Zhang Zhanwen, Lyu Qinghu, Chen Feini, Zhang Jie, Lu Dan, Hu Ping, Ma Liheng
The Medical Diagnostic Centre, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510610, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2014 Mar;17(3):239-44.
To investigate the value of water enema (18)F-fluorodexyglucose positron emission tomography and computed tomography((18)F-FDG PET-CT) in incidental finding of hypermetabolism focus in the colon and rectum for differential diagnosis of benign or malignant lesions.
From June 2010 to December 2012 in our hospital, 77 patients were found incidentally with uncertain hypermetabolism focuses in the colon and rectum during PET-CT examination. Water enema (18)F-FDG PET-CT was performed to classify the lesions. According to the pathological examination and clinical follow-up, these cases were divided into malignant disease (including advanced colorectal adenoma), benign adenoma, inflammation and physiological uptake. Radioactive uptake level (SUVmax) and change of water enema imaging (retention index, RI) of hypermetabolism focus were compared between groups.
Of these 77 cases, 23 were malignant diseases, 16 benign adenoma, 7 inflammation and 31 physiological uptake. The difference of average SUVmax was not statistically significant between benign and malignant lesions as well as physiological uptake(P>0.05). But the difference of RI was statistically significant between neoplastic lesions and inflammation(P<0.05). The accuracy of water enema (18)F-FDG PET-CT in diagnosing non-neoplastic uptake was 100%, and the sensitivity, specificity and accuracy in differentiation of malignancy form benign lesions were 95.6%, 96.3%, and 96.1% respectively.
The incidental focal colorectal (18)F-FDG uptake in PET-CT may indicate potential colorectal malignant lesions and adenoma. Water enema can effectively differentiate the physiological uptake and predict benign lesions or malignancy in the colon and rectum colorectum with good accuracy.
探讨水灌肠（18）F - 氟脱氧葡萄糖正电子发射断层扫描与计算机断层扫描（（18）F - FDG PET - CT）在偶然发现的结直肠代谢增高灶鉴别诊断良恶性病变中的价值。
2010年6月至2012年12月在我院，77例患者在PET - CT检查时偶然发现结直肠存在代谢增高灶但性质不明。行水灌肠（18）F - FDG PET - CT对病变进行分类。根据病理检查及临床随访，将这些病例分为恶性疾病（包括进展期结直肠腺瘤）、良性腺瘤、炎症及生理性摄取。比较各组间代谢增高灶的放射性摄取水平（SUVmax）及水灌肠影像变化（潴留指数，RI）。
这77例病例中，恶性疾病23例，良性腺瘤16例，炎症7例，生理性摄取31例。良性与恶性病变以及生理性摄取之间的平均SUVmax差异无统计学意义（P>0.05）。但肿瘤性病变与炎症之间的RI差异有统计学意义（P<0.05）。水灌肠（18）F - FDG PET - CT诊断非肿瘤性摄取的准确率为100%，鉴别恶性与良性病变的敏感度、特异度及准确率分别为95.6%、96.3%和96.1%。
PET - CT偶然发现的结直肠局灶性（18）F - FDG摄取可能提示潜在的结直肠恶性病变及腺瘤。水灌肠能有效鉴别生理性摄取，并准确预测结直肠的良性病变或恶性病变。
