^(18)F-FDG PET/CT显像在不明原因腹膜增厚中的诊断价值

Diagnosis of ^(18)F-FDG PET/CT in Peritoneal Thickening of Undetermined Origin

目的探讨^(18)F-FDG PET/CT显像在腹膜增厚病因诊断中的价值及显像特点。资料与方法回顾性分析2017年1月—2021年6月于济宁医学院附属医院行^(18)F-FDG PET/CT显像的108例腹膜增厚患者,检查前临床均未明确病因且未进行治疗。观察腹膜增厚形式、病变范围、器官病变、腹膜及器官最大标准化摄取值(SUVmax)、CT值、有无腹水等。通过视觉分析及半定量分析法,结合临床及显像资料,对病因及原发灶做出诊断,比较PET/CT、PET、CT显像的诊断效能及恶性腹膜增厚与结核性腹膜增厚之间的区别。结果108例患者中,恶性肿瘤性病变90例,良性病变18例。PET/CT、PET、CT分别诊断出69、58、51例恶性腹膜病变原发灶,未准确诊断21、32、39例。PET/CT、PET、CT在腹膜增厚病因诊断中的敏感度分别为76.7%、64.4%、56.7%,特异度分别为72.2%、66.7%、83.3%,准确度分别为75.9%、64.8%、61.1%,阳性预测值分别为93.2%、90.6%、94.4%,阴性预测值分别为38.2%、27.3%、27.8%。90例恶性腹膜增厚的SUVmax(7.4±4.9)高于7例非结核性良性腹膜增厚(1.9±1.1;t=5.372,P=0.000),但与11例结核性腹膜增厚(6.1±3.5)差异无统计学意义(t=0.431,P=0.795)。恶性腹膜增厚与结核性腹膜增厚患者年龄(t=5.218,P=0.001)、腹膜增厚形式(χ^(2)=7.182,P=0.007)、有无其他器官病变(χ^(2)=9.395,P=0.002)、有无腹水(χ^(2)=3.947,P=0.047)、是否伴发热(χ^(2)=41.749,P=0.000)差异有统计学意义,腹膜及器官SUVmax、CT值、腹膜病变范围差异无统计学意义(P均>0.05)。结论^(18)F-FDG PET/CT显像对腹膜增厚病因诊断具有较高的价值,恶性腹膜增厚的SUVmax高于非结核性良性腹膜增厚,但与结核性腹膜增厚其他显像及临床特点存在差异。

Purpose To explore the value and imaging characteristics of ^(18)F-FDG PET/CT in peritoneal thickening of undetermined origin.Materials and Methods 108 people with peritoneal thickening of undetermined origin who were underwent the ^(18)F-FDG PET/CT scanning in Affiliated Hospital of Jining Medical University from January 2017 to June 2021 were involved.All patients had no clear clinical cause and no treatment before examination.The pattern of peritoneal thickening,extent of disease,visceral lesions,maximum standardized uptake value(SUVmax)of peritoneal thickening and visceral were measured.Through visual analysis and semi-quantitative analysis,combined with the clinical and imaging data,the origin and primary site were diagnosed.The diagnostic performances of ^(18)F-FDG PET/CT,PET and CT were evaluated.Results Among the 108 patients,90 cases were malignant peritoneal thickening and 18 cases were benign peritoneal thickening.PET/CT,PET and CT respectively diagnosed 69,58 and 51 cases of malignant peritoneal thickening,while 21,32 and 39 cases were not diagnosed accurately.The sensitivity of PET/CT,PET and CT in the diagnosis of peritoneal thickening were 76.7%,64.4%,56.7%,respectively;the specificity were 72.2%,66.7%,83.3%,respectively;the accuracy were 75.9%,64.8%,61.1%,respectively;the positive predictive value were 93.2%,90.6%,94.4%,respectively;the negative predictive value were 38.2%,27.3%,27.8%,respectively.The SUVmax of malignant peritoneal thickening(7.4±4.9)were higher than nontuberculous benign peritoneal thickening(n=7,1.9±1.1;t=5.372,P=0.000),but has no significant difference with tuberculous peritoneum thickening(n=11,6.1±3.5,t=0.431,P=0.795).The age(t=5.218,P=0.001),pattern of peritoneum thickening(χ^(2)=7.182,P=0.007),presence of visceral lesions(χ^(2)=9.395,P=0.002),presence of ascites(χ^(2)=3.947,P=0.047)and presence of fever(χ^(2)=41.749,P=0.000)were significantly different between patients with malignant peritoneum thickening and those with tuberculous peritoneum thickening.There were no significant differences in SUVmax and CT values of peritoneum and organs and the range of peritoneal lesions(P>0.05).Conclusion ^(18)F-FDG PET/CT is of high value in peritoneal thickening of undetermined origin,SUVmax of malignant peritoneal thickening are higher than nontuberculous benign peritoneal thickening,and the clinical characteristics and PET/CT imaging features are different in patients with malignant and tuberculous peritoneum thickening.