18 氟脱氧葡萄糖正电子发射断层扫描对胰腺导管腺癌的诊断没有帮助。

18-Fluorodeoxyglucose positron emission tomography does not aid in diagnosis of pancreatic ductal adenocarcinoma.

机构信息

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan.

出版信息

Clin Gastroenterol Hepatol. 2013 Jun;11(6):712-8. doi: 10.1016/j.cgh.2012.12.033. Epub 2013 Jan 22.

DOI:10.1016/j.cgh.2012.12.033

PMID:23353642

Abstract

BACKGROUND & AIMS: There are no accurate and reliable tools for diagnosis of early stage pancreatic ductal adenocarcinoma (PDA) or small metastatic lesions. It is also a challenge to differentiate PDA from focal mass-forming pancreatitis (FMP). There is controversy regarding the efficacy of 18-fluorodeoxyglucose positron-emission tomography (FDG-PET) in the diagnosis of PDA. We investigated whether FDG-PET provides information that, combined with data from other imaging techniques, can aid in decision making for patients with suspected PDA.

METHODS

We performed a retrospective analysis of data collected from 232 consecutive patients with suspected PDA at Kobe University Hospital from January 2006 through June 2012. All patients underwent a diagnostic imaging protocol that included multidetector row computed tomography, superparamagnetic iron oxide-enhanced magnetic resonance imaging, and FDG-PET. Based on endoscopic ultrasonography, fine-needle aspiration biopsy, or endoscopic retrograde cholangiopancreatography analyses, 218 patients had PDA (89 underwent resection and 129 did not) and 14 patients had FMP (8 had focal mass-forming chronic pancreatitis and 6 had focal mass-forming autoimmune pancreatitis).

RESULTS

FDG-PET detected 50% of stages 0 and I, 91.9% of stage II, 100% of stage III, and 96.8% of stage IV tumors. Detection was affected significantly by tumor size (P = .024) and T stage (P = .023) in resected tumors. Multidetector row computed tomography detected significantly more liver metastases than FDG-PET. Few para-aortic lymph node or peritoneal metastases were detected by FDG-PET. FDG-PET correctly identified 11 of the 14 patients with FMP (5 of 8 with focal mass-forming chronic pancreatitis and 6 of 6 with focal mass-forming autoimmune pancreatitis).

CONCLUSIONS

FDG-PET is not effective in detecting early stage PDA and small metastases, or in differentiating PDA from FMP. Combining FDG-PET with current diagnostic techniques for PDA did not provide any decisive information, therefore it should not be included in this analysis.

摘要

背景与目的

目前尚无准确、可靠的工具用于诊断早期胰腺导管腺癌（PDA）或小的转移性病变。区分 PDA 与局限性肿块型胰腺炎（FMP）也颇具挑战。18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在 PDA 诊断中的有效性存在争议。我们旨在研究 FDG-PET 是否能提供信息，这些信息与其他影像学技术的数据相结合，有助于疑似 PDA 患者的决策。

方法

我们对 2006 年 1 月至 2012 年 6 月期间在神户大学医院接受疑似 PDA 诊断的 232 例连续患者的数据进行了回顾性分析。所有患者均接受了包括多排螺旋 CT、超顺磁性氧化铁增强磁共振成像和 FDG-PET 在内的诊断性影像学检查。根据内镜超声、细针抽吸活检或内镜逆行胰胆管造影分析，218 例患者患有 PDA（89 例行切除术，129 例未行切除术），14 例患者患有 FMP（8 例为局限性肿块型慢性胰腺炎，6 例为局限性肿块型自身免疫性胰腺炎）。

结果

FDG-PET 检测到 50%的 0 期和 1 期、91.9%的 2 期、100%的 3 期和 96.8%的 4 期肿瘤。在切除肿瘤中，肿瘤大小（P =.024）和 T 分期（P =.023）显著影响检测。多排螺旋 CT 检测到的肝转移灶明显多于 FDG-PET。FDG-PET 很少检测到腹主动脉旁淋巴结或腹膜转移。FDG-PET 正确识别了 14 例 FMP 患者中的 11 例（8 例局限性肿块型慢性胰腺炎中的 5 例，6 例局限性肿块型自身免疫性胰腺炎中的 6 例）。