^18 F-FDG PET/CT在自身免疫性胰腺炎诊断及全身评价中的应用

目的 探讨^18F-FDG PET/CT全身显像在自身免疫性胰腺炎（AIP）诊断及全身评估中的价值.方法 回顾性分析2010年8月至2013年2月长海医院核医学科行18F-FDG PET/CT全身检查的20例AIP患者的临床及FDG PET/CT影像资料,重点分析胰腺及全身病变的形态及代谢特征.结果 20例AIP患者中男性17例,女性3例,平均年龄60岁.18例主要临床表现为腹部疼痛或不适,黄疸,反复脂肪泻.2例为体检发现.血清IgG水平升高15例次,血清IgG4升高17例次,血CA19-9升高8例次.PET/CT显示20例患者胰腺病灶FDG摄取均明显增高,最大标准摄取值（SUVmax）为5.09±2.10（2.71～ 11.88）,其中16例早期SUVmax为5.14±2.25,延迟扫描后SUVmax达6.23±2.77,平均滞留指数（RI）为21.20％.分型：弥漫型12例,局限型3例,混合型4例,多灶型1例.20例患者中19例发现胰腺外病灶,其中8例次合并胆管炎症,6例次涎腺肿大、代谢增高,13例次伴有1处以上的高代谢肿大淋巴结,8例次合并肺部间质性炎症或结节,11例次男性患者前列腺呈现“八字形”高摄取,3例次合并十二指肠乳头肿大伴代谢增高,2例次合并腹膜后纤维化,2例次合并溃疡型结肠炎,节段性结肠壁增厚伴FDG摄取增高.结论 18F-FDG PET/CT检查不仅可以很好地显示AIP的胰腺病变的形态、代谢特征,且能显示胰腺外器官的受累情况,有助于AIP的及时准确诊断及全身评估.

^18 F-FDG PET/CT in the diagnosis and systemic evaluation of autoimmune pancreatitis

Objective To investigate the role of ^18F-fluorodeoxyglucose positron emission tomography/ computed tomography （^18F-FDG PET/CT） in diagnosing of autoimmune pancreatitis （AIP） and systemic evaluation.Methods Twenty AIP patients who underwent 18F-FDG PET/CT whole-body examination in Department of Nuclear Medicine,Changhai Hospital from August 2010 to February 2013 were analyzed retrospectively.The morphology and metabolic characteristics of pancreatic and extra-pancreatic lesions （EPLs） were analyzed.Results The mean age of 20 AIP patients （17 male and 3 female） was 60 years old.The main clinical features were abdominal pain or discomfort,jaundice,and repeated steatorrhea.Two patients were detected during routine health check-up.Elevated serum IgG levels were found in 15 cases,and elevated serum IgG4 was detected in 17 cases,and elevated serum CA19-9 was found in 8 cases.The maximumstandardized uptake value （SUVmax） of the pancreas of the 20 patients were significantly increased,and the SUVmax was 5.09 ± 2.10 （2.71 ～ 11.88）,and it was 5.14 ± 2.25 in early scanning,and it increased to 6.23 ±2.77 after delayed scanning,and the retention index was 21.20%.Morphologically,diffuse type was found in 12 cases,segmental enlargement type in 3 cases,mixed type in 4 cases,multifocal enlargement in 1 case.Extra-pancreatic lesions were observed in 19 cases,which including cholangitis （n =8） ; sialosis with increased metabolism （n =6） ; lymphadenectasis with increased FDG uptake （n =13） ; interstitial pneumonia or nodule （n =8） ; inverted ＂V＂ shaped high FDG uptake foci in prostate （n =11） ; enlarged duodenal papilla with increased metabolism （n =3） ; retroperitoneal fibrosis （n =2） ; ulcerative colitis with segmental increased metabolism （n =2）.Conclusions ^18F-FDG PET/CT can show the morphology and metabolic characteristics of pancreatic lesions of AIP,and detect the extra-pancreatic lesions as well.It helps in diagnosis and wholebody evaluation of AIP.