Choi Byung Wook, Zeon Seok Kil, Kim Sung Hun, Jo Il, Kim Hae Won, Won Kyoung Sook
Department of Nuclear Medicine, Keimyung University, School of Medicine, #194, Dongsan-Dong, Jung-Gu, Daegu Korea.
Nucl Med Mol Imaging. 2011 Dec;45(4):285-90. doi: 10.1007/s13139-011-0105-9. Epub 2011 Sep 9.
The aim of this study was to characterize the patterns of fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography/computed tomography (FDG PET/CT) at the anastomotic site of gastroduodenostomy after distal subtotal gastrectomy in patients with gastric cancer.
From May 2007 to May 2010, two or more follow-up measurements using FDG PET/CT scans were done for 19 patients (11 men, 8 women; mean age, 62.0 ± 10.3 years) who underwent distal subtotal gastrectomy with gastroduodenostomy between February 2006 and March 2008 for detecting gastric cancer recurrence at our medical center. The FDG PET/CT images were retrospectively reviewed. Patients with local recurrence, regional nodal metastasis or distant metastasis on follow-up studies were excluded. CT and endoscopy were done within 1 month before or after the FDG PET/CT scan. Eight patients had two follow-ups of FDG PET/CT, and 11 patients had three follow-ups. The mean interval between surgery and the first follow-up FDG PET/CT was 12.9 ± 0.8 months (n = 19); between the first and second it was 12.3 ± 1.0 months (n = 19); between the second and third it was 11.6 ± 0.7 months (n = 11). The F-18 FDG uptakes at the anastomotic site and fundus in the remnant stomach were measured by maximum standardized uptake value (SUVmax) using a region of interest technique.
The SUVmax at the anastomotic site was significantly higher than that of the fundus on all series of first, second and third follow-up studies (3.3 ± 1.1 vs. 2.1 ± 0.7, p < 0.001: 3.1 ± 0.9 vs. 2.2 ± 0.7, p = 0.001: 3.0 ± 0.6 vs. 2.1 ± 0.7, p = 0.006, respectively). The SUVmax for the anastomotic site and fundus, and SUVmax ratio for the anastomotic site over the fundus were not significantly different throughout the series.
The SUVmax at the anastomotic site is significantly higher than that of the fundus and does not decrease significantly over time. Therefore, the local recurrence of gastric cancer after surgery could not be definitely differentiated from physiologic uptake or postoperative inflammatory change.
本研究旨在描述胃癌患者远端胃次全切除术后胃十二指肠吻合口处18F氟脱氧葡萄糖（FDG）摄取模式在F-18 FDG正电子发射断层扫描/计算机断层扫描（FDG PET/CT）上的表现。
2007年5月至2010年5月，对19例患者（11例男性，8例女性；平均年龄62.0±10.3岁）进行了两次或更多次FDG PET/CT扫描随访，这些患者于2006年2月至2008年3月在本医疗中心接受了远端胃次全切除术并进行胃十二指肠吻合术，以检测胃癌复发情况。对FDG PET/CT图像进行回顾性分析。排除随访研究中出现局部复发、区域淋巴结转移或远处转移的患者。在FDG PET/CT扫描前或后1个月内进行CT和内镜检查。8例患者进行了两次FDG PET/CT随访，11例患者进行了三次随访。手术至首次随访FDG PET/CT的平均间隔时间为12.9±0.8个月（n = 19）；首次与第二次之间为12.3±1.0个月（n = 19）；第二次与第三次之间为11.6±0.7个月（n = 11）。采用感兴趣区技术通过最大标准化摄取值（SUVmax）测量吻合口处及残胃底部的F-18 FDG摄取情况。
在所有系列的首次、第二次和第三次随访研究中，吻合口处的SUVmax均显著高于胃底部（分别为3.3±1.1 vs. 2.1±0.7，p < 0.001；3.1±0.9 vs. 2.2±0.7，p = 0.001；3.0±0.6 vs. 2.1±0.7，p = 0.006）。整个系列中，吻合口处和胃底部的SUVmax以及吻合口处与胃底部的SUVmax比值均无显著差异。
吻合口处的SUVmax显著高于胃底部，且随时间无明显下降。因此，术后胃癌的局部复发无法与生理性摄取或术后炎症改变明确区分。
