual analysis.The areas under the receiver operating characteristics curves（ROC-AUC） were all more than 0.90.The average value of SUV_max for malignant lesions（8.06±2.96） was statistically different from benign lesions（3.13±2.09,t=7.344,P0.01）,but no statistical difference was found between peripancreatic tissue invasion or metastasis group（8.06±3.01） and primary pancreatic carcinoma group（7.23±2.96,t=0.693,P=0.381）.With a threshold of 4.65,SUV_max showed a sensitivity of 87.69% and a specificity of 86.96% in differentiating malignant lesions from benign lesions.Conclusion 18F-FDG PET/CT has important value in the diagnosis of pancreatic malignant tumor,and the 5-point rank scale-visual assessment of PET/CT is an excellent method in differentiating malignant pancreatic lesions from benign lesions.