18F-脱氧葡萄糖PET对判断脑胶质瘤手术并放疗后肿瘤残留的价值

背景与目的:恶性肿瘤治疗后残留的判断靠CT或MRI有时是很困难的,18F-脱氧葡萄糖(fluorodeoxyglucose,FDG)正电子发射型体层摄影术(positron emission tomography,PET)在这方面的应用是放射肿瘤学目前研究的热点之一.本研究旨在探讨18F-FDG PET在判断脑胶质瘤手术后并放疗后肿瘤残留的临床价值.方法:对23例脑胶质瘤手术后并放疗后临床疑肿瘤残留患者同期行18F-FDG PET和CT/MRI检查,最后诊断结合手术后病理检查和临床随访.结果:23例患者中18F-FDGPET显像阳性12例,阴性11例,其中3例为假阴性.9例CT/MRI未能确定肿瘤残留,PET显示其中7例FDG异常浓聚,2例FDG摄取缺损;8例CT/MRI诊断为肿瘤残留者PET显示FDG异常浓聚.18F-FDG PET显像检查的准确率为87.0%(20/23),而CT/MRI检查的准确率为60.9%(14/23),前者准确率明显高于后者(P＜0.05).结论:18F-FDG PET在判断脑胶质瘤手术后并放疗后的脑损伤和肿瘤残留方面具有明显的优势,结合CT和MRI能更好的提供解剖结构和功能改变的综合信息.

Value of 18F-FDG PET imaging in diagnosing tumor residue of intracranial glioma after surgery and radiotherapy

BACKGROUND &OBJECTIVE:It is difficult to diagnose tumor residue by CT/MRI after treatment. The application of 18F-fluorodeoxyglucose positron emi ssion tomography (18F-FDG PET) to determine the suspected tumor residue after t reatment has become a hot target in the study of radiotherapy. This study was de signed to discuss the clinical value of 18F-FDG PET imaging in post-operative and post-radiotherapeutic intracranial glioma. METHODS: 18F-FDG PET imaging wa s performed in 23 patients with post-operative and post-radio-therapeutic int racranial glioma, and compared with CT/MRI. The final diagnosis of tumor residue was proved by pathology or clinical follow-up. RESULTS: Of 23 patients, 12 sho wed 18F-FDG PET positive,and 11 showed negative, among which 3 were false negat ive. The accuracy of 18F-FDG PET was 87 0%(20/23), significantly higher than 60 9%(14/23) of CT/MRI scan (P< 0 05). The diagnosis of tumor residue in 9 pa tients cannot be determined by CT/MRI,while 4 of these patients showed 18F-FDG PET positive, and the other 5 showed 18F-FDG PET negative. Eight of 23 patients diagnosed tumor residues by CT/MRI, showed 18F-FDG PET positive, too. Six pati ents, diagnosed by CT/MRI as radioactive-disease sufferers, and PET indicated w ith low or deficient FDG metabolism,were proved to have radioactive diseases by follow-up. CONCLUSIONS: 18F-FDG PET imaging has significant dominance in chara cterizing lesions, and differentiating tumor residue in post-operative and post-radiotherapeutic intracranial glioma. Combined with CT and MRI,it can provide both anatomical and functional information for treatment.