摘要
目的探讨^18氟-氟代脱氧葡萄糖（^18F—FDG）PET／CT检查在胃癌与原发性胃淋巴瘤（PGL）鉴别诊断中的价值。方法回顾性分析2006年6月至2014年5月天津医科大学肿瘤医院收治的80例胃癌（60例胃非黏液腺癌、20例胃黏液腺癌）患者和47例PGL[22例黏膜相关淋巴瘤（MALT）、25例弥漫性大B细胞淋巴瘤（DLBCL）]患者的临床资料。首先行螺旋CT扫描，后行PET采集。对CT值、最大标准摄取值（SUVmax）、病灶最大厚度之间的比较采用方差分析，其中两组问的SUVmax值比较采用SNK方法；病灶形态采用，检验；病灶最大厚度与SUVmax值相关性采用两变量Pearson相关分析。结果胃癌及PGL患者的PET／CT检查结果均可表现为不同形式的胃壁增厚，胃癌以节段性或局限性胃壁增厚多见，而PGL以弥漫性或节段性胃壁增厚多见。60例胃非黏液腺癌患者病灶形态Ⅰ、Ⅱ、Ⅲ型分别为12、21、27例，20例胃黏液腺癌患者分别为2、7、11例，22例MALT患者分别为8、8、6例，25例DLBCL患者分别为13、7、5例。4类不同病理学分型患者的病灶形态比较，差异有统计学意义（χ^2=14．849，P〈0．05）。胃癌患者中，7例合并脾肿大，16例累及腹膜后肾门下淋巴结。PGL患者中，12例合并脾脏肿大，10例累及腹膜后肾门下淋巴结。PGL患者较胃癌患者更容易出现脾肿大，两者比较，差异有统计学意义（χ^2=7．506，P〈0．05）。胃癌与PGL患者在腹膜后肾门下淋巴结转移方面比较，差异无统计学意义（χ^2=0．178，P〉0．05）。80例胃癌患者中，79例表现为^18F—FDG阳性，仅1例胃黏液腺癌患者表现为^18F—FDG阴性，分期为仍期。47例PGL患者中，46例表现为^18F—FDG阳性，仅1例MALT患者表现为^18F—FDG阴性，分期为I期。胃非黏液腺癌、胃黏液腺癌、MALT和DLBCL患者CT值、SUVmax值、病灶最大厚度分别为（40±8）HU、（39±11）HU、（41±11）HU、（38±9）HU，9．9±6．6、5．6±1．9、4．6±2．9、18．3±7．6，（2．1±1．2）cm、（1．9±0．9）cm、（1．3±1．1）cm、（2．6±1．5）cm，4类不同病理学分型患者病灶的SUVmax值比较，差异有统计学意义（F=26．920，P〈0．05），两两比较发现：MALT与胃黏液腺癌患者比较，差异无统计学意义（P〉0．05），其他各组两两比较，差异均有统计学意义（P〈0．05）。4类不同病理学分型患者的CT值、病灶最大厚度比较，差异无统计学意义（F=0．578，4．510，P〉0．05）。上述4类患者各自SUVmax与病灶最大厚度无关（r=0．055，0．346，0．226，0．133，P〉0．05）。结论PET／CT检查在胃癌及PGL的鉴别诊断中具有重要价值。胃癌及PGL常见的病灶形态不同，PGL较胃癌更易合并脾肿大。DLBCL的SUVmax值高于胃癌及MALT。胃黏液腺癌及MALT患者的^18F—FDG摄取水平不高，应警惕PET／CT检查假阴性的可能。
Objective To explore the value of ^18F-fluorodeoxyglucose （^18F-FDG） PET/CT examination in the differential diagnosis of the gastric cancer and primary gastric lymphoma （PGL）. Methods The clinical data of 80 patients with gastric cancer （60 with non-mucinous adenocarcinoma and 20 with mucinous adenocarcinoma） and 47 patients with PGL [ 22 with mucosa-associated lymphoid tissue （MALT） and 25 with diffuse large B-cell lymphoma （DLBCL）] who were admitted to the Tianjin Medical University Cancer Institute and Hospital from June 2006 to May 2014 were retrospectively analyzed. Spiral CT scan was first done and then followed by PET.The CT value of the lesions, maximum standardized uptake value （SUVmax） of patients and maximal gastrointestinal wall thickness （THKmax） were analyzed by the ANOVA test. The SUVmax comparison between groups was evaluated with the Student-Newman-Keuls. The lesions type was analyzed by the chi-square test. The THKmax and SUVmax among groups were analyzed by the Pearson correlation analysis. Results ^18F-FDG PET/CT imaging of patients with gastric cancer and PGL showed different types of gastric wall thickening, segmental and limited thickening of gastric wall were the main features of gastric cancer and diffuse and segmental thickening of gastric wall were the main features of PGL. The type Ⅰ , Ⅱ and m of lesions were detected in 12, 21 and 27 of 60 patients with non- mucinous adenocarcinoma, in 2, 7 and 11 of 20 patients with mucinous adenocarcinoma, in 8, 8 and 6 of 22 patients with MALT and in 13, 7 and 5 of 25 patients with DLBCL respectively. There were significant differences in the 4 pathological types of lesions among all the patients （χ^2= 14. 849, P 〈 0.05 ）. The lymph nodes beneath the renal hilum and at the retroperitoneum were involved in 16 patients with gastric cancer and in 10 patients with PGL, and 7 patients with gastric cancer and 12 patients with PGL were complicated with splenomegalia, respec- tively, showing a significant difference in the splenomegalia between patients with PGL and gastric cancer （χ^2= 7. 506, P 〈 0.05）. There was no significant difference in the metastasis of lymph nodes beneath the renal hilum and at the retroperitoneum between patients with PGL and gastric cancer （χ^2= 0. 178, P 〉 0. 05）. Among 80 patients with gastric cancer, positive 18F-FDG was detected in 79 patients and negative ^18F-FDG in 1 patient with 13 stage of mucinous adenocarcinoma. Among 47 patients with PGL, positive as F-FDG was detected in 46 patients and negative ISF-FDG in 1 patient with stage I of MALT. The CT value of the lesion, SUVmax and THKmax in patients with non-mucinous adenocarcinoma, mucinous adenocarcinoma, MALT and DLBCL were （40 ± 8 ） HU, （39±11）HU, （41＋11）HU, （38±9）HU and 9.9 ±6.6, 5.6 ±1.9, 4.6±2.9, 18.3 ±7.6 and （2.1 ± 1.2） cm, （ 1.9±0.9） cm, （ 1.3 ± 1.1 ） em and （2.6 ±1.5 ） em, respectively, showing significant differences in the SUVmax among all the groups （ F = 26. 920, P 〈 0.05 ）. In the pairwise comparisons, there were no significant difference between the MALT group and mutinous adenocarcinoma group （ P 〉 0.05 ） , and significant differences among the other groups （ P 〈 0.05 ）. The CT value of the lesions and THKmax among all the patients were compared, with no significant differences （F = 0. 578, 4. 510, P 〉 0.05 ）. There were no significant differences in the SUVmax and THKmax among all the patients （r = 0. 055, 0. 346, 0. 226, 0. 133, P 〉 0.05 ）. Conclusions There is an important diagnosis value of PET/CT examination in patients with gastric cancer and PGL. The patho- logical types of the lesions in patients with gastric cancer and PGL are different. The occurrence of splenomegalia in patients with PGL is easier than that with gastric cancer. SUVmax of patients with DLBCL is higher than those with gastric cancer and MALT. FDG uptake in patients with mueinous adenocarcinoma and MALT are not enough, and these may lead to false negative result of PET/CT examination.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第3期216-220,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金青年基金（81302003）
天津市教委课题（200120109）
天津市肿瘤医院基金（Y1310）
天津市卫生局科技基金（2013KZ088）
关键词
胃肿瘤
胃淋巴瘤
体层摄影术
正电子发射断层显影术
最大摄取值
Gastric neoplasms
Gastric lymphoma
Tomography
Positron-emission tomography
Maximum standardized uptake value
