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目的探讨18F-FDG PET/CT双时相(早期、延迟显像)在胰腺病变良恶性鉴别诊断中的价值。方法回顾性分析治疗前在我院行PET/CT检查的胰腺病例,共入选病例68例,其中男43例,女25例,恶性病变48例,良性20例。记录胰腺病灶的大小、SUV max早期、SUV max延迟,计算滞留率(RI),并以病理及临床影像随访结果作为金标准,绘制ROC曲线寻找诊断胰腺恶变的SUV max、RI临界值,计算诊断胰腺恶性病变的灵敏度、特异度及准确率。采用SPSS18.0统计软件进行分析,绘制ROC曲线,并使用约登指数最大的原则寻找鉴别胰腺良恶性病变最佳SUV max及RI诊断界值。分别计算其诊断胰腺癌恶性病变的灵敏度、特异度及准确率,良恶性组之间SUV max及RI的差异性采用非参数Mann-Whitney U检验。以P<0.05为差异有统计学意义。结果良性病变组SUVmax早期平均5.06(范围1.10~29.10),恶性病变组SUV max延迟平均7.80(范围1.60~17.60)。良恶性组SUV max早期之间有显著差异(Mann-Whitney U=760.500,P=0.001)。SUV max早期诊断胰腺恶性病变的ROC曲线下面积为0.792;以SUV max=5.65为临界值诊断胰腺恶性病变的灵敏度为81.3﹪,特异度为80﹪。恶性组肿瘤直径平均(3.03±1.27)cm,肿瘤直径与SUV max之间无显著相关性(P=0.383)。良性组RI平均为8.6﹪(-28.0﹪~50.0﹪),恶性组RI平均为25.4﹪(-7.4﹪~96.4﹪)。良、恶性病变组之间RI的差异有统计学意义(Mann-Whitney U=540.000,P=0.017)。以SUV max早期≥5.65且RI≥17.1﹪可以提高诊断胰腺恶性病变的特异性,但并不能提高诊断的敏感性。结论 18F-FDG PET/CT的SUV max早期在胰腺恶性病变诊断中具有较高的敏感性和特异性,结合RI可以进一步提高诊断胰腺恶性肿瘤的特异性,但仅以PET显像作为诊断标准仍具有假阴性和假阳性,临床工作中需要结合病史及多种影像资料进行综合诊断才能获得更准确的结果。
Objective To investigate the value of 18F-FDG PET / CT double-phase (early and delayed imaging) in the differential diagnosis of benign and malignant pancreatic lesions. Methods Retrospective analysis of pancreatic cases with PET / CT examination in our hospital before retrospective analysis included 68 cases, including 43 males and 25 females, 48 malignant lesions and 20 benign lesions. The size of pancreatic lesions, early SUV max, delay of SUV max, and retention rate (RI) were recorded. The ROC curve was drawn to find the critical value of SUV max and RI for the diagnosis of pancreatic malignancies according to the pathological and clinical follow-up results Pancreatic malignancy sensitivity, specificity and accuracy. SPSS18.0 statistical software was used to analyze and draw the ROC curves, and use the principle of maximum Youding index to find the best SUV max and RI diagnostic threshold for the differential diagnosis of benign and malignant pancreatic lesions. The sensitivity, specificity and accuracy of the diagnosis of malignant pancreatic cancer were calculated respectively. The differences of SUV max and RI between benign and malignant groups were analyzed by the non-parametric Mann-Whitney U test. P <0.05 for the difference was statistically significant. Results The average SUVmax in the benign group was 5.06 (range 1.10-29.10) in the early stage and 7.80 (range 1.60-17.60) in the malignant group. There was a significant difference in the early stage of SUV max between benign and malignant groups (Mann-Whitney U = 760.500, P = 0.001). The area under the ROC curve of SUV max early diagnosis of pancreatic malignant lesions was 0.792. The sensitivity and specificity of SUV max of 5.65 for diagnosis of pancreatic malignant lesions were 81.3% and 80% respectively. Malignant tumor diameter average (3.03 ± 1.27) cm, tumor diameter and SUV max no significant correlation (P = 0.383). The mean RI was 8.6% (- 28.0% ~ 50.0%) in the benign group and 25.4% (-7.4% ~ 96.4%) in the malignant group. There was a statistically significant difference in RI between benign and malignant lesions (Mann-Whitney U = 540.000, P = 0.017). Early detection of SUV max ≥5.65 and RI ≥17.1% can improve the specificity of the diagnosis of pancreatic malignancies, but does not improve the diagnostic sensitivity. Conclusions SUV max of 18F-FDG PET / CT is highly sensitive and specific in the early diagnosis of pancreatic malignant lesions. Combined with RI, the specificity of diagnosing pancreatic malignancies can be further improved. However, only PET imaging is still the diagnostic criteria With false negative and false positive, clinical work needs a combination of history and a variety of imaging data for comprehensive diagnosis in order to get more accurate results.