PET/CT在直肠癌术后放化疗患者癌灶远端转移诊断及预后评估中的应用  

Application of PET/CT tomography in the diagnosis of lesion distal metastasis and evaluation of prognosis in patients with chemoradiotherapy after rectal cancer surgery

作　　者：雍伟 姚佳 刘平[3] YONG Wei;YAO Jia;LIU Ping(Department of Surgery,Sichuan Provincial Rehabilitation Hospital/Sichuan Provincial Bayi Rehabilitation Center,Chengdu 611135,China;Chengdu Ruishi Medical Imaging Diagnosis Center,Chengdu 611130,China;Department of Radiography,the Sixth People's Hospital of Chengdu,Chengdu 610051,China)

机构地区：[1]四川省康复医院/四川省八一康复中心外科,四川成都611135 [2]成都锐视医学影像诊断中心,四川成都611130 [3]成都市第六人民医院放射影像科,四川成都610051

出　　处：《分子影像学杂志》2023年第5期895-899,共5页Journal of Molecular Imaging

基　　金：四川省医学(青年创新)科研课题(S20021);四川青年创新科研课题(Q20073)。

摘　　要：目的探究PET/CT在直肠癌术后放化疗患者癌灶远端转移诊断及预后评估中的应用效果。方法回顾性分析我院2019年3月~2020年3月70例直肠癌手术患者的资料,所有患者术后均进行放化疗辅助治疗,并采用PET/CT检测治疗效果,根据治疗后是否出现复发、转移评估患者预后,以病理学检测为金标准,比较CT、PET/CT对直肠癌患者癌灶远端转移的诊断价值;将复发、转移者纳入复发转移组(n=26),无复发转移者纳入预后良好组(n=44),对比两组的临床资料;采用多因素Logistic回归分析影响直肠癌患者术后放化疗患者预后的相关因素。结果70例患者中,术后3年经病理诊断癌灶远端转移阳性21例,阴性49例,CT诊断癌灶远端转移阳性22例,阴性48例,其中漏诊4例,误诊5例,诊断敏感度为80.95%,特异性为88.37%,准确率为87.14%,阳性预测值为77.27%,阴性预测值为91.67%,Kappa值为0.698;PET/CT诊断远端转移阳性23例,阴性47例,其中漏诊2例,误诊4例,诊断敏感度为90.47%,特异性为91.84%,准确率为91.43%,阳性预测值为82.61%,阴性预测值为95.74%,Kappa值为0.801;复发转移组年龄、病灶最大直径、TNM分期、最大标准化摄取值(SUV_(max))、最小标准化摄取值(SUV_(min))、滞留指数(RI)均高于预后良好组(P<0.05),两组性别、BMI、病理类型比较,差异无统计学意义(P>0.05);多因素Logistic回归分析显示,年龄、病灶最大直径、TNM分期、SUV_(max)值、SUV_(min)值、RI值是影响直肠癌患者术后放化疗预后的危险因素(P<0.05)。结论PET/CT技术对直肠癌术后放化疗患者癌灶远端转移诊断价值较高,且其诊断参数SUV_(max)值、SUV_(min)值、RI值是影响患者术后放化疗预后的危险因素,可用于临床术后复发转移预测。Objective To explore the application effects of PET/CT in the diagnosis of lesion distal metastasis and evaluation of prognosis in patients with chemoradiotherapy after rectal cancer surgery.Methods Retrospective analysis was conducted on the data of 70 patients with rectal cancer surgery in the hospital from March 2019 to March 2020.All patients received adjuvant therapy with chemoradiotherapy after surgery,and PET/CT technology was used to detect the therapeutic effect.The prognosis of patients was evaluated according to whether recurrence or metastasis occurred after treatment.With postoperative pathological detection as the gold standard,the diagnostic value of CT and PET/CT on lesion distal metastasis in patients with rectal cancer was compared.Patients with recurrence and metastasis were included in the recurrence metastasis group(n=26),and those without recurrence and metastasis were included in the good prognosis group(n=44).The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to analyze the related factors affecting prognosis of patients with chemoradiotherapy after rectal cancer surgery.Results Among the 70 patients at 3 year after surgery,distal metastasis was positive in 21 cases and negative in 49 cases by pathological diagnosis,distal metastasis was positive in 22 cases and negative in 48 cases by CT diagnosis,including 4 cases of missed diagnosis and 5 cases of misdiagnosis.The diagnostic sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value and Kappa value were 80.95%,88.37%,87.14%,77.27%.91.67%and 0.698.PET/CT diagnosis showed 23 cases of positive distal metastasis and 47 negative cases,including 2 cases of missed diagnosis and 4 cases of misdiagnosis,and the diagnostic sensitivity,specificity,accuracy rate,positive predictive value,negative predictive value and Kappa value were 90.47%,91.84%,91.43%,82.61%,95.74%and 0.801.The age,maximum lesion diameter,TNM stage,maximum standardized uptake value(SUV_(max)),minimu

关 键 词：正电子发射计算机断层显像 直肠癌 放化疗 转移 预后 诊断价值 

分 类 号：R735.3[医药卫生—肿瘤] R730.44[医药卫生—临床医学]