【摘要】 目的结直肠癌术后复发转移的早期诊断对提高患者的远期生存率有突出的临床意义。本研究通过回顾性分析18氟-氟代脱氧葡萄糖正电子发射型计算机断层显像(18 F-fluorodeoxyglucose positron emission tomography/computed tomography,¹⁸F-FDG PET/CT)在结直肠癌患者术后监测中的价值,探讨结直肠癌术后检测的最佳方案。方法收集2008-01-10-2013-12-25山东省肿瘤医院收治的直肠癌患者117例,所有病例均经常规检查疑诊为复发转移,并于1周内接受¹⁸F-PDG PET/CT检查及增强CT（contrast-enhanced computerized tomography,ce CT）扫描和血清癌胚抗原（carcinoembryonic antigen,CEA）检测。按病例和按病灶分别统计18 F-FDG PET/CT和ce CT的灵敏度、特异度和准确度,比较PET/CT与ce CT的诊断效率的差异,分析PET/CT诊断效率在CEA正常组和升高组的差别,研究18 F-FDG PET/CT对复发转移结直肠癌治疗策略的影响。结果在全组患者中,按病例分析18 F-FDG PET/CT的灵敏度为95.6%（86/90）,明显优于CT的78.4%（69/88）,差异有统计学意义,χ²=9.826,P=0.002;18 F-FDG PET/CT的特异度为81.5%（22/27）,优于CT的72.4%（21/29）;¹⁸F-FDG PET/CT的准确度为92.3%（108/117）,明显优于CT的76.9%（90/117）,差异有统计学意义,χ²=10.636,P=0.001。按病灶分析,¹⁸F-FDG PET/CT的灵敏度为95.0%（151/159）,明显优于CT的83.9%（125/149）,差异有统计学意义,χ²=10.135,P=0.001;18 F-FDG PET/CT特异度为83.3%（45/54）,明显优于CT的73.8%（31/42）;¹⁸F-FDG PET/CT准确度为92.0%（196/213）,明显优于CT的81.7%（156/191）,χ²=9.607,P=0.002。CEA升高组,按病例分析¹⁸F-FDG PET/CT的灵敏度为97.3%（71/73）,特异度为80.0%（12/15）,准确度为96.5%（83/86）,与CEA正常组之间差异无统计学意义。按病灶分析,18 F-FDG PET/CT在CEA升高组的灵敏度为96.6%（141/146）,特异度为80.6%（25/31）,准确度为93.8%（166/177）,其中灵敏度（χ²=4.319,P=0.038）和准确度（χ²=5.166,P=0.023）与CEA正常组之间差异有统计学意义。在18 F-FDG PET/CT显像阳性的病例中,15.4%（14/91）的患者接受了二次手术治疗,46.2%（42/91）的患者改变了治疗方案。结论 18 F-FDG PET/CT对结直肠癌的复发转移具有较高的诊断价值,不失为结直肠癌术后随访的有效工具,并且对CEA升高的患者可能更有意义。更多还原

【Abstract】 OBJECTIVE Early diagnosis of recurrence and metastasis has notable clinical significance for the longsurvival of postoperative colorectal cancer（CRC）patients.This study evaluated the role of Fluorine-18(¹⁸F)fluorodeoxyglucose（FDG）positron emission tomography（PET）/computerized tomography（CT）in follow up of postoperative CRC patients.METHODS The study included one hundred and seventeen postoperative CRC patients who were suspected recurrence or metastasis by regularly clinical examination.¹⁸F-FDG PET/CT,ce CT and serum carcinoembryonic antigen（CEA）were performed within one week in all patients.The final diagnosis of recurrence or metastasis was confirmed by histocytology or clinical follow-up over at least six months.The sensitivity,specificity,and accuracy of ¹⁸F-FDG PET/CT and ce CT were calculated using standard statistical formula in the case-based and lesion-based analyses.The diagnostic performance of PDG PET/CT and ce CT in different groups of patients were statistically analyzed with SPSS.RESULTS In the case-based analysis,the sensitivity,specificity,and accuracy of FDG PET/CT were 95.6%（86/90）,81.5%（22/27）,and 92.3%（108/117）,respectively,and the sensitivity（χ²=9.826,P=0.002）and accuracy（χ²=10.636,P=0.001）of FDG PET/CT significantly differed from ce CT.In the lesion-based analysis,the sensitivity,specificity,and accuracy of FDG PET/CT were 95.0%（151/159）,83.3%（45/54）and 92.0%（196/213）,respectively,and FDG PET/CT significantly differed from ce CT with sensitivity（χ²=10.135,P=0.001）and accuracy（χ²=9.607,P=0.002）.In patients with abnormal CEA level,the sensitivity,specificity and accuracy of FDG PET/CT were 97.3%（71/73）,80.0%（12/15）and 96.5%（83/86）,respectively,and didn’t significantly differ from the patients with normal CEA level.In lesion-based analysis,the sensitivity,specificity and accuracy of FDG PET/CT in abnormal CEA group were 96.6%（141/146）,80.6%（25/31）,93.8%（166/177）,the sensitivity（χ²=4.319,P=0.038）and accuracy（χ²=5.166,P=0.023）significantly differed from that of the normal CEA group.In patients with positive PET/CT scans,15.4%（14/91）patients received secondary operation and FDG PET/CT changed the management in 46.2%（42/91）patients.CONCLUSIONS ¹⁸F-FDG PET/CT showed superior value for diagnose of recurrence and metastasis of CRC patients and highlighted the role in follow up of postoperative CRC.It may be even more effective in patients with abnormal CEA levels.更多还原