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18F-FDG PET/CT、超声造影及联合应用对胰腺良恶性病变的鉴别诊断价值比较
DOI: 10.3969/j.issn.1001-5256.2022.12.017
Value of 18F-FDG PET/CT, contrast-enhanced ultrasound, and their combined use in differential diagnosis of benign and malignant pancreatic lesions: A comparative study
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摘要:
目的 探讨18F-FDG PET/CT、超声造影及联合应用对胰腺病变良恶性鉴别的诊断价值。 方法 回顾性分析2015年1月—2020年12月于唐山市工人医院行18F-FDG PET/CT和超声造影检查的胰腺病变患者资料，以病理结果为标准，分析18F-FDG P ET/CT、超声造影及两者联合时对胰腺病变良恶性鉴别诊断的灵敏度、特异度、准确度、阳性预测值及阴性预测值。计量资料组间比较采用t检验；计数资料组间比较采用χ2检验。 结果 108例病变中恶性83例、良性25例，18F-FDG PET/CT诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为86.75%、80.00%、85.19%、93.51%及64.52%，超声造影分别为69.88%、76.00%、71.30%、90.63%及43.18%，两者联合应用时分别为90.36%、84.00%、88.89%、94.94%及72.41%。18F-FDG PET/CT与超声造影两者间灵敏度、准确度比较差异均有统计学意义(P值均＜0.05)。 结论 18F-FDG PET/CT对胰腺病变良恶性鉴别具有较高的诊断价值，高于超声造影，两者联合应用时可进一步提高诊断价值。 -
关键词:
- 胰腺肿瘤 /
- 正电子发射断层显像计算机体层摄影术 /
- 体层摄影术, X线计算机 /
- 氟脱氧葡萄糖F18
Abstract:Objective To assess the value of 18F-FDG PET/CT, contrast-enhanced ultrasound, and their combination in the differential diagnosis of benign and malignant pancreatic lesions. Methods A retrospective analysis was performed on patients with pancreatic lesions who underwent18F-FDG PET/CT and contrast-enhanced ultrasound who were admitted to Tangshan Gongren Hospital from January 2015 to December 2020. The imaging results were confirmed by pathology examination to evaluate diagnostic sensitivity, specificity, accuracy, positive and negative predictive value. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between groups. Results There were 83 malignant lesions and 25 benign lesions in 108 patients. The sensitivity, specificity, accuracy, positive and negative predictive value were 86.75%, 80.00%, 85.19%, 93.51% and 64.52% for 18F-FDG PET/CT; and 69.88%, 76.00%, 71.30%, 90.63% and 43.18% for contrast-enhanced ultrasound, respectively. The two methods differed significantly in sensitivity and accuracy (all P < 0.05), but not in specificity, negative and positive predictive value (all P > 0.05). When combined with the contrast-enhanced ultrasound, 18F-FDG PET/CT had an increased sensitivity, specificity, accuracy, positive and negative predictive value of 90.36%, 84.00%, 88.89%, 94.94% and 72.41%, respectively, though this was not statistically significant due to the increased signal of blood supply in the lesions. Conclusion 18F-FDG PET/CT has a better performance than contrast-enhanced ultrasound in the differential diagnosis of benign and malignant pancreatic lesions, and their combination can improve the diagnostic value. -
图 1 PDAC18F-FDG PET/CT图像
注：患者，男，58岁，胰头导管腺癌，18F-FDG PET/CT显示18F-FDG明显不均匀性增高，SUVmax为5.4(箭头)。a，PET；b，CT；c，PET/CT；d，PET MIP。
Figure 1. 18F-FDG PET/CT imaging of pancreatic ductal adenocarcinoma
图 2 AIP18F-FDG PET/CT图像
注：患者，男，36岁，AIP，18F-FDG PET/CT显示胰腺整体弥漫性肿大，18F-FDG摄取呈弥漫性增高，呈“腊肠样”表现，SUVmax为6.1 (箭头)。a，PET；b，CT；c，PET/CT；d，PET MIP。
Figure 2. 18F-FDG PET/CT imaging of autoimmune pancreatitis
图 3 PDAC超声造影动脉期图像
注：患者，男，58岁，胰头导管腺癌(与图 1同一患者)，超声造影显示胰头病变动脉期呈低增强(箭头)。a，常规超声；b，超声造影动脉期。
Figure 3. Contrast-enhanced ultrasound imaging of pancreatic ductal adenocarcinoma in arterial phase
图 4 PDAC超声造影静脉期图像
注：患者，男，58岁，胰头导管腺癌(与图 1同一患者)，超声造影显示胰头病变静脉期呈低增强(箭头)。a，常规超声；b，超声造影静脉期。
Figure 4. Contrast-enhanced ultrasound imaging of pancreatic ductal adenocarcinoma in venous phase
图 5 AIP超声造影动脉期图像
注：患者，男，36岁，AIP(与图 2同一患者)，超声显示胰腺整体弥漫性肿大，动脉期造影呈均匀性等增强表现(箭头)。a，常规超声；b，超声造影动脉期。
Figure 5. Contrast-enhanced ultrasound imaging of autoimmune pancreatitis in arterial phase
图 6 AIP超声造影静脉期图像
注：患者，男，36岁，AIP(与图 2同一患者)，超声显示胰腺整体弥漫性肿大，静脉期造影呈均匀性等增强表现(箭头)。a，常规超声；b，超声造影静脉期。
Figure 6. Contrast-enhanced ultrasound imaging of autoimmune pancreatitis in venous phase
表 1 3种诊断方法分别对胰腺良恶性病变检出的数目比较
Table 1. Comparison of 3 diagnostic results with the number of benign and malignant pancreatic lesions
病理 例数 PET/CT(例) 超声造影(例) PET/CT+超声造影(例) + － + － + － 恶性 83 72 11 58 25 75 8 良性 25 5 20 6 19 4 21 
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表 2 3种诊断方法对胰腺良恶性病变诊断指标比较
Table 2. Comparison of 3 diagnostic indexes of benign and malignant pancreatic lesions
组别 灵敏度 特异度 准确度 阳性预测值 阴性预测值 PET/CT 86.75%1) 80.00% 85.19%1) 93.51% 64.52% 超声造影 69.88% 76.00% 71.30% 90.63% 43.18% PET/CT+超声造影 90.36%1) 84.00% 88.89%1) 94.94% 72.41% χ2值 6.952 0.117 6.119 0.403 3.316 P值 0.008 0.733 0.013 0.546 0.069 注：与超声造影比，1)P＜0.05。
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