De Gaetano Anna Maria, Calcagni Maria Lucia, Rufini Vittoria, Valenza Venanzio, Giordano Alessandro, Bonomo Lorenzo
Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Largo Agostino Gemelli 8, Rome, Italy.
Abdom Imaging. 2009 May-Jun;34(3):391-402. doi: 10.1007/s00261-008-9405-7.
Early diagnosis of peritoneal spread in malignant disease is essential to prevent unnecessary laparotomies and to select the patients in whom complete cytoreduction is feasible. Although anatomic imaging is the mainstay for evaluating peritoneal seeding, small neoplastic implants can be difficult to detect with CT and MR imaging. FDG PET-CT has the potential to improve detection of peritoneal metastases as lesion conspicuity is high at PET due to low background activity and fused PET-CT offers the combined benefits of anatomic and functional imaging. Correlation of uptake modalities with the pathogenesis of intraperitoneal spread of malignancies, provides a rational system of analysis and is essential to define disease. Distinct patterns appear to predict the presence of either nodular or diffuse peritoneal pathology. Main pitfalls are related to normal physiologic activity in bowel loops and blood vessels or focal retained activity in ureters and urinary bladder. PET-CT is most suitable in patients with high tumor markers and negative or uncertain conventional imaging data and in selecting patients for complete cytoreduction. FDG PET-CT adds to conventional imaging in the detection and staging of peritoneal carcinomatosis and is a useful diagnostic tool in monitoring response to therapy and in long term follow-up.
恶性疾病腹膜播散的早期诊断对于避免不必要的剖腹手术以及选择可行完全细胞减灭术的患者至关重要。尽管解剖成像仍是评估腹膜种植的主要手段，但CT和磁共振成像难以检测到小的肿瘤种植灶。氟代脱氧葡萄糖正电子发射断层显像-CT（FDG PET-CT）有潜力提高腹膜转移瘤的检测率，因为在PET上由于背景活性低，病变的清晰度高，且融合的PET-CT兼具解剖成像和功能成像的优势。摄取方式与恶性肿瘤腹膜播散发病机制的相关性提供了一个合理的分析系统，对于明确疾病至关重要。不同的模式似乎可预测结节状或弥漫性腹膜病变的存在。主要陷阱与肠袢和血管的正常生理活性或输尿管和膀胱的局灶性潴留活性有关。PET-CT最适用于肿瘤标志物升高且传统成像数据为阴性或不确定的患者，以及选择进行完全细胞减灭术的患者。FDG PET-CT在腹膜癌的检测和分期方面补充了传统成像，并且是监测治疗反应和长期随访的有用诊断工具。
