多模式PET/CT影像技术对不同证型肝恶性肿瘤临床诊断应用分析

Analysis of the Value of Multi-mode PET/CT Image Technology Applied to Clinical Diagnosis of Intrahepatic Malignant Tumor of Different Patterns

目的:探讨多模式PET/CT影像技术在不同证型肝恶性肿瘤临床诊断中的应用价值。方法:采用PET/CT扫描仪对156例肝恶性肿瘤患者(血瘀成毒证65例、湿痰化毒证92例)行全身扫描,运用滤波反投影(FBP)2D有序子集迭代法(OS-EM)重建图像,通过计算机分析处理得到横断位、冠状位以及矢状位的融合图像。采用MSCT增强检查方法做全肝平扫,然后做螺旋CT肝脏3期增强扫描。采用双盲法、肝脏PET图像分级标准及小肝癌CT诊断标准进行图像分析。采用Kaplan-Meier分析生存曲线。结果:^(18)F-FDGPET/CT对湿痰化毒证肝肿瘤的检出率为71.7%,对于小肝癌的检出率较低;^(18)F-FDGPET/CT对血瘀成毒证肝肿瘤的检出率为96.8%,较湿痰化毒证的敏感性高,差异具有统计学意义(P<0.05)。但两种证型中超过3厘米的病灶检出率比较差异无统计学意义(P>0.05);^(18)F-FDGPET/CT对血瘀成毒证肝癌的检出率为68.42%。SUVmax分级在两种证型小肝癌术后生存率方面比较差异无统计学意义(P>0.05)。结论:在常规PET/CT采集图像后再行诊断部位的CT增强扫描,可获得明确诊断意义的CT图像。

Objective： To discuss clinical values of multi-mode PET/CT image technology applied to clinicaldiagnosis of intrahepatic malignant tumor of different patterns. Methods： The whole body of 156 patients （65 casesof blood stasis into toxin pattern and 92 cases of damp-phlegm into toxin pattern） suffering intrahepatic malignanttumor were scanned by using PET/CT scanner, blending images in transverse position, coronal position and sagittalpositions were obtained after dealing by the computer and reconstructing the image by usng filtered back projection（FBP） 2D ordered subsets expectation maximization. Plain scan of the whole liver was performed by using MSCTenhanced inspection method, and three-phase enhanced liver scanning by using spiral computed tomography （CT）.The images were analyzed by adopting double-blind method, liver PET image classification standard and small livercancer CT diagnostic standard. Survival curve was analyzed by using Kaplan-Meier. Results： The detection rate ofhepatic tumor of damp-phlegm into toxin pattern by 18F-FDG PET/CT was 71.7%, while the detection rate of smallliver cancer was lower; the detection rate of hepatic tumor of blood stasis into toxin pattern by 18F-FDG PET/CT was96.8%, higher than the rate of hepatic tumor of damp-phlegm and toxin pattern, and the difference had statisticalmeaning（P〈0.05）, while the difference had no statistical meaning in the comparisons of the detection rate for thefocus larger than three centimeters among the two patterns（P〉0.05）; the detection rate of hepatic tumor of bloodstasis and toxin pattern was 68.42% by 18F-FDG PET/CT. The difference had no statistical meaning in thecomparisons of SUVmax classifications between postoperative survival rates of small liver cancer of two patterns（P〉0.05）. Conclusion： CT images with specific diagnostic meaning could be obtained by performing CT enhancedscan of diagnostic sites after the images were collected by using conventional PET/CT.