^(18)F-FDGPET/CTF-FDGPET/CT双时相显像在膀胱癌术前分期中的临床价值

Value of dual-phase ^(18)F-FDG PET/CT in preoperative staging of bladder cancer

目的探讨18F-FDG PET/CT双时相显像在膀胱癌术前分期中的应用价值。方法 2003年5月~2012年5月进行18F-FDG PET/CT检查的膀胱癌初诊患者73例,男54例,女19例,年龄58.7(41~80)岁。所有患者18F-FDG PET/CT常规全身显像后,口服40 mg呋塞米并多饮水,多次排尿,服呋塞米后约2 h憋尿充盈膀胱,再进行18F-FDG PET/CT盆腔延迟显像。所有患者于18FFDG PET/CT检查后1周内进行手术治疗,将PET/CT与手术病理学检查结果进行对比分析,评价18F-FDG PET/CT双时相显像在膀胱癌术前分期中的应用价值。结果18F-FDG PET/CT双时相显像对膀胱癌原发灶的T分期与病理分期符合率为63.0%(46/73),其中pT4期膀胱癌的分期符合率为100%(7/7);另外检出75.0%(6/8)的淋巴结转移灶,100%(4/4)的远隔器官转移灶和100%(4/4)原发性第二种恶性肿瘤病灶。结论本研究结果表明18F-FDG PET/CT双时相显像在T分期方面,尽管对pTa、pT1、pT2、pT3期膀胱癌的T分期价值不大,但对pT4期膀胱癌的T分期可能有重要的应用价值;在膀胱癌的N分期、M分期及发现第二种原发癌方面也可能有重要的应用价值。

Objective To investigate the clinical value of dual-phase ^18F-FDG PET/CT with oral diuretics in preoperative staging of bladder cancer. Methods The imaging data were analyzed of 73 patients with bladder cancer undergoing preoperative dual-phase ^18F-FDG PET/CT with oral diuretic between May, 2003 and May, 2012. All the patients underwent whole-body PET/ CT scan 60 min after intravenous injection of 270-350 MBq of ^18F-FDG. Additional delayed pelvic PET/CT images were acquired after forced diuresis using oral furosemide （40 mg）. All the patients underwent subsequent radical cystectomy, and ^18F-FDG PET/CT findings were compared with the histopathologic results to evaluate the value of dual-phase ^18F-FDG PET/CT in preoperative staging. Results The concordance rate of dual-phase FDG PET/CT-based bladder cancer staging with the histopathologic results was 63.0% in the 73 patients, and was 100% （7/7） for pT4 bladder cancers. With dual-phase FDG PET/ CT, the detection rate was 75.0% （6/8） for lymph node metastases, 100% （4/4） for distant metastases, and 100% （4/4） for other concurrent primary malignancies. Conclusion Though with limited accuracy in T-staging of pTa, pT1, pT2, and pT3 bladder cancer, dual-phase FDG PET/CT has important clinical value in staging of pT4 bladder cancer and in N-staging, M-staging and detection of other concurrent primary malignancies.