18F-FDG PET/CT检查中腹腔积液SUV对不明原因腹腔积液的辅助诊断价值  

The role of standardized uptake value in 18F-FDG PET/CT for auxiliary diagnosis of ascites with unknown cause

作　　者：李现军[1] 李凤岐[1] 韩建奎[2] 赵志华[1] 宋振国[1] 代学之[1] 

机构地区：[1]261041,潍坊市人民医院核医学科 [2]山东大学齐鲁医院核医学科

出　　处：《中华核医学与分子影像杂志》2013年第6期-,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 分析良恶性腹腔积液患者18 F-FDG PET/CT显像特点,探讨腹腔积液SUV对不明原因腹腔积液的辅助诊断价值.方法 回顾性分析首次18 F-FDG PET/CT检查前病因不明、但随访诊断明确的腹腔积液患者55例,其中男24例,女31例,年龄23～82(平均54.8)岁;良性腹腔积液19例,恶性腹腔积液36例.测定良恶性腹腔积液的SUV,并计算其与正常肝脏SUV的比值(T/NT).比较PET/CT肿瘤定位诊断、腹腔积液代谢判定及细胞学检查三者的诊断效能.采用两样本t检验、x2检验或确切概率法分析数据.结果 恶性腹腔积液患者18F-FDG PET/CT显像示腹腔积液代谢升高,MIP图像呈肝脾“淹没征”.恶性腹腔积液的SUVmax及SUVmax.分别为1.78±0.65和1.37±0.38,良性腹腔积液的相应值分别为1.11 ±0.36和0.72±0.22,前者明显高于后者(t=4.13、6.82,均P＜0.05).恶性腹腔积液的T/NT值明显高于良性腹腔积液(基于SUVmax的T/NT值:0.64±0.20与0.48±0.12,t=3.27;基于SUVmean.的T/NT值:0.68±0.17与0.38±0.10,t=7.21,均P＜0.05).根据腹腔积液代谢诊断恶性腹腔积液的灵敏度、特异性及准确性分别为75.0％(27/36)、94.7％(18/19)和81.8％(45/55),其灵敏度及准确性明显高于腹腔积液细胞学检查[44.4％(16/36)与63.6％(35/55);X2=6.98和4.58,均P＜0.05],其特异性明显高于PET/CT肿瘤定位诊断[63.2％ (12/19)X2=5.70,P＜0.05].结论 腹腔积液代谢升高对恶性腹腔积液的辅助诊断具有重要价值,18 F-FDG PET/CT阅片分析应密切结合腹腔积液SUV及与肝脏的T/NT值,以进一步提高对不明原因腹腔积液的良恶性鉴别诊断效率.Objective To explore the value of SUV in patients with ascites of unknown cause.Methods A total of 55 patients (24 males,31 females,average age 54.8 years,age range:23-82 years) with ascites of unknown cause who underwent 18F-FDG PET/CT scan were retrospectively enrolled in this study.SUVmax and SUVmean of ascites and liver were measured and their ratios (T/NT) were calculated and compared by two-sample t test.All patients were followed up and had final diagnoses.Sensitivity,specifici ty,accuracy,positive predictive value and negative predictive value were calculated respectively.The diagnostic efficiency was compared among 18F-FDG PET/CT tumor localization alone,ascites radioactivity and ascites cytology examination by x2 test or Fisher exact test.Results Besides the high metabolized primary lesions and/or metastasis,the liver and spleen swamped by ascites with high radioactivity were visualized on MIP images.The SUVmax and SUVmean of malignant ascites were 1.78±0.65 and 1.37±0.38 respectively,which were higher than those of benign ascites (1.11±0.36 and 0.72±0.22; t=4.13,6.82,both P＜0.05).T/NT of malignant ascites was higher than that of benign ascites (SUVmax:0.64±0.20 vs 0.48±0.12,t =3.27,SUVmeax:0.68±0.17 vs 0.38±0.10,t =7.21 ; both P＜0.05).The diagnostic sensitivity,specificity and accuracy of SUV in ascites were 75.0％ (27/36),94.7％ (18/19) and 81.8％ (45/55),respectively.The sensitivity and accuracy of SUV were higher than those of cytological examination (44.4％ (16/36) and 63.6％ (35/55) ; x2 =6.98,4.58,both P＜0.05).The specificity of SUV was higher than that of tumor localization by 18F-FDG PET/CT (63.2％,12/19; x2 =5.70,P＜0.05).Conclusion Significantly higher SUVmax and SUV in malignant ascites than benign ascites were noted,which might play an adjuvant role in patients with ascites of unknown cause.

关 键 词：腹水 体层摄影术 发射型计算机 体层摄影术 X线计算机 诊断 鉴别 脱氧葡萄糖 

分 类 号：R730.5[医药卫生—肿瘤]