Higashi Tatsuya, Saga Tsuneo, Nakamoto Yuji, Ishimori Takayoshi, Fujimoto Koji, Doi Ryuichiro, Imamura Masayuki, Konishi Junji
Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Sakyo, Japan.
Ann Nucl Med. 2003 Jun;17(4):261-79. doi: 10.1007/BF02988521.
The present review will provide an overview of the literature concerning the FDG PET diagnosis of pancreatic cancer and a summary from our experience of 231 cases of pancreatic lesions. FDG PET can effectively differentiate pancreatic cancer from benign lesion with high accuracy. Newly-developed PET scanners can detect small pancreatic cancers, up to 7 mm in diameter, by their high resolution, which could make a great contribution to the early detection of resectable and potentially curable pancreatic cancers. FDG PET is useful and cost-beneficial in the pre-operative staging of pancreatic cancer because an unexpected distant metastasis can be detected by whole-body PET in about 40% of the cases, which results in avoidance of unnecessary surgical procedures. FDG PET is also useful in evaluation of the treatment effect, monitoring after the operation and detection of recurrent pancreatic cancers. However, there are some drawbacks in PET diagnosis. A relatively wide overlap has been reported between semiquantitative uptake values obtained in cancers and those in inflammatory lesions. As for false-positive cases, active and chronic pancreatitis and autoimmune pancreatitis sometimes show high FDG accumulation and mimic pancreatic cancer with a shape of focal uptake. There were 8 false negative cases in the detection of pancreatic cancer by FDG PET, up to 33 mm in diameter, mainly because of their poor cellularity in cancer tissues. In addition, there are 19% of cancer cases with a decline in FDG uptake from 1 hr to 2 hr scan. FDG PET was recently applied to and was shown to be feasible in the differential diagnosis of cystic pancreatic lesions, such as intraductal papillary mucinous tumor of the pancreas. Further investigations are required to clarify the clinical value of FDG PET in predicting prognosis of the pancreatic patients.
本综述将概述有关FDG PET诊断胰腺癌的文献，并总结我们对231例胰腺病变的经验。FDG PET能够以高准确率有效区分胰腺癌与良性病变。新开发的PET扫描仪凭借其高分辨率可检测出直径达7毫米的小胰腺癌，这对可切除且有可能治愈的胰腺癌的早期检测有很大贡献。FDG PET在胰腺癌术前分期中有用且具有成本效益，因为全身PET可在约40%的病例中检测到意外的远处转移，从而避免不必要的手术。FDG PET在评估治疗效果、术后监测及检测复发性胰腺癌方面也很有用。然而，PET诊断存在一些缺点。据报道，癌症与炎症性病变的半定量摄取值之间存在相对较大的重叠。对于假阳性病例，急性和慢性胰腺炎以及自身免疫性胰腺炎有时会显示出高FDG摄取，并以局灶性摄取的形式模拟胰腺癌。在FDG PET检测胰腺癌时，有8例假阴性病例，直径达33毫米，主要原因是癌组织细胞含量低。此外，有19%的癌症病例在1小时至2小时扫描期间FDG摄取下降。FDG PET最近应用于胰腺囊性病变的鉴别诊断，如胰腺导管内乳头状黏液性肿瘤，并显示出可行性。需要进一步研究以阐明FDG PET在预测胰腺疾病患者预后方面的临床价值。
