天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (2): 215-219.doi: 10.11958/20160954

• 诊断技术 • 上一篇    下一篇

体检人群血清 CEA 不明原因升高行 18F-FDG PET/CT 诊断肿瘤的临床价值

郑红娜， 李敬， 解敬慧， 杜雪梅， 陈博， 张延军△   

  1. 大连医科大学附属第一医院核医学科 （邮编 116021）
  • 收稿日期:2016-09-06 修回日期:2016-12-16 出版日期:2017-02-15 发布日期:2017-02-14
  • 通讯作者: △通讯作者 E-mail: yjzhang78@163.com E-mail:zhenghongna@126.com
  • 作者简介:郑红娜 （1982）， 女， 硕士， 主要从事 PET/CT 肿瘤影像诊断方面研究

The clinical value of 18F-FDG PET/CT for diagnosing tumor in physical examination people with unexplained elevated serum CEA

ZHENG Hong-na, LI Jing, XIE Jing-hui, DU Xue-mei, CHEN Bo, ZHANG Yan-jun△   

  1. Department of Nuclear Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
  • Received:2016-09-06 Revised:2016-12-16 Published:2017-02-15 Online:2017-02-14
  • Contact: △Corresponding Author E-mail:yjzhang78@163.com E-mail:zhenghongna@126.com

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摘要： 目的 探讨 18氟-氟代脱氧葡萄糖（ 18F-FDG） PET/CT 在体检人群血清癌胚抗原（CEA）水平不明原因升高时诊断肿瘤的临床价值。方法 选取 2010 年 6 月—2014 年 12 月我院健康体检时发现血清 CEA 不明原因升高并行 18F-FDG PET/CT 检查的体检者 100 例。结合病理学检查、 临床随访和其他影像学检查结果， 评价 18F-FDG PET/ CT 对恶性肿瘤的诊断价值。对于接受＞2 次血清 CEA 测定的患者， 计算 CEA 倍增时间（DT）； 分析血清 CEA 水平及其 DT 与 18F-FDG PET/CT 显像的关系。利用受试者工作特征（ROC）曲线分析血清 CEA 诊断恶性肿瘤的效能。结果 100 例患者中有 27 例最终确诊为恶性肿瘤， 73 例排除恶性肿瘤。18F-FDG PET/CT 诊断假阳性和假阴性各 1 例， 其诊断敏感度、 特异度、 准确度、 阳性预测值和阴性预测值分别为 96.3%、 98.6%、 98.0%、 96.3%和 98.6%。18FFDG PET/CT 显像阳性者血清 CEA 水平明显高于显像阴性者（Z=5.796， P＜0.05）； 且随着 CEA 水平的升高， 显像阳性率有升高的趋势（χ2=37.823， P＜0.05）。18F-FDG PET/CT 显像阳性患者血清 CEA DT 明显短于显像阴性患者（Z= 4.301， P＜0.05）； DT 为 0~180 d 的患者显像阳性率明显高于 DT＞180 d 及 DT＜0 d 的患者（χ2 分别为 17.472、 17.325， 均 P＜0.05）； DT＞180 d 与 DT＜0 d 的患者 18F-FDG PET/CT 显像阳性率差异无统计学意义（χ2=0.255， P＞ 0.05）。血清 CEA 诊断恶性肿瘤的 ROC 曲线下面积 （AUC） 为 0.894， 当诊断界值为 14.24 μg/L 时诊断效能最佳。结论 18F-FDG PET/CT 显像对于血清 CEA 不明原因升高者是否罹患肿瘤具有较高的诊断价值， 尤其对于血清 CEA≥ 14.24 μg/L 或呈进行性升高的患者， 行 18F-FDG PET/CT 探查恶性肿瘤的价值更大。

关键词: 正电子发射断层显像术, 氟脱氧葡萄糖 F18, 癌胚抗原, 体格检查, 诊断, 鉴别, 肿瘤

Abstract: Objective To evaluate the clinical value of 18F-FDG PET/CT for detecting tumor on physical examination people with unexplained elevated serum carcinoembryonic antigen (CEA). Methods A total of 100 physical examination people with unexplained elevated serum levels of CEA in our hospital from June 2010 to December 2014 were involved in the study. All the people were detected with 18F-FDG PET/CT. The pathology, clinical follow ups and conventional medical imaging results were combined to evaluate the value of 18F-FDG PET/CT in diagnosing tumor. The doubling time (DT) of CEA was calculated in the patients who were received more than twice of serum CEA detection. The relationships between serum CEA levels, CEA DT and 18F-FDG PET/CT imaging were analyzed. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of serum CEA. Results Twenty-seven patients were confirmed with malignant tumor, and the rest of 73 cases were excluded. The 18F- FDG PET/CT reported one false positive and one false negative respectively. The sensitivity, specificity, accuracy, positive and negative predictive values of 18F-FDG PET/CT in diagnosing malignant tumors were 96.3% , 98.6% , 98.0% , 96.3% and 98.6% respectively. The median serum CEA levels were significantly higher in the positive 18F-FDG PET/CT patients than those in the negative patients (Z=5.796, P＜0.05). The prevalence of 18F-FDG PET/CT positive patients was higher with an increase in absolute CEA levels (χ2=37.823, P＜0.05). The median DT of serum CEA levels was shorter in the positive 18F-FDG PET/CT patients than that in the negative patients (Z=4.301， P＜0.05). The positive rates of 18F-FDG PET/CT in patients with 0 d＜DT＜180 d were significantly higher than patients with DT＞180 d and DT＜0 d (χ2=17.472 and 17.325, both P＜0.05). There was no significant difference in the positive rate of 18F-FDG PET/CT between patients with DT＞180 d and patients with DT＜0 d (χ2=0.255， P＞0.05). The area under the curve (AUC) of serum CEA was 0.894, the optimal diagnostic cutoff value was 14.24 μg/L. Conclusion 18FFDG PET/CT is a useful image modality for detecting malignant tumors in patients with unexplained elevated serum CEA, especially for patients with CEA≥14.24 μg/L and increase progressively.

Key words: positron-emission tomography, fluorodeoxyglucose F18, carcinoembryonic antigen, physical examination people, cancer detection