双探头 18F-FDG-PET/CT 在伴有和不伴有合并慢性胰腺炎的胰腺腺癌患者中的诊断作用：与 CECT 和 EUS 的比较。

Role of dual-point 18F-FDG-PET/CT in the diagnosis of pancreatic adenocarcinoma, in patients with and without concomitant chronic pancreatitis: Comparison with CECT and EUS.

机构信息

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Pancreatology. 2021 Jun;21(4):746-754. doi: 10.1016/j.pan.2021.02.011. Epub 2021 Feb 18.

DOI:10.1016/j.pan.2021.02.011

PMID:33632664

Abstract

PURPOSE

The aim of this study was to evaluate the diagnostic performance of dual-time-point-PET/CT, CECT and EUS + FNA in diagnosing pancreatic-ductal-adenocarcinomas (PDAC), in context of concomitant Chronic Pancreatitis (CP).

METHODS

18F-FDG-PET/CTs were prospectively acquired in 22 confirmed CP and 23 confirmed PDAC patients (calculated for 90% power); and cut-offs of 2.2 for early-SUV(∼1hr), 2.4 for delayed-SUV(∼3hr) and 1.36 for Retention-index (RI), were derived. These cut-offs were validated in PET/CTs of 75 patients (51.9 ± 13.3years; 54 men) with pancreatic masses of unknown nature. Comparisons were made with triple-phase-CECT (73 patients) and EUS + FNA (54 patients). Histopathology was obtained in 68 patients (including all PDACs) and 7 were followed up for minimum of 2 years.

RESULTS

In patients without concomitant CP, sensitivity, specificity and accuracy for diagnosing malignancy in standard-acquisition-PET/CT, dual-time-point-PET/CT, CECT and EUS + FNA were 97.4%, 83.3%, 94.0%; 97.4%, 75.0%, 92%; 94.6%, 66.7%, 87.8% and 92.6%, 88.9%, 91.7% respectively. Corresponding values in patients with concomitant CP were 88.9%, 57.1%, 80.0%; 100%, 57.1%, 88%; 82.4%, 57.1%, 75% and 100%, 100%, 100% respectively. In lesions ≤2 cm (AJCC-T1), dual-time-point-PET/CT was the most sensitive (95.8%). ROC-analysis revealed significantly higher area-under-the-curve for RI over early-SUV (p = 0.002) in cases with concomitant CP only. In patients with confirmed liver-metastases, PET/CT and CECT identified 15/16 and 13/16 lesions. PET/CT identified additional lung-metastases in 3 and bone-metastasis in one patient.

CONCLUSION

In patients without concomitant CP and with larger lesions, PET/CT and CECT are equivocal as screening modalities, with no benefit of dual-time-point-PET/CT acquisitions. However, in patients with concomitant CP and smaller lesions, dual-time-point PET/CT is better; with sensitivity comparable to EUS + FNA.

摘要

目的

本研究旨在评估双时相 PET/CT、CECT 和 EUS+FNA 在伴有慢性胰腺炎（CP）的情况下，对胰腺导管腺癌（PDAC）的诊断性能。

方法

前瞻性地在 22 例确诊 CP 和 23 例确诊 PDAC 患者（计算 90%的效能）中获得 18F-FDG-PET/CT；并得出早期 SUV（~~1 小时）的 2.2 为截断值，延迟 SUV（~~3 小时）的 2.4 为截断值和滞留指数（RI）的 1.36 为截断值。这些截断值在 75 例胰腺肿块性质不明的患者的 PET/CT 中得到验证（51.9±13.3 岁；54 名男性）。与三期 CECT（73 例）和 EUS+FNA（54 例）进行比较。在 68 例患者（包括所有 PDAC 患者）中获得了组织病理学结果，7 例患者进行了至少 2 年的随访。

结果

在无合并 CP 的患者中，标准采集 PET/CT、双时相 PET/CT、CECT 和 EUS+FNA 诊断恶性肿瘤的灵敏度、特异度和准确率分别为 97.4%、83.3%、94.0%；97.4%、75.0%、92%；94.6%、66.7%、87.8%和 92.6%、88.9%、91.7%。在伴有 CP 的患者中，相应的值分别为 88.9%、57.1%、80.0%；100%、57.1%、88%；82.4%、57.1%、75%和 100%、100%、100%。在≤2cm（AJCC-T1）的病变中，双时相 PET/CT 的灵敏度最高（95.8%）。ROC 分析显示，在仅伴有 CP 的病例中，RI 的曲线下面积显著高于早期 SUV（p=0.002）。在确诊有肝转移的患者中，PET/CT 和 CECT 分别识别出 16/16 和 13/16 个病灶。PET/CT 还在 3 例患者中发现了额外的肺转移灶，在 1 例患者中发现了骨转移灶。