18F-FDG PET/CT在拟诊眼内转移瘤患者中的应用价值

目的 探讨眼内转移瘤18F-FDG PET/CT的影像学特点及临床应用价值。 方法 回顾性分析2011年3月至2019年2月于北京医院和首都医科大学附属北京同仁医院经病理学或临床确诊的眼内转移瘤患者53例（54只眼睛，其中1例为双眼转移），其中男性23例、女性30例，年龄22~73（52.7±11.6）岁。所有患者行18F-FDG PET/CT检查，并对影像学表现特征及参数进行分析，包括最大标准化摄取值（SUV_max）和平均标准化摄取值（SUV_mean）；评估PET/CT对肿瘤原发灶的探查及其他部位转移灶发现的价值。多组计量资料之间的比较采用方差分析；相关性采用Pearson相关分析。 结果 眼内转移瘤CT形态多样，以梭形软组织影最为多见。47例可测量的眼内转移瘤CT值与SUV_max、SUV_mean均无明显线性关系（均r=?0.252，均P=0.088）。50例放射性摄取增高转移瘤的SUV_max、SUV_mean均与其长径、短径、上下径呈显著正相关（r=0.631~0.791，均P=0.000）。既往无肿瘤病史患者43例，PET/CT对原发灶的检出率为97.7%（42/43），其中来源于肺癌36例、乳腺癌2例、食管癌、胃癌、鼻咽癌和前列腺癌各1例。PET/CT显示转移灶≥2个的患者51例（51/53，96.2%），其中主要伴淋巴结转移43例（43/53，81.1%）、骨转移42例（42/53，79.2%）。 结论 眼内转移瘤CT形态多样，SUV仅与其大小有关。18F-FDG PET/CT在眼内转移瘤诊断、肿瘤原发灶的探查及其他部位转移灶的发现等方面具有重要的临床应用价值。

Value of 18F-FDG PET/CT in patients with suspected intraocular metastases

Objective To analyze the features and application value of 18F-FDG PET/CT in detecting intraocular metastases. Methods A total of 53 patients with intraocular metastasis (54 eyes, including 1 case of binocular metastasis) diagnosed by pathology or clinical assessment at the Beijing Hospital and Beijing Tongren Hospital, Capital Medical University from March 2011 to February 2019 were enrolled in this retrospective study. The patients included 23 males and 30 females aged 22–73(52.7±11.6) years. All patients underwent 18F-FDG PET/CT, and the features and parameters of the resulting images, including maximum (SUV_max) and average (SUV_mean) standardized uptakes, were analyzed. The value of PET/CT for the detection of primary tumors and metastases was then assessed. Analysis of variance was used to compare the data of multiple groups, and Pearson's correlation analysis was used to determine correlations. Results Intraocular metastases showed a variety of unique CT features, the most common of which was spindle-like soft tissue shadows. No significant linear relationship between the CT value and SUV_max or SUV_mean (both r=?0.252; both P=0.088) among 47 cases of measurable intraocular metastasis was detected. SUV_max and SUV_mean were positively correlated with their long, short, upper, and lower diameters (r=0.631–0.791; all P=0.000). The detection rate of the primary focus by PET/CT among 43 patients with no prior history of cancer was 97.7% (42/43). Among the cases of intraocular metastasis, 36 originated from lung cancer, 2 were from breast cancer, 1 was from esophageal cancer, 1 was from gastric cancer, 1 was from nasopharyngeal cancer, and 1 was from prostate cancer. PET/CT revealed 51 patients (51/53, 96.2%) with more than two metastatic lesions, 81.1% (43/53) with lymph node metastasis, and 79.2% (42/53) with bone metastasis. However, PET/CT may result in false negative findings for small intraocular and brain metastases. Conclusions Intraocular metastases exhibit a variety of distinct CT features, and only the SUV is related to the tumor size. 18F-FDG PET/CT is useful for the diagnosis of intraocular metastases, exploration of primary tumors, and discovery of metastases in other sites.