目的：探讨氟-代脱氧葡萄糖正电子发射型断层显像(18 fluorodeoxyglucose positron emission tomography,18 F-FDG PET/CT )对直肠癌术后骶前复发的诊断价值。方法回顾性分析61例直肠癌Mile’ s术后的患者,因发现骶前软组织病变行18 F-FDG PET/CT显像。图像分析采用视觉分析和通过半定量分析测量病变最大标准摄取值( SUVmax )。病例经手术病理学诊断或临床大于6个月以上的随访。计算18 F-FDG PET/CT显像诊断直肠癌术后骶前复发的敏感度和特异度。结果61例直肠癌患者中,经病理学和随访最终诊断为骶前复发30例,骶前良性病变31例。骶前复发病变的SUVmax为9.44±3.78,良性病变SUVmax为2.24±2.15,两者差异具有统计学意义(t=9.10,P<0.01)。通过ROC曲线分析,以SUVmax为4.45是良恶性病变的界值,18 F-FDG PET/CT显像诊断直肠癌术后骶前复发的敏感度为96%,特异度为87%。曲线下面积为0.976。结论骶前复发性病变的18 F-FDG摄取值明显高于骶前良性病变,以SUVmax为4.45是良恶性病变的界值,18 F-FDG PET/CT显像对直肠癌术后骶前复发具有很好的诊断价值。%Objective To assess the value of 18 F-FDG PET/CT in the diagnosis of presacral recurrence after Mile’ s operation for rec-tal cancer patients. Methods Sixty-one patients with presacral lesions after operation for rectal cancer underwent 18 F-FDG PET/CT. The images were interpreted by visual and semi-quantitative analysis(maximum standard uptake value, SUVmax). All the cases were confirmed by pathology and clinical follow up( >6 months) . The sensitivity, specificity of 18 F-FDG PET/CT for detecting presacral re-currence were calculated. Results Thirty cases were confirmed presacral recurrence of rectal cancer, and 31 cases were diagnosed as benign diseases. SUVmax was 9. 44 ± 3. 78 for recurrence lesions and 2. 24 ± 2. 15 for benign lesions. The uptake of 18 F-FDG was significantly higher in presacral recurrence lesions than in benign lesions(t=9. 10,P<0. 01). ROC curve analysis showed that a cut-off value of SUVmax was 4. 45 for benign and malignant lesions. The sensitivity of 18 F-FDG PET/CT was 96%, and the specificity was 87%. The area under the ROC curve was 0. 976. Conclusion The uptake of 18 F-FDG in presacral recurrent lesions is higher than that in benign lesions. The cut-off value of SUVmax is 4. 45 for malignant and benign lesions. 18 F-FDG PET/CT in the diagnosis of pre-sacral recurrence after operation for rectal cancer have a good diagnostic value.
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