PET/CT显像对血清CA19-9升高患者原发肿瘤诊断的意义  

The value of PET/CT imaging for detecting primary malignant tumor to patients with elevated serum CA19-9

作　　者：任东栋 孙达[2] 任春玲 于军 李洋 Ren Dongdong;Sun Da;Ren Chunling;Yu Jun;Li Yang(PET/CT Center, Ningbo Mingzhou Hospital, Ningbo 315100, China;Department of Nuclear Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Chin)

机构地区：[1]宁波明州医院PET/CT中心,315100 [2]浙江大学医学院附属第二医院核医学科,杭州310009

出　　处：《中国医师杂志》2018年第6期865-868,共4页Journal of Chinese Physician

摘　　要：目的分析探讨血清糖类抗原19-9(CA19-9)升高行18F-氟代脱氧葡萄糖正电子发射计算机断层/计算机断层扫描(^(18)F-FDG PET/CT)显像受检者中CA19-9及SUVmax数值高低与恶性肿瘤诊断效能的相关性。方法既往无恶性肿瘤病史而血清CA19-9升高的受检者149例,行全身^(18)F-FDG PET/CT显像,血清CA19-9均在显像前2周内检测。通过手术/活检病理以及临床随访结果确诊。结果 149例受检者中证实为恶性肿瘤者64例,非恶性肿瘤者85例,^(18)F-FDG PET/CT显像真阳性60例、假阳性13例、真阴性72例、假阴性4例。PET/CT显像诊断恶性肿瘤的准确率为88. 6%,明显高于单纯血清、CA19-9诊断准确率43.0%(X^2=59. 882,P <0. 05)。血清CA19-9按照37～100 U/ml、100～500 U/ml、500～1 000 U/ml、> 1 000 U/ml不同水平分成4组,每组PET/CT显像诊断准确率分别为94. 5%、84. 9%、81. 3%、88.0%,各组比较差异无统计学意义(X^2=3.503,P>0. 05)。血清CA19-9诊断恶性肿瘤受试者工作特征曲线(ROC)的曲线下面积(AUC)为0. 726,诊断界值为152. 75 U/ml时的敏感度、特异度分别为70. 3%、68. 2%。病灶最大标准化摄取值(SUVmax)诊断恶性肿瘤AUC为0. 742,SUVmax分界值为6. 95时的敏感度、特异度分别为73. 3%、69. 2%。结论 ^(18)F-FDG PET/CT显像在血清CA19-9升高受检者中诊断恶性肿瘤具有重要临床价值,当血清CA19-9> 152. 75 U/ml时有必要行PET/CT显像,病灶SUVmax>6. 95时应考虑恶性肿瘤。Objective To investigate the diagnostic accuracy of malignant tumor of 18 F-fluorodeoxyglucose positron emission tomography/computed tomograprhy （18 F-FDG PET/CT） imaging in the patients of elevated serum carbohydrate antigen 19-9 （CA19-9） and its correlation with maximum standardized uptake value （SUVmax） and serum CA19-9 level. Methods Whole-body ISF-FDG PET/CT scan was performed in 149 patients with elevated serum CA19-9 level without the history of malignancy. Blood sample was drawn in each case for CA19-9 assay two weeks or less before the performing PET/CT. Final diagnoses were confirmed by operation/biopsy pathological results and clinical follow-ups. Results Among the 149 patients, 64 cases were finally diagnosed as malignancies and 85 cases of non-malignancy diseases. The true positive of the diagnoses by 18 F-FDG PET/CT was 60 cases, the false positive 13 cases, the true negative 72 cases, the false negative 4 cases. The accuracy of diagnosis of malignant tumor with elevated serum CA19- 9 was 43.0%, while elevated serum CA19-9 combined with ISF-FDG PET/CT imaging was 88. 6%, with statistically significant difference （X2 = 59. 882,P 〈 0. 05 ）. The serum CA19-9 was divided into 4 groups according to the different levels of 37 - 100 U/ml, 100 - 500 U/ml, 500 - 1000 U/ml and 〉 1 000 U/ml. The diagnostic accuracy of each group of PET/CT was 94. 5%, 84. 9%, 81.3% and 88.0%, respectively. There was no statistically significant difference between each group （x2 = 3. 503 ,P 〉 0. 05 ）. The area under the curve （AUC） of the serum CA19-9 for the diagnosis of malignant tumor （ROC） was 0. 726, and the sensitivity and specificity of the diagnostic boundary value of 152. 75 U/ml were 70. 3% and 68. 2%, respectively. The AUC of SUVmax in diagnosis of malignant tumor was 0. 742, the best cutoff value was 6. 95, and the sensitivity and specificity were 73.3%, 69.2% respectively. Conclusions 18 F-FDG PET/CT is useful for detecting malignant tumors combined with serum tumor marker CA19-9. T

关 键 词：肿瘤/诊断 CA-19—9抗原/血液 体层摄影术 发射型计算机 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R730.44[医药卫生—肿瘤]