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目的探讨PET在肾肿瘤术前诊断中作用。方法回顾性分析134例肾肿瘤患者PET图像。134例肾肿瘤术前评估患者中,32例行常规氟-18脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)PET或PET/CT显像(以下简称FDG-PET),51例行FDG-PET双时相显像,51例1周内分别行FDG-PET及碳-11乙酸盐(11C-acetate,AC)PET或PET/CT(以下简称AC-PET)双核素检查。收集其临床资料和影像检查结果。以病理结果为金标准。结果 FDG-PET对肾原发恶性肿瘤总的诊断准确率为48.5%,阳性预测值为96.3%,对透明细胞癌诊断准确率最低,为28.6%。对肾盂癌及其他恶性肿瘤诊断准确率为92.9%和75.0%。AC-PET对透明细胞癌诊断准确率93.5%。FDG-PET双时相显像60.0%阳性病灶标准摄取值(standard uptake value,SUV)升高,2例阴性病灶变为阳性。20例PET检查前其他检查发现肾外病灶的患者,检查后排除4例,并新发现6例患者肾外转移病灶。结论 FDG-PET检查对肾盂癌及其他恶性肿瘤诊断准确性高,对肾实质肿瘤诊断能力差,对肾肿瘤患者术前分期有帮助。AC-PET可弥补FDG-PET的不足。FDG-PET双时相显像不能从根本上解决FDG-PET对肾肿瘤诊断假阴性的问题。
Objective To investigate the role of PET in the preoperative diagnosis of renal tumors. Methods Retrospective analysis of PET images of 134 patients with renal tumors. Among 134 patients with preoperative renal tumor, 32 patients underwent 18F-fluorodeoxyglucose (18F-FDG) PET or PET / CT imaging (FDG-PET) 51 cases of FDG-PET and carbon-11 acetate (11C-acetate, AC) PET or PET / CT (hereinafter referred to as AC-PET) double nuclide examination. Collect their clinical data and imaging findings. Pathological results as the gold standard. Results The overall diagnostic accuracy of FDG-PET for primary renal cancer was 48.5% and the positive predictive value was 96.3%. The lowest diagnostic accuracy of FDG-PET was 28.6% for clear cell carcinoma. The diagnostic accuracy of renal pelvis and other malignant tumors was 92.9% and 75.0%. The diagnostic accuracy rate of AC-PET to clear cell carcinoma was 93.5%. The standard uptake value (SUV) was increased in 60.0% of FDG-PET bi-phase images, and two negative lesions became positive. Twenty patients with extrahepatic lesions were examined before the other 20 PET examinations. Four patients were excluded after the examination, and six extranodal metastases were found newly. Conclusion The FDG-PET examination has high diagnostic accuracy for renal pelvic and other malignant tumors, poor diagnostic ability for renal parenchymal tumors, and is helpful for the preoperative staging of renal cancer patients. AC-PET can make up for the lack of FDG-PET. FDG-PET dual-phase imaging can not fundamentally solve the problem of FDG-PET on the diagnosis of renal tumors false negative.