18F-FDG PET/CT在不明原因腹膜增厚鉴别诊断中的价值  

The value of 18F-FDG PET/CT in differential diagnosis of peritoneal thickening of undetermined origin

作　　者：王运 李林法[1] 庞伟强[1] 易贺庆[1] 龙斌[1] 叶雪梅[1] WANG Yun;LI Linfa;PANG Weiqiang(Department of Nuclear Medicine,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院(中国科学院肿瘤与基础医学研究所中国科学院大学附属肿瘤医院)核医学科

出　　处：《浙江医学》2020年第3期240-244,253,共6页Zhejiang Medical Journal

基　　金：国家卫生计生委科学研究基金-浙江省医药卫生重大科技计划（WKJ-ZJ-1814）

摘　　要：目的探讨18F-脱氧葡萄糖(FDG)PET/CT在不明原因腹膜增厚鉴别诊断中的价值。方法对60例疑有腹膜增厚患者的18F-FDG PET/CT检查结果进行分析。利用视觉分析法并同时测量腹膜病灶的最大标准化摄取值(SUVmax),比较18F-FDG PET/CT与同机CT在鉴别不明原因腹膜增厚中的诊断效能,以及恶性与结核性腹膜增厚者PET/CT各项参数和临床特征的区别。结果检出恶性腹膜增厚病灶者42例、结核性良性腹膜增厚病灶者18例。18F-FDG PET/CT与同机CT在鉴别不明原因腹膜增厚中的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为0.905、0.833、0.883、0.927、0.789以及0.548、0.778、0.617、0.852、0.424。恶性组腹膜增厚的SUVmax较结核性良性组升高,分别为5.63±2.69和3.19±2.20(P<0.05)。ROC曲线分析显示,SUVmax>4.24可作为鉴别两者的最佳截断值(曲线下面积为0.77)。此外,两组年龄、腹水密度、腹膜增厚形式及腹水量方面比较差异均有统计学意义(均P<0.05)。结论18F-FDG PET/CT鉴别不明原因腹膜增厚性质具有较高价值,但需注意与结核性腹膜炎的鉴别,其腹膜SUVmax往往较高,可与恶性腹膜增厚相似,此时需结合多项PET/CT参数来鉴别。Objective To evaluate the application of 18F-fluorodeoxyglucose(FDG)PET/CT in the differential diagnosis of peritoneal thickening of undetermined origin.Methods This study included 60 patients(35 men and 25 women with a mean age of 52.7±12.6 years)who had undergone 18F-FDG PET/CT for evaluation of peritoneal thickening of undetermined origin.All 18F-FDG PET/CT images were visually interpreted,and the maximal standardized uptake value(SUVmax)was measured.The diagnostic value in detecting peritoneal thickening of undetermined origin was compared between 18F-FDG PET/CT and CT alone.PET/CT parameters and clinical features of malignant and tuberculous peritoneal thickening were compared.Results There were 42 cases of malignant peritoneal thickening and 18 cases of tuberculous peritoneal thickening.The sensitivity,specificity,accuracy,positive predictive value(PPV),and negative predictive value(NPV)for 18F-FDG PET/CT to differentiate malignant from benign peritoneal thickening were 0.905,0.833,0.883,0.927,and 0.789,respectively.Those indicators for CT alone were 0.548,0.778,0.617,0.852,and 0.424,respectively.Malignant peritoneal thickening had a significantly higher SUVmax than tuberculous peritoneal thickening(5.63±2.69 vs 3.19±2.20;P<0.05).Based on ROC analysis,SUVmax>4.24 was chosen as the optimal cut-off value for differentiating malignant from benign peritoneal thickening.The area under the ROC curve for the selected cut-off value was 0.77.There were significant differences in age,ascites density,pattern of peritoneal thickening,and amount of ascites between malignant and benign peritoneal thickening(P<0.05).Conclusion 18F-FDG PET/CT has a higher clinical value for the differentiation of peritoneal thickening of undetermined origin.For differentiation between tuberculous peritonitis and malignant peritoneal thickening,multiple PET/CT parameters should be taken into consideration to make a correct diagnosis.

关 键 词：腹膜增厚 标准化摄取值 18F-FDG 正电子发射断层显像术 

分 类 号：R817.4[医药卫生—影像医学与核医学] R572[医药卫生—放射医学]