^(18)F-FDG PET/CT对腹膜良恶性病变的鉴别诊断价值

The value of ^(18)F-FDG PET/CT in differential diagnosis of benign and malignant peritoneal lesions

目的分析腹膜病变的^(18)F-FDG PET/CT的代谢和形态特点,探讨^(18)F-FDG PET/CT在腹膜良恶性病变鉴别诊断中的价值。方法回顾性分析经^(18)F-FDG PET/CT检查腹膜有病变的病人70例,男22例,女48例,平均年龄(58.20±13.18)岁。根据病理结果将病人分为恶性组(61例)和良性组(9例)。记录腹膜病变最大标准化摄取值(SUV_(max)),FDG代谢分布特征、大网膜挛缩、病灶大小及边界,测量腹水CT值、SUV_(max)及腹腔积液SUV_(max)/肝脏SUV_(max)的比值(即T/NT值)。2组间非正态分布的计量资料采用Mann-Whitney U检验进行比较,采用连续校正卡方检验或Fisher确切概率检验对计数资料进行差异性分析。结果与良性组相比,恶性组大网膜更易出现挛缩,呈不规则状及条状改变(P<0.05),且大网膜及肠系膜FDG代谢摄取多呈局限性改变(均P<0.05);肿块样病变(>3 cm)只在恶性组中出现,大网膜、小网膜、肠系膜、盆腔腹膜的病灶中大结节(>5 mm)病变占比更高(均P<0.05)。良性组大网膜病灶边界不清晰占比更高(P<0.05)。2组间其余差异均无统计学意义(如腹水CT值、SUV_(max)、T/NT值)(均P>0.05)。结论病变大小、大网膜及肠系膜FDG代谢分布特征、大网膜挛缩及大网膜病变CT边界等影像特征有助于良恶性腹膜病变的鉴别。

Objective To explore the value of ^(18)F-FDG PET/CT in differential diagnosis of benign and malignant peritoneal lesions by analyzing metabolic and morphologic features of peritoneal lesions on ^(18)F-FDG PET/CT.Methods All of 70 patients with peritoneal lesions identified by ^(18)F-FDG PET/CT were retrospectively collected,including 22 males and 48 females with a mean age of 58.2±13.18 years.The patients were divided into malignant group(n=61)and benign group(n=9).The lesion’s maximum standardized uptake value(SUV_(max)),metabolic distribution,greater omental contracture,lesion’s size and border on CT images were recorded.CT and SUV_(max) values of ascites,the ratio of SUV_(max) of ascites and liver(T/NT)were also measured.Mann-Whitney U test were used for the measurement data of non-normal distribution between malignant group and benign group.For count data,the comparison between the two group was performed with correction for continuity or Fisher’s exact test,as appropriate.Results Compared with benign group,the omentum appeared more common irregular and strip changes due to its contraction in the malignant group(P<0.05).Focal FDG uptakes of greater omentum and mesentery were more common in the malignant group(all P<0.05).The mass lesions larger than 3 cm were only seen in the malignant group(all P<0.05),the nodular lesions larger than 5 mm were more common in the greater omentum,lesser omentum,mesentery and pelvic peritoneum.The ill-defined border of greater omental lesions was more common in the benign group(P<0.05).No statistical differences were found in the other parameters(CT values,SUV_(max) of ascites and T/NT value)between the two groups(all P>0.05).Conclusion The size of lesion,the distribution of FDG uptake in greater omentum and mesentery,greater omental contracture,border of greater omental lesions in ^(18)F-FDG PET/CT imaging may help distinguish benign from malignant peritoneal lesions.