直肠癌患者复发的检测：经腹会阴联合切除术或前切除术后的PET/CT检查

Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection.

作者信息

Even-Sapir Einat, Parag Yoav, Lerman Hedva, Gutman Mordechai, Levine Charles, Rabau Micha, Figer Arie, Metser Ur

机构信息

Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 64239, Israel.

出版信息

Radiology. 2004 Sep;232(3):815-22. doi: 10.1148/radiol.2323031065. Epub 2004 Jul 23.

DOI:10.1148/radiol.2323031065

PMID:15273334

Abstract

PURPOSE

To assess diagnostic accuracy of combined positron emission tomography (PET) and computed tomography (CT) in detection of pelvic recurrence in patients with rectal cancer who underwent abdominoperineal or anterior resection.

MATERIALS AND METHODS

Sixty-two patients were enrolled; 37 were men, and 25 were women. Seventeen patients underwent abdominoperineal resection and 45 underwent anterior resection with an anastomosis in the pelvic region before referral for PET/CT. Pelvic sites of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake were rated separately on PET and PET/CT images as benign or malignant on the basis of shape, location, and intensity of (18)F FDG uptake (1-2 = benign and/or physiologic, 3 = equivocal, 4-5 = malignant). Two readers interpreted images in consensus. Altered pelvic anatomy and presence of presacral abnormalities were assessed with CT. Pelvic recurrence was confirmed with histologic analysis or clinical and imaging follow-up. Sensitivity, specificity, positive and negative predictive values, and accuracy of PET and PET/CT in the detection of pelvic recurrence were compared with lesion- and patient-based analyses by using the chi(2) test. Clinical relevance of PET/CT assessment was determined.

RESULTS

Of 81 pelvic sites with increased (18)F FDG uptake, 44 were malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differentiating malignant from benign (18)F FDG uptake in the pelvis were 98%, 96%, 90%, 97%, and 93% for PET/CT and 82%, 65%, 73%, 75%, and 74% for PET, respectively. The most common cause for false-positive interpretation of PET findings was physiologic (18)F FDG uptake in displaced pelvic organs. Presacral CT abnormalities were present in 30 (48%) of 62 patients, and seven (23%) abnormalities were malignant. PET/CT was used to distinguish benign and malignant presacral abnormalities with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 96%, 88%, and 100%, respectively. PET/CT findings were clinically relevant in 29 (47%) of 62 patients.

CONCLUSION

PET/CT is an accurate technique in the detection of pelvic recurrence after surgical removal of rectal cancer.

摘要

目的

评估正电子发射断层扫描（PET）与计算机断层扫描（CT）联合检查在检测接受腹会阴联合切除术或前切除术的直肠癌患者盆腔复发中的诊断准确性。

材料与方法

纳入62例患者，其中男性37例，女性25例。17例患者接受了腹会阴联合切除术，45例患者在转诊进行PET/CT检查前接受了盆腔吻合的前切除术。根据18F氟脱氧葡萄糖（FDG）摄取的形状、位置和强度，在PET和PET/CT图像上分别将盆腔18F FDG摄取部位评定为良性或恶性（1 - 2 = 良性和/或生理性，3 = 可疑，4 - 5 = 恶性）。两名阅片者达成共识解读图像。通过CT评估盆腔解剖结构改变和骶前异常情况。通过组织学分析或临床及影像学随访确认盆腔复发。采用卡方检验对PET和PET/CT检测盆腔复发的敏感性、特异性、阳性和阴性预测值及准确性进行基于病变和患者的分析比较。确定PET/CT评估的临床相关性。

结果

在81个18F FDG摄取增加的盆腔部位中，44个为恶性。PET/CT区分盆腔恶性与良性18F FDG摄取的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为98%、96%、90%、97%和93%，PET分别为82%、65%、73%、75%和74%。PET结果假阳性解读的最常见原因是移位盆腔器官的生理性18F FDG摄取。62例患者中有30例（48%）存在骶前CT异常，其中7例（23%）异常为恶性。PET/CT用于区分良性和恶性骶前异常的敏感性、特异性、阳性预测值和阴性预测值分别为100%、96%、88%和100%。PET/CT结果在62例患者中的29例（47%）具有临床相关性。