中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2014年
6期
374-379
,共6页
张建%贾宁阳%余仲飞%杨剑%刘晓东%胡胜平%冯菲%孙高峰%程超
張建%賈寧暘%餘仲飛%楊劍%劉曉東%鬍勝平%馮菲%孫高峰%程超
장건%가저양%여중비%양검%류효동%호성평%풍비%손고봉%정초
胰腺肿瘤%正电子发射体层摄影术%体层摄影术,X线计算机%对比增强%诊断,鉴别%肿瘤分期
胰腺腫瘤%正電子髮射體層攝影術%體層攝影術,X線計算機%對比增彊%診斷,鑒彆%腫瘤分期
이선종류%정전자발사체층섭영술%체층섭영술,X선계산궤%대비증강%진단,감별%종류분기
Pancreatic neoplasms%Positron-emission tomography%Tomography,X-ray computed%Contrastenhancement%Diagnostic,differential%Neoplasm staging
目的 探讨FDG PET与增强CT(CECT)异机融合技术在胰腺病变良恶性鉴别诊断及胰腺癌分期中的价值.方法 回顾性分析2010年9月至2013年10月在上海长海医院行CECT和常规PET/CT检查的70例胰腺病患者的资料,其中男性45例,女性25例,中位年龄57岁;恶性50例,良性20例.使用西门子Multimodality Workplace TureD软件获得PET/CECT异机融合图像.以病理及临床影像随访结果作为标准,比较CECT、PET/CT、PET/CECT异机融合图像对胰腺病变鉴别诊断以及胰腺癌分期的效能.结果 CECT、PET/CT、PET/CECT异机融合在胰腺病灶良恶性诊断方面的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确率和Kppa值分别为82.0％、65.0％、85.4％、59.1％、77.1％及0.465; 92.0％、65.0％、86.8％、76.5％、84.2％及0.597; 96.0％、90.0％、96.0％、90.0％、94.3％及0.860,其中CECT与PET/CECT诊断良恶性病变的敏感性、NPV及准确率的差异有统计学意义(P值均＜0.05).31例胰腺癌经手术证实,其中15例发现伴胰周血管侵犯,3种检查方法诊断的敏感性、特异性、PPV、NPV和准确率分别为93.3％、93.7％、93.3％、93.8％及93.5％;26.7％、75.0％、50.0％、52.2％及51.6％;93.3％、93.7％、93.3％、93.8％及93.5％,其中PET/CT与CECT、PET/CECT诊断胰周血管侵犯的敏感性、PPV、NPV及准确性的差异有统计学意义(P值均＜0.05).19例病理证实有区域淋巴结转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为63.2％、91.7％、92.3％、61.1％及74.2％; 78.9％、83.3％、88.2％、71.4％及80.6％; 89.5％、91.7％、94.4％、84.6％及90.3％,差异均无统计学意义.50例恶性病变中17例经组织学或临床随访证实有远处转移,3种方法诊断的敏感性、特异性、PPV、NPV和准确率分别为58.8％、100％、100％、82.5％及86％;82.4％、91.0％、82.4％、90.9％及88％;94.1％、97.0％、94.1％、97.0％及96.0％,其中CECT与PET/CECT诊断远处转移的敏感性及NPV的差异有统计学意义(P值均＜0.05).结论 将PET/CT和CECT进行异机融合是一种方便有效的方法,有助于弥补PET/CT和CECT在胰腺病变诊断和分期的一些不足,提高诊断效能.
目的 探討FDG PET與增彊CT(CECT)異機融閤技術在胰腺病變良噁性鑒彆診斷及胰腺癌分期中的價值.方法 迴顧性分析2010年9月至2013年10月在上海長海醫院行CECT和常規PET/CT檢查的70例胰腺病患者的資料,其中男性45例,女性25例,中位年齡57歲;噁性50例,良性20例.使用西門子Multimodality Workplace TureD軟件穫得PET/CECT異機融閤圖像.以病理及臨床影像隨訪結果作為標準,比較CECT、PET/CT、PET/CECT異機融閤圖像對胰腺病變鑒彆診斷以及胰腺癌分期的效能.結果 CECT、PET/CT、PET/CECT異機融閤在胰腺病竈良噁性診斷方麵的敏感性、特異性、暘性預測值(PPV)、陰性預測值(NPV)、準確率和Kppa值分彆為82.0％、65.0％、85.4％、59.1％、77.1％及0.465; 92.0％、65.0％、86.8％、76.5％、84.2％及0.597; 96.0％、90.0％、96.0％、90.0％、94.3％及0.860,其中CECT與PET/CECT診斷良噁性病變的敏感性、NPV及準確率的差異有統計學意義(P值均＜0.05).31例胰腺癌經手術證實,其中15例髮現伴胰週血管侵犯,3種檢查方法診斷的敏感性、特異性、PPV、NPV和準確率分彆為93.3％、93.7％、93.3％、93.8％及93.5％;26.7％、75.0％、50.0％、52.2％及51.6％;93.3％、93.7％、93.3％、93.8％及93.5％,其中PET/CT與CECT、PET/CECT診斷胰週血管侵犯的敏感性、PPV、NPV及準確性的差異有統計學意義(P值均＜0.05).19例病理證實有區域淋巴結轉移,3種方法診斷的敏感性、特異性、PPV、NPV和準確率分彆為63.2％、91.7％、92.3％、61.1％及74.2％; 78.9％、83.3％、88.2％、71.4％及80.6％; 89.5％、91.7％、94.4％、84.6％及90.3％,差異均無統計學意義.50例噁性病變中17例經組織學或臨床隨訪證實有遠處轉移,3種方法診斷的敏感性、特異性、PPV、NPV和準確率分彆為58.8％、100％、100％、82.5％及86％;82.4％、91.0％、82.4％、90.9％及88％;94.1％、97.0％、94.1％、97.0％及96.0％,其中CECT與PET/CECT診斷遠處轉移的敏感性及NPV的差異有統計學意義(P值均＜0.05).結論 將PET/CT和CECT進行異機融閤是一種方便有效的方法,有助于瀰補PET/CT和CECT在胰腺病變診斷和分期的一些不足,提高診斷效能.
목적 탐토FDG PET여증강CT(CECT)이궤융합기술재이선병변량악성감별진단급이선암분기중적개치.방법 회고성분석2010년9월지2013년10월재상해장해의원행CECT화상규PET/CT검사적70례이선병환자적자료,기중남성45례,녀성25례,중위년령57세;악성50례,량성20례.사용서문자Multimodality Workplace TureD연건획득PET/CECT이궤융합도상.이병리급림상영상수방결과작위표준,비교CECT、PET/CT、PET/CECT이궤융합도상대이선병변감별진단이급이선암분기적효능.결과 CECT、PET/CT、PET/CECT이궤융합재이선병조량악성진단방면적민감성、특이성、양성예측치(PPV)、음성예측치(NPV)、준학솔화Kppa치분별위82.0％、65.0％、85.4％、59.1％、77.1％급0.465; 92.0％、65.0％、86.8％、76.5％、84.2％급0.597; 96.0％、90.0％、96.0％、90.0％、94.3％급0.860,기중CECT여PET/CECT진단량악성병변적민감성、NPV급준학솔적차이유통계학의의(P치균＜0.05).31례이선암경수술증실,기중15례발현반이주혈관침범,3충검사방법진단적민감성、특이성、PPV、NPV화준학솔분별위93.3％、93.7％、93.3％、93.8％급93.5％;26.7％、75.0％、50.0％、52.2％급51.6％;93.3％、93.7％、93.3％、93.8％급93.5％,기중PET/CT여CECT、PET/CECT진단이주혈관침범적민감성、PPV、NPV급준학성적차이유통계학의의(P치균＜0.05).19례병리증실유구역림파결전이,3충방법진단적민감성、특이성、PPV、NPV화준학솔분별위63.2％、91.7％、92.3％、61.1％급74.2％; 78.9％、83.3％、88.2％、71.4％급80.6％; 89.5％、91.7％、94.4％、84.6％급90.3％,차이균무통계학의의.50례악성병변중17례경조직학혹림상수방증실유원처전이,3충방법진단적민감성、특이성、PPV、NPV화준학솔분별위58.8％、100％、100％、82.5％급86％;82.4％、91.0％、82.4％、90.9％급88％;94.1％、97.0％、94.1％、97.0％급96.0％,기중CECT여PET/CECT진단원처전이적민감성급NPV적차이유통계학의의(P치균＜0.05).결론 장PET/CT화CECT진행이궤융합시일충방편유효적방법,유조우미보PET/CT화CECT재이선병변진단화분기적일사불족,제고진단효능.
Objective To explore the value of the cross-modality fusion images provided by PET/CT and contrast-enhanced CT (CECT) in differentiating malignant from benign pancreatic lesions and evaluating staging for pancreatic cancer.Methods Data from 70 patients with pancreatic lesions who had undergone CECT and PET/CT examinations in our hospital from September 2010 to October 2013 were analyzed.Of these 70 patients,45 were males and 25 females; the median age was 57 years old.Fifty patients had malignant lesions,and 20 patients had benign lesions.Cross-modality image fusion (PET/CECT) was obtained using Multimodality Workplace Ture D software (Siemens Ltd).The pathological and imaging follow-up were used as gold standard,then the value of PET/CT,CECT and PET/CECT in differentiating malignant from benign pancreatic lesions and evaluating staging for pancreatic cancer was determined.Results The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),accuracy and Kappa value of CECT,PET/CT and PET/CECT the 3 methods in differentiating benign from malignant pancreatic lesions were 82.0％,65.0％,85.4％,59.1％,77.1％ and 0.465; 92.0％,65.0％,86.8％,76.5％,84.2％ and 0.597 ; 96.0％,90.0％,96.0％,90.0％,94.3％ and 0.860,and the difference of sensitivity,NPV,and accuracy between CECT and PET/CECT was statistically significant (P ＜ 0.05).In 15 of 31 patients who were confirmed to have malignant tumor after surgery,peripancreatic vessel invasion was verified.The sensitivity,specificity,PPV,NPV,accuracy of the 3 methods in diagnosing peripancreatic vessel invasion were 93.3％,93.7％,93.3％,93.8％,and 93.5％; 26.7％,75％,50.0％,52.2％ and 51.6％; 93.3％,93.7％,93.3％,93.8％ and 93.5％,and the difference of sensitivity,NPV,and accuracy between CECT and PET/CECT was statistically significant (P＜0.05).In 19 of 31 patients who were confirmed to have malignant tumor after surgery,regional lymph node metastasis was histologically detected.The sensitivity,specificity,PPV,NPV,accuracy of 3 methods in detecting regional lymph node metastasis were 63.2％,91.7％,92.3％,61.1％ and 74.2％; 78.9％,83.3％,88.2％,71.4％ and 80.6％; 89.5％,91.7％,94.4％,84.6％ and 90.3％,and there were no statistically significant differences.In 17 of 50 patients with malignant tumor,distant metastasis was confirmed after biopsy or follow-up.The sensitivity,specificity,PPV,NPV and accuracy of 3 methods in detecting distant metastasis were 58.8％,100％,100％,82.5％ and 86％ ;82.4％,91.0％,82.4％,90.9％ and 88％; 94.1％,97.0％,94.1％,97.0％ and 96.0％,and the difference of sensitivity and NPV between CECT and PET/CECT was statistically significant (P ＜ 0.05).Conclusions Cross-modality image fusion of PET/CT and CECT is a convenient and effective method that can be used to compensate for some limitations of PET/CT and CECT in differential diagnosis of pancreatic lesions and staging assessments of pancreatic cancer,and to improve the diagnostic efficacy.
