天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 220-224.doi: 10.11958/20161088

• 诊断技术 • 上一篇    

18F-FDG PET/CT 对结核性与恶性腹膜弥漫性病变的鉴别诊断价值

张文延， 蔡莉， 王颖， 俞浩楠， 高硕△   

  1. 天津医科大学总医院 PET/CT 中心 （邮编 300052）
  • 收稿日期:2016-10-09 修回日期:2016-11-17 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail：dr_shuogao@hotmail.com E-mail:dr_shuogao@hotmail.com
  • 作者简介:张文延 （1990）， 男， 硕士在读， 主要从事肿瘤分子影像诊断研究

Value of 18F-FDG PET/CT in differentiating tuberculous and cancerous diffuse peritoneal lesions

ZHANG Wen-yan, CAI Li, WANG Ying, YU Hao-nan, GAO Shuo△   

  1. PET/CT Center, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2016-10-09 Revised:2016-11-17 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail: dr_shuogao@hotmail.com E-mail:dr_shuogao@hotmail.com

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摘要： 目的 分析结核性与恶性腹膜弥漫性病变的 18F-氟脱氧葡萄糖 （ 18F-FDG） 正电子发射断层显像/X 线计算机体层成像 （PET/CT） 表现， 探讨其对两者的诊断及鉴别诊断价值。方法 回顾性分析经病理和 （或） 临床证实的 72 例结核性腹膜炎 （结核组）、 163 例恶性腹膜病变 （恶性组， 包括 28 例原发性腹膜浆液性乳头状腺癌、 135 例腹膜转移癌）的 18F-FDG PET/CT 图像表现。记录 2 组腹膜病变形态， 测量并分析 2 组腹膜及腹腔积液最大标准摄取值（SUVmax）、 腹腔积液 SUVmax/肝脏 SUVmax （即 T/NT 值） 的差异。对腹膜 SUVmax、 腹腔积液 SUVmax、 腹腔积液 T/NT 鉴别诊断的准确性进行受试者工作特征 （ROC） 曲线分析。结果 结核性腹膜炎大网膜及肠系膜多呈 “污迹样” 改变， 而壁腹膜最常见为弥漫均匀性增厚， 18F-FDG 分布较均匀； 恶性腹膜病变多为壁腹膜、 大网膜及肠系膜不规则增厚， 呈多发结节状及饼状改变， 18F-FDG 分布不均匀。2 组病变腹膜 18F-FDG 代谢程度均增高 （结核组 SUVmax=10.53±5.44， 恶性组 SUVmax=11.45±6.78）， 两者间差异无统计学意义（t=1.017， P＞0.05）。恶性组的腹腔积液 18F-FDG 浓聚程度（SUVmax=1.88±0.65， T/NT=0.73±0.18） 高于结核组 （SUVmax=1.67±0.69， T/NT=0.57±0.27）， 两者间差异有统计学意义 （t 分别为 2.243 和 5.045， 均 P＜0.05）。腹膜 SUVmax、 腹腔积液 SUVmax、 腹腔积液 T/NT 的 ROC 曲线下面积（AUC）分别为 0.536、 0.593、 0.707。结论 18F-FDG PET/CT 体部显像可反映腹膜弥漫性病变的形态及代谢异常， 密切结合腹腔积液代谢程度有助于鉴别结核性与恶性腹膜病变。

关键词: 腹膜, 肿瘤, 结核, 正电子发射断层显像术, 体层摄影术, X 线计算机, 脱氧葡萄糖 F18, 诊断, 鉴别, ROC 曲线

Abstract: Objective To study the 18F-FDG PET/CT features of tuberculous and malignant diffuse peritoneal lesions and to discuss the diagnostic value of 18F-FDG PET/CT in diagnosing and differentiating the lesions. Methods The 18FFDG PET/CT features of 72 patients with tuberculous peritonitis， 28 primary serous papillary carcinoma of the peritoneum and 135 peritoneal metastases confirmed by clinic and/or histopathology, were retrospectively reviewed. The peritoneal thickening features of tuberculous and malignant peritoneal lesions were observed. The maximal standardized uptake value (SUVmax) of peritoneal lesions and ascites, ascites SUVmax/liver SUVmax (T/NT) were compared between tuberculous peritonitis and cancerous peritonitis. The ROC curve was used to analyze the diagnostic efficiency of T/NT, SUVmax of peritoneal lesions and ascites. Results The typical 18F-FDG PET/CT features of tuberculous peritonitis were uniformity thickening of parietal peritoneum, mesenteric and omental stain like changes, widely and even distribution of the peritoneal 18F-FDG, while the cancerous peritonitis was obvious uneven thickening of parietal peritoneum, mesenteric and omental nodules and pie-shape changes, uneven distribution of the peritoneal 18F- FDG. The degree of 18F- FDG uptake was increased in all peritoneal lesions, and there was no significant difference between the tuberculous group (SUVmax=10.53±5.44) and the cancerous group (SUVmax=11.45±6.78, t=1.017, P＞0.05). The 18F-FDG concentration in malignant ascites (SUVmax=1.88±0.65， T/NT=0.73± 0.18) was obvious higher than that of tuberculous ascites (SUVmax=1.67±0.69， T/NT=0.57±0.27, t=2.243 and 5.045， both P＜0.05). The area under the ROC curve of T/NT, SUVmax of ascites, SUVmax of peritoneal lesions were 0.707, 0.593, 0.536, respectively. Conclusion The 18F-FDG PET/CT imaging can reflect the morphology and metabolic changes of peritoneal lesions. It is important to combine the SUVmax of ascites in order to improve the efficiency of diagnosing the diffuse peritoneal diseases.

Key words: peritoneum, neoplasms, tuberculosis, positron- emission tomography, tomography, X- ray computed, fluorodeoxyglucose F18, diagnosis, differential, ROC curve