18F-FDG PET/CT在脉络膜黑色素瘤与脉络膜转移癌鉴别诊断中的应用价值

目的 分析脉络膜黑色素瘤和脉络膜转移癌患者氟-18-脱氧葡萄糖(¹⁸F-fluorodeoxyglucose,¹⁸F-FDG)正电子发射型计算机断层显像/电子计算机断层显像(positron emission tomography/computed tomography,PET/CT)影像特点及代谢参数,探讨其在两者的诊断及鉴别中的应用价值。 方法 回顾性分析2020年5月至2022年3月首次因眼部症状就诊,在首都医科大学附属北京同仁医院核医学科行¹⁸F-FDG PET/CT 检查,并经手术病理证实或临床最终诊断为脉络膜黑色素瘤或脉络膜转移癌的患者的影像和代谢参数。对比两组间影像学表现及¹⁸F-FDG PET代谢参数,后者包括病灶最大标准化摄取值(maximum standardized uptake value, SUV_max)、峰值标准摄取值(peak standardized uptake value, SUV_peak)、病灶糖酵解总量(total lesion glycolysis,TLG)。应用Spearman相关性分析,评价代谢参数与病变大小之间的相关性。 结果 共纳入76例患者,其中脉络膜黑色素瘤58例(58只眼)、脉络膜转移癌18例(18只眼)。两组间性别、年龄、患侧差异均无统计学意义(均P＞0.05)。两组间病变位置(χ²=9.263,P=0.041)、形状(χ²=21.735,P<0.001)差异有统计学意义。脉络膜黑色素瘤组平均隆起高度明显高于脉络膜转移癌组(t=2.539,P=0.013);两组之间基底最大径差异无统计学意义(P>0.05)。在代谢参数中,脉络膜黑色素瘤组SUV_max低于脉络膜转移癌组(P<0.05),两组间SUV_peak及TLG差异无统计学意义(均P＞0.05)。脉络膜黑色素瘤组病灶SUV_max、SUV_peak、TLG与病变基底最大径(r=0.528、0.613、0.732,均P<0.001)、隆起高度(r=0.521、0.605、0.730,均P<0.001)均呈正相关。脉络膜转移癌组SUV_peak、TLG与病变基底最大径(r=0.528、0.661,P=0.024、0.003)、隆起高度(r=0.591、0.688,P=0.010、0.002)均呈正相关,而SUV_max与病变基底最大径、隆起高度均无显著相关性(均P＞0.05)。 结论 ¹⁸F-FDG PET/CT影像表现及代谢参数SUV_max对于脉络膜黑色素瘤和转移癌的鉴别诊断有一定价值。

Application value of 18F-FDG PET/CT in differential diagnosis of choroidal melanoma and choroidal metastatic carcinoma

Objective To analyze the imaging characteristics and metabolic parameters of fluoro-18-deoxyglucose(¹⁸F-FDG) positron emission tomography/computed tomography(PET/CT) in patients with choroidal melanoma and choroidal metastatic carcinoma, and to explore its clinical application value in the diagnosis and differentiation of the two diseases. Methods The patients that underwent ¹⁸F-FDG PET/CT examination in the Department of Nuclear Medicine, Beijing Tongren Hospital, Capital Medical University from May 2020 to March 2022 and finally diagnosed as choroidal melanoma or choroidal metastatic carcinoma were enrolled. The CT imaging features and ¹⁸F-FDG PET metabolic parameters of the two diseases were compared with each other, the latter including maximum standardized uptake value (SUV_max), peak standardized uptake value (SUV_peak), and total lesion glycolysis (TLG). Chi-square test, Fisher exact test, two independent samples t-test and rank sum test were used to compare the differences of the above mentioned between the two group. Spearman correlation analysis was used to evaluate the correlation between metabolic parameters and lesion size. Results A total of 76 patients were enrolled, including 58 cases of choroidal melanoma and 18 cases of choroidal metastatic carcinoma. There were no significant differences in gender, age, and affected side between the two groups (all P> 0.05). There were statistically significant differences in the location(χ²=9.263, P=0.041)and shape(χ²=21.735, P<0.001)of lesions between the two groups. The thickness of the choroidal melanoma group was significantly higher than that of the choroidal metastatic carcinoma group (t=2.539, P=0.013). There was no significant difference in the largest basal diameter between the two groups (P>0.05). The SUV_max of the choroidal melanoma group was lower than that of the choroidal metastatic carcinoma group (P<0.05). There was no significant difference in SUV_peak and TLG between the two groups (all P>0.05). In the choroidal melanoma group, SUV_max, SUV_peak, and TLG were positively correlated with the largest basal diameter (r=0.528, 0.613, 0.732, all P<0.001) and thickness (r=0.521, 0.605, 0.730, all P<0.001). In the choroidal metastatic carcinoma group, SUV_peak and TLG were positively correlated with the largest basal diameter (r=0.528, 0.661, P=0.024, 0.003) and thickness (r=0.591, 0.688, P=0.010, 0.002). However, there was no significant correlation between SUV_max and the largest basal diameter and thickness (all P>0.05). Conclusion ¹⁸F-FDG PET/CT imaging findings and metabolic parameter SUV_max have certain value in the differential diagnosis of choroidal melanoma and metastatic carcinoma.