^(18)F-FDGPET/CT结直肠代谢活跃灶分型对于良恶性判断的价值  

Using ^(18)F-FDG positron emission tomography/computed tomography to judge benign or malignant colorectal hypermetabolic lesions

作　　者：李伟[1,2,3] 樊卫[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心核医学科,广东广州510060 [3]广州医学院附属肿瘤医院放射科,广东广州510095

出　　处：《癌症》2010年第3期330-336,共7页Chinese Journal of Cancer

摘　　要：背景与目的:结直肠迁延迂曲且位置不固定,肠管自身蠕动造成肠壁厚度变化。结直肠自身葡萄糖代谢不稳定,平滑肌蠕动、腺体分泌活动、痉挛、炎症等均可造成代谢异常。这些解剖和生理代谢方面的因素均会给18F-FDGPET/CT的正确诊断带来一定困难。本研究探讨18F-FDGPET/CT结直肠代谢活跃灶的影像特点及对于临床诊断的价值。方法:将74例患者共118个18F-FDGPET/CT发现的结直肠代谢活跃灶依据代谢及形态特点分为6型,局灶/CT+型、局灶/CT-型、节段/CT+型、节段/CT-型、弥漫/CT+型、弥漫/CT-型。将各分型情况与定性资料进行对比分析,采用R×C列联表χ2检验进行统计学分析。结果:118个结直肠代谢活跃灶定性为恶性共50个、非恶性68个,其中局灶/CT+型共30个(恶性23个、非恶性7个)、局灶/CT-型35个(恶性22个、非恶性13个)、节段/CT+型4个(恶性4个、非恶性0个)、节段/CT-型35个(恶性1个、非恶性34个)、弥漫/CT+型0个、弥漫/CT-型14个(恶性0个、非恶性14个)。"节段/CT-型"、"弥漫/CT-型"的非恶性病变发生率(97.1%、100%)和"节段/CT+型"的恶性病变发生率(100%)分布相似,这3型合并为"非局灶型";剔除无意义的"弥漫/CT+型"。"局灶/CT+型"、"局灶/CT-型"、"非局灶型"整体上差异存在统计学意义(P<0.001)。"局灶/CT+型"和"局灶/CT-型"之间差异无统计学意义(P=0.229),故合并为"局灶型"。"非局灶型"和"局灶型"之间差异有统计学意义(P<0.001)。结论:(1)当18F-FDGPET/CT示"弥漫/CT-型"或"节段/CT-型"时,应高度怀疑为非恶性;"节段/CT+型"时,应高度怀疑为恶性;"局灶/CT+"或"局灶/CT-"型时,只能一般怀疑为恶性。(2)在诊断结直肠代谢活跃灶时,必须综合考虑代谢和解剖信息。尤其对于"非局灶型",更应结合相关临床资料才可作出相应良恶性判断。Background and Objective：The colorectum is long and its position is not fixed. The thickness of the colorectal wall is unfixed because it changes following wall contractions. The metabolism of the colorectum is not stable and abnormal metabolism results from smooth muscle movement,gland action,spasm,inflammation,and so on. These anatomic and physiologic factors can bring a few difficulties in correctly judging colorectal information on ^18F-FDG positron emission tomography/computed tomography （PET/CT） scans. This study was to discuss the imaging characterstics of colorectal hypermetabolic lesions in ^18F-FDG PET/CT and their values to clinical diagnosis. Methods： According the metabolic characteristics and the shape of the lesion,118 colorectal hypermetabolic lesions of 74 patients were detected by 18F-FDG PET/CT and separated to 6 groups （localized/CT^＋,localized/CT^-,segmented/CT^＋,segmented/CT^-,diffuse/CT^＋,diffuse/CT^-）. To contrast groups and the qualitative data,a R×C χ^ 2 test was performed to judge statistical differences. Results： In the 118 lesions,50 were determined to be malignant and 68 nonmalignant. A total of 30 lesions were in the localized/CT^＋group （23 malignant,7 non）,35 to the localized/CT^-group （22 malignant,13 non）,4 to the segmented/CT^＋group （4 malignant,0 non）,35 to the segmented/CT^-group （1 malignant,34 non）,0 to the diffuse/CT^＋group,14 to the diffuse/CT^-group （0 malignant,14 non）. The rates of nonmalignant lesions in the segmented/CT^-and diffuse/CT^-groups （97.1%,100%） and of malignant lesions in the segmented/CT^＋groups （100%） were similar,so these three groups were combined to a nonlocalized group. The group of diffuse/CT^＋was deleted. There were significant differences among the three groups of nonlocalized,localized/CT^＋,and localized/CT^- （ P〈0.001）. The localized/CT^＋and localized/CT^-groups were combined into one localized group because no significant difference was found between them （ P=0.229）. Ther

关 键 词：大肠肿瘤 脱氧葡萄糖 PET/CT 诊断影像学 

分 类 号：R817.4[医药卫生—影像医学与核医学]