Le Roux Pierre-Yves, Duong Cuong P, Cabalag Carlos S, Parameswaran Bimal K, Callahan Jason, Hicks Rodney J
Peter MacCallum Cancer Centre, Division of Radiation Oncology and Cancer Imaging, East Melbourne, Australia.
Department of Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France.
Eur J Nucl Med Mol Imaging. 2016 Apr;43(4):644-53. doi: 10.1007/s00259-015-3211-6. Epub 2015 Oct 21.
To assess the diagnostic utility of gastric distension (GD) FDG PET/CT in both patients with known gastric malignancy and those not known to have gastric malignancy but with incidental focal FDG uptake in the stomach.
This retrospective analysis included 88 patients who underwent FDG PET/CT following GD with hyoscine N-butylbromide (Buscopan®) and water ingestion as part of routine clinical evaluation between 2004 and 2014. FDG PET/CT scans before and after GD were reported blinded to the patient clinical details in 49 patients undergoing pretreatment staging of gastric malignancy and 39 patients who underwent GD following incidental suspicious gastric uptake. The PET findings were validated by a composite clinical standard.
In the 49 patients undergoing pretreatment staging of gastric malignancy, GD improved PET detection of the primary tumour (from 80 % to 90 %). PET evaluation of tumour extent was concordant with endoscopic/surgical reports in 31 % (interpreter 1) and 45 % (interpreter 2) using pre-GD images and 73 % and 76 % using GD images. Interobserver agreement also improved with GD (κ = 0.29 to 0.69). Metabolic and morphological quantitative analysis demonstrated a major impact of GD in normal gastric wall but no significant effect in tumour, except a minor increase in SUV related to a delayed acquisition time. The tumour to normal stomach SUVmax ratio increased from 3.8 ± 2.9 to 9.2 ± 8.6 (mean ± SD) with GD (p < 0.0001), facilitating detection and improved assessment of the primary tumour. In 25 (64 %) of the 39 patients with incidental suspicious gastric uptake, acquisition after GD correctly excluded a malignant process. In 10 (71 %) of the remaining 14 patients with persistent suspicious FDG uptake despite GD, malignancy was confirmed and in 3 (21 %) an active but benign pathology was diagnosed.
GD is a simple way to improve local staging with FDG PET in patients with gastric malignancy. In the setting of incidental suspicious gastric uptake, GD is also an effective tool for ruling out malignancy and leads to the avoidance of unnecessary endoscopy.
评估胃扩张（GD）氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG PET/CT）在已知患有胃恶性肿瘤的患者以及未知患有胃恶性肿瘤但胃内有偶然局灶性FDG摄取的患者中的诊断效用。
这项回顾性分析纳入了88例患者，这些患者在2004年至2014年间作为常规临床评估的一部分，在服用丁溴东莨菪碱（解痉灵®）和水后进行了GD，随后接受了FDG PET/CT检查。在49例接受胃恶性肿瘤预处理分期的患者和39例胃内偶然出现可疑摄取后接受GD的患者中，对GD前后的FDG PET/CT扫描结果进行了报告，报告时对患者的临床细节不知情。PET检查结果通过综合临床标准进行验证。
在49例接受胃恶性肿瘤预处理分期的患者中，GD提高了PET对原发性肿瘤的检测率（从80%提高到90%）。使用GD前图像时，PET对肿瘤范围的评估与内镜/手术报告的一致性为31%（解读员1）和45%（解读员2），使用GD图像时为73%和76%。观察者间的一致性也因GD而提高（κ值从0.29提高到0.69）。代谢和形态学定量分析表明，GD对正常胃壁有重大影响，但对肿瘤无显著影响，除了与采集时间延迟相关的SUV略有增加。随着GD的进行，肿瘤与正常胃的SUVmax比值从3.8±2.9增加到9.2±8.6（平均值±标准差）（p<0.0001），有助于原发性肿瘤的检测和评估。在39例胃内偶然出现可疑摄取的患者中，25例（64%）在GD后采集正确排除了恶性病变。在其余14例尽管进行了GD仍持续存在可疑FDG摄取的患者中，10例（71%）确诊为恶性肿瘤，3例（21%）诊断为活跃但良性的病变。
GD是一种在胃恶性肿瘤患者中通过FDG PET改善局部分期的简单方法。在胃内偶然出现可疑摄取的情况下，GD也是排除恶性肿瘤的有效工具，可避免不必要的内镜检查。
