核医学正电子断层显像在肾肿瘤患者术前诊断中的作用  

Diagnostic value of positron emission tomography(PET) in patients with renal tumor before surgical treatment

作　　者：霍力[1,2] 党永红[1,2] 崔瑞雪[1,2] 程欣[1,2] 李汉忠[3,2] 邢海群[1,2] 王瞳[1,2] 吕京桥[1,2] 李方[1,2] 

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核医学科 [2]北京协和医院转化医学中心,北京100730 [3]北京协和医院泌尿外科

出　　处：《实用肿瘤杂志》2013年第6期583-587,共5页Journal of Practical Oncology

基　　金：国家自然科学基金资助项目(81071188)

摘　　要：目的探讨PET在肾肿瘤术前诊断中作用。方法回顾性分析134例肾肿瘤患者PET图像。134例肾肿瘤术前评估患者中,32例行常规氟-18脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)PET或PET/CT显像(以下简称FDG-PET),51例行FDG-PET双时相显像,51例1周内分别行FDG-PET及碳-11乙酸盐(11C-acetate,AC)PET或PET/CT(以下简称AC-PET)双核素检查。收集其临床资料和影像检查结果。以病理结果为金标准。结果 FDG-PET对肾原发恶性肿瘤总的诊断准确率为48.5%,阳性预测值为96.3%,对透明细胞癌诊断准确率最低,为28.6%。对肾盂癌及其他恶性肿瘤诊断准确率为92.9%和75.0%。AC-PET对透明细胞癌诊断准确率93.5%。FDG-PET双时相显像60.0%阳性病灶标准摄取值(standard uptake value,SUV)升高,2例阴性病灶变为阳性。20例PET检查前其他检查发现肾外病灶的患者,检查后排除4例,并新发现6例患者肾外转移病灶。结论 FDG-PET检查对肾盂癌及其他恶性肿瘤诊断准确性高,对肾实质肿瘤诊断能力差,对肾肿瘤患者术前分期有帮助。AC-PET可弥补FDG-PET的不足。FDG-PET双时相显像不能从根本上解决FDG-PET对肾肿瘤诊断假阴性的问题。Objective To assess the diagnostic value of positron emission tomography （PET） for patients with renal tumor before surgical treatment. Methods All clinical data and PET images of 134 patients with renal tumor who underwent pre-operational PET investigation were analysed retrospectively. Among them,32 patients received routine tSF_fluorodeoxyglucose （ 18 F-FDG） PET or PET/CT （FDG-PET） ,51 also received 11 C-acetate （ AC ） PET or PET/CT （AC-PET） and another 51 patients received delayed FDG- PET images （dual-phase FDG-PET）. Pathological results were taken as gold standard. Results The accuracy of FDG-PET in the diagnosis of renal tumor was 48.5% and positive predictive value was 96.3%. FDG-PET was less sensitive in the detection of clear cell carcinoma than renal pelvic cancer and other malignant lesions ,the diagnosis accuracy was 28.6% vs 92.9% and 75.0% respectively. AC-PET detected 93.5% clear cell carcinoma. The standard uptake value （SUV） of 60.0% patients with positive lesions in routine FDG-PET images was increased in delayed phase and two negative cases changed to positive. In 20 metastatic cases diagnosed by other examinations,metastases were denied in 4 patients and additional metastases were detected in 6 patients by FDG-PET images. Conclusion FDG-PET is more effective in the diagnosis of renal pelvic and non-classified carcinoma than that of renal cell carcinoma, and it is useful in clinical stage evaluation before surgery. AC-PET is a complementary method to FDG-PET. Dual-phase FDG-PET would not improve the accuracy in the diagnose of renal cell carcinoma.

关 键 词：肾肿瘤 诊断 氟脱氧葡萄糖F18 正电子发射断层显像术 乙酸盐类 回顾性研究 

分 类 号：R737.11[医药卫生—肿瘤] R730.4[医药卫生—临床医学]