18F-FDG PET/CT双时相显像在胰腺病变良恶性鉴别诊断中的价值  

18F-FDG PET/CT dual-phase imaging in the differential diagnosis of pancreatic lesions

作　　者：余仲飞[1] 杨剑[2] 张建[2] 吴仪仪[2] 冯菲[2] 左长京[2] 崔斌[2] 高明军[2] 邱爽[2] 孔令山[2] 

机构地区：[1]第二军医大学长海医院放射科,上海200433 [2]第二军医大学长海医院核医学科,上海200433

出　　处：《功能与分子医学影像学（电子版）》2012年第4期43-46,共4页Functional and Molecular Medical Imaging(Electronic Edition)

基　　金：中国博士后基金(20100480545);上海市科委国际合作基金(10410708800);国家自然基金(81170435)

摘　　要：目的 探讨18F-FDG PET/CT双时相（早期、延迟显像）在胰腺病变良恶性鉴别诊断中的价值.方法 回顾性分析治疗前在我院行PET/CT检查的胰腺病例,共入选病例68例,其中男43例,女25例,恶性病变48例,良性20例.记录胰腺病灶的大小、SUVmax早期、SUVmax延迟,计算滞留率（RI）,并以病理及临床影像随访结果作为金标准,绘制ROC曲线寻找诊断胰腺恶变的SUVmax、RI临界值,计算诊断胰腺恶性病变的灵敏度、特异度及准确率.采用SPSS18.0统计软件进行分析,绘制ROC曲线,并使用约登指数最大的原则寻找鉴别胰腺良恶性病变最佳SUVmax及RI诊断界值.分别计算其诊断胰腺癌恶性病变的灵敏度、特异度及准确率,良恶性组之间SUVmax及RI的差异性采用非参数Mann-Whitney U检验.以P＜0.05为差异有统计学意义.结果 良性病变组SUVmax早期平均5.06（范围1.10～29.10）,恶性病变组SUVmax延迟平均7.80（范围1.60～ 17.60）.良恶性组SUVmax早期之间有显著差异（Mann-Whitney U=760.500,P=0.001）.SUVmax早期诊断胰腺恶性病变的ROC曲线下面积为0.792;以SUVmax=5.65为临界值诊断胰腺恶性病变的灵敏度为81.3％,特异度为80％.恶性组肿瘤直径平均（3.03±1.27）cm,肿瘤直径与SUVmax之间无显著相关性（P=0.383）.良性组RI平均为8.6％（-28.0％～50.0％）,恶性组RI平均为25.4％（-7.4％～96.4％）.良、恶性病变组之间RI的差异有统计学意义（Mann-Whitney U=540.000,P=0.017）.以SUVmax早期≥5.65且RI≥17.1％可以提高诊断胰腺恶性病变的特异性,但并不能提高诊断的敏感性.结论 18F-FDG PET/CT的SUVmax早期在胰腺恶性病变诊断中具有较高的敏感性和特异性,结合RI可以进一步提高诊断胰腺恶性肿瘤的特异性,但仅以PET显像作为诊断标准仍具有假阴性和假阳性,临床工作中需要结合病史及多种影像资料进行综合诊断才能获得更准确的结果.Objective To investigate the value of 18F-FDG PET/CT dual-phase imaging in the differential diagnosis of pancreatic benign and malignant lesions. Methods 68 cases with pancreatic lesions undergoing PET/CT were retrospectively analyzed. 48 cases were malignant, and 20 cases were benign. The size of the foci, SUVmax max delay, SUVmax delay, RI were recorded. ROC were drawn to analyze the criteria value of SUVmax and RI, and the sensitivity, specificity and accuracy were calculated.SPSS 18.0 were used to draw ROC carve. The optimal diagnostic value of SUVmax and RI to identify the benign and maligmant foci were determined by the principle of maximumyouden index. Mann-Whitney U test was applied to determine the difference of SUVmax and RI between the benign and malignant groups P 〈 0.05 were considered significantly different. Results The average SUVmax early of the benign foci group were 5.06 with a range of 1.10-29.10. And the average SUVmax delay of the malignant foci group were 7.80 with a range of 1.60-17.60. There was significant difference of SUVmax early between the benign and malidnant groups（Mann-Whitney U=760.500, P = 0.001〈 0.05）. Area under the ROC curve of SUVmax early for the diagnosis of pancreatic malignant lesions was 0.792.5.65 was used as the crossline of SUVmax for the diagnosis of pancreatic malignant lesions with a sensitivity of 81.3 % and a specificity of 80 % .The average diameter of malignant tumor group was （3.03 ± 1.27） cm.There was no significant relationship between the tumor diameter and SUVmax（P = 0.383 〉 0.05）.The average RI of the benign group was 8.6 % （-28.0 % to 50.0 % ）, and the average RI of the malignant group was25.4 % （-7.4 % to 96.4 % ）. The difference of RI between the two groups was statistically significant（Mann-Whitney U=540.000, P = 0.017〈 0.05）.Using both SUV ly ≥ 5.65 and RI ≥ 17.1 as diagnostic criteria can improve the specificity, but it has no improvement for the sensitivity. Conclusion The sensitivity and specificity of SUVmax

关 键 词：胰腺病变 体层摄影术 发射型计算机 体层摄影术 X线计算机 脱氧葡萄糖 双时相显像 

分 类 号：R735.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]