18F—FDGPET／CT同机序贯增强CT在胃癌治疗前分期中的价值  

Sequential 18F-FDG PET/CT and contrast-enhanced CT in the pretreatment staging of gastric cancer

作　　者：尤徐阳[1] 贺锋[2] 徐巧玲[1] 高其忠[3] 吴娜静[1] 杜晓庆[1] 米宝明[1] 郁春景[1] 万卫星[1] 费伯健[3] 

机构地区：[1]江南大学附属医院、无锡市第四人民医院核医学科,无锡214062 [2]江南大学附属医院、无锡市第四人民医院影像科,无锡214062 [3]江南大学附属医院、无锡市第四人民医院胃肠外科,无锡214062

出　　处：《中华核医学与分子影像杂志》2016年第4期315-321,共7页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：无锡市医院管理中心资助项目（CSEY1N1108）

摘　　要：目的探讨18F—FDGPET／CT同机序贯CECT（PET／CT＋CECT）在胃癌治疗前分期中的价值，并分析影响胃癌原发灶18F—FDG摄取的相关因素。方法前瞻性地选择经胃镜活组织检查病理证实为胃癌的未治患者28例[男23例，女5例，年龄（62．0±11．3）岁]，常规18F．FDGPET／CT显像后，患者原位行腹盆部CECT。比较常规18F—FDGPET／CT与CECT在诊断胃癌原发灶、胃周淋巴结转移、腹盆腔脏器转移上的差异。数据分析采用Pearson相关分析、Kappa检验、Mann—Whiteyu检验、Kruskal—WallisH检验、配对疋。检验。结果28例患者中，12例为临床Ⅳ期，其中2例患者18F—FDGPET／CT发现CECT未显示的3枚较小肝转移灶。CECT发现了全部16例根治术患者的原发灶，其中15例胃癌原发灶放射性摄取明显增高，SUVmax3．15—19．99。16例胃癌患者原发灶体积与SUVmax有中度相关性（r=0．573，95％CI：0．108-0．832，P〈0．05）。CECT判断16例胃癌患者原发灶浆膜有无浸润与术后病理对比的一致性较低（k=0．143，95％CI：一0．338～0．624）。有无原发灶脉管和（或）神经浸润者，不同T分期，不同组织学分级的原发灶SUVmax差异均无统计学意义（u=27．00，H=4．79和1．99，均P〉0．05）；16例胃癌根治术患者共清扫淋巴结399枚，发现转移淋巴结81枚。CECT所示淋巴结转移与常规PET／CT所示转移淋巴结判断结果并不完全相符，两者之间有互补性。CECT判断胃周转移淋巴结的灵敏度、特异性、准确性、PPV和NPV分别为10／10、1／6、11／16、10／15和1／1；PET／CT的相应值分别为6／10、6／6、12／16、6／6和6／10；PET／CT＋CECT的相应值分别为10／10、4／6、14／16、10／12和4／4。结论常规18F—FDGPET／CT能够弥补CECT在较小肝癌转移灶诊断上的不足．18F—FDGPET／CT＋CECT有助于提高胃痛治疗前分期的准确性．Objective To evaluate the value of sequential ISF-FDG PET/CT and CECT （PET/CT＋ CECT） in the pretreatment staging of gastric cancer, and to analyze the factors affecting the uptake of ~SF- FDG in gastric cancer. Methods A total of 28 untreated gastric cancer patients （23 males, 5 females, age （62.0＋ 11.3） years） confirmed by endoscopy biopsy were selected for this prospectively study. ~SF-FDG PET/CT was performed first, followed by 3-phase abdominopelvic CECT in the same position. They were compared in terms of their efficacy in primary gastric tumor detection, and accuracy in finding peri-gastric lymph node and abdominopelvic organ metastasis. Pearson correlation analysis, Kappa test, Mann-Whitney u test, Kruskal-Wallis H test, pairedX2 test were used. Results Of 12 stage 1V inoperable patients, ISF- FDG PET/CT revealed 3 more small liver metastases in 2 patients which were negative on CECT. In 16 patients who underwent gastrectomy and lymph node dissection, all primary tumors were positive on CECT while 15/16 were positive on PET （SUVmax 3.15-19.99）. The remaining case was a poorly differentiated signet-ring gastric adenocarcinoma with mild uptake （SUVmax 1.62）. In all 16 patients, there was moderate correlation between primary tumor volume and SUV （r = 0.573, 95% CI： 0. 108-0.832, P〈0.05）. The consistency of serosal infiltration evaluated by CECT was low as compared with post-operative pathology （ K = 0.143, 95% CI： -0.338-0.624）. There was no significant statistical correlation between SUVmax of primary tumors with presence/absence of vascular or perineural infiltration, different T staging and histological grades （u= 27.00, H= 4.79 and 1.99, all P〉0.05）. A total of 399 lymph nodes were dissected from the 16 patients ; 81 were confirmed metastatic. The evaluation of lymph node metastasis by PET/CT and CECT was not consistent but complementary. The sensitivity, specificity, accuracy, PPV and NPV for the detection of lymph node metastasis were 10/10, 1/6, 11/16, 10/15

关 键 词：胃肿瘤 肿瘤分期 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 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]