氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）对胰腺肿块性病变的诊断价值

Diagnostic usefulness of FDG PET for pancreatic mass lesions.

作者信息

Koyama K, Okamura T, Kawabe J, Nakata B, Chung K H, Ochi H, Yamada R

机构信息

Department of Radiology, Osaka City University School of Medicine, Osaka, Japan.

出版信息

Ann Nucl Med. 2001 Jun;15(3):217-24. doi: 10.1007/BF02987835.

DOI:10.1007/BF02987835

PMID:11545191

Abstract

UNLABELLED

The purpose of this study was to investigate the feasibility of [18F]2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) in patients with a pancreatic mass by comparing the results with those of X-ray computed tomography (CT) and magnetic resonance (MR) imaging.

METHODS

Eighty-six patients with pancreatic lesions, included 65 malignant tumors and 21 benign masses (55 masses were proven histologically and the others were diagnosed clinically), were studied. The diagnostic factors of CT and MR imaging were evaluated, and those of FDG PET were also evaluated for malignant and benign masses by visual interpretation and quantitative interpretation with the standardized uptake value (SUV) and SUVgluc which was designed to reduce the effects of a high blood sugar level. Visual interpretations were evaluated only in FDG PET images, and quantitative interpretations were evaluated by referring to CT and/or MR imaging. The correlation between SUV and the degree of histological differentiation in pancreatic ductal adenocarcinoma was investigated.

RESULTS

Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for CT imaging were 91, 62, 88, 68 and 84%, and for MR imaging 78, 70, 88, 54 and 76%, respectively. In visual interpretation of FDG PET images, the sensitivity, specificity, PPV, NPV and accuracy were 82, 81, 93, 59 and 81%, respectively. Significant differences between malignant and benign lesions existed in SUV and SUVgluc (p < 0.0001, each). With the cutoff value of SUV as 2.1 and SUVgluc as 2.2, the accuracy of diagnosis was maximal. With that cutoff value, the sensitivity, specificity, PPV, NPV and accuracy for SUV were 89, 76, 92, 70 and 86%, and for SUVgluc 91, 76, 92, 73 and 87%, respectively. The sensitivity and NPV of SUVgluc were higher than those of SUV, which suggests that SUVgluc may be more useful in reducing the number of overlooked malignant tumors. The specificity and PPV of FDG PET were superior to those of CT and MR imaging. There were no significant differences between the SUVs of moderately differentiated adenocarcinomas and those of well differentiated adenocarcinomas.

CONCLUSION

To improve the diagnostic procedure for classifying masses, FDG PET with not only SUV but also SUV corrected by the blood sugar level is required in addition to morphological diagnosis by CT and/or MR imaging.

摘要

未标注

本研究的目的是通过将[18F]2-脱氧-2-氟-D-葡萄糖（FDG）正电子发射断层扫描（PET）的结果与X射线计算机断层扫描（CT）和磁共振（MR）成像的结果进行比较，来研究其在胰腺肿块患者中的可行性。

方法

对86例胰腺病变患者进行了研究，其中包括65例恶性肿瘤和21例良性肿块（55例肿块经组织学证实，其余经临床诊断）。评估了CT和MR成像的诊断因素，并通过视觉解读以及使用标准化摄取值（SUV）和为减少高血糖水平影响而设计的SUVgluc进行定量解读，对FDG PET在恶性和良性肿块中的诊断因素也进行了评估。仅在FDG PET图像中评估视觉解读，通过参考CT和/或MR成像来评估定量解读。研究了SUV与胰腺导管腺癌组织学分化程度之间的相关性。

结果

CT成像的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为91%、62%、88%、68%和84%，MR成像的分别为78%、70%、88%、54%和76%。在FDG PET图像的视觉解读中，敏感性、特异性、PPV、NPV和准确性分别为82%、81%、93%、59%和81%。SUV和SUVgluc在恶性和良性病变之间存在显著差异（均为p < 0.0001）。当SUV的临界值为2.1且SUVgluc为2.2时，诊断准确性最高。以此临界值，SUV的敏感性、特异性、PPV、NPV和准确性分别为89%、76%、92%、70%和86%，SUVgluc的分别为91%、76%、92%、73%和87%。SUVgluc的敏感性和NPV高于SUV，这表明SUVgluc在减少被漏诊的恶性肿瘤数量方面可能更有用。FDG PET的特异性和PPV优于CT和MR成像。中分化腺癌的SUV与高分化腺癌的SUV之间无显著差异。