CAJ | 학술논문

目的探讨18F-FDG PET/CT全身显像对小肠腺癌(SIA)的诊断价值.方法回顾29例SIA(男17例,女12例)、21例小肠淋巴瘤(SIL；男15例,女6例)及10例小肠结核(SIT；男4例,女6例)的18F-FDG PET/CT显像资料,采用目测法和半定量方法(SUVmax)分析3种疾病PET/CT显像特点.计量资料差异比较用单因素方差分析,率的比较行x2检验.结果 (1) PET/CT图像上SIA多表现为小肠局部团块状、结节状高代谢灶,典型的SIL为小肠局部环形异常放射性浓聚灶,SIT多呈结节状、条状高代谢灶、病灶呈“跳跃性”分布；SIA的SUVmax为8.44±3.82,低于SIL(11.54±4.02; F=86.96,t=2.77,均P＜0.01),与SIT的8.61±2.99差异无统计学意义(t=0.11,P＞0.05).(2)SIA、SIL和SIT的灶周淋巴结肿大检出率分别为72.41％ (21/29)、85.71％(18/21)和70.00％ (7/10) (x2=1.50,P＞0.05)；SIA的灶周肿大淋巴结SUVmax为5.59±2.86,明显低于SIL的11.10±5.72(F=56.56,t=3.85,均P＜0.01),与SIT的5.63±3.36差异无统计学意义(t=0.30,P＞0.05).PET/CT显像对SIA的灶周淋巴结肿大检出率明显高于CT(41.38％,12/29;x2=5.69,P＜0.05).(3)55.17％(16/29)的SIA有小肠外转移灶；66.67％(14/21)的SIL有小肠外病灶,以全身多发淋巴结浸润多见；80.00％(8/10)的SIT有腹腔外结核灶；三者小肠外病灶检出率差异无统计学意义(x2=2.13,P＞0.05).(4)29例SIA中15例(51.72％)累及回肠,8例(27.59％)累及空肠,4例(13.79％)空肠回肠同时受累,2例(6.90％)空肠十二指肠同时受累,病灶分布差异有统计学意义(x2=18.16,P＜0.01).(5)29例SIA中单原发癌8例(27.59％),转移性癌14例(48.28％),7例(24.14％)考虑为双原发癌.(6)以病理、诊断性治疗和临床随访结果为标准,18F-FDG PET/CT显像诊断SIA的灵敏度为93.10％(27/29),特异性为80.00％(8/10).结论 18F-FDG PET/CT全身显像可用于SIA的鉴别诊断,可为单原发、多原发及转移性SIA诊断提供依据.
목적 탐토18F-FDG PET/CT전신현상대소장선암(SIA)적진단개치.방법 회고29례SIA(남17례,녀12례)、21례소장림파류(SIL；남15례,녀6례)급10례소장결핵(SIT；남4례,녀6례)적18F-FDG PET/CT현상자료,채용목측법화반정량방법(SUVmax)분석3충질병PET/CT현상특점.계량자료차이비교용단인소방차분석,솔적비교행x2검험.결과 (1) PET/CT도상상SIA다표현위소장국부단괴상、결절상고대사조,전형적SIL위소장국부배형이상방사성농취조,SIT다정결절상、조상고대사조、병조정“도약성”분포；SIA적SUVmax위8.44±3.82,저우SIL(11.54±4.02; F=86.96,t=2.77,균P＜0.01),여SIT적8.61±2.99차이무통계학의의(t=0.11,P＞0.05).(2)SIA、SIL화SIT적조주림파결종대검출솔분별위72.41％ (21/29)、85.71％(18/21)화70.00％ (7/10) (x2=1.50,P＞0.05)；SIA적조주종대림파결SUVmax위5.59±2.86,명현저우SIL적11.10±5.72(F=56.56,t=3.85,균P＜0.01),여SIT적5.63±3.36차이무통계학의의(t=0.30,P＞0.05).PET/CT현상대SIA적조주림파결종대검출솔명현고우CT(41.38％,12/29;x2=5.69,P＜0.05).(3)55.17％(16/29)적SIA유소장외전이조；66.67％(14/21)적SIL유소장외병조,이전신다발림파결침윤다견；80.00％(8/10)적SIT유복강외결핵조；삼자소장외병조검출솔차이무통계학의의(x2=2.13,P＞0.05).(4)29례SIA중15례(51.72％)루급회장,8례(27.59％)루급공장,4례(13.79％)공장회장동시수루,2례(6.90％)공장십이지장동시수루,병조분포차이유통계학의의(x2=18.16,P＜0.01).(5)29례SIA중단원발암8례(27.59％),전이성암14례(48.28％),7례(24.14％)고필위쌍원발암.(6)이병리、진단성치료화림상수방결과위표준,18F-FDG PET/CT현상진단SIA적령민도위93.10％(27/29),특이성위80.00％(8/10).결론 18F-FDG PET/CT전신현상가용우SIA적감별진단,가위단원발、다원발급전이성SIA진단제공의거.
Objective To evaluate the value of whole body 18F-FDG PET/CT in detecting small intestine adenocarcinoma (SIA).Methods A retrospective study of 18F-FDG PET/CT was performed on 29 cases (male 17,female 12) of SIA,21 cases of small intestine lymphoma (SIL) (male 15,female 6) and 10 cases of small intestine tuberculosis (SIT) (male 4,female 6).Visual and semi-quantitative methods (SUVmax) were used to summarize and analyse the 18F-FDG PET/CT resutls.One-way analysis of variance and x2 test were used to analyze the data.Results (1) 18F-FDG PET/CT for SIA showed a partially conglomerate pattern of hypermetabolic small bowel masses with nodular configurations.A typical SIL showed a partially annular abnormal growth with aggregated foci of radioactivity.SIT lesions were usually in form of stripes and/or nodules with high metabolic foci or lesions with " skipped" distribution.The SUVmax of SIA (8.44±3.82) was significantly lower than that of SIL (11.54±4.02; F=86.96,t=2.77,both P＜0.01),but not significantly different when compared with SIT (8.61±2.99; t=0.11,P＞0.05).(2) The incidence rates of peri-lesion lymph node enlargement in SIA,SIL and SIT were 72.41％ (21/29),85.71％ (18/21) and 70.00％ (7/10),respectively (x2 =1.50,P＞0.05).The SUVmax of peri-lesion lymph nodes in SIA (5.59±2.86) was significantly lower than that of SIL (11.10±5.72; F=56.56,t=3.85,both P＜0.01),but was not significantly different when compared with SIT (5.63± 3.36; t =0.30,P＞ 0.05).The detection rate of PET/CT on pefi-lesion lymph node enlargement of SIA was higher than CT (41.38％,12/29; x2 =5.69,P＜0.05).(3) The incidence rate of extra-intestinal metastases was 55.17％ (16/29) in SIA,and the most common metastatic sites were liver,bone and adrenal gland.The incidence rate of extra-intestinal lesions was 66.67％ (14/21) in SIL,most commonly presented as widespread multifocal nodal permeation.Extra abdominal tuberculous loci were found in 80.00％ (8/10) of SIT.The incidence rates of extra-intestinal involvement were not significantly different among SIA,SIL and SIT (x2=2.13,P＞0.05).(4) Among the 29 SIA cases,15 (51.72％) involved the ileum,8 (27.59％) jejunum,4 (13.79％) both jejunum and ileum,and 2 (6.90％) both jejunum and duodenum (x2 =18.16,P＜0.01).(5) Among the 29 SIA cases,primary SIA was found in 8 cases (27.59％),double primary in 7 cases (24.14％) and metastatic SIA in 14 eases (48.28％).(6) Based on the clinical data,pathological results and clinical follow-up,the diagnosis of SIA by 18F-FDG PET/CT had a sensitivity and specificity of 93.10％ (27/29) and 80.00％ (8/10),respectively.Conclusions 18F-FDG PET/CT is useful for the differential diagnosis of S1A and for supporting the diagnosis of single primary,multi-primary and metastatic SIA.