18F-FDGPET／CT显像在胰腺淋巴瘤与胰腺癌鉴别诊断中的价值  

Diagnostic value of ISF-FDG PET/CT in differentiating pancreatic lymphoma and pancreatic carcinoma

作　　者：任胜男[1] 张建[1] 袁渊[2] 胡胜平[1] 程超[1] 董爱生[1] 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,上海200433

出　　处：《中华胰腺病杂志》2016年第4期243-247,共5页Chinese Journal of Pancreatology

基　　金：国家自然科学基金（81471714）

摘　　要：目的评估18F—FDGPET／CT显像在胰腺淋巴瘤（PL）与胰腺癌（PC）鉴别诊断中的价值。方法回顾性分析经病理证实的16例PL患者的18F—FDGPET／CT资料，并与同期随机抽取的32例经病理证实的PC患者进行比较。分析患者的年龄，胰腺病变的位置、直径及最大标准化摄取值（SUVmax），胰管有无扩张，远端胰腺有无萎缩，血清CA19-9有无升高，胰腺外组织侵犯的情况。结果16例PL患者中男性8例，女性8例，平均年龄（46±17）岁，11．1％（1／9）患者血CA19-9升高；32例PC患者中男性15例，女性17例，平均年龄（61±12）岁，81．3％（26／32）患者血CA19—9升高。PL组与PC组的性别分布差异无统计学意义，但PL组的平均年龄较Pc组小，血CA19-9升高例数较Pc组少，差异均有统计学意义（P值均〈0．05）。16例PL中12例为胰腺弥漫大B细胞淋巴瘤，2例为B淋巴母细胞性淋巴瘤／白血病，1例滤泡性淋巴瘤，1例间变大T细胞性淋巴瘤。两组胰腺病灶部位的差异无统计学意义，但PL组胰腺病灶直径显著大于PC组[（6．6±3．3）cm比（4．3±1．8）cm，P=0．038]，胰管扩张、远端胰腺组织萎缩例数显著少于PC组（3／16比17／32，1／16比13／32），胰腺病灶SUVmax显著高于Pc组（12．0±5．5比8．6±3．8），差异均有统计学意义（P值均〈0．05）。SUVmax诊断临界值为9．95，约登指数为0．406，诊断PL的敏感性为68．8％，特异性为71．9％。PL组胰腺外骨、肾脏及脾脏侵犯率显著高于PC组（56．3％比6．25％，43．8％比3．1％，50．0％比6．3％），肝转移率显著低于PC组（12．5％比75．0％），差异均有统计学意义（P值均〈0．01）。两组胰腺外其他部位侵犯率的差异无统计学意义。结论相对年轻的患者发现胰腺肿块体积较大，伴有明显脱氧葡萄糖（FDG）摄取，且无明显胰管扩张或远端胰腺组织萎缩，累及骨、肾脏�Objective To evaluate the differential diagnostic value of lSF-FDG PET/CT between pancreatic lymphoma （PL） and pancreatic carcinoma （PC）. Methods The ~SF-FDG PET-CT data of 16 patients who were pathological diagnosed with PL were retrospectively reviewed and compared with those of 32 consecutive pancreatic cancer patients who were pathologically diagnosed and randomly enrolled. The age, location, diameter and the maximum standard uptake values （ SUVmax ） of pancreatic lesions, pancreatic duetal dilatation, distal pancreatic atrophy, serum CA19-9 level and extrapancreatic organs involvement were analyzed. Results The 16 patients with PL included 8 men and 8 women, the mean age was （46 ±17）year,and 11.1% （1/9） patients had elevated CA19-9. The 32 patients with PC included 15 men and 17 women, the mean age was （61 ± 12）year, and 81.3% patients had elevated CA19-9. There were no significant differences on gender between the two groups, while the mean age of PL patients was younger than that of PC, elevated CA19-9 was less common than that in PC, and the differences were statistically significant （all P 〈0.05 ）. There were 12 cases of diffusive large B cell lymphoma, 2 cases of B lymphoblastie lymphoma/leukaemia, 1 case of follicular lymphoma and 1 case of dysplastic large T cell lymphoma in 16 PL patients. There was no significant difference on the site of pancreatic lesions between the two groups , but long diameter of PL lesions was larger than that of PC [ （ 6.6 ±3.3 ） vs （ 4.3 ± 1.8 ） cm, P = 0.038 ]. Dilated pancreatic duct and distal parenehyma atrophy in PL were less than those in PC （3/16 vs 17/32, 1/16 vs 13/32 ）, and SUVmx of PL lesions was significantly higher than that of PC （ 12.0± 5.5 vs 8.6±3.8 ） , indicating that the differences were statistically significant （ all P 〈 0.05 ）. The cut-off value of SUVmax was 9.95, and Youden＇s index was 0. 406 with the sensitivity and specificity of 68.8% and 71.9% for differentiating PL from PC. The incidenc

关 键 词：淋巴瘤 胰腺肿瘤 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 诊断 鉴别 

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