Turku PET Centre, Turku University Hospital, Turku, Finland.
Ann Surg. 2009 Dec;250(6):957-63. doi: 10.1097/SLA.0b013e3181b2fafa.
To prospectively compare the accuracy of combined positron emission tomography/computed tomography using F-fluorodeoxyglucose (FDG-PET/CT), multidetector row computed tomography (MDCT), and magnetic resonance imaging (MRI) in the evaluation of patients with suspected pancreatic malignancy.
FDG-PET/CT imaging is increasingly used for staging of pancreatic cancer. Preliminary data suggest a significant influence of FDG-PET/CT on treatment planning, although its role is still evolving.
Thirty-eight consecutive patients with suspicion of pancreatic malignancy were enrolled. Patients underwent a protocol including FDG-PET/CT, MDCT, and MRI combined with magnetic resonance cholangiopancreatography, all of which were blindly evaluated. The findings were confirmed macroscopically at operation and/or by histopathologic analysis (n = 29) or follow-up (n = 9). Results of TNM classification of different imaging methods were compared with clinical TNM classification.
Pancreatic adenocarcinoma was diagnosed in 17 patients, neuroendocrine tumor in 3, mass-forming pancreatitis in 4, cystic lesion in 6, and fibrosis in 2. Six patients had a finding of a normal pancreas. The diagnostic accuracy of FDG-PET/CT for pancreatic malignancy was 89%, compared with 76% and 79% for MDCT and MRI, respectively. In the differential diagnosis of suspected malignant biliary stricture at endoscopic retrograde cholangiopancreaticography (n = 21), FDG-PET/CT had a positive predictive value of 92%. In 17 patients with advanced pancreatic adenocarcinoma, FDG-PET/CT had a sensitivity of 30% for N- and 88% for M-staging. Both MDCT and MRI had sensitivities of 30% for N- and 38% for M-staging. Furthermore, the clinical management of 10 patients (26%) was altered after FDG-PET/CT.
FDG-PET/CT was more sensitive than conventional imaging in the diagnosis of both primary pancreatic adenocarcinoma and associated distant metastases. In contrast, the sensitivity of FDG-PET/CT was poor in detecting local lymph node metastasis, which would have been important for an assessment of resectability. We recommend the use of FDG-PET/CT in the evaluation of diagnostically challenging cases, especially in patients with biliary strictures without evidence of malignancy in conventional imaging.
前瞻性比较氟-18 氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）、多排计算机断层扫描（MDCT）和磁共振成像（MRI）联合应用在评估疑似胰腺恶性肿瘤患者中的准确性。
FDG-PET/CT 成像在胰腺癌分期中越来越多地被应用。初步数据表明 FDG-PET/CT 对治疗计划有显著影响，尽管其作用仍在不断发展。
连续纳入 38 例疑似胰腺恶性肿瘤的患者。所有患者均接受 FDG-PET/CT、MDCT 和 MRI 联合磁共振胰胆管成像方案检查，所有检查均为盲法评估。根据手术和/或组织病理学分析（n = 29）或随访（n = 9）结果对结果进行宏观确认。不同影像学方法的 TNM 分类结果与临床 TNM 分类进行比较。
17 例患者诊断为胰腺腺癌，3 例为神经内分泌肿瘤，4 例为肿块型胰腺炎，6 例为囊性病变，2 例为纤维化。6 例患者胰腺正常。FDG-PET/CT 对胰腺恶性肿瘤的诊断准确率为 89%，而 MDCT 和 MRI 的准确率分别为 76%和 79%。在经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）怀疑恶性胆道狭窄的 21 例患者中，FDG-PET/CT 的阳性预测值为 92%。在 17 例晚期胰腺腺癌患者中，FDG-PET/CT 对 N 分期的敏感性为 30%，对 M 分期的敏感性为 88%。MDCT 和 MRI 对 N 分期的敏感性均为 30%，对 M 分期的敏感性均为 38%。此外，FDG-PET/CT 后有 10 例（26%）患者的临床治疗发生改变。
FDG-PET/CT 在诊断原发性胰腺腺癌和相关远处转移方面比常规影像学检查更敏感。相比之下，FDG-PET/CT 对局部淋巴结转移的敏感性较差，这对于评估可切除性非常重要。我们建议在诊断具有挑战性的病例中使用 FDG-PET/CT，特别是在常规影像学检查无恶性肿瘤证据的患者中存在胆道狭窄的情况下。
