速尿促排^18F-FDGPET/CT显像在尿路上皮癌诊断及分期中的应用价值

Evaluation of furosemide ^(18)F-FDG PET/CT imaging for primary diagnosis and staging of urothelial carcinoma

目的:探索^(18)F-FDG PET/CT常规显像和速尿促排延迟显像在尿路上皮癌的诊断及分期中的应用价值。方法:回顾性分析70例患者(包括因泌尿系统占位性病变就诊者51例和镜下血尿原因未明者19例)的^(18)F-FDG PET/CT常规和速尿促排延迟显像图像,并收集患者的手术或活检的组织病理学诊断、临床症状和随访结果。速尿促排对尿路放射性的清除效果分为优良、良好和差3个等级。当CT所示病变处PET显像放射性分布明显高于周围尿液并能与尿液清楚区分者则考虑为肿瘤阳性。对PET/CT所发现的病灶计算SUV_(max)、SUV_(ave)和肿瘤/尿液比值。结果:70例患者中,46例经组织病理学确诊为尿路上皮癌,包括10例肾盂尿路上皮癌、14例输尿管尿路上皮癌和22例膀胱尿路上皮癌。5例确诊为尿路良性病变,19例镜下血尿查因者临床随访大于1年未发现尿路恶性肿瘤。在63例行速尿促排延迟显像患者中,速尿促排成功率为96.8%。在39例同时行常规和速尿促排显像的尿路上皮癌中,肉眼分析肿瘤阳性率从常规显像的17.9%明显提高到速尿促排显像的89.7%。肿瘤/尿液比值从速尿促排前的(2.77±3.15)提高到促排后的(10.17±11.39)(t=-4.358,P=0.000)。速尿促排对尿路上皮癌病灶的阳性检出影响分别为膀胱>肾盂>输尿管。尿路上皮癌的^(18 )F-FDG摄取明显高于肝脏放射性,两者的SUV_(max)分别为(19.63±15.34)、(3.28±0.60)(t=-7.223,P=0.000)。^(18 )F-FDG PET/CT对尿路上皮癌的诊断灵敏度、特异性和准确性分别为91.3%、87.5%和90.0%,对区域淋巴结转移灶的诊断灵敏度、特异性和准确性分别为85.7%、90.9%和89.6%。46例尿路上皮癌患者中,9例(19.6%)全身PET/CT显像诊断有远处转移,其中8例(17.4%)因此而更改了治疗方案。结论:速尿促排延迟显像对尿路上皮癌的^(18)F-FDG PET/CT诊断是必需的,^(18)F-FDG PET/CT常规显像结合速尿促排显像在尿路上皮癌的诊断和分期方面有良好的应用价值。

Objective：To investigate the application of routine and delayed furosemide ^18F-FDG PET/CT for primary diagnosis and staging of urothelial carcinoma.Method：^（18）F-FDG PET/CT routine and delayed diuretic imagings of 70patients,including 51patients with urothelial space occupying lesions and 19patients with unknown origin of microscopic hematuria were retrospectively analyzed.Histopathological diagnosis,clinical symptoms and following-up results of these patients were also collected.The quality of diuretic excretion was classified as three levels of excellent,good and poor.When a lesion,which was detected on CT,showed high uptake of ^18F-FDG on PET and could be clearly distinguished from the surrounding urine radioactivity,which was considered positive of malignant tumor.The maximum and average of standardized uptake value（SUVmaxand SUVave）were measured for the lesions.Tumor/urine ratio was also calculated by dividing the SUVave of tumor to that of urine.Result：Of 70patients,46were diagnosed pathologically to have urothelial carcinoma,including tumor in the renal pelvis in 10patients,in the ureter in 14and in the bladder in 22.Benign lesions of urinary tract were diagnosed in 5patients.On the other hand,no malignant lesion was found in 19patients with unknown origin of microscopic hematuria by following-up.The delayed diuretic ^18F-FDG PET/CT was successfully in 96.8%of patients.In 39patients with urothelial carcinoma,who underwent not only routine but also delayed diuretic imaging,which the positive detection of tumors increased from 17.9%of routine imaging to 89.7%of delayed diuretic imaging by visual analysis.Tumor/urine ratio also increased from（2.77±3.15）of routine imaging to（10.17±11.39）of delayed diuretic imaging（t=-4.358,P=0.000）.Additional effect of delayed diuretic imaging for positive detection of tumor was best for bladder,followed by renal pelvis and ureter.The uptake of ^18F-FDG in urothelial carcinoma was significantly higher than that in liver tissue[SUVmax（19.63±15.34）vs.（3.28±0.60）,t=-7.223,P=0.000].The diagnostic sensitivity,specificity and accuracy of ^18F-FDG PET/CT were 91.3%,87.5%,90%for the urothelial cancer and 85.7%,90.9%,89.6%for the regional lymph node metastases,respectively.Of 46patients with urothelial carcinoma,9（19.6%）were diagnosed with distant metastases by whole-body PET/CT imaging,which changed the management of 8（17.4%）patients from surgery to systemic palliative care.Conclusion：Delayed diuretic imaging is necessary for diagnosis of urothelial carcinoma,when ^18F-FDG PET/CT is used.Routine and delayed diuretic ^18F-FDG PET/CT are useful for primary diagnosis and staging of urothelial carcinoma.