利尿后延迟18F-FDG PET/CT显像诊断直肠癌盆腔局部复发的临床研究

Clinical study of ^(18)F-FDG PET/CT delayed imaging after diuretic in the diagnosis of pelvic local recurrence of rectal cancer

目的观察利尿后延迟^(18)F-FDG PET/CT显像诊断直肠癌盆腔局部复发的临床价值。方法回顾性分析2013年2月至2015年10月在本院进行直肠癌根治术后复查的患者54例,均予以CT扫描与PET发射扫描,且扫描前予以插入导尿管、注射1500 mL的0.9%氯化钠溶液、口服葡萄糖20 min后推注速尿等进行膀胱准备,采用CT图像重建及PET图像重建并用CT图像对PET图像进行衰减校正。分析患者的CT及PET/CT融合图,并以病理结果为金标准计算^(18)F-FDG PET/CT与CT诊断直肠癌术后盆腔局部复发的准确率。结果 54例患者病理结果证实共49例发生盆腔局部复发,复发率90.74%。利尿后延迟^(18)F-FDG PET/CT与CT的特异性、阳性预测值分别为60.00%、28.57%与96.08%、91.43%,无明显差异(P>0.05)。利尿后延迟^(18)F-FDG PET/CT诊断直肠癌盆腔局部复发的敏感性、准确率、阴性预测值分别为100.00%、96.30%、100.00%,均显著高于CT(均P<0.05)。结论利尿后延迟^(18)F-FDG PET/CT显像诊断直肠癌盆腔局部复发具有较高准确率,效果优于传统强化CT,值得推广应用。

Objective To evaluate the clinical value of ^18F-FDG PET/CT delayed imaging after diuretic in the diagnosis of pelvic local recurrence of rectal cancer. Methods Clinical data of 54 patients undergoing radical resection of rectal cancer in our hospital from February 2013 to October 2015 were analyzed retrospectively. Patients were given CT scan and PET emission scan. Before the scan,1500 mL of 0.9% sodium chloride solution was administrated through catheter, followed by injection of furosemide after 20 min of oral glucose and other bladder preparation. CT and PET image reconstruction were performed and the PET images were attenuated and corrected with CT images. CT and PET/CT fusion images were analyzed and the accuracy of ^18F-FDG PET/CT and CT in the diagnosis of postoperative recurrence of rectal cancer was evaluated with the pathological findings as the reference. Results 49 out of 54 patients were pathologically confirmed as with pelvic local recurrence. The recurrence rate was 90.74%. The specificity and positive predictive value of delayed ^18F-FDG PET/CT scan were 60%, 28.57%, respectively and the corresponding figures for CT were 91.43% and96.08%, respectively, with no significant difference（P〈0.05）. The sensitivity, accuracy and negative predictive value of ^18F-FDG PET/CT delayed imaging after diuretic were 100%, 96.30% and 100% respectively, which were significantly higher than those of CT（P〈0.05）. Conclusion ^18F-FDG PET/CT delayed imaging after diuretic can accurately diagnose pelvic local recurrence of rectal cancer.The diagnostic accuracy was higher than the traditional enhanced CT, with high application potential.