18F-FDG PET/CT显像在肝单发占位病变中的诊断价值

摘要

目的:评价正电子发射计算机断层显像(positron emission tomography/computed tomography,PET/CT)对肝单发占位病变的诊断价值.方法:收集2012年3月至2017年9月天津医科大学肿瘤医院177例肝单发占位病变患者PET/CT检查资料.在PACS上测量病灶CT值及长、短径.所有图像通过后处理工作站,应用PETVCAR软件测量病灶及肝脏正常组织的标准化摄取(stan-dardized uptake value,SUV),并计算肝脏病灶(T)与正常肝组织(N)的T/N比值.分析比较各参数对不同病理类型肝单发占位的诊断价值.两连续性变量间的相关性采用Pearson相关性分析.结果:肝原发恶性肿瘤的长、短径均>肝转移瘤,差异有统计学意义(P<0.05).PET显像诊断肝细胞肝癌(hepatocellular carcinoma,HCC)、胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)及肝转移瘤的阳性率分别为67.6%、95.2%、98.7%.HCC PET显像的各个代谢指标均小于其他类型肝癌及肝转移瘤,差异有统计学意义(P<0.05).SUV诊断ICC及转移瘤的ROC曲线下面积>0.5,但不同SUV对ICC和转移瘤的诊断效能差异无统计学意义(P>0.05).此外,SUVmax与病灶大小相关(r=0.535,P<0.001).结论:18F-FDG PET/CT显像对ICC及转移瘤具有较高的诊断阳性率,且对两者的诊断效能优于HCC.%Objective: To evaluate the diagnostic value of PET/CT in single space-occupying lesion of the liver hepatic disease. Meth-ods: Data of 177 patients from Tianjin Medical University Cancer Institute and Hospital between March 2012 and September 2017 with a single hepatic space-occupying lesion who had undergone 18F-FDG PET/CT were collected. CT values and the long and short di-ameters were measured in PACS system. A post-processing workstation was employed, and PETVCAR software was used to automati-cally measure the standardized uptake value (SUV) of the focal and the normal liver tissue. Afterward, T (SUV of the focal)/N (SUV of the normal liver tissue) ratios were calculated. Then, the diagnostic value of various parameters for different pathological types was an-alyzed. The correlation between two continuous variables was calculated using Pearson analysis. Results: The long and short diame-ters of the primary hepatic carcinoma were significantly larger than those of metastatic lesions (P<0.05). The positive rates of hepato-cellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and metastases were 67.6%, 95.2%, and 98.7%, respectively. All meta-bolic parameters of HCC were significantly lower than those of the other pathological types of liver cancer or metastases (P<0.05). The AUCs for diagnosis of ICC and metastases were higher than 0.5, but there was no statistical difference between the AUCs of different SUVs. Moreover, SUVmax was related to lesion size (r=0.535, P<0.001). Conclusions: 18F-FDG PET/CT has a high positive predictive val-ue and effective diagnostic function for ICC and metastasis, and the diagnostic efficacy for both is higher than that for HCC.