~(18)F-FDG PET/CT对肝内胆管癌的诊断价值研究

目的探讨~(18)F-FDG PET/CT对肝内胆管癌的临床诊断价值,探寻鉴别肝内胆管癌与良性病灶的最佳放射摄取半定量诊断界值。方法收集2010年8月~2012年12月因常规影像学怀疑肝内胆管癌并行PET/CT检查患者的资料。分别使用视觉分析法、SUV_(max)法、T/N比法及综合分析法进行诊断,以手术病理结果为金标准,计算并比较各种方法诊断肝内胆管癌的效能。结果共入组51例患者,2例为肝细胞癌,39例肝内胆管癌及10例良性病灶;PET/CT诊断肝内胆管癌的敏感度92.3%;特异度75.0%;准确度88.2%;阳性预测值92.3%;阴性预测值75.0%。39例肝内胆管癌的SUV_(max)均值是9.65±4.44,10例良性病灶的SUV_(max)为5.17±2.30,差异有显著统计学意义(P0.05);39例肝内胆管癌的T/N均值是4.29±2.16,10例良性病灶是2.03±0.74,差异有显著统计学意义(P0.05)。绘制诊断胆管癌的SUV_(max)、T/N的ROC曲线。当SUV_(max)最佳诊断界值是4.05时,诊断肝内胆管癌的敏感度和特异度分别为94.9%、50.0%。当T/N最佳诊断界值是2.85时,诊断肝内胆管癌的敏感度和特异度分别为76.9%、90.0%。视觉分析法较T/N法有较高的敏感度(P0.05),T/N法较视觉分析法有较高的特异度(P0.05);SUV_(max)法较T/N法有较高的敏感度(P0.05)。结论PET/CT诊断肝内胆管癌有较高诊断效能,但仍存在部分假阳性和假阴性,合理应用各项代谢参数并结合同层CT及临床资料有助于进一步提高诊断效能。

Evaluation of the role of 18F-FDG PET/CT in the diagnosis of intrahepatic cholangiocarcinoma

...Objective...To assess the value of 18F-FDG PET/CT in patients with intrahepatic cholangiocarcinoma and the efficacy of SUVmax and T/N ratio for differentiating malignant from benign hepatic lesions. .Methods 51 patients with suspected intrahepatic cholangiocarcinomas who underwent 18F-FDG PET/CT scan between August 2010 and December 2012 were included in the analysis using visual assessment, SUVmax, T/N ratio, and receiver operating characteristic (ROC) curves. Using SUVmax cutoff values of 4.05,.the sensitivity and specificity for diagnosing intrahepatic cholangiocarcinoma were 94.9%and 50.0%, respectively. With T/N cutoff value of 2.85, the sensitivity and specificity were 76.9%and 90.0%, respectively. Visual analysis had significantly higher sensitivity and lower specificity than T/N (P<0.05)..SUVmax also had significantly higher sensitivity than T/N (P<0.05). Results Of 51 patients, the final histological diagnosis was hepatocellular carcinoma (2), cholangiocarcinoma (39) and benign disease (10). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT in primary tumor detection were 92.3%, 75.0%, 88.2%, 92.3%, and 75.0%, respectively. The SUVmax of intrahepatic cholangiocarcinoma ( 9 . 65 ± 4 . 44 ) was significantly ( P<0 . 05 ) higher than that of benign lesions ( 5 . 17 ± 2 . 30 ) . The T/N of malignancy (4.29±2.16) was also significantly (P<0.05) higher than that of benign lesions (2.03±0.74). Conclusion 18F-FDG PET/CT has high sensitivity and positive predictive value for differentiating intrahepatic cholangiocarcinoma and benign lesions.