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前列腺癌(prostate cancer,PCa)是男性常见的恶性肿瘤,早发现、早诊断可显著改善患者预后[1]。PCa诊断的“金标准”是穿刺活体组织病理学检查,但40%~50%的患者可能会因穿刺到正常组织而导致漏诊,且其属于有创性检查、无法随诊、重复性差[2]。PCa的影像学检查方法主要有CT、MRI和超声,但都存在一定的不足[3]。18F-FDG PET/CT已被广泛应用于临床,可根据SUVmax进行半定量评估。由于18F-FDG主要经泌尿系统进行排泄,因此18F-FDG PET/CT全身显像会对PCa的诊断造成干扰[4]。利尿后延迟显像可通过排空膀胱减少干扰,从而提高18F-FDG PET/CT显像对PCa诊断的灵敏度,但目前关于最佳延迟显像的时间还未统一[5]。有研究结果显示,在注射18F-FDG 2 h后,PCa患者延迟显像的SUVmax可升高80%~90%,但4~5 h后,SUVmax不再升高[6]。因此,本研究通过比较利尿后不同延迟时间18F-FDG PET/CT显像的SUVmax,进一步探讨利尿后延迟显像对PCa的诊断价值及最佳延迟时间,旨在为临床医师提供参考。
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由表1可知,77例前列腺恶性病变患者利尿后延迟1、2、3 h 显像的SUVmax均分别高于利尿前,且差异均有统计学意义(均P<0.05);9例前列腺恶性病变患者利尿后延迟4 h显像的SUVmax与利尿前相比,差异无统计学意义(P>0.05)(图1)。158例前列腺良性病变患者利尿后延迟1、2、3、4 h显像的SUVmax分别与利尿前相比,差异均无统计学意义(均P>0.05)。组间比较结果显示,恶性病变患者与良性病变患者利尿后延迟1、2、3 h显像的SUVmax间的差异均有统计学意义(均P<0.05);利尿后延迟4 h显像的SUVmax间的差异无统计学意义(t=1.379,P=0.181);利尿前不同延迟时间的SUVmax间的差异均无统计学意义(t=0.233~0.507,均P>0.05)。
组别 利尿前SUVmax 利尿后SUVmax t值 P值 1 h 组 良性病变(n=57) 4.45±1.77 4.74±1.81 0.865 0.389 恶性病变(n=26) 4.32±1.01 5.57±1.58a, b 3.399 0.001 2 h 组 良性病变(n=51) 4.51±1.59 4.76±2.16 0.666 0.507 恶性病变(n=29) 4.62±1.84 7.04±3.03a, b 3.676 <0.001 3 h 组 良性病变(n=33) 4.48±1.34 4.64±1.98 0.384 0.702 恶性病变(n=13) 4.73±1.88 7.28±2.90a, b 2.660 0.014 4 h 组 良性病变(n=17) 4.58±1.52 4.43±1.74 0.268 0.791 恶性病变(n=9) 4.43±1.65 5.76±3.22 1.103 0.286 注:a表示与良性病变利尿后同组间的SUVmax相比,差异均有统计学意义(t=2.013、3.910、3.554,均P<0.05);b表示与良性病变利尿前同组间的SUVmax相比,差异均有统计学意义(t=3.399、3.676、2.660,均P<0.05)。 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;SUVmax为最大标准化摄取值 表 1 235例前列腺病变患者利尿前、后不同延迟时间18F-FDG PET/CT显像SUVmax的比较(
)$ \bar x \pm s $ Table 1. Comparison of SUVmax before and after diuresis with different delayed time 18F-FDG PET/CT imaging in 235 patients with prostate diseases (
)$ \bar x \pm s$ 77例恶性病变患者中,利尿前不同延迟时间显像的SUVmax两两比较,差异均无统计学意义(t=0.178~0.891,均P>0.05);利尿后延迟2、3 h比延迟1 h显像的SUVmax高(t=2.220、2.400,均P<0.05);其他各时间段(利尿后延迟4 h显像与延迟1 h、2 h、3 h显像,利尿后延迟3 h显像与延迟2 h显像)间的SUVmax差异均无统计学意义(t=0.261~0.816,均P>0.05)。
158例良性病变患者中,利尿前不同延迟时间显像的SUVmax两两比较,差异均无统计学意义(t=0.785~0.933,均P>0.05);利尿后延迟1、2、3、4 h显像间的SUVmax两两比较,差异均无统计学意义(t=0.534~0.958,均P>0.05)。
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利尿后不同延迟时间显像的结果显示,恶性病变患者的RI分别为27.9%±12.4%、47.3%±17.4%、53.8%±20.3%、33.3%±16.6%,良性病变患者的RI分别为5.7%±6.2%、6.5%±9.0%、3.4%±7.0%、−4.2%±5.7%,同组间良恶性RI的差异均有统计学意义(t=8.538~13.840,均P<0.05)。
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利尿后延迟1、2、3、4 h显像的诊断灵敏度见表2。其中,利尿后延迟3 h显像的诊断灵敏度、阴性预测值最高,而延迟2 h显像的诊断特异度、准确率及阳性预测值最高。
延迟时间 灵敏度 特异度 准确率 阳性预测值 阴性预测值 1 h 61.5(16/26) 50.9(29/57) 54.2(45/83) 36.4(16/44) 74.4(29/39) 2 h 79.3(23/29) 74.5(38/51) 76.3(61/80) 63.9(23/36) 86.4(38/44) 3 h 84.6(11/13) 69.7(23/33) 73.9(34/46) 52.4(11/21) 92.0(23/25) 4 h 66.7(6/9) 58.8(10/17) 61.5(16/26) 46.2(6/13) 76.9(10/13) 表 2 利尿后不同延迟时间18F-FDG PET/CT显像对前列腺癌患者诊断效能的比较(%)
Table 2. Comparison of diagnostic efficacy of 18F-FDG PET/CT imaging with different delay time after diuresis in patients with prostate cancer (%)
利尿后18F-FDG PET/CT延迟显像对前列腺癌的临床诊断价值
Clinical diagnostic value of 18F-FDG PET/CT delayed imaging after diuresis for prostate cancer
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摘要:
目的 探讨利尿后18F-氟脱氧葡萄糖(FDG) PET/CT延迟显像对前列腺癌(PCa)的临床诊断价值和最佳延迟显像时间。 方法 回顾性分析2009年3月至2018年12月于武装警察部队特色医学中心行18F-FDG PET/CT全身显像显示前列腺病变的235例男性患者的临床资料,其中前列腺恶性病变患者77例、前列腺良性病变患者158例,年龄50~87(69.6±13.6)岁。所有患者均行利尿前及利尿后延迟显像(1、2、3、4 h),获得利尿前、后病灶的最大标准化摄取值(SUVmax)。以利尿后SUVmax>2.5且利尿前、后SUVmax的储留指数>15%作为判断良、恶性的标准。2组间数据的比较采用独立样本t检验。 结果 前列腺恶性病变患者利尿后延迟1、2、3 h显像的SUVmax均分别高于利尿前,差异均有统计学意义(5.57±1.58对4.32±1.01、7.04±3.03对4.62±1.84、7.28±2.90对4.73±1.88,t=3.399、3.676、2.660,均P<0.05);利尿后延迟4 h显像的SUVmax与利尿前相比,差异无统计学意义(t=1.103,P=0.286)。前列腺良性病变患者利尿后延迟1、2、3、4 h显像的SUVmax与利尿前相比,差异均无统计学意义(t=0.268~0.865,均P>0.05)。恶性病变患者利尿后延迟1、2、3 h显像的SUVmax均分别高于良性病变患者(t=2.013、3.910、3.554,均P<0.05),而2组患者利尿后延迟4 h显像的SUVmax差异无统计学意义(t=1.379,P=0.181)。恶性病变患者利尿后延迟2、3 h比延迟1 h显像的SUVmax高(t=2.220、2.400,均P<0.05)。利尿后18F-FDG PET/CT延迟1、2、3、4 h显像对前列腺癌诊断效能中,延迟2 h显像的特异度[74.5%(38/51)]和准确率[76.3%(61/80)]最高,而延迟3 h显像的灵敏度[84.6%(11/13)]最高。 结论 PCa患者利尿后延迟显像可提高显像效果和临床诊断的效能,利尿后延迟2 h显像的诊断效果较优。 -
关键词:
- 前列腺肿瘤 /
- 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 /
- 最大标准化摄取值
Abstract:Objective To evaluate the clinical diagnostic value and optimum delay time of 18F-fluorodeoxyglucose (FDG) PET/CT delayed imaging after diuresis in prostate cancer (PCa). Methods The clinical data of 235 male patients with prostate diseases who underwent 18F-FDG PET/CT whole-body imaging at the Characteristic Medical Center of the Chinese People's Armed Police Force from March 2009 to December 2018, including 77 patients with malignant prostate diseases and 158 patients with benign prostate diseases were retrospectively analyzed, aged 50–87(69.6±13.6) years old. All patients underwent delayed imaging before and after diuresis(1, 2, 3, and 4 h) to obtain the maximum standardized uptake value (SUVmax) of lesions before and after diuresis. SUVmax>2.5 after diuresis and a retention index>15% of SUVmax before and after diuresis were used as the criteria to judge as benign or malignant. Independent sample t-test was used to compare the data between the two groups in accordance with normal distribution. Results The SUVmax of patients with prostate malignant lesions delayed 1, 2, and 3 h imaging after diuresis was significantly higher than that before diuresis (5.57±1.58 vs. 4.32±1.01, 7.04±3.03 vs. 4.62±1.84, 7.28±2.90 vs. 4.73±1.8; t=3.399, 3.676, 2.660; all P<0.05). No significant difference in SUVmax existed between prediuretic and delayed 4 h imaging after diuresis (t=1.103, P=0.286). In patients with benign prostate diseases, no significant difference existed in SUVmax delayed 1, 2, 3, and 4 h imaging after diuresis compared with that before diuresis (t=0.268–0.865, all P>0.05). The SUVmax of malignant lesions delayed 1, 2, and 3 h imaging after diuresis was higher than that in benign lesions (t=2.013, 3.910, 3.554; all P<0.05). However, no significant difference in SUVmax delayed 4 h imaging existed between the two groups (t=1.379, P=0.181). The SUVmax of patients with malignant lesions delayed 2 and 3 h was higher than that for diuretic imaging delayed 1 h (t=2.220, 2.400; both P<0.05). Diagnostic efficiency of 18F-FDG PET/CT delayed imaging (1, 2, 3, and 4 h) after diuresis in Pca, the specificity (74.5%, 38/51) and accuracy (76.3%, 61/80) of 2 h delayed imaging were the highest, while the sensitivity (84.6%, 11/13) of 3 h delayed imaging was the highest. Conclusions Delayed imaging after diuresis can improve the imaging effect and clinical diagnostic efficacy of PCa patients. The diagnostic effect of delayed imaging after diuresis for 2 h was better. -
表 1 235例前列腺病变患者利尿前、后不同延迟时间18F-FDG PET/CT显像SUVmax的比较(
)$ \bar x \pm s $ Table 1. Comparison of SUVmax before and after diuresis with different delayed time 18F-FDG PET/CT imaging in 235 patients with prostate diseases (
)$ \bar x \pm s$ 组别 利尿前SUVmax 利尿后SUVmax t值 P值 1 h 组 良性病变(n=57) 4.45±1.77 4.74±1.81 0.865 0.389 恶性病变(n=26) 4.32±1.01 5.57±1.58a, b 3.399 0.001 2 h 组 良性病变(n=51) 4.51±1.59 4.76±2.16 0.666 0.507 恶性病变(n=29) 4.62±1.84 7.04±3.03a, b 3.676 <0.001 3 h 组 良性病变(n=33) 4.48±1.34 4.64±1.98 0.384 0.702 恶性病变(n=13) 4.73±1.88 7.28±2.90a, b 2.660 0.014 4 h 组 良性病变(n=17) 4.58±1.52 4.43±1.74 0.268 0.791 恶性病变(n=9) 4.43±1.65 5.76±3.22 1.103 0.286 注:a表示与良性病变利尿后同组间的SUVmax相比,差异均有统计学意义(t=2.013、3.910、3.554,均P<0.05);b表示与良性病变利尿前同组间的SUVmax相比,差异均有统计学意义(t=3.399、3.676、2.660,均P<0.05)。 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;SUVmax为最大标准化摄取值 表 2 利尿后不同延迟时间18F-FDG PET/CT显像对前列腺癌患者诊断效能的比较(%)
Table 2. Comparison of diagnostic efficacy of 18F-FDG PET/CT imaging with different delay time after diuresis in patients with prostate cancer (%)
延迟时间 灵敏度 特异度 准确率 阳性预测值 阴性预测值 1 h 61.5(16/26) 50.9(29/57) 54.2(45/83) 36.4(16/44) 74.4(29/39) 2 h 79.3(23/29) 74.5(38/51) 76.3(61/80) 63.9(23/36) 86.4(38/44) 3 h 84.6(11/13) 69.7(23/33) 73.9(34/46) 52.4(11/21) 92.0(23/25) 4 h 66.7(6/9) 58.8(10/17) 61.5(16/26) 46.2(6/13) 76.9(10/13) -
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