可疑肾实质来源肿瘤患者术前评估^(18)F-FDG PET/CT图像特点分析

Research on FDG PET/CT imaging characteristics of the patients suspicious for renal parenchyma neoplasm before surgery

目的:分析探讨临床可疑肾实质来源肿瘤患者术前^(18)F-FDG PET/CT影像特点。方法:回顾性选取126例可疑肾实质来源恶性肾肿瘤患者,按照患者的年龄将其分为老年组(42例)和中青年组(84例)。所有患者按常规方法行^(18)F-FDG PET显像,通过勾画感兴趣区(ROI)方法计算原发、转移灶及正常肾实质标准化摄取值最大值(SUVmax)和原发灶靶本比(T/B),以病理结果为金标准进行统计分析。结果:1恶性114例,良性12例,^(18)F-FDG PET诊断敏感度、特异度、阳性和阴性预测值分别为37.72%、83.33%、95.56%和12.35%;2转移患者16例,原发灶大小及SUV均明显高于未转移患者,差异有统计学意义(Z=-4.12,Z=-4.26,P<0.001);3老年患者组原发灶大小、SUV及转移发生率与中青年组相比无显著差异;4透明细胞癌病灶^(18)F-FDG PET阳性率及代谢活性显著低于非透明细胞癌病灶,大小无差异。结论:SUVmax和T/B值均不适用于肾实质来源肿瘤诊断。原发灶代谢明显增高时,诊断恶性把握较大,且病理类型常为非透明细胞癌。肿瘤原发灶越大、代谢越高则越易发生转移。老年肾肿瘤患者的^(18)F-FDG PET影像特点与中青年组一致。

Objective： To conduct retrospective analysis on ^（18F-FDG-PET imaging characteristics of patients suspicious for renal parenchyma neoplasm before surgery. Methods： One hundred and twenty six patients with suspicious for renal parenchyma tumor were enrolled and divided into aged group and middle-age group. All patients underwent routine ^18F-FDG-PET examination. Standard uptake value and T/B ratio were collected by drawing ROI in primary, metastasis lesions and normal renal parenchyma around the primary lesion. Pathological results were taken as golden criterion for further statistical analysis. Results：（1）One hundred and fourteen cases were diagnosed with malignant tumor and 12 with benign. The sensitivity, specificity, positive predictive value and negative predictive value of ^18F-FDG PET/CT were 37.72%, 83.33%, 95.56% and 12.35% respectively.（2）The size and SUV of primary tumors in 16 cases with metastasis increased significantly to those without metastasis（Z=-4.12, Z=-4.26, P〈0.001）.（3）The size, SUV of primary tumors and incidence of metastasis of 41 old patients against middle-age group have not statistic significance.（4）The SUV of primary clear-cell carcinoma were decreased significantly than other pathological subtype of parenchyma neoplasm. No difference was found between clear cell carcinoma and other malignant tumor. Conclusion： SUVmax and T/B ratio are not suitable to renal parenchyma carcinoma diagnosis. Hyper-metabolism in primary tumor can guarantee malignant recognition and give clue for pathological type. With the increase of the primary tumor size and metabolism, the incidence of metastasis raise. These results provide probability that ^18F-FDG-PET can be used as prognosis method for this malignant group. The approaches of this study can be applied to middle age population with suspicious for renal parenchyma tumor.