18F-FDG PET/CT对恶性胸膜间皮瘤诊断及预后评估的价值

doi:10.7538/tws.2012.25.01.0058

摘要/Abstract

摘要： 回顾性分析了本院2006年10月—2010年3月间19例临床怀疑胸膜间皮瘤患者的¹⁸F-FDG PET/CT图像，探讨¹⁸F-FDG PET/CT对恶性胸膜间皮瘤诊断及预后评估的价值。通过¹⁸F-FDG PET/CT显像获得最大标准摄取值（SUVmax）、摄取类型、临床分期、病理类型及血清中癌胚抗原（CEA）水平，对恶性胸膜间皮瘤进行准确诊断、术前分期及预后评估。所有患者扫描后分别经外科手术、穿刺活检、胸腔镜、胸水细胞学检查或纵隔镜等检查，以病理结果为金标准。结果显示，19例中17例经病理证实为恶性胸膜间皮瘤(PET/CT确诊16例，漏诊1例)，2例良性病变（PET/CT确诊1例，误诊1例）。¹⁸F-FDG PET/CT显像判断胸膜间皮瘤的符合率为89%（17/19），敏感度为94%（16/17），假阴性率为6%（1/17），特意度为50%（1/2）。恶性胸膜间皮瘤SUVmax（11.88±5.39）与良性组SUVmax（4.10±0.85）相比，其差异具有统计学意义（P=0.005 8，P＜0.01)。恶性胸膜间皮瘤病理包括上皮型、肉瘤型、混合型及非典型4种，在各不同病理类型间，非上皮型SUVmax（15.88±3.94）较上皮型（7.40±2.82）高，其差异具有统计学意义（t=4.56，P＜0.01)。在不同临床分期中，Ⅳ级SUVmax（19.83±3.57）较Ⅱ、Ⅲ分级患者放射性摄取明显增高，其差异具有统计学意义（F=7.69，P<0.01)。胸膜间皮瘤¹⁸F-FDG PET/CT显像中，病灶摄取类型可分为结节形、线形、环形及混合形4种，其中环形放射性摄取（SUVmax=16.63±4.51）与其他三种摄取类型（SUVmax=10.61±4.85）相比，其差异具有统计学意义(t=3.64,P＜0.01)。以血清中癌胚抗原（CEA）≥5 μg/L为标准,患者SUVmax(14.19±5.15)明显高于CEA＜5 μg/L组SUVmax(8.60±4.04)，其差异具有统计学意义( t=2.39，P＜0.05)。以上结果提示，¹⁸F-FDG PET/CT对于恶性胸膜间皮瘤的诊断的敏感度较高；不同组织病理学类型中，上皮型预后好于其他类型；随着临床分期的进展，SUVmax递增，提示与肿瘤恶性程度加剧相关。不同类型¹⁸F-FDG PET/CT显像中，环形摄取类型常提示肿瘤恶性程度较高。血清中CEA升高，也提示肿瘤恶性程度增加，预后不良。综上所述，¹⁸F-FDG PET/CT显像在临床分期、疗效评价、监测复发及预后评估等方面将发挥重要作用。

关键词: ¹⁸F-FDG, PET/CT, 恶性胸膜间皮瘤

Abstract: In order to evaluate the importance of ¹⁸F-FDG PET/CT imaging in diagnosing and prognosticating Malignant Pleural Mesothelioma(MPM), The clinical ¹⁸F-FDG PET/CT images of nineteen patients, treated in this hospital from October, 2006 to March, 2010, were reviewed. The patients’plasma carcinoembryonic antigen (CEA) was measured，and the maximum standardized uptake value (SUVmax) was determined from the most active pleural lesion in each patient, MPM was histologically confirmed in 17 patients while 2 patients were diagnosed to have benign pleural diseases. The coincidence rate of PET/CT was 89%。Significant differences in SUVmax were found between patients with MPM （11.88±5.39）and those with benign pleural lesions（4.1±0.85）(P=0.005 8，P＜0.01)). The results showed that the intensity of uptake was higher in non-epithelial tumors (SUVmax15.88±3.94) than the epithelial subtype (SUVmax7.4±2.82), with the difference showing a trend towards statistical significance(t=4.56,P＜0.01)). Four patterns of uptake were observed in tumor diseases such as focal, linear, mixed (focal/linear), and encasing, with a significant difference between the intensity of uptake in encasing group （SUVmax16.63±4.51）compared to others types (SUVmax10.61±4.85) (t=3.64, P＜0.01). For different clinical grades, Grade Ⅳ（SUVmax19.83±3.57） was higher than GradesⅡandⅢ（F=7.69, P<0.01). The SUVmax values of the group with CEA≥5 μg/L (SUVmax 14.19±5.15) were significantly higher than the groups with CEA＜5 μg/L (SUVmax 8.6±4.04), the differernce being statistically significant (t=2.39,P＜0.05). The results showed that ¹⁸F-FDG PET/CT is an sensitive technique for diagnosing malignant pleural mesothelioma and the SUVmax is correlated histologically with clinical grades, update types and CEA levels. Poor prognosis was observed for the following cases：non-epithelial subtype; Grad Ⅳ; encasing updated group; and the group with CEA≥5 μg/L. In summary, ¹⁸F-FDG PET/CT should play important roles in diagnosing and prognosticating malignant pleural mesothelioma.

Key words: ¹⁸F-FDG, PET/CT, malignant pleural mesothelioma

陆国秀;张彩霞;徐薇娜;于树鹏;辛军. ¹⁸F-FDG PET/CT对恶性胸膜间皮瘤诊断及预后评估的价值[J]. 同位素, 2012, 25(1): 58-63.

LU Guo-xiu;ZHANG Cai-xia;XU Wei-na;YU Shu-peng;XIN Jun. ¹⁸F-FDG PET/CT Imaging in Diagnosing and Prognosticating Malignant Pleutal Mesothelioma[J]. Journal of Isotopes, 2012, 25(1): 58-63.

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¹⁸F-FDG PET/CT对恶性胸膜间皮瘤诊断及预后评估的价值

¹⁸F-FDG PET/CT Imaging in Diagnosing and Prognosticating Malignant Pleutal Mesothelioma

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