血糖水平对原发性肝癌患者^(18)F-FDG摄取和PET/CT检查图像质量的影响研究

Impact of blood glucose levels on imaging quality of PET/CT examination in patients with primary liver cancer

目的探讨原发性肝癌(PLC)患者血糖水平对肝脏氟脱氧葡萄糖F^(18)(^(18)F-FDG)摄取的影响。方法 2015年1月～2018年1月我院行正电子发射断层显像/电子计算机断层扫描(PET/CT)检查的PLC患者187例,其中空腹血糖水平正常者71例,高血糖者116例。在PET/CT检查后,测量肝右叶平均标准化摄取值(SUVmean)。比较两组肝图像质量和^(18)F-FDG摄取结果,采用相关分析和偏相关分析计算连续性变量与肝脏SUVmean间的相关系数和偏相关系数,再行多元逐步线性回归分析影响肝脏SUVmean的影响因素。结果血糖正常患者肝图像质量为0级者5例(7.0%),1级者14例(19.7%),显著低于血糖升高患者的20例(17.2%)和31例(26.7%),肝图像质量为2级者21例(29.5%),为3级者31例(43.8%),显著高于血糖升高患者的30例(25.8%)和35例(30.3%,P<0.05);高血糖组患者肝脏^(18)F-FDG摄取为(5.1±1.4),显著高于血糖水平正常组患者【(3.9±1.3),P<0.05】;血糖、年龄、FT3和基础代谢率(BMR)与SUVmean间的相关和偏相关系数均存在统计学意义(P<0.05),多元回归分析显示,血糖、年龄和血清甲状腺素(FT3)是影响肝脏SUVmean变化的独立因素。结论血糖水平可影响PLC患者肝脏^(18)F-FDG摄取和PET/CT检查图像质量,而年龄和血清FT3也是影响肝脏SUVmean变化的独立因素。临床在行^(18)F-FDG PET/CT检查前,应积极调控血糖水平至合理范围,并在判读PET/CT检查图像时,考虑到这些因素的影响。

Objective To explore the impact of blood glucose levels on imaging quality of positron emission tomography/computed tomography(PET/CT)examination in patients with primary liver cancer(PLC).Methods^187 patients with PLC were recruited in this study between January 2015 and January 20^18,and 71 had normal blood glucose and 116 were hyperglycemic.All patients received PET/CT examination.SUVmean was measured in the right lobe of the liver.The liver image quality and fluorodeoxyglucose F^18(^18F-FDG)uptake were compared between the two groups,and the correlation of each variable to liver SUVmean was analyzed.Results The grade 0,1,2 and 3 of liver image quality by PET/CT scan in patients with normal blood glucose levels 7.0%,19.7%,29.5%and 43.8%,significantly superior to 17.2%,26.7%,25.8%and 30.3%in patients with elevated blood glucose levels(P<0.05);the^18F-FDG uptake in patients with hyperglycemia was significantly higher than in patients with normal blood glucose[(5.1±1.4)vs.(3.9±1.3),P<0.05];Correlation and partial correlation coefficients between blood glucose,age,free thyroxine 3(FT3)and liver BMR,and SUVmean were statistically significant(P<0.05)and further multivariate stepwise linear regression analysis showed that blood glucose,age and FT3 were the independent factors affecting liver SUVmean.Conclusions Blood glucose levels and liver glucose metabolism might affect liver^18F-FDG uptake and the image quality of PET/CT scan in patientswith PLC,and the patients’age and serum FT3 are independent factors affecting liver SUVmean.Clinicians should actively regulate the blood glucose levels to a reasonable range before PET/CT examination.