18F-FDG PET显像在胰腺恶性病变鉴别诊断及转移灶探查中的应用价值

目的研究18F-FDGPET显像在胰腺恶性肿瘤诊断与鉴别诊断中的应用价值。方法 40例临床疑为胰腺恶性病变的患者均行18F-FDGPET显像,对显像结果进行目测法及SUV值半定量分析,并结合CT,MRI等影像学检查进行综合诊断,最后诊断根据手术病理或经4个月以上随访证实。结果如果以SUV为2.5作为鉴别诊断胰腺病灶良恶性的阈值,24例证实为胰腺癌患者中18F-FDGPET显像正确诊断22例,16例胰腺良性病变患者18F-FDGPET检出13例,其灵敏度、特异度及准确性分别为91.7%（22/24）,81.3%（13/16）及87.5%（35/40）;而结合CT,MRI等其他检查结果进行综合诊断,其诊断灵敏度、特异度及准确性分别为91.7%（22/24）、87.5%（14/16）及90%（36/40）。恶性病变的SUV平均值为4.6±2.6,良性病变的SUV平均值为2.3±1.5,良恶性病变间SUV平均值差异有统计学意义（P〈0.01）。在转移灶的检出中,18F-FDGPET显像发现了全部38处转移灶,并发现6处CT,MRI未能发现的远处转移病灶,排除了1例CT认为是胰周转移性淋巴结肿大的病例。结论 18F-FDGPET对鉴别诊断胰腺良恶性肿瘤的灵敏度、特异性较高,尤其在远处转移灶的探查中有较高应用价值。

Usefulness of 18F-FDG PET in differentiating benign from malignant pancreatic lesions and in detecting metastases

Objective To study the usefulness of 18F-fluorodeoxyglucose positron emission tomography（18F-FDG PET） in differentiating benign from malignant pancreatic lesions and in detecting metastases.Methods Forty patients with clinically suspected malignant pancreatic lesions underwent 18F-FDG PET imaging.Subsequently,the half-quantitative analysis of the imaging results was performed by eye-measurement and standardized uptake value（SUV）.The comprehensive diagnosis was performed together with CT and MRI examinations,while finally definite diagnosis was based on surgery and pathology or clinical follow-up for more than four months.Results When 2.5 of SUV was taken as a threshold value in differentinting benign from malignant pancreatic lesions,18F-FDG PET imaging correctly diagnosed 22 of 24 pancreatic carcinoma patients who were demonstrated by surgery and pathology and 13 of 16 benign pancreatic lesions patients who were demonstrated by clinical follow-up.The sensitivity,specificity and accuracy of 18F-FDG PET in the group patients were 91.7%（22/24）,81.3%（13/16） and 87.5%（35/40）,respectively.Following comprehensive diagnosis combined with CT and MRI,the sensitivity,specificity and accuracy were 91.7%（22/24）,87.5%（14/16） and 90%（36/40）,respectively.The average SUV of malignant pancreatic lesions was 4.6±2.6,while that of benign pancreatic lesions was 2.3±1.5 and there was statistically significant difference between the both（P 0.01）.During the detection of metastases,18F-FDG PET showed all 38 metastatic foci and found 6 remote metastases,which could not be found by either CT or MRI,simultaneously ruled out 1 case of metastatic peripancreatic lymphadenovarix which was misdiagnosed by CT.Conclusion 18F-FDG PET has higher sensitivity and specificity in differentiating benign from malignant pancreatic lesions,especially it plays important role in the detection of remote metastases.