^(18)F-FDG PET/CT对肝内胆管癌的诊断价值研究  

Evaluation of the role of ^(18)F-FDG PET/CT in the diagnosis of intrahepatic cholangiocarcinoma

作　　者：张建[1] 吴仪仪[2] 左长京[3] 张桉瑜[3] 杨剑[3] 杨春山[1] 

机构地区：[1]解放军第八五医院PET/CT影像诊断中心,上海200052 [2]徐州医学院附属医院放射科,江苏徐州221005 [3]第二军医大学长海医院核医学科,上海200433

出　　处：《影像诊断与介入放射学》2016年第2期161-166,共6页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金(81170435;81471714);上海市卫生局项目(XBR2011040)

摘　　要：目的探讨^(18)F-FDG PET/CT对肝内胆管癌的临床诊断价值,探寻鉴别肝内胆管癌与良性病灶的最佳放射摄取半定量诊断界值。方法收集2010年8月~2012年12月因常规影像学怀疑肝内胆管癌并行PET/CT检查患者的资料。分别使用视觉分析法、SUV_(max)法、T/N比法及综合分析法进行诊断,以手术病理结果为金标准,计算并比较各种方法诊断肝内胆管癌的效能。结果共入组51例患者,2例为肝细胞癌,39例肝内胆管癌及10例良性病灶;PET/CT诊断肝内胆管癌的敏感度92.3%;特异度75.0%;准确度88.2%;阳性预测值92.3%;阴性预测值75.0%。39例肝内胆管癌的SUV_(max)均值是9.65±4.44,10例良性病灶的SUV_(max)为5.17±2.30,差异有显著统计学意义(P<0.05);39例肝内胆管癌的T/N均值是4.29±2.16,10例良性病灶是2.03±0.74,差异有显著统计学意义(P<0.05)。绘制诊断胆管癌的SUV_(max)、T/N的ROC曲线。当SUV_(max)最佳诊断界值是4.05时,诊断肝内胆管癌的敏感度和特异度分别为94.9%、50.0%。当T/N最佳诊断界值是2.85时,诊断肝内胆管癌的敏感度和特异度分别为76.9%、90.0%。视觉分析法较T/N法有较高的敏感度(P<0.05),T/N法较视觉分析法有较高的特异度(P<0.05);SUV_(max)法较T/N法有较高的敏感度(P<0.05)。结论PET/CT诊断肝内胆管癌有较高诊断效能,但仍存在部分假阳性和假阴性,合理应用各项代谢参数并结合同层CT及临床资料有助于进一步提高诊断效能。Objective To assess the value of -（18）F-FDG PET / CT in patients with intrahepatic cholangiocarcinoma and the efficacy of SUV_（max） and T / N ratio for differentiating malignant from benign hepatic lesions..Methods 51 patients with suspected intrahepatic cholangiocarcinomas who underwent -（18）F-FDG PET / CT scan between August 2010 and December 2012 were included in the analysis using visual assessment, SUV_（max）, T / N ratio, and receiver operating characteristic（ROC） curves. Using SUV_（max）cutoff values of 4.05,.the sensitivity and specificity for diagnosing intrahepatic cholangiocarcinoma were 94.9% and 50.0%, respectively.With T / N cutoff value of 2.85, the sensitivity and specificity were 76.9% and 90.0%, respectively. Visual analysis had significantly higher sensitivity and lower specificity than T / N（P〈0.05）..SUV_（max） also had significantly higher sensitivity than T / N（P〈0.05）.Results Of 51 patients, the final histological diagnosis was hepatocellular carcinoma（2）, cholangiocarcinoma（39） and benign disease（10）. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of -（18）F-FDG PET / CT in primary tumor detection were 92.3%, 75.0%, 88.2%, 92.3%, and 75.0%, respectively. The SUV_（max） of intrahepatic cholangiocarcinoma（ 9. 65 ± 4. 44） was significantly（ P〈0. 05） higher than that of benign lesions（ 5. 17 ± 2. 30）. The T / N of malignancy（4.29 ±2.16） was also significantly（P〈0.05） higher than that of benign lesions（2.03 ±0.74）. Conclusion -（18）F-FDG PET / CT has high sensitivity and positive predictive value for differentiating intrahepatic cholangiocarcinoma and benign lesions.

关 键 词：肝内胆管癌 正电子发射体层摄影术 体层摄影术 X线计算机 氟脱氧葡萄糖 

分 类 号：R735.8[医药卫生—肿瘤] R730.44[医药卫生—临床医学]