18F-FDGPET／CT联合腹部增强CT对诊断胰腺癌及评估肿瘤可切除性的临床应用

目的评价18F-脱氧葡萄糖（FDG）PET／CT联合腹部增强CT对诊断胰腺癌、鉴别诊断胰腺良恶性病变以及评估肿瘤可切除性的临床应用价值。方法回顾性分析行18F—FDGPET／CT和腹部增强CT检查并经病理检查或临床等方法证实的48例原发性胰腺病变患者的资料，其中胰腺癌34例，胰腺良性病变14例。对胰腺癌和胰腺良性病变患者最大标准摄取值（SUVmax）进行t检验；比较分析单独PET、腹部增强CT、PET／CT、PET／CT联合腹部增强CT4种方法的图像特征和诊断价值，对灵敏度和准确性进行x2检验，对特异性进行Fisher确切概率法检验。结果34例胰腺癌患者与14例胰腺良性病变患者的SUVmax（5．91±2．90和2．24±1．13）差异有统计学意义（t=4．56，P〈0．01）。PET／CT联合腹部增强CT诊断胰腺癌的灵敏度、特异性和准确性分别为97．1％（33／34）、92．9％（13／14）和95．8％（46／48），与单纯PET的88．2％（30／34）、64．3％（9／14）和81．2％（39／48）相比，x2=0．863和P=0．352，P=0．038,X2=5．031和P=0．024；与腹部增强CT的76．5％（26／34）、71．4％（10／14）和75．0％（36／48）相比，x2=6．274和P=0．012，P=0．042，x2=8．362和P=0．003；与PET／CT的88．2％（30／34）、78．6％（11／14）和85．4％（41／48）相比，x2=0．863和P=0．352，P=0．048,x2=3．928和P=0．047。PET／CT全身显像几乎发现了全部转移灶，使14例胰腺癌患者避免了不必要的外科手术；PET／CT可对单独PET显像诊断的胰腺癌患者胰腺外假阳性病灶进行正确诊断，使1例胰头癌患者分期下调，进行了外科手术。腹部增强CT通过多期显像，可以准确判断肿瘤对胰腺周围主要血管的侵犯程度，腹部增强CT按血管受侵程度评估肿瘤可切除性的准确性为83．3％（15／18），不可切除的准确性为9／9。结论PET／CT联合增强CT对于诊断胰腺癌、鉴别胰腺良恶性病变及评估肿瘤的可切除性准确性有一定临床价值。

~(18)F-FDG PET/CT combined with abdominal contrast enhanced CT for the diagnosis of pancreatic cancer and assessment of its resectability

Objective To assess the value of ~(18)F-fluorodeoxyglucose (FDG) PET/CT combined with abdominal contrast enhanced CT for the differential diagnosis and assessment of the resectability of pan-creatic cancer.Methods Forty-eight patients with ~(18)F-FDG PET/CT and abdominal contrast-enhanced CT performed for primary pancreatic disease (confirmed by pathology and/or clinical follow-up) were analyzed retrospectively.There were 34 patients with pancreatic cancer and 14 with benign pathology.The maximum standardized uptake values(SUV_(max)) of the malignant and benign lesions were compared by t-test.The diag-nostic values of PET, abdominal contrast enhanced CT, PET/CT, PET/CT combined with abdominal con-trast enhanced CT were compared using χ~2-test (sensitivity and accuracy) and Fisher exact probability test (specificity).Results The SUV_(max) in malignant and benign pancreatic lesions had a statistically signifi-cant difference (t=4.56, P <0.01).The sensitivity, specificity and accuracy of PET/CT combined with abdominal contrast enhanced CT were 97.1% (33/34), 92.9% (13/14) and 95.8% (46/48), respec-tively, which were all higher than those (88.2% (30/34), 64.3% (9/14) and 81.2% (39/48)) of PET alone (χ~2 =0.863, P=0.352 and P=0.038 ; χ~2 = 5.031, P=0.024), those (76.5 % (26/34), 71.4% (10/14) and 75.0% (36/48)) of abdominal contrast enhanced CT (χ~2 =6.274, P=0.012 and P=0.042 ; χ~2=8.362, P=0.003), those (88.2% (30/34), 78.6% (11/14) and 85.4% (41/48)) of PET/CT (χ~2=0.863, P=0.352 and P=0.048 ; χ~2 = 3.928, P=0.047).Whole-body PET/CT detected almost all metastases of carcinoma of pancreas and changed the management of 14 patients intended for sur-gical resection.PET/CT also changed the diagnosis of a false-positive extrapancreatic lesion by PET alone,and therefore changed the treatment method of this patient to curative surgery.Abdominal contrast enhanced CT could accurately evaluate the status of vascular invasion of primary carcinoma of pancreas, with an accu-racy of resectability and unresectability of 83.3% (15/18) and 9/9, respectively.Conclusion PET/CT combined with contrast enhanced CT could accurately diagnose pancreatic cancer, differentiate malignant from benign pancreatic lesions and assess the resectability of pancreatic malignancy.