Медицинская литература. Новинки

 

 

 

 

 

 

Возможности ПЭТ/КТ с 18F-ФДГ в дифференциальной диагностике метастазов колоректального рака в печень

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Цель. Изучить возможности ПЭТ/КТ с 18F-ФДГ в дифференциальной диагностике метастазов колоректального рака в печень. Материал и методы. Проведен ретроспективный анализ результатов лучевого обследования 126 больных колоректальным раком. Гистологический диагноз устанавливали на основании анализа морфологического материала из первичной опухоли. Природу очагов в печени подтверждали гистологическим исследованием или результатами лучевого обследования (динамического наблюдения). Чувствительность и специфичность метода определяли с помощью ROC-анализа c использованием показателя SUV в качестве числового классификатора. Результаты. У 51 (40,5%) пациента с колоректальным раком обнаружены метастазы в печень, у 25 (19,8%) - признаки внепеченочного распространения опухоли, у остальных 50 (39,7%) больных данных о прогрессировании заболевания не получено. Доброкачественные образования выявлены у 22 больных: у 10 они были обнаружены вместе с метастазами в печень, у 12 - без метастазов. Общее число выявленных в печени образований составило 166: 125 (75,3%) метастазов и 41 (24,7%) доброкачественное образование. По данным ROC-анализа при SUV ? 3,0 чувствительность ПЭТ/КТ с 18F-ФДГ в диагностике метастазов в печени составила 84,8%, специфичность - 97,6%, площадь под ROC-кривой - 0,893 (95% ДИ 0,836-0,936, p 0,0001), положительное прогностическое значение - 99,1%, отрицательное прогностическое значение - 67,8%. Заключение. ПЭТ/КТ с 18F-ФДГ является эффективной технологией лучевой дифференциальной диагностики новообразований печени более 10 мм у больных колоректальным раком. Применение количественной обработки данных с пороговым значением SUV ? 3,0 позволяет добиться высокой чувствительности и специфичности метода.

Ключевые слова:
колоректальный рак, печень, метастазы, доброкачественныеновообразования, ПЭТ/КТ, 18F-ФДГ, РФП, colorectal cancer, liver, metastases, benign tumors, PET/CT, 18F-FDG, radiotracer

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Capabilities of 18F-FDG PET/CT in the differential diagnosis of colorectal liver metastases

Aim. To study the capabilities of 18F-FDG PET/CT in the differential diagnosis of colorectal liver metastases. Materials and methods. A retrospective analysis of 18F-FDG PET/CT data of 126 patients with colorectal cancer was carried out. The final diagnosis of colorectal cancer was established based on the analysis of morphological material obtained from the primary tumor. The metastatic or benign origins of the liver foci was confirmed by histological examination or by the results of radiation examination (dynamic observation). Sensitivity and specificity of this method were determined using ROC analysis using the SUV as a numerical classifier. Results. Colorectal liver metastases were detected in 51 (40.5%) patients. Advanced extrahepatic tumor process was detected in 25 (19.8%) cases. There were no progression in 50 (39.7%) patients. Benign tumors were detected in 22 patients with colorectal cancer: in 10 cases coupled with liver metastases, in 12 - without them. Totally 166 focal liver lesions were found: 125 (75.3%) metastases and 41 (24.7%) benign tumors. According to ROC analysis, sensitivity and specificity of 18F-FDG PET/CT with SUV ? 3.0 in the diagnosis of liver metastases were 84.8% and 97.6% respectively, the area under the ROC curve - 0.893 (95% CI 0.836-0.936 , p 0.0001), positive predictive value and negative predictive value were - 99.1% and 67.8%, respectively. Conclusion. 18F-FDG PET/CT is a highly informative imaging method in the differential diagnosis of colorectal liver metastases larger than 10 mm. The use of quantitative data processing with a threshold value SUV ? 3.0 allows to achieve high sensitivity and specificity of the method.

Keywords:
колоректальный рак, печень, метастазы, доброкачественныеновообразования, ПЭТ/КТ, 18F-ФДГ, РФП, colorectal cancer, liver, metastases, benign tumors, PET/CT, 18F-FDG, radiotracer