^(18)F-FDG PET/CT诊断肾细胞癌

^(18)F-FDG PET/CT in diagnosis of renal cell carcinoma

目的探讨^(18)F-FDG PET/CT诊断肾细胞癌(RCC)的价值。方法回顾性分析32例确诊为RCC患者的病理及PET/CT影像资料,比较不同病理类型(透明细胞癌与非透明细胞癌)、Fuhrman分级(高级别与低级别透明细胞癌)和临床分期(有无远处转移)RCC的肿瘤直径和最大标准摄取值(SUV_(max))差异。结果 32例患者共33个原发灶,PET/CT检出31个,2个假阴性,检出率为93.94%(31/33)。31个原发灶PET/CT表现为肾实质内混杂密度的软组织团块,其^(18)F-FDG摄取可接近、高于或低于正常肾实质;2个原发灶PET/CT未见异常表现。8例伴静脉瘤栓,19例伴远处转移,瘤栓及转移灶的FDG摄取均高于受累器官本底。不同病理类型组和不同Fuhrman分级RCC的肿瘤最长径及SUV_(max)差异无统计学意义;不同临床分期RCC的肿瘤最长径差异无统计学意义,SUV_(max)差异有统计学意义(t=3.852,P=0.001)。结论 RCC原发灶的PET/CT表现多样,较小的低级别肾透明细胞癌可无明显异常表现而漏诊;18 F-FDG PET/CT在RCC术前分期中具有重要价值。

Objective To evaluate the value of ^18F-FDG PET/CT in diagnosis of renal cell carcinoma （RCC）. Methods Totally 32 patients with RCC confirmed by pathology were analyzed retrospectively. The tumor diameter and maximum standard uptake values （SUVmax） of different pathological types （clear and none clear RCC）, different Fuhrman grades （high grade and low grade of clear RCC） and different clinical stages （distant and without distant metastases） were analyzed and compared. Results 32 RCC patients including 33 primary tumors, 31 lesions were detected by PET/CT and 2 were false negative, the detection rate was 93.94%. The PET/CT findings of 31 primary lesions were mixed density soft tissue masses, and the 18F-FDG uptake accessible, above or below to the normal renal parenchyma; the other 2 lesions of PET/CT findings were normal. 18F-FDG uptake of vein tumor thrombus in 8 cases and metastases in 19 cases were higher than the organs affected. The tumor diameter and SUVmax had no statistically significant difference in different pathological types and Fuhrman grades; The tumor diameter had no statistically significant difference, and SUVmax had statistically significant （t=3.852, P=0.001） between different clinical stages. Conclusion The PET/CT findings of RCC primary lesion are varied, and small clear RCC with low Furhman grade may have no obvious abnormality and missed diagnosis; ^18F-FDG PET/CT has important value in the preoperative staging of RCC.