温水保留灌肠18氟-脱氧葡萄糖正电子发射计算机断层成像术对鉴别结直肠意外发现高代谢灶良恶性的诊断价值  

Diagnostic value of water enema 18F-fluorodexyglucose positron emission tomography and computed tomography in incidental finding of hypermetabolism focus in the colorectum

作　　者：张占文[1] 吕清湖 陈斐妮[1] 张杰[1] 卢丹[1] 胡平[1] 马立恒[1] 

机构地区：[1]中山大学附属第六医院影像检验中心,广州510610

出　　处：《中华胃肠外科杂志》2014年第3期239-244,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省卫生厅医学科研基金项目（A2013231）

摘　　要：目的探讨温水保留灌肠对”氟一脱氧葡萄糖正电子发射计算机断层成像术（18F—FDGPET．CT）检查意外发现的结直肠高代谢灶鉴别良恶性的诊断价值。方法2010年6月至2012年12月间在中山大学附属第六医院行PET．CT检查时意外发现有77例患者结直肠存在性质不明的高代谢灶，予以行温水保留灌肠PET—CT扫描，根据最终的诊断分为恶性病变（包括结直肠癌和恶性腺瘤）、良性病变（包括良性腺瘤和炎性病变）和生理性摄取，对高代谢灶的放射性摄取程度（最大标准摄取值，SUVmax）和灌肠前后SUVmax的变化（滞留指数，RI）进行组间比较。结果77例患者行温水保留灌肠PET—CT扫描后，诊断结直肠恶性病变23例，良性腺瘤16例，炎性病变7例，生理性摄取31例。恶性与良性病变常规SUVmax及RI比较，差异均无统计学意义（均P〉0．05）。肿瘤性病变与非肿瘤性摄取之间SUVmax的差异均无统计学意义（均P〉0．05）；但肿瘤性病变与炎性病变之间的RI差异有统计学意义（P〈0．05）。温水保留灌肠PET．CT对结直肠生理性摄取诊断的准确性为100％。对结直肠良、恶性病变判断的灵敏度为95．6％，特异度为96．3％，准确性为96．1％。结论温水保留灌肠PET—CT有助于常规PET—CT意外发现的结直肠高代谢灶中良恶性病变的鉴别，有效排除肠道生理性摄取的影响，避免不必要的结肠镜检查。Objective To investigate the value of water enema lSF-fluorodexyglucose positron emission tomography and computed tomography （ 18F-FDG PET-CT） in incidental finding of hypermetabolism focus in the colon and rectum for differential diagnosis of benign or malignant lesions. Methods From June 2010 to December 2012 in our hospital, 77 patients were found incidentally with uncertain hypermetabolism focuses in the colon and rectum during PET-CT examination. Water enema ISF-FDG PET-CT was performed to classify the lesions. According to the pathological examination and clinical follow-up, these cases were divided into malignant disease （including advanced colorectal adenoma）, benign adenoma, inflammation and physiological uptake. Radioactive uptake level （SUVmax） and change of water enema imaging （retention index, RI） of hypermetabolism focus were compared between groups. Result Of these 77 cases, 23 were malignant diseases, 16 benign adenoma, 7 inflammation and 31 physiological uptake. The difference of average SUVmax was not

关 键 词：结肠病变 直肠病变 正电子发射计算机断层成像术 18氟-脱氧葡萄糖 温水保留灌肠 鉴别诊断 

分 类 号：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]