偶发^(18)F-FDG PET/CT结直肠局灶性摄取增高对结直肠早期腺癌及高风险腺瘤的预测价值  

Predictive value of incidental focal colorectal FDG uptake on^(18)F-FDG PET/CT in early colorectal adenocarcinoma and advanced adenomas

作　　者：李文婵[1] 刘甫庚[1] 姚稚明[1] 王宇芃 刘秀芹[1] 张竹[2] Li Wenchan;Liu Fugeng;Yao Zhiming;Wang Yupeng;Liu Xiuqin;Zhang Zhu(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院消化内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《国际放射医学核医学杂志》2023年第5期274-280,共7页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨偶发^(18)F-氟脱氧葡萄糖(FDG)PET/CT结直肠局灶性摄取增高对结直肠早期腺癌及高风险腺瘤的预测价值。方法回顾性分析2016年1月至2020年6月在北京医院因非结直肠病变行全身^(18)F-FDG PET/CT显像并偶然发现结直肠局灶性摄取增高的56例患者[男性31例、女性25例,年龄(66±11)岁,范围38~84岁]的临床资料,以^(18)F-FDG PET/CT检查后3个月内的结肠镜及组织病理学检查结果作为最终诊断标准,分析^(18)F-FDG PET/CT对结直肠早期腺癌及高风险腺瘤的预测价值。正态分布的计量资料的两组间比较采用独立样本t检验,多组间比较采用方差分析;偏态分布的计量资料的两组间比较采用Mann-Whitney检验,多组间比较采用Kruskal-Wallis检验。计数资料的比较采用卡方检验。勾画受试者工作特征(ROC)曲线,分析最大标准化摄取值(SUVmax)对结直肠早期腺癌和高风险腺瘤的诊断效能及最佳诊断临界值。结果56例受检者中,^(18)F-FDG PET/CT共发现74处结直肠局灶性摄取增高灶,结肠镜共发现140处阳性病灶。^(18)F-FDG PET/CT发现的74处结直肠局灶性摄取增高灶中,结肠镜发现阳性病灶59处[其中69.5%(41/59)为早期腺癌(7处)和高风险腺瘤(34处)]、阴性病灶15处。^(18)F-FDG PET/CT共漏诊81处病灶,其中55.6%为非高风险腺瘤(45处),27.2%为非腺瘤性息肉(22处)。^(18)F-FDG PET/CT诊断非腺瘤性息肉、非高风险腺瘤、高风险腺瘤、早期腺癌的灵敏度分别为26.7%(8/30)、10.0%(5/50)、72.3%(34/47)和100%(7/7)(χ^(2)=35.09,P<0.001)。^(18)F-FDG PET/CT诊断结直肠早期腺癌和高风险腺瘤的阳性预测值为55.4%(41/74)。ROC曲线分析结果显示,SUVmax诊断结直肠早期腺癌及高风险腺瘤的最佳临界值为11.6。结论偶发^(18)F-FDG PET/CT结直肠局灶性摄取增高对结直肠早期腺癌及高风险腺瘤的诊断灵敏度及阳性预测值均较高。对于偶发^(18)F-FDG PET/CT结直肠局灶性摄取增高灶,后Objective To investigate the predictive values of^(18)F-fluorodeoxyglucose(FDG)PET/CT in patients with incidental focal colorectal FDG uptake in diagnosing early colorectal adenocarcinoma and advanced adenomas by comparing such values with colonoscopic and histopathologic findings.Methods Fifty-six patients(31 males and 25 females,aged(66±11)years,range 38–84 years)were retrospectively enrolled for the study.These patients underwent^(18)F-FDG PET/CT for noncolorectal lesions with incidental focal colorectal FDG uptake in Beijing Hospital between January 2016 and June 2020.Taking the results of colonoscopy and histopathology within 3 months after^(18)F-FDG PET/CT examination as the final diagnostic criteria,the predictive values of^(18)F-FDG PET/CT for early colorectal adenocarcinoma and advanced adenoma were analyzed.The normally distributed measurement data were compared between two groups using independent sample t-test(with equal variance)and among multiple groups using analysis of variance.Skewed distribution measurement data were compared between these two groups using Mann-Whitney test,whereas those for multiple groups were compared using the Kruskal-Wallis test.Rate enumeration data were also compared using the Chi-square test.Furthermore,the receiver operating characteristic(ROC)curve was delineated to analyze the diagnostic efficacy and optimal diagnostic threshold of maximum standardized uptake value(SUVmax)for diagnosing early colorectal adenocarcinoma and advanced adenomas.Results Fifty-six patients were enrolled in this study.A total of 74 incidental colorectal^(18)F-FDG uptake foci were found,while colonoscopy revealed 140 lesions.Among 74 incidental colorectal^(18)F-FDG uptake foci,59 and 15 foci were found to be positive and negative,respectively,during colonoscopy.Among 59 positive colonoscopic findings,69.5%(41/59)were early colorectal adenocarcinoma(n=7)and advanced adenomas(n=34).Among 81 lesions that were considered missed diagnoses via^(18)F-FDG PET/CT,55.6%were nonadvanced adenomas(n=45)

关 键 词：结直肠肿瘤 腺癌 腺瘤 氟脱氧葡萄糖F18 正电子发射断层显像术 结肠镜检查 局灶性摄取 

分 类 号：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]