18F-FDG SPECT-CT诊断胃癌术后复发及转移的价值

目的 探讨18F-FDG SPECT-CT在监测胃癌术后复发及转移中的临床价值.方法 回顾性分析122例胃癌术后患者的SPECT-CT显像资料,结合再次病理检查结果,其中79例与同期增强CT检查及二者联合检查两两比较其在残胃或吻合口复发的诊断效能；109例与同期胃肿瘤标志物结果及二者联合检查两两比较其在评价转移灶的诊断效能.应用SPSS13.0软件进行卡方检验或Fisher精确检验.结果 ①18F-FDG SPECT-CT诊断残胃或吻合口复发的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为84.0％、96.3％、91.3％、92.9％及92.4％；同期增强CT为58.3％、78.2％、53.8％、81.1％及72.2％,其中前者的灵敏度、特异度、阳性预测值及准确率均显著高于增强CT( x2=3.953～11.805,P均＜0.05),阴性预测值虽然高于增强CT,但差异无统计学意义(x2=3.344,P＞0.05)；二者联合诊断的指标为:88.0％、98.1％、95.7％、94.6％及94.9％,显著高于增强CT( x2=4.732～10.341,P均＜0.05),二者联合诊断虽然也高于18F-FDG SPECT-CT,但差异均无统计学意义(x2均=0.000,P＞0.05).②18F-FDG SPECT-CT诊断胃癌术后转移的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为92.9％、87.5％、96.3％、80.8％及91.7％；胃肿瘤标志物检测为81.2％、75.0％、92.0％、52.9％及79.8％,其中前者灵敏度、阴性预测值及准确率显著高于胃肿瘤标志物检测(x2=4.026～6.355,P均＜0.05),特异度与阳性预测值虽然也高于胃肿瘤标志物检测,但差异无统计学意义(x2=0.574,x2=0.681,P＞0.05)；二者联合诊断的指标分别为96.5％、83.3％、95.3％、87.0％及93.6％,与18F-FDG SPECT-CT大致相仿,且差异均无统计学意义(x2=4.026～6.355,P均＞0.05),但灵敏度、阴性预测值及准确率显著高于胃肿瘤标志物(x2=7.143～10.014,P均＜0.05).结论 18F-FDG SPECT-CT诊断胃癌术后复发及转移具有较大的临床价值.

The value of 18F-FDG SPECT-CT in detecting recurrence and metastasis of gastric carcinoma

Objective To evaluate the clinical value of 18F-FDG SPECT-CT in detecting recurrence and metastasis of gastric cancer.Methods Analyzed the SPECT-CT imaging data in 122 cases with gastric cancer retrospectively,and then combined with the results of pathological examination,of which 79 cases compared with the same period of enhanced CT and the joint inspection of the two by each other in the remnant stomach or anastomotic recurrence of diagnostic performance; 109 cases with the comparison of stomach tumor markers and the joint inspection of the two by each other in the diagnosis of metastatic evaluation of performance.SPSS13.0 software package was used to performx2 test and fisher's exact probability.Results ① The sensitivity,specificity,positivity predicitive value (PPV),negative predictive value (NPV),and accuracy of 18F-FDG SPECT-CT in diagnosing residual stomach or anastomotic recurrence was 84.0％,96.3％,91.3％,92.9％ and 92.4％ respectively.Those of enhanced CT was 58.3％,78.2％,53.8％,81.1％ and 72.2％ respectively.The former of which the sensitivity,specificity,PPV and accuracy were significantly higher than enhanced CT,and the difference was statistically significant (χ2=3.953～11.805,all P＜0.05).Although the NPV is higher than enhanced CT,the difference was not statistically significant (χ2=3.344,P＞0.05).Joint diagnosis of the two indicators was 88.0％,98.1％,95.7％,94.6％ and 94.9％ respectively,significantly higher than the enhanced CT,and the difference was statistically significance (x2=4.732～10.341,all P＜0.05).Although the indicators were higher than 18F-FDG SPECT-CT,the difference was not statistically significant (allχ2=0.000,P＞0.05).② The sensitivity,specificity,PPV,NPV,and accuracy of 18F-FDG SPECT-CT in diagnosing metastasis of gastric cancer was 92.9％,87.5％,96.3％,80.8％ and 91.7％ respectively.Those of gastric tumor markers was 81.2％,75.0％,92.0％,52.9％ and 79.8％.Where the former sensitivity,NPV and accuracy were significantly higher than the stomach tumor markers,the difference was statistically significant(χ2=4.026～6.355,all P＜0.05).Although specificity and PPV were higher than the gastric tumor markers,the difference was not statistically significant (χ2=0.574,0.681,P＞0.05).The two combined diagnostic indicators was 96.5％,83.3％,95.3％,87.0％ and 93.6％ respectively,similarly with the 18F-FDG SPECT-CT,and the difference was not statistically significant(χ2=4.026～6.355,all P＞0.05),but significantly higher than the gastric tumor markers,and the sensitivity,NPV and accuracy of the difference was statistically significant (χ2=7.143～10.014,all P＜0.05).Conclusion 18F-FDG SPECT-CT has greater clinical value in detecting recurrence and metastasis of gastric cancer.