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目的探讨18F-FDG PET/CT与增强CT(CECT)在胰腺良恶性病变鉴别及胰腺癌分期中的价值。方法回顾性分析治疗前在我院行CECT和PET/CT检查的胰腺病例(时间间隔≤2周),并以病理及临床影像随访结果作为金标准,比较CECT、PET/CT对胰腺病变良恶性鉴别诊断以及胰腺癌TNM分期的灵敏度、特异度及准确率。结果共入选病例68例,其中男43例,女25例,恶性48例,良性20例。良性病变组SUVmax平均5.06(范围1.10～29.10),恶性病变组SUVmax平均7.80(范围1.60～17.60)。CECT与最终诊断有中度一致(κ=0.414,P<0.05);PET/CT与最终诊断有较高度的一致性(κ=0.677,P<0.05)。术前CECT和PET/CT诊断胰周血管侵犯的灵敏度、特异度、准确率分别为(92.9%、93.3%、93.1%)vs(21.4%、93.3%、58.6%)。CECT和PET/CT诊断区域淋巴结转移的灵敏度、特异度、准确率分别为(64.7%、91.7%、75.9%)vs(76.5%、83.3%、79.3%)。CECT和PET/CT诊断远处转移的灵敏度、特异度、准确率分别为(58.8%,100%,85.4%)vs(88.2%,96.8%,93.7%)。结论 PET/CT在胰腺恶变的诊断中具有更高的敏感性和特异性,对远处转移的有更高的敏感性;而CECT可以精确地显示肿瘤与血管的关系、对远处转移的有更高的特异性,两者各有优势不能相互取代,临床工作中需要我们根据患者的实际情况合理选择,必要时联合应用,更好地发挥它们的优势。
Objective To investigate the value of 18F-FDG PET / CT and enhanced CT (CECT) in differential diagnosis of benign and malignant pancreatic lesions and pancreatic cancer staging. Methods The pancreatic cases with CECT and PET / CT examination in our hospital were retrospectively analyzed (interval ≤2 weeks). The pathological and clinical imaging follow-up results were used as the gold standard. Compared with CECT and PET / CT, the pancreatic lesions were benign and malignant Differential diagnosis and TNM staging of pancreatic cancer sensitivity, specificity and accuracy. Results A total of 68 cases were enrolled in this study, including 43 males and 25 females, 48 malignant and 20 benign. The average SUVmax was 5.06 (range 1.10-29.10) in benign lesions and 7.80 (range 1.60-17.60) in malignant lesions. There was moderate agreement between CECT and final diagnosis (κ = 0.414, P <0.05). PET / CT was highly consistent with final diagnosis (κ = 0.677, P <0.05). The sensitivity, specificity and accuracy of preoperative CECT and PET / CT in diagnosing peripancreatic vessels were (92.9%, 93.3%, 93.1%) vs (21.4%, 93.3%, 58.6%, respectively). The sensitivity, specificity and accuracy of CECT and PET / CT in diagnosing regional lymph node metastasis were (64.7%, 91.7%, 75.9%) vs (76.5%, 83.3%, 79.3%) respectively. The sensitivity, specificity and accuracy of CECT and PET / CT for distant metastasis were (58.8%, 100%, 85.4%) vs (88.2%, 96.8%, 93.7%) respectively. Conclusions PET / CT is more sensitive and specific in the diagnosis of pancreatic malignancies and has higher sensitivity to distant metastasis. However, CECT can accurately show the relationship between tumor and blood vessel, Higher specificity, both have their own advantages can not be replaced by each other, we need clinical work in accordance with the actual situation of patients a reasonable choice, if necessary, joint application, to better play their advantages.