联合示踪剂正电子发射计算机断层显像用于肝脏占位术前诊断  

Application of Dual-tracer Positron Emission Tomography in the Pre-operative Diagnosis of Liver Masses

作　　者：杜顺达[1] 桑新亭[1] 胡蓉蓉[1] 卢欣[1] 毛一雷[1] 杨志英[1] 徐意瑶[1] 徐海峰[1] 赵海涛[1] 迟天毅[1] 钟守先[1] 黄洁夫[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肝脏外科,北京100730

出　　处：《协和医学杂志》2011年第1期15-18,共4页Medical Journal of Peking Union Medical College Hospital

基　　金：国家863计划项目(2007AA021808);国家自然科学基金(30901453)

摘　　要：目的观察两种正电子发射计算机断层显像(positron emission tomography,PET)示踪剂对肝脏占位的诊断价值。方法选取本院2004年10月至2010年8月经常规检查无法定性的肝脏占位患者40例,所有患者均接受18F-去氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)-PET和11C-乙酸盐(11C-Acetate)-PET检查。结果 40例肝脏占位患者经病理证实恶性病变33例,癌前病变2例,良性病变5例。双示踪剂PET检查诊断恶性病变34例,敏感性为97.1%,阳性预测值为91.9%;18F-FDG PET诊断恶性病变20例,敏感性为57.1%;11C-Acetate PET诊断恶性病变29例,敏感性为82.9%。对于不典型增生、高分化及中高分化的肝脏恶性肿瘤,11C-Acetate的敏感性为100%,显著高于18F-FDG的敏感性28.6%(P<0.01);对于低分化、中低分化的肝脏恶性肿瘤,18F-FDG的敏感性稍高,但两者差异无统计学意义。结论两种PET示踪剂联合应用能提高肝脏占位的术前诊断率,且有可能提示肿瘤的分化程度,对于手术的选择有一定指导意义。Objective To evaluate the value of the dual-tracer positron emission tomography（PET）in the pre-operative diagnosis of liver masses.Methods Totally 40 patients whose liver masses could not be positioned by routine examination were enrolled in this study from October 2004 to August 2010.All patients received PET examination using 18F-fluorodeoxyglucose（18F-FDG）and 11C-Acetate as tracer.Results Of these 40 patients,the masses were pathologically confirmed to be malignant in 33 patients,precancerous changes in 2 patients,and benign in 5 patients.On the contrary,dual-tracer PET found malignant lesions in 34 patients,with a sensitivity of 97.1% and a positive predictive value of 91.9%.18F-FDG PET identified 20 malignant masses（57.1%）and 11C-Acetate PET identified 29（82.9%）.For atypical hyperplasia,well differentiated lesions,and moderately well-differentiated lesions,the sensitivity of 11C-acetate（100%）was significantly higher than 18F-FDG（28.6%）（P〈0.01）.However,for poorly differentiated lesions and moderately poor-differentiated lesions,the sensitivity of 18F-FDG was a bit higher but without statistical significance.Conclusion The combined application of these two tracers in PET can increase the diagnostic accuracy for liver masses preoperatively and may indicate the differentiation levels of tumors,and thus provides useful information for surgical decision-making.

关 键 词：肝脏占位 正电子断层显像 18F-去氧葡萄糖 11C-乙酸盐 诊断 

分 类 号：R445[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]