Kadhim Lujaien A, Dholakia Avani S, Herman Joseph M, Wahl Richard L, Chaudhry Muhammad A
Tawam Molecular Imaging Center, P.O. Box 220323, Al Ain, United Arab Emirates.
Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA.
J Radiat Oncol. 2013 Dec;2(4):341-352. doi: 10.1007/s13566-013-0130-7. Epub 2013 Oct 30.
Pancreatic cancer continues to have a grim prognosis with 5-year survival rates at less than 5 %. It is a particularly challenging health problem given these poor survival outcomes, aggressive tumor biology, and late onset of symptoms. Most patients present with advanced unresectable cancer however, margin-negative resection provides a rare chance for cure for patients with resectable disease. The standard imaging modality for the diagnosis and management of pancreatic cancer is contrast-enhanced multidetector computed tomography. Remarkable advances in CT technology have led to improvements in the ability to detect small tumors and intricate vasculature involvement by the tumor, yet CT is still restricted to providing a morphological portrait of the tumor. Diagnosis can be challenging due to similar appearance of certain benign and malignant disease. Distant metastatic disease can be silent on CT leading to improper staging, and thus management, of certain patients. Furthermore, radiation-induced fibrosis and necrosis complicate assessment of treatment response by CT alone. F-fluorodeoxyglucose positron emission tomography (F-FDG-PET) is becoming a prevalent tool employed by physicians to improve accuracy in these clinical scenarios. Malignant transformation causes a high metabolic activity of cancer cells. F-FDG-PET captures this functional activity of malignancies by capturing areas with high glucose utilization rates. Imaging function rather than morphological appearance, F-FDG-PET has a unique role in the management of oncology patients with the ability to detect regions of tumor involvement that may be silent on conventional imaging. Literature on the sensitivity and specificity of F-FDG-PET fails to reach a consensus, and improvements resulting in hybridization of F-FDG-PET and CT imaging techniques are preliminary. Here we review the potential role of F-FDG-PET and PET/CT in improving accuracy in the initial evaluation and subsequent steps in the management of pancreatic cancer patients.
胰腺癌的预后仍然严峻，5年生存率不到5%。鉴于其生存结果不佳、肿瘤生物学行为侵袭性强以及症状出现较晚，这是一个极具挑战性的健康问题。大多数患者就诊时已患有无法切除的晚期癌症，然而，切缘阴性的切除术为可切除疾病的患者提供了罕见的治愈机会。胰腺癌诊断和管理的标准成像方式是对比增强多排螺旋计算机断层扫描（CT）。CT技术的显著进步提高了检测小肿瘤以及肿瘤对复杂血管侵犯的能力，但CT仍局限于提供肿瘤的形态学图像。由于某些良性和恶性疾病外观相似，诊断可能具有挑战性。远处转移瘤在CT上可能不显示，导致对某些患者的分期及后续治疗不当。此外，放射诱导的纤维化和坏死使仅通过CT评估治疗反应变得复杂。氟脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）正成为医生用于提高这些临床情况下准确性的常用工具。恶性转化导致癌细胞具有高代谢活性。F-FDG-PET通过捕捉葡萄糖利用率高的区域来获取恶性肿瘤的这种功能活性。F-FDG-PET成像的是功能而非形态外观，在肿瘤患者管理中具有独特作用，能够检测出常规成像可能未显示的肿瘤受累区域。关于F-FDG-PET敏感性和特异性的文献尚未达成共识，F-FDG-PET与CT成像技术融合带来的改进仍处于初步阶段。在此，我们综述F-FDG-PET和PET/CT在提高胰腺癌患者初始评估及后续管理步骤准确性方面的潜在作用。
