18F-FDG PET/CT显像在恶性胸膜间皮瘤诊断中的价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在恶性胸膜间皮瘤(MPM)诊断中的临床价值及原发肿瘤病灶平均标准摄取值(SUVmax)对患者预后的判断价值.方法 回顾性总结17例2002-2008年临床疑诊MPM患者18F-FDG PET/CT显像资料,测量病灶的SUVmax.将病理检查及临床随访证实的MPM患者按照有无转移分为2组,测定每例患者原发肿瘤病灶的SUVmax,用受试者工作特征(ROC)曲线评价SUVmax对患者转移与否的诊断价值,判断预后.采用SPSS 11.0软件进行t检验.结果 经病理及随访结果证实MPM 12例,良性胸膜病变5例,二者的SUVmax分别为5.78±1.81和2.72±2.51,差异有统计学意义(t=2.8,P<0.05).全身18F-FDG PET/CT显像诊断MPM的灵敏度为100%(12/12),特异性为4/5,准确性为94%(16/17),18F-FDG PET/CT显像有7例MPM伴有骨和(或)淋巴结转移.SUVmaxROC曲线分析表明曲线下面积(AUC)为0.80.结论 全身18F-FDG PET/CT显像对于MPM的诊断有重要价值.原发肿瘤病灶SUVmax越高越易发生转移,预后越差.

Application of PET/CT imaging in the diagnosis of malignant pleural mesothelioma

Objective Malignant pleural mesothelioma (MPM) is an uncommon neoplasm arising from mesothelial cells of the pleura. The prognosis is poor with median survival of 4- 12 months. The aim of this study was to evaluate the clinic value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the diagno-sis and to staging of MPM and to determine if the mean standardized uptake value (SUVmax) of primary tumor correlates with staging and prognosis. Methods Study was conducted retrospectively including 17 pa-tients with clinical suspicion of MPM from 2002 to 2008. Twelve cases of MPM and 5 cases benign pleural pa-thology were proven by histopathology and clinical follow-up. 18F-FDG PET/CT imaging was performed 1 h af-ter injection of 7.4 MBq/kg 18F-FDG. Patients with MPM confirmed by histopatholagy were divided into two groups: with and without metastasis. PET/CT findings were analyzed to determine if SUVmax of primary tumor correlates with staging and prognosis. Receiver operating characteristic (ROC) curve of SUVmax of primary tumor was evaluated to determine if it was a predictor of metastasis and survival time. Results The difference in SUVmax between MPM and benign pleural were statistical significant (5.78±1.81 vs 2.72± 2.51, t = 2. 8, P < 0.05). The diagnostic sensitivity, specificity and accuracy of 18F-FDG PET/CT imaging for MPM were 100% (12/12) , 4/5 and 94% (16/17). All 7 cases of bone and lymph node metastases were detected by 18F-FDG PET/CT imaging. Area under the curve (AUC) was 0.80. Conclusions 18F-FDG PET/CT imaging is useful in the diagnosis and staging of MPM. High SUVmax in the primary tumor correlates well with prognosis and predication of a greater propensity to have nodal and distant metastasis.