^(18)F-脱氧葡萄糖PET/CT与增强CT在胰腺癌鉴别诊断中应用价值

Application value of ^(18)F-FDG PET/CT and enhanced CT in the differential diagnosis of pancreatic cancer

目的探讨^(18)F-脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层显像(PET)、增强CT在胰腺癌鉴别诊断中的应用价值。方法选取自2011年5月至2016年8月沈阳军区总医院收治的经B超、CT、核磁共振成像(MRI)以及临床综合资料证实为胰腺占位性病变的56例患者为研究对象。对所有56例患者行^(18)F-FDG PET/CT全身检查及增强CT检查。比较单纯^(18)F-FDG PET/CT、增强CT显像及两种显像方法联合应用对胰腺良恶性肿瘤诊断的灵敏度、特异度、阳性预测值、阴性预测值及准确率等,以及与最终诊断的一致性。结果本组56例胰腺病变患者中,胰腺癌38例,良性病变18例。^(18)F-FDG PET/CT对胰腺癌诊断的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为88.3%、80.2%、93.0%、82.7%及85.6%;增强CT诊断的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为74.1%、68.6%、80.9%、63.2%、72.6%,^(18)F-FDG PET/CT的诊断效能均高于增强CT。PET/CT联合增强CT对胰腺病变诊断的灵敏度为100.0%,特异度为90.9%,准确率为95.2%。^(18)F-FDG PET/CT与最终诊断具有较高的一致性(k=0.705),增强CT的诊断结果与最终诊断结果中度一致(k=0.409),两者联合具有极好的一致性(k=0.816)。结论^(18)F-FDG PET/CT对胰腺癌的诊断具有较高的灵敏度及特异性,^(18)F-FDG PET/CT联合增强CT可以明显提高诊断的灵敏度、特异性及准确率。

Objective To investigate the value of ^18F-fluorodeoxyglucose（^18F-FDG） positron emission computed tomography（ PET/CT） and enhanced computed tomography（ CT） in differential diagnosis of pancreatic cancer. Methods A retrospective study was performed on 56 cases of patients with pancreatic occupying lesions who were admitted and detected by ultrasound,CT and MRI from May2011 to August 2016. Patients were examined by^18F-FDG PET/CT and enhanced CT scan. Comparison simple^18F-FDG PET/CT and enhanced CT imaging and two imaging methods were combined on diagnosis of benign and malignant pancreatic tumor disease on sensitivity,specificity,positive predictive value,negative predictive value and accuracy,and the consistency with the final diagnosis.Results Amongthe 56 cases of pancreatic lesions,38 cases were pancreatic cancer and 18 cases were benign lesions. The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy for pancreatic cancer using^18F-FDG PET/CT versus enhanced CT were 88. 3% versus 74. 1%,80. 2% versus 68. 6%,93. 0% versus 80. 9%,82. 7% versus 63. 2% and 85. 6%versus 72. 6%,respectively. The diagnostic efficacy of^18F-FDG PET/CT was higher than those of enhanced CT. The sensitivity,specificity and accuracy rate of PET/CT combined with enhanced CT examination for pancreatic lesions diagnose was 100. 0%,90. 9% and95. 2%,respectively.^18F-FDG PET/CT had a high consistency（ k = 0. 705）,enhanced CT diagnosis results were moderate consistent with the final diagnosis（ k = 0. 409）,and the combination of the two imaging methods had excellent consistency（ k = 0. 816）.Conclusion^18F-FDGPET/CT has a high sensitivity and specificity for the diagnosis of pancreatic cancer.^18F-FDG PET/CT combined with enhanced CT can significantly improve the sensitivity,specificity and accuracy of diagnosis.