18F-FDG PET/CT对检出恶性腹腔积液患者原发癌灶的临床价值

目的 探讨18F-FDG PET/CT显像对检出恶性腹腔积液患者原发癌灶的临床价值.方法 回顾性分析既往以腹腔积液为首发症状、在腹腔积液中发现肿瘤细胞并最终检出原发癌灶的患者51例,其中胃癌14例,肠癌7例(乙状结肠癌1例,降结肠癌1例,升结肠癌3例,直肠癌2例),卵巢癌22例,胰腺癌6例,肝癌2例,均接受体部18F-FDG PET/CT扫描,并经进一步检查或3～13个月随访证实；分别统计PET/CT及单独CT查找原发病灶的诊断价值.结果 51例中,PET/CT检查发现原发灶40例,其中胃癌10例,肠癌4例(乙状结肠癌1例,升结肠癌2例,直肠癌1例),卵巢癌19例,胰腺癌5例,肝癌2例,检出率为78.43％ (40/51)；11例PET/CT检查未发现原发灶,5例仅为腹膜增厚、代谢增高,3例仅为大网膜增厚、无代谢异常,3例仅提示腹腔积液.CT提示原发病灶31例,其中胃癌6例,肠癌3例,卵巢癌18例,胰腺癌3例,肝癌1例,检出率为60.78％(31/51),占 PET/CT发现原发灶的77.50％ (31/40).结论 对于在不明原因腹腔积液中发现肿瘤细胞者,PET/CT查找其原发病灶具有较高临床价值.

Clinical value of 18F-FDG PET/CT in detection of original disease of patients with malignant ascites

Objective To investigate the clinical value of ¹⁸F-FDG PET/CT in detection of the original disease of patients with malignant ascites. Methods A total of 51 patients whose primary symptom were ascites in which tumor cells had been found were included, including 14 cases of gastric cancer, 7 cases of intestinal tract cancer (1 sigmoid colon cancer, 1 descending colon cancer, 3 ascending colon cancer and 2 rectal cancer), 22 cases of ovarian cancer, 6 cases of pancreatic cancer and 2 cases of liver cancer. All patients underwent whole body PET/CT scan, and the diagnosis was confirmed by series imaging examination, gastroscopy and enteroscopy, etc. or clinical following-up of 3-13 months. The diagnostic value of PET/CT and CT in detection of the original disease was calculated, respectively. Results Of 51 patients, original disease of 40 patients were confirmed by PET/CT, including 10 cases of gastric cancer, 4 of intestinal tract cancer (1 sigmoid colon cancer, 2 ascending colon cancer and 1 rectal cancer), 19 of ovarian cancer, 5 of pancreatic cancer and 2 of liver cancer, the detection rate was 78.43% (40/51). PET/CT failed to detect the original disease of 11 cases, but found thickening and high metabolism of peritoneum in 5 cases, thickening and normal metabolism of peritoneum in 3 cases, while appearances of ascites in 3 cases. The original disease of 31 patients were confirmed by CT alone, including 6 cases of gastric cancer, 3 of intestinal tract cancer, 18 of ovarian cancer, 3 of pancreatic cancer and 1 case of liver cancer, and the detection rate was 60.78% (31/51), lower than that of PET/CT. Conclusion PET/CT is an accurate technique in detection of the original disease of patients with malignant ascites.