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结直肠癌是最常见的恶性肿瘤之一,复发和转移是其主要的病死原因。肝脏是结直肠癌血行转移的最常见部位,超过一半的患者在其疾病发展过程中会发生肝转移[1-3]。结直肠癌肝转移(colorectal cancer liver metastases,CRCLM)是影响患者预后的重要因素之一,手术是其主要的治疗手段,但只有7%~25%的CRCLM患者在确诊后可以行根治性切除手术[4-6],大部分患者由于病灶数量、大小和位置等原因无法行根治性手术,只能通过化疗、射频和靶向治疗等手段延长生存期及提高生活质量。目前,CRCLM患者治疗后的5年总生存率已提高至35%~50%或以上,而未经治疗的患者5年生存率低于5%~10%[2-4]。因此,早期准确地诊断CRCLM并明确转移灶的数量和位置等,对于肿瘤的分期、治疗方案的选择和预后的评估都具有重要的临床意义。CT、MRI和18F-FDG PET/CT等均是检测和诊断CRCLM的重要手段,近年来出现的一体化PET/MRI亦被广泛关注。目前,关于CRCLM 18F-FDG PET/MRI显像的文献报道较少,笔者回顾性分析27例结直肠癌患者同日先后行全身18F-FDG PET/CT显像与上腹部PET/MRI局部显像的相关资料,评估18F-FDG PET/MRI显像对CRCLM的诊断价值,并比较其与PET/CT的差异。
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根据诊断标准可知,27例结直肠癌患者中,肝转移瘤患者16例,肝良性病变患者11例。16例肝转移瘤患者中,6例肝内病灶经组织病理学检查确诊,6例在18F-FDG PET/CT、PET/MRI和另外一种影像学检查[CT和(或)MRI]中均有典型肝转移瘤表现,4例在随访期间(随访时间:126~386 d)显示病灶增多或体积增大。11例肝良性病变患者在随访期间(97~308 d)肝内病灶均无明显改变(随访期间无肿瘤治疗史)。在27例结直肠癌患者中,共发现118个肝内病灶,其中肝转移瘤病灶72个,长径(2.2±1.5) cm;肝良性病灶46个,长径(0.8±0.6) cm。
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由表1可知,18F-FDG PET/MRI诊断CRCLM的灵敏度和准确率均高于PET/CT,但差异均无统计学意义(均P>0.05),二者特异度一致。16例CRCLM患者中,PET/CT假阴性3例,PET/MRI检出了其中的2例,病灶长径均<1.0 cm(图1),另外1例PET/MRI亦呈假阴性,病灶长径为1.1 cm。该假阴性患者的病灶在PET/CT中不可见,在PET/MRI中未见18F-FDG代谢增高,影像学随访结果示病灶明显增大(图2)。
影像学方法 灵敏度 特异度 准确率 阳性预测值 阴性预测值 PET/CT 81(13/16) 100(11/11) 89(24/27) 100(13/13) 79(11/14) PET/MRI 94(15/16) 100(11/11) 96(26/27) 100(15/15) 92(11/12) 检验值 − − − χ2=0.000 χ2=0.851 P值 0.500 1.000 0.500 1.000 0.598 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;CT为计算机体层摄影术;MRI为磁共振成像;−为McNemar检验,无检验值 表 1 27例结直肠癌肝转移患者18F-FDG PET/CT与PET/MRI 诊断效能的比较 (%)
Table 1. Comparison of diagnostic efficacy between 18F-FDG PET/CT and PET/MRI in colorectal cancer liver meastases based on 27 patients (%)
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由表2可知,18F-FDG PET/MRI诊断CRCLM的灵敏度、准确率和阴性预测值均高于PET/CT,且差异有统计学意义(均P<0.05)。1例患者在行PET/CT检查时,在肝尾状叶见18F-FDG代谢增高病灶,考虑为肝转移瘤,但PET/MRI及影像学随访在肝尾状叶均未见异常病灶,考虑肝尾状叶病灶在PET/CT上呈假阳性(图3)。在16例CRCLM患者中,与PET/CT相比,44%(7/16)的患者在PET/MRI上发现更多肝转移病灶。72个肝转移病灶中,PET/CT假阴性病灶27个,其中长径≤1 cm组的病灶25个,1 cm<长径≤2 cm组的病灶2个;PET/MRI假阴性病灶11个,其中长径≤1 cm组的病灶10个,1 cm<长径≤2 cm组的病灶1个。
影像学
方法灵敏度 特异度 准确率 阳性
预测值阴性
预测值PET/CT 63(45/72) 98(45/46) 76(90/118) 98(45/46) 63(45/72) PET/MRI 85(61/72) 100(46/46) 91(107/118) 100(61/61) 81(46/57) 检验值 − − − χ2=1.339 χ2=5.072 P值 <0.001 1.000 <0.001 0.430 0.024 注:表中,FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;CT为计算机体层摄影术;MRI为磁共振成像;−为McNemar检验,无检验值 表 2 18F-FDG PET/CT与PET/MRI在27例结直肠癌患者肝 转移病灶(72个)中诊断效能的比较 (%)
Table 2. Comparison of diagnostic efficacy between 18F-FDG PET/CT and PET/MRI in colorectal cancer patients(27) liver meastases lesion(72) (%)
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长径≤1 cm组的病灶27个,PET/MRI的诊断灵敏度63%(17/27)高于PET/CT 7%(2/27),且差异有统计学意义(McNemar检验,P<0.05);1 cm<长径≤2 cm组的病灶8个,PET/MRI的诊断灵敏度88%(7/8)高于PET/CT 75%(6/8),差异无统计学意义(McNemar检验,P>0.05);长径>2 cm组的病灶37个,2种方法的诊断灵敏度均为100%(37/37)。
18F-FDG PET/CT与PET/MRI在结直肠癌肝转移诊断中的比较分析
Comparative analysis of 18F-FDG PET/CT and PET/MRI in the diagnosis of colorectal cancer liver metastases
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摘要:
目的 比较18F-氟脱氧葡萄糖(FDG) PET/CT与PET/MRI显像对结直肠癌肝转移的诊断价值。 方法 回顾性分析2018年9月至2019年9月于宁波明州医院行全身18F-FDG PET/CT显像及上腹部18F-FDG PET/MRI显像,并疑似有结直肠癌肝转移的27例患者的临床资料,其中男性19例、女性8例,年龄28~78(60.6±12.2)岁。肝内病灶的最终诊断以组织病理学检查或影像学随访结果为参考标准,分别计算2种检查方法诊断结直肠癌肝转移瘤的灵敏度、特异度、准确率、阳性预测值和阴性预测值。根据肝转移病灶大小分长径≤1 cm、1 cm<长径≤2 cm、长径>2 cm 3组,分别计算各组的2种检查方法的灵敏度。采用McNemar检验比较2种检查方法诊断结直肠癌肝转移瘤的灵敏度、特异度和准确率;采用χ2检验比较2种检查方法诊断结直肠癌肝转移瘤的阳性预测值和阴性预测值。 结果 基于27例结直肠癌患者分析,18F-FDG PET/MRI诊断肝转移瘤的灵敏度、准确率[94%(15/16)、96%(26/27)]均高于PET/CT[81%(13/16)、89%(24/27)],但差异均无统计学意义(McNemar检验,均P>0.05)。基于病灶分析,在27例结直肠癌患者中共发现118个肝内病灶,其中肝转移瘤病灶72个,18F-FDG PET/MRI诊断结直肠癌肝转移瘤病灶的灵敏度、准确率、阴性预测值[85%(61/72)、91%(107/118)、81%(46/57)]均高于PET/CT[63%(45/72)、76%(90/118)、63%(45/72)],且差异均有统计学意义(McNemar检验,χ2=5.072,均P<0.05)。对于长径≤1 cm的肝转移病灶,18F-FDG PET/MRI的诊断灵敏度[63%(17/27)]明显高于PET/CT[7%(2/27)],且差异有统计学意义(McNemar检验,P<0.05)。 结论 与18F-FDG PET/CT相比,18F-FDG PET/MRI在结直肠癌肝转移中具有更高的诊断价值,尤其是在长径≤1 cm的病灶中。 -
关键词:
- 结直肠肿瘤 /
- 肝 /
- 肿瘤转移 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 磁共振成像
Abstract:Objective To compare the diagnostic values of 18F-fluorodeoxyglucose (FDG) PET/CT and PET/MRI in colorectal cancer liver metastases. Methods A retrospective analysis was performed on data collected from 27 patients with suspected colorectal cancer liver metastases, including 19 males and 8 females aged 28–78 (60.6±12.2) years old who underwent whole-body 18F-FDG PET/CT and upper abdomen 18F-FDG PET/MRI examination in Ningbo Mingzhou Hospital from September 2018 to September 2019. The result of histopathological examination and imaging follow-up served as the reference standards. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of both methods in the diagnosis of liver metastases were calculated. Liver metastases lesions were divided into three groups according to size: lesion length≤1 cm, 1 cm< lesion length≤2 cm, and lesion length>2 cm. The sensitivity of 18F-FDG PET/CT and PET/MRI in each group were calculated. McNemar test was used to compare the sensitivity, specificity, and accuracy of the two methods in the diagnosis of liver metastases. χ2 test was used to compare the PPV and NPV of the two methods in the diagnosis of liver metastases. Results Based on 27 patients with colorectal cancer analysis, the sensitivity and accuracy of 18F-FDG PET/MRI in the diagnosis of liver metastases (94% (15/16) and 96% (26/27)) were higher than those of PET/CT (81% (13/16) and 89% (24/27)), but the difference was not statistically significant (McNemar test, both P>0.05). Based on lesion analysis, mong the 118 liver lesions found in the 27 patients, 72 lesions were liver metastases and 46 lesions were benign liver lesions. The sensitivity, accuracy, and NPV of 18F-FDG PET/MRI in the diagnosis of liver metastases (85% (61/72), 91% (107/118) and 81% (46/57)) were significantly higher than those of PET/CT (63% (45/72), 76% (90/118) and 63% (45/72); McNemar test, χ2=5.072, all P<0.05). The sensitivity of 18F-FDG PET/MRI (63% (17/27)) for lesions with length≤1 cm was significantly higher than that of PET/CT (7% (2/27); McNemar test, P<0.05). Conclusion Compared with 18F-FDG PET/CT, 18F-FDG PET/MRI has higher diagnostic value in colorectal cancer liver metastases, especially for lesion with length≤1 cm. -
表 1 27例结直肠癌肝转移患者18F-FDG PET/CT与PET/MRI 诊断效能的比较 (%)
Table 1. Comparison of diagnostic efficacy between 18F-FDG PET/CT and PET/MRI in colorectal cancer liver meastases based on 27 patients (%)
影像学方法 灵敏度 特异度 准确率 阳性预测值 阴性预测值 PET/CT 81(13/16) 100(11/11) 89(24/27) 100(13/13) 79(11/14) PET/MRI 94(15/16) 100(11/11) 96(26/27) 100(15/15) 92(11/12) 检验值 − − − χ2=0.000 χ2=0.851 P值 0.500 1.000 0.500 1.000 0.598 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;CT为计算机体层摄影术;MRI为磁共振成像;−为McNemar检验,无检验值 表 2 18F-FDG PET/CT与PET/MRI在27例结直肠癌患者肝 转移病灶(72个)中诊断效能的比较 (%)
Table 2. Comparison of diagnostic efficacy between 18F-FDG PET/CT and PET/MRI in colorectal cancer patients(27) liver meastases lesion(72) (%)
影像学
方法灵敏度 特异度 准确率 阳性
预测值阴性
预测值PET/CT 63(45/72) 98(45/46) 76(90/118) 98(45/46) 63(45/72) PET/MRI 85(61/72) 100(46/46) 91(107/118) 100(61/61) 81(46/57) 检验值 − − − χ2=1.339 χ2=5.072 P值 <0.001 1.000 <0.001 0.430 0.024 注:表中,FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;CT为计算机体层摄影术;MRI为磁共振成像;−为McNemar检验,无检验值 -
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