双时相18F-FDG PET/CT代谢参数对结直肠癌分期的诊断价值

Diagnostic value of dual-phase 18F-FDG PET/CT metabolic parameters in staging of colorectal cancer

摘要:

目的 探讨双时相¹⁸F-FDG PET/CT代谢参数与结直肠癌患者临床病理特征的相关性及代谢参数对T4分期、N分期、M分期的诊断价值。方法 根据纳入标准、排除标准，回顾性分析了46例治疗前行PET/CT检查同时经病理确诊的结直肠癌患者，测量代谢参数并收集患者的临床病理资料，将肿瘤代谢体积（MTV）、MTV2.5（SUVmax=2.5为阈值勾画的ROI统计分析）、糖酵解总量（TLG）、TLG2.5对淋巴结转移进行受试者工作特征（ROC）曲线分析，选取最优代谢参数，将代谢参数与病理特征进行相关性分析，用ROC曲线预测代谢参数对T4分期、淋巴结转移、M分期的诊断价值。结果 MTV、TLG对淋巴结转移的曲线下面积（AUC）值大于MTV2.5、TLG2.5 （0.752 vs. 0.737，0.802 vs. 0.787）。最大标准摄取值（SUVmax）、峰值标准摄取值（SUVpeak）、最大去脂肪标准摄取值（SUL）与T分期、淋巴结转移、肿瘤长径呈正相关（r值分别为0.335、0.409、0.297，0.319、0.376、0.297，0.299、0.401、0.332，P均<0.05），SUL与肿瘤长径的相关系数高于SUVmax。MTV、TLG与T4分期、淋巴结转移、M分期呈正相关（r值分别为0.584、0.436、0.349，0.598、0.521、0.366，P均<0.05），且TLG的相关系数最高。SUVmax、SUVpeak、肿瘤与肝脏标准摄取值比值（TLR）与肿瘤分化程度呈负相关（r值为-0.395、-0.298、-0.328，P均<0.05）。TLG对于T4分期、淋巴结转移、M分期的预测价值较高，AUC值分别为0.688、0.802、0.716。结论 MTV、TLG比MTV2.5、TLG2.5对淋巴结转移更有意义。双时相PET/CT代谢参数与临床病理特征相关，TLG对于术前结直肠癌分期有更重要的预测作用。

Abstract:

Objective To investigate the correlation between metabolic parameters of dual-phase ¹⁸F-FDG PET/CT and clinicopathological characteristics of patients with colorectal cancer and the predictive value of metabolic parameters for T4 stage, lymph node metastasis and M stage.Methods According to the inclusion and exclusion criteria, 46 patients with colorectal cancer who were pathologically confirmed and who underwent PET/CT examination before treatment were retrospectively analyzed. The metabolic parameters were measured and the clinicopathological data were collected. The ROC curves of MTV, MTV2.5 (SUVmax=2.5 as threshold delineation of ROI statistically analysis), TLG and TLG2.5 on lymph node metastasis were analyzed. The optimal metabolic parameters were selected, and the correlation between metabolic parameters and pathological features was analyzed. The ROC curve was used to predict the diagnostic value of metabolic parameters for T4 stage, lymph node metastasis and M stage.Results The AUC value of MTV and TLG for lymph node metastasis was greater than MTV2.5, TLG2.5 (0.752 vs. 0.737, 0.802 vs. 0.787). The SUVmax, SUVpeak and SUL were positively correlated with T stage, lymph node metastasis and tumor length (r=0.335, 0.409, 0.297; 0.319, 0.376, 0.297; 0.299, 0.401, 0.332, P all<0.05). The correlation coefficient between SUL and tumor length was higher than that between SUVmax. The MTV and TLG were positively correlated with T4 stage, lymph node metastasis and M stage (r=0.584, 0.436, 0.349; 0.598, 0.521, 0.366, P all <0.05), and TLG had the highest correlation coefficient. The SUVmax, SUVpeak and TLR were negatively correlated with tumor differentiation (r=-0.395, -0.298, -0.328, P all<0.05). The TLG had a high predictive value for T4 stage, lymph node metastasis and M stage, with AUC values of 0.688, 0.802 and 0.716, respectively.Conclusion MTV and TLG are more significant for lymph node metastasis than MTV2.5 and TLG2.5. Dual-phase PET/CT metabolic parameters are correlated with clinicopathological features, and TLG has an important significance for clinical staging.