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胃癌是最常见的消化道恶性肿瘤,病死率位居肿瘤相关致死疾病的第2位[1]。目前胃癌的主要治疗手段是根治性胃切除联合淋巴结清扫,但术后5年生存率低于30%[2],术后生存率较低的主要原因之一是术后复发[3]。因此,对于胃癌术后复发的监测尤为重要,早期发现并合理调整治疗方案能够有效改善预后。18F-FDG PET/CT能够检测组织生理代谢功能,同时应用CT技术对核素分布情况进行解剖定位,被广泛应用于胃癌术后复发的监测。笔者回顾性分析18F-FDG PET/CT在胃癌术后复发监测中的临床价值。
18F-FDG PET/CT在胃癌复发及转移监测中的临床价值
The value of 18F-FDG PET/CT in the detection of gastric cancer recurrence and metastasis
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摘要:
目的 探讨18F-FDG PET/CT在胃癌术后复发及转移监测中的临床价值。 方法 回顾性分析2013年1月至2017年8月行18F-FDG PET/CT及增强CT检查的52例胃癌术后疑似复发转移患者[男性40例,女性12例,年龄30~86(61.73±11.44)岁]。通过定量分析与半定量分析的比较,确定吻合口复发的最大标准化摄取值(SUVmax)的临界值。采用ROC曲线分析吻合口的SUVmax临界值,t检验比较组间SUVmax,χ2检验比较定性分析与半定量分析及18F-FDG PET/CT与增强CT对于胃癌术后吻合口、淋巴结、远处转移的诊断效能。 结果 吻合口SUVmax临界值取3.14时,18F-FDG PET/CT诊断吻合口复发的特异度高于定性分析法,差异有统计学意义(χ2=5.439,P<0.05)。吻合口复发的SUVmax明显高于吻合口炎,差异有统计学意义(t=4.701,P<0.05)。18F-FDG PET/CT与增强CT诊断吻合口复发、淋巴结、远处转移的灵敏度的比较,差异有统计学意义(90.48% vs. 23.81%、92.00% vs. 60.00%、87.50% vs. 34.38%,χ2=19.363、5.373、16.804,均 P<0.05);特异度的比较均无统计学意义(100% vs. 100% 、 100% vs. 92.5% 、 100% vs. 95.00% , χ2 = 0.000、2.850、1.412 , 均 P>0.05)。 结论 18F-FDG PET/CT诊断胃癌术后复发转移优于CT,对胃癌术后复发转移的监测有重要临床价值。 Abstract:Objective To investigate the value of 18F-FDG PET/CT in the detection of gastric cancer recurrence and metastasis. Methods A retrospective analysis involving 52 patients with suspected recurrence and metastasis after gastric cancer surgery and who underwent 18F-FDG PET/CT and contrast-enhanced CT examinations over the period of January 2013 to August 2017 was performed, including 40 males and 12 females, aged between 30 and 86 years old(61.73±11.44). Receiver operating characteristic analysis was conducted on the basis of imaging data for the detection of a cutoff SUVmax value that is indicative of the presence of recurrent lesions. Differences among groups were determined through the t-test. The results of different methods were compared through the χ2 test. Results The specificity of 18F-FDG PET/CT was favorable and was higher than that of the qualitative analytical method(χ2=5.439, P<0.05) when a cutoff of 3.14 was used to evaluate for anastomosis. The SUVmax of anastomotic recurrence was higher than that of anastomotic inflammation(t=4.701, P<0.05). The sensitivity of 18F-FDG PET/CT in diagnosing recurrence, lymph node metastasis and distant metastasis was higher than that of contrast-enhanced CT, the difference was statistically significant(90.48% vs.23.81%, 92.00% vs.60.00%, 87.50% vs.34.38%, χ2=19.369, 5.373, 16.804, all P<0.05). The specificity of 18F-FDG PET/CT and contrast-enhanced CT in diagnosing recurrence, lymph node metastasis and distant metastasis was not statistically significant(100% vs.100%, 100% vs.92.5%, 100% vs.95.00%, χ2=0.000, 2.850, 1.412, all P>0.05). Conclusions The performance of PET/CT in the diagnosis of gastric cancer recurrence and metastasis is better than that of contrast-enhanced CT. Therefore, 18F-FDG PET/CT imaging has a high clinical value in the postoperative detection of gastric cancer. -
图 2 行胃癌根治术患者(男性,71岁,中分化腺癌)的18F-FDG PET/CT与增强CT的影像图 患者术后行常规辅助化疗,术后7个月行18F-FDG PET/CT和增强CT检查。图中,A、B、C:PET/CT横断位、矢状位、冠状位可见吻合口胃壁放射性摄取增高,SUVmax=6.75;D、E、F:CT平扫吻合口未见明显异常,增强CT动脉期、静脉期未见明显异常强化。患者最终经组织病理学证实为吻合口复发。箭头示复发部位。FDG:氟脱氧葡萄糖;PET:正电子发射断层显像术;CT:计算机体层摄影术;SUVmax;最大标准化摄取值。
Figure 2. 18F-FDG PET/CT and contrast-enhanced CT images of patient undergoing radical gastrectomy (male, 71 years old, moderately differentiated adenocarcinoma)
图 3 行胃癌根治术患者(男性,56岁,中-低分化腺癌)的18F-FDG PET/CT与增强CT的影像图 患者术后行常规辅助化疗,术后7个月行PET/CT和增强CT检查。图中,A、B、C:PET/CT横断位、矢状位、冠状位上均可见后腹膜淋巴结放射性摄取增高,SUVmax=6.7;D、E、F:CT平扫后腹膜淋巴结直径<1 cm,增强CT动脉期、静脉期未见明显异常强化。患者最终经组织病理学证实为淋巴结转移。箭头示转移部位。FDG:氟脱氧葡萄糖;PET:正电子发射断层显像术;CT:计算机体层摄影术;SUVmax;最大标准化摄取值。
Figure 3. 18F-FDG PET/CT and contrast-enhanced CT images of patient undergoing radical gastrectomy (male, 56 years old, moderately-poorly differentiated adenocarcinoma)
图 4 行胃癌根治术患者(男性,61岁,中分化腺癌)的18F-FDG PET/CT与增强CT的影像图 患者术后行常规辅助化疗,术后7个月行PET/CT和增强CT检查。A、B、C:PET/CT横断位、矢状位、冠状位上均可见直肠前方结节放射性摄取增高,SUVmax=5.03;D、E、F:CT平扫见直肠前方组织结节状稍增厚,增强CT动脉期、静脉期未见明显异常强化。患者最终经组织病理学证实为种植转移。箭头示转移部位。FDG:氟脱氧葡萄糖;PET:正电子发射断层显像术;CT:计算机体层摄影术;SUVmax;最大标准化摄取值。
Figure 4. 18F-FDG PET/CT and contrast-enhanced CT images of patient undergoing radical gastrectomy (male, 61 years old, moderately differentiated adenocarcinoma)
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