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目的:评价18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层摄影(PET-CT)、增强计算机断层摄影(CT)在胰腺癌的诊断、鉴别诊断和分期中的价值。方法:对经病理和临床等综合手段证实的31例胰腺病变患者资料进行回顾分析。分别观察其CT图像中胰腺病变处的形态、密度、强化程度、胰胆管扩张、转移及PET显像胰腺病灶感兴趣区(ROI)最大标准摄取值(SUV max),并结合临床和病理诊断结果,比较单纯PET、增强CT、PET-CT、PET-CT结合增强CT检测对胰腺疾病诊断的灵敏度、特异度及准确率。结果:31例胰腺病变的患者中,胰腺恶性肿瘤20例,良性病变11例。单纯PET对胰腺病变诊断的灵敏度和特异度为85.0%和54.5%,而PET-CT的诊断特异度高于单纯PET,PET-CT诊断的灵敏度、特异度和准确率均高于增强CT[(85.0%、81.8%、83.9%)比(75.0%、72.7%、73.1%)]。PET-CT结合增强CT检查对胰腺病变诊断的灵敏度为100%,特异度为90.9%。增强CT诊断Ⅰ期和Ⅱ期胰腺癌的灵敏度高于PET-CT,但对于Ⅲ期和Ⅳ期胰腺癌患者,PET-CT则可发现更多的淋巴结转移和远处转移。胰腺恶性病变的SUVmax为1.7～18.9,良性病变的SUVmax为0.6～5.0,良恶性病变间平均SUVmax差异有统计学意义(P<0.05)。结论:PET-CT检查将功能学与解剖形态学显像相结合,在胰腺肿瘤的诊断与分期中的作用优于单纯PET或CT检查。对于胰腺癌的T分期,增强CT优于PET-CT,而PET-CT在显示淋巴结和远处转移方面优于增强CT,两者各有优缺点。在胰腺癌的诊断和分期中,PET-CT检查结合增强CT能提高诊断的灵敏度、特异度及准确率。
Objective: To evaluate the value of 18F-FDG positron emission tomography (PET-CT) in enhancing the diagnostic, differential diagnosis and staging of computed tomography (CT) in pancreatic cancer. Methods: The data of 31 patients with pancreatic lesions confirmed by pathological and clinical methods were retrospectively analyzed. The morphology, density, degree of enhancement, extent of pancreaticobiliary duct dilatation, metastasis and the maximum standard of interest area (ROI) of pancreatic lesions (PET) in CT images were observed respectively. Combined with clinical and pathological findings The sensitivity, specificity and accuracy of PET, CT, PET-CT and PET-CT in the diagnosis of pancreatic diseases were compared. Results: Of the 31 patients with pancreatic lesions, 20 had pancreatic malignancies and 11 had benign lesions. The sensitivity and specificity of simple PET in the diagnosis of pancreatic lesions were 85.0% and 54.5%, while the diagnostic specificity of PET-CT was higher than that of PET alone. The sensitivity, specificity and accuracy of PET-CT diagnosis were higher than those of enhanced CT [ 85.0%, 81.8%, 83.9%) (75.0%, 72.7%, 73.1%)]. The sensitivity of PET-CT combined with enhanced CT in the diagnosis of pancreatic lesions was 100% and the specificity was 90.9%. Enhanced CT diagnosis of stage I and II pancreatic cancer sensitivity than PET-CT, but for patients with stage III and IV pancreatic cancer, PET-CT can be found in more lymph node metastasis and distant metastasis. The SUVmax of pancreatic malignant lesions was 1.7 ~ 18.9, the SUVmax of benign lesions was 0.6 ~ 5.0, the mean SUVmax of benign and malignant lesions was statistically significant (P <0.05). Conclusion: PET-CT combined with functional and anatomical imaging is superior to PET or CT in the diagnosis and staging of pancreatic tumors. For T-staging of pancreatic cancer, enhanced CT is superior to PET-CT, whereas PET-CT is superior to enhanced CT in displaying lymph nodes and distant metastases, both of which have advantages and disadvantages. In the diagnosis and staging of pancreatic cancer, PET-CT combined with enhanced CT can improve the diagnostic sensitivity, specificity and accuracy.