18F-FDGPET／CT显像在胰腺癌TNM分期中的价值及对治疗决策影响  

Clinical Value of 18F-FDG PET-CT imaging in TNM staging and its influence on treatment decision of pancreatic cancer

作　　者：蒲朝煜[1] 毛新远[1] 张弛[1] 周卫华[1] 张海英[1] 李菲[1] 蔡莉[1] 王剑杰[1] 

机构地区：[1]中国人民武装警察部队总医院核医学科,北京100039

出　　处：《中国急救复苏与灾害医学杂志》2017年第4期349-352,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨18F-FDGPET／CT显像在胰腺癌TNM分期中的价值以及对治疗决策影响。方法回顾分析2014年3月-2016年5月期间武警总医院核医学科，96例确诊为胰腺癌的门诊及住院患者的18F-FDGPET／CT检查资料，并与同期的CT及MRI资料对比，了解18F-FDGPET／CT对胰腺癌的TNM分期、临床分期情况及其对治疗决策的更改情况。结果18F-FDGPET／CT胰腺癌TNM分期与临床分期：96例胰腺癌患者中，T1-224例，T323例，T449例，N154例，M151例；早期（Ⅰ±Ⅱ）期占29．2％（28／96）；中晚期（Ⅲ＋Ⅳ）期占70．8％（68／96）。而同期CT及MRI检查：发现原发灶9l例，其中T1-221例、T322例、T448例，较18F-FDGPET／CT漏诊5例；N147例，较18F-FDGPET／CT少发现7例；M140例，较18F-FDGPET／CT少发现11例；早期（Ⅰ±Ⅱ）期38例，中晚期（Ⅲ＋Ⅳ）期51例。通过18F-FDGPET／CT检查，有占26．0％（25／96）的患者调整了治疗方案，5例发现为CT及MR漏诊胰腺癌原发灶；20例较CT及MRI提高了临床分期，其中5例原发灶升高至T4期、4例有手术无法清除的多发淋巴结转移、11例远处转移。结论18F-FDGPET／CT在胰腺癌TNM分期和临床分期的价值较常规CT及MRI高，尤其对较小的原发灶、小淋巴结转移以及远处转移病灶更具优势。18F-FDGPET／CT与CT及MRI结合，能提供更准确的临床分期，为合理选择治疗方案的提供可靠的依据。Objective To evaluate the value of 18F-fluorodeoxyglucose （18F-FDG） PET/CT in TNM staging and its influence on treatment decisions of pancreatic cancer. Methods A total of 96 patients who underwent 18F-FDG PET/ CT examination for diagnosed pancreatic cancer during March 2014 to May 2016 were analyzed comparing with CT and MRI images of the same period retrospectively. Pathological diagnosis or regular imaging follow-up were adopted as the golden standard. Results In 96 patients with pancreatic cancer, 24 patients with T1-T2 stage, 23 and 49 patients with T3 and T4 stage, 54 patients in N1 stage,51 patients in M1 stage by 18F-FDG PET/CT scan. while the T staging on CT and MRI examination, the number was 21 ,22 and 48 in T1-2, T3 and T4 staging corresponding, 5 primary pancreatic cancer were missed, 91 lesions were detected altogether. 47 patients in N1 stage, with 7 cases missed, and 40 patients in M1 stage, with 11 cases missed. As for clinical staging, the early stage （Ⅰ±Ⅱ） accounted for 29.2% （28/96）, the middle and late stage （Ⅲ＋Ⅳ） accounted for 70.8% （68/96） by 18F-FDG PET/CT, while the number was 38 and 51 respectively by CT and MRI staging. The treatment plans in 25 patients （25/96,accounted for 26.0%） were changed by 18F-FDG PET/CT, 5 primary cancer which neglected on CT and MRI were detected on 18F-FDG PET/ CT, clinical stage was increased in 20 patients. Condusioli 18F-FDG PET/CT is more accurate than traditional imaging modality in TNM and clinical staging of pancreatic Carcinoma. Especially in small primary tumor, small lymph node metastasis and distant metastasis. 18F-FDG PET/CT combined with CT and MRI examination can provide moreaccurate clinical stage and a reliable basis for the rational selection of treatment.

关 键 词：正电子发射计算机断层显像 18F-脱氧葡萄糖 计算机体层摄影术 胰腺肿瘤 癌 肿瘤分期 

分 类 号：R817.4[医药卫生—影像医学与核医学]