FDG PET与增强CT异机融合图像在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值  

Cross-modality image fusion of FDG PET and contrast-enhanced CT for the diagnoses of pancreatic lesions and staging of pancreatic cancer

作　　者：张建[1] 贾宁阳[3] 余仲飞[2,4] 杨剑[1] 刘晓东 胡胜平[1] 冯菲[1] 孙高峰[1] 程超[1] 王书中[6] 左长京[1] 

机构地区：[1]第二军医大学长海医院核医学科,上海200433 [2]第二军医大学长海医院放射科 [3]第二军医大学东方肝胆外科医院放射科 [4]解放军411医院PET/CT中心 [5]江阴华西医院PET/CT中心 [6]南京医科大学附属淮安第一医院

出　　处：《中华胰腺病杂志》2014年第6期374-379,共6页Chinese Journal of Pancreatology

基　　金：国家自然基金（81170435）;中国博士后基金（20100480545）;上海市科委国际合作基金（10410708800）;上海市卫生局项目（XBR2011040）

摘　　要：目的 探讨FDG PET与增强CT（CECT）异机融合技术在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值.方法 回顾性分析2010年9月至2013年10月在上海长海医院行CECT和常规PET/CT检查的70例胰腺病患者的资料,其中男性45例,女性25例,中位年龄57岁;恶性50例,良性20例.使用西门子Multimodality Workplace TureD软件获得PET/CECT异机融合图像.以病理及临床影像随访结果作为标准,比较CECT、PET/CT、PET/CECT异机融合图像对胰腺病变鉴别诊断以及胰腺癌分期的效能.结果 CECT、PET/CT、PET/CECT异机融合在胰腺病灶良恶性诊断方面的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确率和Kppa值分别为82.0％、65.0％、85.4％、59.1％、77.1％及0.465; 92.0％、65.0％、86.8％、76.5％、84.2％及0.597; 96.0％、90.0％、96.0％、90.0％、94.3％及0.860,其中CECT与PET/CECT诊断良恶性病变的敏感性、NPV及准确率的差异有统计学意义（P值均＜0.05）.31例胰腺癌经手术证实,其中15例发现伴胰周血管侵犯,3种检查方法诊断的敏感性、特异性、PPV、NPV和准确率分别为93.3％、93.7％、93.3％、93.8％及93.5％;26.7％、75.0％、50.0％、52.2％及51.6％;93.3％、93.7％、93.3％、93.8％及93.5％,其中PET/CT与CECT、PET/CECT诊断胰周血管侵犯的敏感性、PPV、NPV及准确性的差异有统计学意义（P值均＜0.05）.19例病理证实有区域淋巴结转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为63.2％、91.7％、92.3％、61.1％及74.2％; 78.9％、83.3％、88.2％、71.4％及80.6％; 89.5％、91.7％、94.4％、84.6％及90.3％,差异均无统计学意义.50例恶性病变中17例经组织学或临床随访证实有远处转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为58.8％、100％、100％、82.5％及86％;82.4％、91.0％、82.4％、90.9％及88％;94.1％、97.0％、94.1％、97.0％及96.0％,Objective To explore the value of the cross-modality fusion images provided by PET/CT and contrast-enhanced CT （CECT） in differentiating malignant from benign pancreatic lesions and evaluating staging for pancreatic cancer.Methods Data from 70 patients with pancreatic lesions who had undergone CECT and PET/CT examinations in our hospital from September 2010 to October 2013 were analyzed.Of these 70 patients,45 were males and 25 females; the median age was 57 years old.Fifty patients had malignant lesions,and 20 patients had benign lesions.Cross-modality image fusion （PET/CECT） was obtained using Multimodality Workplace Ture D software （Siemens Ltd）.The pathological and imaging follow-up were used as gold standard,then the value of PET/CT,CECT and PET/CECT in differentiating malignant from benign pancreatic lesions and evaluating staging for pancreatic cancer was determined.Results The sensitivity,specificity,positive predictive value （PPV）,negative predictive value （NPV）,accuracy and Kappa value of CECT,PET/CT and PET/CECT the 3 methods in differentiating benign from malignant pancreatic lesions were 82.0%,65.0%,85.4%,59.1%,77.1% and 0.465; 92.0%,65.0%,86.8%,76.5%,84.2% and 0.597 ; 96.0%,90.0%,96.0%,90.0%,94.3% and 0.860,and the difference of sensitivity,NPV,and accuracy between CECT and PET/CECT was statistically significant （P 〈 0.05）.In 15 of 31 patients who were confirmed to have malignant tumor after surgery,peripancreatic vessel invasion was verified.The sensitivity,specificity,PPV,NPV,accuracy of the 3 methods in diagnosing peripancreatic vessel invasion were 93.3%,93.7%,93.3%,93.8%,and 93.5%; 26.7%,75%,50.0%,52.2% and 51.6%; 93.3%,93.7%,93.3%,93.8% and 93.5%,and the difference of sensitivity,NPV,and accuracy between CECT and PET/CECT was statistically significant （P〈0.05）.In 19 of 31 patients who were confirmed to have malignant tumor after surgery,regional lymph node metastasis was histologically detected.The sensitivity,specificity,PPV,NPV,accuracy of 3 methods in detecti

关 键 词：胰腺肿瘤 正电子发射体层摄影术 体层摄影术 X线计算机 对比增强 诊断 鉴别 肿瘤分期 

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