Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses

被引:127
作者
Diederichs, CG
Staib, L
Vogel, J
Glasbrenner, B
Glatting, G
Brambs, HJ
Beger, HG
Reske, SN
机构
[1] Univ Hosp Ulm, Dept Nucl Med, Ulm, Germany
[2] Univ Hosp Ulm, Dept Surg, Ulm, Germany
[3] Univ Hosp Ulm, Dept Diagnost Radiol, Ulm, Germany
[4] Univ Hosp Ulm, Dept Internal Med, Ulm, Germany
关键词
F-18-fluorodeoxyglucose; positron-emission tomography; pancreatic cancer; pancreatitis; radionuclide imaging;
D O I
10.1097/00006676-200003000-00001
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The aim of this study was to determine the value and limitations of F-18-fluorodeoxyglucose (FDG)-position-emission tomography (PET) for differentiating benign and malignant pancreatic disease and for staging malignant disease. One hundred fifty-nine patients with 89 malignant and 70 benign pancreatic lesions all received PET, computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) before pancreatic surgery. The original reports were compared for all patients (group I; N = 159), for a subgroup that neither had fasting plasma glucose levels greater than or equal to 130 mg/dL or known elevated levels of C-reactive protein ([CRP], group TI; n = 123), and for the remaining patients (group III; n = 36). For group I, accuracy values (areas under receiver operating characteristic [ROC] curves) for differentiation of benign/malignant masses were 0.86 (PET), 0.93 (ERCP), 0.82 (CT), and 0.95 for ERCP + PET (N = 159). For group TT, ROC areas increased to 0.92 (PET), 0.94 (p < 0.05; n = 123) (ERCP), 0.82 (CT), 0.97 (p < 0.05; n = 123) (ERCP + PET). The results for group IU were 0.71 (PET), 0.81 (CT), and 0.93 (ERCP); (n = 36). With 54 patients of group n that either had contradictory or indeterminate/technically unsuccessful CT/ERCP, PET was correct in 43 patients (84%). Sensitivity/specificity for lymph node staging was 49%/63%, respectively. For patients with hepatic metastasis, PET was 70% sensitive and 95% specific, missing some metastasis that were <1 cm. PET detected peritoneal metastasis in 25% of patients, missing poorly localized microscopic spread. For selected patients who have indeterminate pancreatic masses but no hyperglycemia or serologic evidence of active inflammation, FDG-PET is an independent functional assay that significantly adds to the diagnostic accuracy of ERCP and CT in the differentiation of benign and malignant pancreatic disease. PET can reliably detect hepatic, peritoneal, and other distant metastases that are greater than or equal to 1 cm.
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页码:109 / 116
页数:8
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