^(18)F-FDGPET/CT在胰腺腺癌术前评估中的价值及对治疗决策的影响  

Value of ^(18)F-FDG PET / CT for pre-operative evaluation of pancreatic adenocarcinoma and its effects on the therapeutic decision

作　　者：徐枫[1,2] 李彪[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院核医学科,上海200025 [2]上海交通大学医学院附属第九人民医院核医学科,上海200011

出　　处：《上海交通大学学报（医学版）》2016年第5期695-698,715,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家临床重点专科建设项目~~

摘　　要：目的评价^(18)F-FDG PET/CT在胰腺腺癌术前评估中的价值及对治疗决策的影响。方法回顾分析89例具有完整资料(包括腹部增强CT和~18F-FDG PET/CT)且原发肿瘤经病理检查或活检证实为腺癌的胰腺癌患者的临床资料。其中29例被手术证实为有手术指征,60例被手术或随访证实为无手术指征。通过增强CT、18F-FDG PET/CT、增强CT结合^(18)F-FDG PET/CT评估胰腺腺癌患者术前远处转移及手术指征,使用χ~2检验比较3种方法的效能;评估增强CT结合^(18)F-FDG PET/CT后对治疗决策的影响。结果增强CT、~18F-FDG PET/CT、增强CT结合^(18)F-FDG PET/CT评估胰腺腺癌远处转移准确度分别为73.0%、88.8%、92.1%(χ2=14.2,P=0.001),评估手术指征的准确度分别为68.5%、73.0%、85.4%(χ~2=7.4,P=0.025)。在增强CT评估为有手术指征的57例患者中,28例被手术证实为无手术指征,结合^(18)F-FDG PET/CT后准确发现了其中的15例无手术指征患者;而增强CT评估为无手术指征的29例患者均被手术或随访证实为无手术指征,增强CT结合PET/CT检查未改变评估结果。结论对增强CT术前评估为有手术指征的胰腺腺癌患者,增加PET/CT检查是必要的。Objective To assess the value of（18F）-FDGPET/CT for pre-operative evaluation of pancreatic adenocarcinom a and its effects on the therapeutic decision. Methods A retrospective analysis of clinical dada on 89 patients with pathology or biopsy-proven prim ary pancreatic adenocarcinom a and complete hospital records[including abdom inal contrast-enhanced CT（ ce-CT） and（18F）-FDGPET/CT ]. 29 cases were proved by operations to have surgical indications and 60 cases were proved by operations or follow-ups to have no surgical indication. First, pre-operative distant m etastases and surgical indications were assessed via ce-C T,^（18F）-FDGPET / CT, and ce-C T com bined with（18F）-FDGPET / CT for patients with pancreatic adenocarcinom a. T he efficacy of three m ethods w as com pared with χ2test. Second, the effects of ce-C T com bined with（18F）-FDGPET / CTon the therapeutic decision were assessed. Results T he accuracy rates of ce-C T,（18F）-FD G PET /C T, and ce-C T com bined with（18F）-FDGPET / CT for evaluating the distant metastasis of pancreatic adenocarcinom a were 73. 0%, 88. 8%, and 92. 1%, respectively（ χ2= 14. 2, P = 0. 001）. T he accuracy rates for evaluating the surgical indication were 68. 5%, 73. 0%, and 85. 4%, respectively（ χ2= 7. 4, P = 0. 025）. Of 57 patients w ho were evaluated by ce-C T to have surgical indications, 28 were proved by operations to have no surgical indication and 15 of them were correctly identified by the com bination of（18F）-FDGPET / CT. Of 29 patients who were evaluated by ce-C T to have no surgical indication, all of them were proven by operations orfollow-ups to have no surgical indication. C e-C T com bined with PET / CT did not change the evaluation results.Conclusion For patients with pancreatic adenocarcinom a who are pre-operatively evaluated by ce-C T to have surgical indications,（18F）-FDGPET / CT exam ination is necessary.

关 键 词：胰腺肿瘤 18F-FDG PET/CT 诊断 治疗决策 

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