PET—CT在胸腹膜转移瘤诊断中的临床价值

The clinical value of ^18F-FDG PET-CT in diagnosis of the pleural or peritoneal carcinomatosis

目的 评价PET-CT在胸腹膜转移瘤诊断中的临床价值。方法 回顾性分析具有原发恶性肿瘤病史及不明原因胸腹腔积液，临床高度怀疑胸腹转移瘤的37例患者资料。全部患者均行^18F-FDG PET-CT全身显像，经病历记录分析、肿瘤标志物检测、病理检查或临床随访最终判断是否存在胸腹膜转移瘤，并对已确诊胸腹膜转移瘤的患者记录病灶代谢分布形态及测量最大标准化摄取值（SUVmax）.结果 37例行^18F-FDG PET-CT全身显像的患者中，PET-CT诊断阳性的患者共29例，其中，假阳性3例；诊断为阴性的患者共8例，其中，假阴性2例。^18F-FDG PET-CT全身显像诊断胸腹膜转移瘤的灵敏度为92.9％、特异度为66.7％、准确率为86.5％、阳性预测值为89.7％、阴性预测值为75％。在已确诊胸腹膜转移瘤的26例患者的全身显像中，病灶摄取形态呈条形或环形分布者11例、呈点灶状分布者15例，两组病灶SUVmax分别为5.97±3.39和2.89±0.92,差异具有统计学意义（r=2.93,P〈0.05）.结论PET-CT全身显像在胸腹膜转移瘤的诊断中具有简单、无创和灵敏度高等优点，是一种理想的判断胸腹膜转移瘤的方法，具有较高的临床应用价值。

Objective To evaluate the clinical value of ^18F-FDG PET-CT in diagnosis of the pleural or peritoneal earcinomatosis. Methods A total of 37 patients with pleural effusion or asrites of unknown origin were analyzed retrospectively. All patients underwent whole body ^18F-FDG PET-CT. The ^18F-FDG distributional pattern and the maximum standardized uptake value （SUVmax） of lesions were analyzed. The final diagnosis of all eases were established based on the results of catammestic analysis, tumor markers assay. histopathology or clinical follow-up. Results Of all the 37 cases. 29 had positive findings on ^18F-FDG; PET- CT, of which 26 were pleural or peritoneal rarcinomatosis and 3 were pleural or peritoneal tuherculosis： 8 patients had negative findings on ^18F-FDG PET-CT, of whirh 6 were pleural or peritoneal benign lesions and 2 were peritoneal carcinomatosis. The sensitivity, speeificity, accuraey, positive predictive value, negative predietive value of ^18F-FDG PET-CT in diagnosis of peritoneal carcinomatosis were 92.9%, 66.7%. 86.5%, 89.7% and 75.0% respertively. The SUVmax, between the ring-form and slrip-type lesions were significantly different（5.97±3.39 vs. 2.89±0.92, t=2.93. P〈0.05 ）. Conclusions ISF-FDG PET-CT is simple, noninvasive and high sensilive in detecting pleural or periloneal earrinomatosis, and may be an ideal lerhnique of highly clinical usefulness in the diagnosis of the pleural or peritoneal carcinomatosis