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结直肠癌腹膜转移瘤的18F-FDG PET/CT参数与其原发肿瘤位置及病理类型相关性分析

Correlation between 18F-FDG PET/CT parameters of colorectal peritoneal carcinomatosis and their primary tumor location and pathological type

    摘要
  • 摘要:
    目的 探讨结直肠癌腹膜转移瘤（colorectal peritoneal carcinomatosis，CRPC）在18F-FDG PET/CT上的影像学表现及PET/CT参数与原发肿瘤位置与病理类型的关系。
    方法 收集并分析2016年5月30日至2019年12月31日在南通大学附属医院核医学科PET/CT中心完成18F-FDG PET/CT检查的132例CRPC患者的影像学资料。观察指标包括结直肠癌（colorectal cancer，CRC）位置和病理类型、腹膜癌指数（peritoneal carcinomatosis index，PCI）、标准摄取值最大值（SUVmax）、滞留指数（retention index，RI），并且依据CRC位置分3组（右半结肠癌组、左半结肠癌组和直肠癌组）、依据CRC具体病理类型分3组（中高分化腺癌组、低分化腺癌组和黏液腺癌组）进行分析。
    结果 132例CRPC患者中，男性82例，女性50例，平均年龄（61.81±11.52）岁。88例CRC病灶经手术确诊具体病理类型，44例仅获得大体病理类型。CRPC诊断方法包括手术病理（15例）、穿刺活检（32例）、腹水脱落细胞（13例）、影像学随访（病灶好转4例、病灶进展68例）。132例CRPC患者的PCI为2~30，平均值为7.40±8.14。SUVmax为1.2~31.0，平均SUVmax为9.65±6.01。72例CRPC患者RI为－10.0%~112.2%，RI≥5%为阳性者65例，RI < 5%阴性者为7例。按照CRC位置分组，右半结肠癌组与直肠癌组CRC病理类型（P=0.009）和PCI评分（P=0.02）、右半结肠癌组与其他2组RI（P < 0.001）的组间差异均具有统计学意义（P < 0.05）。按照CRC病理类型分组，中高分化腺癌组与黏液腺癌组的CRC位置（P=0.003）、SUVmax（P=0.03）组间差异有统计学意义（P < 0.05）。
    结论 CRPC的PET/CT参数与原发灶CRC的位置和病理类型有一定关系，右半结肠黏液腺癌的PCI高于直肠中高分化腺癌，但葡萄糖代谢指标（SUVmax与RI）相对较低。

     

    Abstract:
    Objective To explore the imaging findings of colorectal peritoneal carcinomatosis (CRPC) on 18F-FDG PET/CT and to explore the relationship between PET/CT parameters and location and pathological type of primary colorectal cancer (CRC).
    Methods The imaging data of 132 CRPC patients who met the inclusion and exclusion criteria and completed 18F-FDG PET/CT examination in the PET/CT center of the nuclear medicine department of the Affiliated Hospital of Nantong University from May 30, 2016 to December 31, 2019 were collected and analyzed. The observation indexes included the location and pathological type of CRC, peritoneal carcinomatosis index (PCI), maximum standard uptake value (SUVmax) and retention index (RI). According to the location of CRC, the patients were divided into three groups (right colon cancer group, left colon cancer group and rectal cancer group), and according to the specific pathological type of CRC, the patients were divided into three groups (moderately and well-differentiated adenocarcinoma group, poorly differentiated adenocarcinoma group and mucinous adenocarcinoma group).
    Results 132 CRPC patients were enrolled in the study, including 82 males and 50 females, with an average age of (61.81±11.52) years. 88 cases of CRC lesions were diagnosed with specific pathological types by surgery, and 44 cases only obtained general pathological type. The diagnostic methods of CRPC included surgical pathology (15 cases), puncture biopsy (32 cases), finding exfoliated cells in ascites (13 cases), and imaging follow-up (4 cases of lesions improved, 68 cases of progressed lesions). The PCI range of 132 patients with CRPC was 2-30, with an average of 7.40±8.14. The SUVmax range of CRPC was 1.2-31.0, the average SUVmax was 9.65±6.01. The range of RI in 72 patients with CRPC was -10.0%-112.2%. 65 cases were positive for RI ≥ 5%, and 7 cases were negative for RI < 5%. The pathological type of CRC (P=0.009) and PCI score (P=0.02) in the right colon cancer group and the rectal cancer group, and the RI (P=0.02) between the right colon cancer group and the other two groups were statistically significant (P < 0.05). Grouped according to the pathological type of CRC, the difference between the CRC position (P=0.003), the SUVmax (P=0.03) between the moderately and well-differentiated adenocarcinoma group and the mucinous adenocarcinoma group was statistically significant (P < 0.05).
    Conclusion The PET/CT parameters of CRPC has a certain relationship with the location and pathological type of the primary CRC, the PCI of the mucinous adenocarcinoma of the right colon is higher than that of the moderately and well-differentiated adenocarcinoma of the rectum, but the glucose metabolism indexes (SUVmax and RI) are relatively low.

     

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