^(18)F-FDGPET/CT诊断小肠恶性肿瘤的价值

^(18)F-FDG PET/CT in Diagnosis of Small Intestinal Malignant Neoplasm

目的分析小肠肿瘤的18F-FDG PET/CT特征,探讨18F-FDG PET/CT诊断小肠恶性肿瘤的价值。资料与方法回顾性分析临床高度怀疑小肠肿瘤并行18F-FDG PET/CT检查的47例患者,将PET/CT检查结果与手术或活检病理结果进行对比,测量小肠病灶的最大标准化摄取值(SUVmax)和最大肠壁厚度(IWTmax),并分析SUVmax与IWTmax的相关性。结果 47例小肠肿瘤中,良性6例;恶性41例,其中恶性淋巴瘤19例,腺癌17例。18F-FDG PET/CT诊断小肠恶性肿瘤的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为92.7%、83.3%、91.5%、97.4%、62.5%。与小肠良性肿瘤比较,小肠恶性肿瘤的SUVmax和IWTmax明显增大(t=5.596、2.376,P<0.05)。小肠腺癌的SUVmax较恶性淋巴瘤明显降低(t=2.419,P<0.05),两者IWTmax差异无统计学意义(t=0.369,P>0.05)。小肠恶性淋巴瘤的SUVmax与IWTmax无相关性(r=0.293,P>0.05),小肠腺癌的SUVmax与IWTmax呈正相关(r=0.542,P<0.05)。结论小肠恶性肿瘤的SUVmax和IWTmax较良性肿瘤增大,18F-FDG PET/CT能对小肠肿瘤的良恶性做出基本准确的定性诊断;小肠恶性淋巴瘤对18F-FDG摄取明显高于小肠腺癌,但两者肠壁厚度无显著差异。

Purpose To analyze the 18F-FDG PET/CT features of small intestinal malignant neoplasm, and to discuss the diagnosis value. Materials and Methods Forty-seven patients who were highly suspected with small intestinal tumors underwent 18F-FDG PET/CT whole body scan were retrospectively analyzed, the results of PET/CT examinations and the findings of biopsy and surgical pathology were compared. The maximum of intestinal wall thickness （IWTmax） and maximum of standardized uptake value （SUVmax） were calculated to analyze the relationship of them under different pathological conditions. Results Six out of the 47 small intestinal tumors were benign, the other 41 were malignant tumors among which 19 were malignant lymphoma and 17 were adenocarcinoma. The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of 18F-FDG PET/CT in the diagnosis of small intestinal malignant neoplasm were 92.7%, 83.3%, 91.5%, 97.4% and 62.5%, respectively. Compared with those of benign tumors, the SUVmax and IWTmax of malignant intestinal tumors were significantly higher （t=5.596 and 2.376, P〈0.05）. The SUVmax in small bowel adenocarcinoma was significantly lower than that in malignant lymphoma （t=2.419, P〈0.05）;the IWTmax. between the two kinds of tumors showed no difference （t=0.369, P〉0.05）. The SUVmax and IWTmax of small intestinal malignant lymphoma had no correlation （r=0.293, P〉0.05）, whilst there was significant correlation between the IWTmax and SUVmax in small intestinal adenocarcinoma （r=0.542, P〈0.05）. Conclusion The SUVmax and IWTmax of malignant intestinal tumors are higher than those of benign intestinal tumors; 18F-FDG PET/CT imaging is rather reliable in differentiating small intestinal malignant tumors from benign ones. Intestinal malignant lymphoma shows a higher uptake of 18F-FDG than intestinal adencarcinoma, but the intestinal wall thickness of the two kinds shows no difference.