体检人群血清CEA不明原因升高行^(18)F-FDG PET/CT诊断肿瘤的临床价值  

The clinical value of ^(18)F-FDG PET/CT for diagnosing tumor in physical examination people with unexplained elevated serum CEA

作　　者：郑红娜[1] 李敬[1] 解敬慧[1] 杜雪梅[1] 陈博[1] 张延军[1] ZHENG Hong-na;LI Jing;XIE Jing-hui;DU Xue-mei;CHEN Bo;ZHANG Yan-jun(Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China)

机构地区：[1]大连医科大学附属第一医院核医学科,116021

出　　处：《天津医药》2017年第2期215-219,共5页Tianjin Medical Journal

摘　　要：目的探讨18氟-氟代脱氧葡萄糖(^(18)F-FDG)PET/CT在体检人群血清癌胚抗原(CEA)水平不明原因升高时诊断肿瘤的临床价值。方法选取2010年6月—2014年12月我院健康体检时发现血清CEA不明原因升高并行^(18)F-FDG PET/CT检查的体检者100例。结合病理学检查、临床随访和其他影像学检查结果,评价^(18)F-FDG PET/CT对恶性肿瘤的诊断价值。对于接受>2次血清CEA测定的患者,计算CEA倍增时间(DT);分析血清CEA水平及其DT与^(18)F-FDG PET/CT显像的关系。利用受试者工作特征(ROC)曲线分析血清CEA诊断恶性肿瘤的效能。结果 100例患者中有27例最终确诊为恶性肿瘤,73例排除恶性肿瘤。^(18)F-FDG PET/CT诊断假阳性和假阴性各1例,其诊断敏感度、特异度、准确度、阳性预测值和阴性预测值分别为96.3%、98.6%、98.0%、96.3%和98.6%。^(18)F-FDG PET/CT显像阳性者血清CEA水平明显高于显像阴性者(Z=5.796,P<0.05);且随着CEA水平的升高,显像阳性率有升高的趋势(χ~2=37.823,P<0.05)。^(18)F-FDG PET/CT显像阳性患者血清CEA DT明显短于显像阴性患者(Z=4.301,P<0.05);DT为0~180 d的患者显像阳性率明显高于DT>180 d及DT<0 d的患者(χ2分别为17.472、17.325,均P<0.05);DT>180 d与DT<0 d的患者^(18)F-FDG PET/CT显像阳性率差异无统计学意义(χ2=0.255,P>0.05)。血清CEA诊断恶性肿瘤的ROC曲线下面积(AUC)为0.894,当诊断界值为14.24μg/L时诊断效能最佳。结论^(18)F-FDG PET/CT显像对于血清CEA不明原因升高者是否罹患肿瘤具有较高的诊断价值,尤其对于血清CEA≥14.24μg/L或呈进行性升高的患者,行^(18)F-FDG PET/CT探查恶性肿瘤的价值更大。Objective To evaluate the clinical value of18F-FDG PET/CT for detecting tumor on physical examinationpeople with unexplained elevated serum carcinoembryonic antigen(CEA).Methods A total of100physical examinationpeople with unexplained elevated serum levels of CEA in our hospital from June2010to December2014were involved inthe study.All the people were detected with18F-FDG PET/CT.The pathology,clinical follow ups and conventional medicalimaging results were combined to evaluate the value of18F-FDG PET/CT in diagnosing tumor.The doubling time(DT)ofCEA was calculated in the patients who were received more than twice of serum CEA detection.The relationships betweenserum CEA levels,CEA DT and18F-FDG PET/CT imaging were analyzed.The receiver operating characteristic(ROC)curvewas used to assess the diagnostic efficiency of serum CEA.Results Twenty-seven patients were confirmed with malignanttumor,and the rest of73cases were excluded.The18F-FDG PET/CT reported one false positive and one false negativerespectively.The sensitivity,specificity,accuracy,positive and negative predictive values of18F-FDG PET/CT in diagnosingmalignant tumors were96.3%,98.6%,98.0%,96.3%and98.6%respectively.The median serum CEA levels weresignificantly higher in the positive18F-FDG PET/CT patients than those in the negative patients(Z=5.796,P<0.05).Theprevalence of18F-FDG PET/CT positive patients was higher with an increase in absolute CEA levels(χ2=37.823,P<0.05).The median DT of serum CEA levels was shorter in the positive18F-FDG PET/CT patients than that in the negative patients(Z=4.301,P<0.05).The positive rates of18F-FDG PET/CT in patients with0d<DT<180d were significantly higher thanpatients with DT>180d and DT<0d(χ2=17.472and17.325,both P<0.05).There was no significant difference in thepositive rate of18F-FDG PET/CT between patients with DT>180d and patients with DT<0d(χ2=0.255,P>0.05).Thearea under the curve(AUC)of serum CEA was0.894,the optimal diagnostic cutoff value was14.24μg/L.Conclusion18FFDGPET/CT is a useful image modality for

关 键 词：正电子发射断层显像术 氟脱氧葡萄糖F18 癌胚抗原 体格检查 诊断 鉴别 肿瘤 

分 类 号：R445.6[医药卫生—影像医学与核医学]