18F-FDG PET/CT诊断肾细胞癌合并静脉瘤栓

18F-FDG PET/CT in diagnosis of renal cell carcinoma with venous tumor thrombosis

目的探讨PET/CT诊断肾细胞癌(RCC)合并静脉瘤栓的价值。方法回顾性分析27例肾癌合并静脉瘤栓患者的PET/CT资料。将PET/CT瘤栓分级与临床分级进行对照,根据病理结果将患者分为瘤栓侵犯静脉壁组和未侵犯静脉壁组,分析2组原发肿瘤SUV max、瘤栓SUV max及下腔静脉最大径的差异。结果PET/CT检出瘤栓27例,瘤栓检出率100%(27/27),静脉瘤栓SUV max平均6.98±5.50;PET/CT正确分级26例(26/27,96.30%)。8例合并下腔静脉血栓,PET/CT诊断准确率87.50%(7/8),静脉血栓平均SUV max为1.30±0.28。瘤栓SUV max明显高于血栓(P<0.001)。2组肿瘤原发灶SUV max、瘤栓SUV max及下腔静脉最大径差异均无统计学意义(P均>0.05)。结论PET/CT对RCC合并静脉瘤栓及血栓具有较高的检测准确率,瘤栓分级准确率较高,但评估瘤栓是否侵犯静脉壁的能力有限。

Objective To explore the diagnosis value of ^18 F-FDG PET/CT for renal cell carcinoma(RCC)with venous tumor thrombosis(VTT).Methods PET/CT data of 27 patients with pathologically confirmed RCC with VTT were analyzed retrospectively.PET/CT grading was compared with clinical grading for classification of VTT.According to pathological findings,the patients were divided into venous wall invasion group and venous wall noninvasion group.SUV max of primary tumor,of VTT and inferior vena cava diameter were compared between two groups.Results The average SUV max of VTT was 6.98±5.50 in 27 cases with 100%(27/27)detection rate for VTT.Correct classification of VTT was performed in 26 cases with PET/CT,the accuracy rate was 96.30%(26/27).The average SUV max of bland thrombosis(BT)was 1.30±0.28 in 8 cases,and the diagnostic accuracy was 87.50%(7/8).SUV max of VTT was significantly higher than that of BT(P<0.001).There was no significant difference in SUV max of primary tumor,SUV max of VTT nor inferior vena cava diameter between 2 groups(all P>0.05).Conclusion PET/CT has high detection accuracy for RCC with VTT and BT,also for tumor thrombus classification,but has limited ability to evaluate vein wall tumor invading.