Imdahl A, Nitzsche E, Krautmann F, Högerle S, Boos S, Einert A, Sontheimer J, Farthmann E H
Department of Surgery, University Hospital of Freiburg, Germany.
Br J Surg. 1999 Feb;86(2):194-9. doi: 10.1046/j.1365-2168.1999.01016.x.
The clinical presentation of patients with pancreatic cancer may resemble the clinical picture of chronic pancreatitis. A definitive preoperative diagnosis is not always obtained in patients with a history of chronic pancreatitis despite the use of modern imaging techniques. Operative strategy therefore remains unclear before operation in these patients.
Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) was introduced recently into clinical oncology because of its ability to demonstrate metabolic changes associated with various disease processes. The impact of FDG-PET on the differentiation of chronic pancreatitis and pancreatic cancer was investigated. FDG-PET was performed in 48 patients with chronic pancreatitis (n = 12), acute pancreatitis (n = 3) and pancreatic cancer (n = 27), and in controls (n = 6). Histological examination was undertaken in all cases except controls. The FDG-PET results were obtained without knowledge of results of other imaging procedures. The results were then compared with those of computed tomography, ultrasonography, endoscopic retrograde cholangiopancreaticography, operative findings and histology. PET images were analysed semiquantitatively by calculating a standard uptake value (SUV) 90-120 min after application of the tracer.
Cut-off values were validated as follows: SUV greater than 4.0 for pancreatic cancer, SUV of 3.0-4.0 for chronic pancreatitis, and SUV of less than 3.0 for controls. Sensitivity and specificity of PET imaging were 0.96 and 1.0 for pancreatic cancer, and 1.0 and 0.97 for chronic pancreatitis. In five cases only FDG-PET led to the correct preoperative diagnosis.
The results give further evidence that FDG-PET is an important non-invasive method for the differentiation of chronic pancreatitis and pancreatic cancer. Delayed image acquisition in the glycolysis plateau phase permits improved diagnostic performance. This imaging technique is extremely helpful before operation in patients with an otherwise unclear pancreatic mass, despite its costs.
胰腺癌患者的临床表现可能类似于慢性胰腺炎的临床表现。尽管使用了现代成像技术，但有慢性胰腺炎病史的患者术前并不总是能获得明确诊断。因此，这些患者术前的手术策略仍不明确。
正电子发射断层扫描（PET）结合2-[18F]氟-2-脱氧-D-葡萄糖（FDG）最近因其能够显示与各种疾病过程相关的代谢变化而被引入临床肿瘤学。研究了FDG-PET对慢性胰腺炎和胰腺癌鉴别的影响。对48例慢性胰腺炎患者（n = 12）、急性胰腺炎患者（n = 3）、胰腺癌患者（n = 27）及对照组（n = 6）进行了FDG-PET检查。除对照组外，所有病例均进行了组织学检查。在不知道其他成像检查结果的情况下获取FDG-PET结果。然后将结果与计算机断层扫描、超声、内镜逆行胰胆管造影、手术所见及组织学结果进行比较。通过计算注入示踪剂后90 - 120分钟的标准摄取值（SUV）对PET图像进行半定量分析。
确定的临界值如下：胰腺癌的SUV大于4.0，慢性胰腺炎的SUV为3.0 - 4.0，对照组的SUV小于3.0。PET成像对胰腺癌的敏感性和特异性分别为0.96和1.0，对慢性胰腺炎的敏感性和特异性分别为1.0和0.97。仅在5例病例中，FDG-PET得出了正确的术前诊断。
结果进一步证明FDG-PET是鉴别慢性胰腺炎和胰腺癌的重要非侵入性方法。在糖酵解平台期延迟图像采集可提高诊断性能。尽管成本较高，但这种成像技术对胰腺肿块情况不明的患者术前极为有用。
