上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

18F-FDG PET/CT在胰腺腺癌术前评估中的价值及对治疗决策的影响

徐枫1，2，李彪1   

  1. 上海交通大学 医学院 1.附属瑞金医院核医学科， 上海 200025；  2.附属第九人民医院核医学科， 上海 200011
  • 出版日期:2016-05-28 发布日期:2016-05-26
  • 通讯作者: 李彪, 电子信箱: lb10363@rjh.com.cn。
  • 作者简介:徐枫（1981—）， 男， 主治医师， 硕士; 电子信箱: xufeng1_917@citiz.net。
  • 基金资助:

    国家临床重点专科建设项目

Value of 18F-FDG PET/CT for pre-operative evaluation of pancreatic adenocarcinoma and its effects on the therapeutic decision

XU Feng1,2, LI Biao1   

  1. 1.Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of medicine, Shanghai 200025, China; 2.Department of Nuclear Medicine, Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of medicine, Shanghai 200011, China
  • Online:2016-05-28 Published:2016-05-26
  • Supported by:

    National Leading Clinical Discipline Project

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摘要：

目的 评价18F-FDG PET/CT在胰腺腺癌术前评估中的价值及对治疗决策的影响。方法 回顾分析89例具有完整资料（包括腹部增强CT和18F-FDG PET/CT）且原发肿瘤经病理检查或活检证实为腺癌的胰腺癌患者的临床资料。其中29例被手术证实为有手术指征，60例被手术或随访证实为无手术指征。通过增强CT、18F-FDG PET/CT、增强CT结合18F-FDG PET/CT评估胰腺腺癌患者术前远处转移及手术指征，使用χ2检验比较3种方法的效能；评估增强CT结合18F-FDG PET/CT后对治疗决策的影响。结果 增强CT、18F-FDG PET/CT、增强CT结合18F-FDG PET/CT评估胰腺腺癌远处转移准确度分别为73.0%、88.8%、92.1%(χ2=14.2，P=0.001)，评估手术指征的准确度分别为68.5%、73.0%、85.4%(χ2=7.4，P=0.025)。在增强CT评估为有手术指征的57例患者中，28例被手术证实为无手术指征，结合18F-FDG PET/CT后准确发现了其中的15例无手术指征患者；而增强CT评估为无手术指征的29例患者均被手术或随访证实为无手术指征，增强CT结合PET/CT检查未改变评估结果。结论 对增强CT术前评估为有手术指征的胰腺腺癌患者，增加PET/CT检查是必要的。

关键词: 胰腺肿瘤, 18F-FDG PET/CT, 诊断, 治疗决策

Abstract:

Objective To assess the value of 18F-FDG PET/CT for pre-operative evaluation of pancreatic adenocarcinoma and its effects on the therapeutic decision. Methods A retrospective analysis of clinical dada on 89 patients with pathology or biopsy-proven primary pancreatic adenocarcinoma and complete hospital records [including abdominal contrast-enhanced CT (ce-CT) and 18F-FDG PET/CT]. 29 cases were proved by operations to have surgical indications and 60 cases were proved by operations or follow-ups to have no surgical indication. First, pre-operative distant metastases and surgical indications were assessed via ce-CT, 18F-FDG PET/CT, and ce-CT combined with 18F-FDG PET/CT for patients with pancreatic adenocarcinoma. The efficacy of three methods was compared with χ2 test. Second, the effects of ce-CT combined with 18F-FDG PET/CT on the therapeutic decision were assessed. Results The accuracy rates of ce-CT, 18F-FDG PET/CT, and ce-CT combined with 18F-FDG PET/CT for evaluating the distant metastasis of pancreatic adenocarcinoma were 73.0%, 88.8%, and 92.1%, respectively (χ2=14.2, P=0.001). The accuracy rates for evaluating the surgical indication were 68.5%, 73.0%, and 85.4%, respectively (χ2=7.4, P=0.025). Of 57 patients who were evaluated by ce-CT to have surgical indications, 28 were proved by operations to have no surgical indication and 15 of them were correctly identified by the combination of 18F-FDG PET/CT. Of 29 patients who were evaluated by ce-CT to have no surgical indication, all of them were proven by operations or follow-ups to have no surgical indication. Ce-CT combined with PET/CT did not change the evaluation results. Conclusion For patients with pancreatic adenocarcinoma who are pre-operatively evaluated by ce-CT to have surgical indications, 18F-FDG PET/CT examination is necessary.

Key words: pancreatic neoplasms, 18F-FDG PET/CT, diagnosis, therapeutic decision