Yoshioka Takashi, Yamaguchi Keiichirou, Kubota Kazuo, Saginoya Toshiyuki, Yamazaki Tetsuro, Ido Tatuo, Yamaura Gengo, Takahashi Hiromu, Fukuda Hiroshi, Kanamaru Ryunosuke
Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
J Nucl Med. 2003 May;44(5):690-9.
PET with 18F-FDG has been widely used in oncology, but its application for stomach neoplasms has been limited. The aim of this study was to evaluate the visual diagnostic accuracy of (18)F-FDG PET for advanced, metastatic, or recurrent gastric cancer and to generate semiquantitative values for lesions.
18F-FDG PET scans were obtained on 42 patients (29 men, 13 women; age, 27-78 y; median age, 63 y): 20 patients with a PT931/04 scanner and 22 patients with a SET2400W scanner. The PT931/04 has a spatial resolution of 6.0 mm at full width at half maximum (FWHM) and covers 15 cm above and below the targeted lesion, and the SET2400W has a spatial resolution of 3.9 mm at FWHM and images the entire body. All PET images were interpreted visually, and tracer uptakes were quantitated as standardized uptake values (SUVs) on SET2400W images.
The sensitivity, specificity, and accuracy as a whole were as follows: 71%, 74%, and 73%, respectively, with the SET2400W scanner and 47%, 79%, and 62%, respectively, with the PT931/04 scanner. Values were high for primary lesions, liver, lymph node, and lung metastases, but were low for bone metastases, ascites, peritonitis, and pleuritis carcinomatoses. SUVs were 8.9 +/- 4.2 (primary lesions, 19 patients/19 lesions), 6.5 +/- 2.2 (liver, 9/55), 6.1 +/- 2.5 (lymph nodes, 14/38), 6.5 +/- 1.8 (abdominal wall, 4/7), 3.9 +/- 2.0 (bone, 3/27), and 4.7 +/- 2.6 (lung, 2/3). Comparing SUVs and histologic findings for 17 untreated patients, values for well-differentiated and moderately differentiated adenocarcinomas versus poorly differentiated adenocarcinomas and signet ring cell carcinomas were 13.2 +/- 6.3 (4/4) versus 7.7 +/- 2.6 (13/13) (P < 0.05) for the primary lesions, 7.0 +/- 2.4 (5/39) versus 5.6 +/- 2.8 (2/2) for the liver, and 5.5 +/- 1.9 (9/28) versus 8.8 +/- 3.3 (3/8) (P < 0.05) for the lymph nodes.
Our results indicate that 18F-FDG PET is a useful diagnostic modality for advanced, metastatic, or recurrent gastric cancer but not for detecting bone metastases, peritonitis, or pleuritis carcinomatoses. 18F-FDG uptake by gastric cancers is relatively high but does not parallel histopathologic features of malignancy.
18F-FDG PET已在肿瘤学中广泛应用，但其在胃肿瘤中的应用有限。本研究的目的是评估18F-FDG PET对晚期、转移性或复发性胃癌的视觉诊断准确性，并为病变生成半定量值。
对42例患者（29例男性，13例女性；年龄27 - 78岁；中位年龄63岁）进行了18F-FDG PET扫描：20例患者使用PT931/04扫描仪，22例患者使用SET2400W扫描仪。PT931/04在半高宽（FWHM）处的空间分辨率为6.0 mm，覆盖目标病变上下15 cm，SET2400W在FWHM处的空间分辨率为3.9 mm，可对全身进行成像。所有PET图像均进行视觉解读，并在SET2400W图像上以标准化摄取值（SUVs）对示踪剂摄取进行定量。
总体而言，SET2400W扫描仪的敏感性、特异性和准确性分别为71%、74%和73%，PT931/04扫描仪分别为47%、79%和62%。原发性病变、肝、淋巴结和肺转移灶的值较高，但骨转移、腹水、腹膜炎和癌性胸膜炎的值较低。SUVs分别为8.9±4.2（原发性病变，19例患者/19个病变）、6.5±2.2（肝脏，9/55）、6.1±2.5（淋巴结，14/38）、6.5±1.8（腹壁，4/7）、3.9±2.0（骨，3/27）和4.7±2.6（肺，2/3）。比较17例未治疗患者的SUVs和组织学结果，高分化和中分化腺癌与低分化腺癌和印戒细胞癌的原发性病变SUVs分别为13.2±6.3（4/4）和7.7±2.6（13/13）（P < 0.05），肝脏分别为7.0±2.4（5/39）和5.6±2.8（2/2），淋巴结分别为5.5±1.9（9/28）和8.8±3.3（3/8）（P < 0.05）。
我们的结果表明，18F-FDG PET是晚期、转移性或复发性胃癌的一种有用诊断方法，但不适用于检测骨转移、腹膜炎或癌性胸膜炎。胃癌的18F-FDG摄取相对较高，但与恶性肿瘤的组织病理学特征不平行。
