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18F-FDG PET/CT在胃癌骨转移中的临床应用

熊敏 张伟光 樊卫 林晓平

熊敏, 张伟光, 樊卫, 林晓平. 18F-FDG PET/CT在胃癌骨转移中的临床应用[J]. 分子影像学杂志, 2022, 45(1): 1-7. doi: 10.12122/j.issn.1674-4500.2022.01.01
引用本文: 熊敏, 张伟光, 樊卫, 林晓平. 18F-FDG PET/CT在胃癌骨转移中的临床应用[J]. 分子影像学杂志, 2022, 45(1): 1-7. doi: 10.12122/j.issn.1674-4500.2022.01.01
XIONG Min, ZHANG Weiguang, FAN Wei, LIN Xiaoping. Clinical application of 18F-FDG PET/CT in bone metastases from gastric cancer[J]. Journal of Molecular Imaging, 2022, 45(1): 1-7. doi: 10.12122/j.issn.1674-4500.2022.01.01
Citation: XIONG Min, ZHANG Weiguang, FAN Wei, LIN Xiaoping. Clinical application of 18F-FDG PET/CT in bone metastases from gastric cancer[J]. Journal of Molecular Imaging, 2022, 45(1): 1-7. doi: 10.12122/j.issn.1674-4500.2022.01.01

18F-FDG PET/CT在胃癌骨转移中的临床应用

doi: 10.12122/j.issn.1674-4500.2022.01.01
基金项目: 

广东省自然科学基金 2021

广东省科技计划项目 2020A1414010227

广东省食管癌研究所基金 Q202011

详细信息
    作者简介:

    熊敏,在读硕士研究生,E-mail: xiongmin@sysucc.org.cn

    通讯作者:

    林晓平,副主任医师,E-mail: linxp@sysucc.org.cn

Clinical application of 18F-FDG PET/CT in bone metastases from gastric cancer

  • 摘要:   目的  探讨胃癌骨转移患者的临床特征以及18F-FDG PET/CT在胃癌骨转移中的临床应用。  方法  选择2010年1月~2020年12月在中山大学肿瘤防治中心治疗前行18F-FDG PET/CT检查且原发灶经病理确诊的21例胃癌骨转移患者,其中男性9例、女性12例,中位年龄57.0(28.0,81.0)岁,回顾性分析其临床资料及18F-FDG PET/CT定性、半定量[最大标准化摄取值(SUVmax)] 指标特点。根据原发灶组织分化情况,将患者分为:低分化组13例(65.0%)和中-低分化组7例(35.0%)。根据Lauren分型,将患者分为:肠型组4例(20.0%),混合型组9例(45.0%),弥漫型组7例(35.0%)。根据Soloway分级将骨转移灶数量分为3组(Ⅰ级≤5,Ⅱ级6~20,Ⅲ级 > 20):Ⅰ级(组)6例,Ⅱ级(组)4例,Ⅲ级(组)11例。根据PET/CT上溶骨性、混合性及成骨性表现将骨转移类型分为3组:纯溶骨性转移6例,混合性(溶骨性/成骨性)11例,成骨性4例。  结果  本组胃癌患者发生骨转移部位依次为脊柱(19/21),肩胛骨、肋骨、锁骨、胸骨(18/21)及骨盆(17/21),其中3例伴有骨髓浸润。患者同期血清碱性磷酸酶升高11例(57.9%),乳酸脱氢酶升高7例(36.8%)。不同骨转移类型组间乳酸脱氢酶水平存在差异(χ2=6.823,P=0.047),混合性转移乳酸脱氢酶升高更常见。骨转移灶SUVmax大小在性别、Lauren分型及Soloway分级的差异有统计学意义(Z=-1.990,H=6.326,H= 6.070,P < 0.05);女性组中位SUVmax为11.6(7.3, 32.1),高于男性组的7.2(3.7, 17.1);弥漫型[12.2(5.3, 32.1)]及混合型组[10.8 (7.2, 17.2)]高于肠型组[6.7(3.7, 7.3)];Soloway分级越高,即骨转移数目越多,骨转移灶的SUVmax越高。Soloway分级在性别上存在差异(χ2=6.832,P=0.033),女性患者Soloway分级普遍高于男性。原发灶及骨转移灶SUVmax大小与年龄有关,低龄组(< 中位年龄57.0岁)骨转移灶SUVmax多较高而原发灶SUVmax多较低(χ2=5.838、10.831,P < 0.05)。  结论  18F-FDG PET/CT能够全面评估胃癌骨转移情况。胃癌骨转移具有一定的特点,常发生于中轴骨,以溶骨性及多灶转移多见,常伴有乳酸脱氢酶、碱性磷酸酶的升高。乳酸脱氢酶升高更常见于混合性骨转移患者。

     

  • 图  1  胃癌伴成骨性骨转移

    患者女性, 57岁, 18F-FDG PET/CT成像显示胃癌伴多发成骨性转移.原发灶位于胃窦, 病理类型为低分化腺癌伴部分印戒细胞, Lauren分型为弥漫性.A~D: 横断面图像(黑色箭头表示原发肿瘤, 白色箭头表示第一腰椎骨转移); E~G: 矢状位图像; H: 全身PET MIP图像.

    Figure  1.  Gastric cancer with osteogenic metastasis.

    表  1  21例胃癌骨转移患者临床及肿瘤特征

    Table  1.   Clinical and tumor characteristics of 21 cases gastric cancer patients with bone metastasis

    一般情况 统计值 肿瘤情况 统计值[n (%)]
    年龄(岁) 57.0 (28.0, 81.0) 骨痛
    性别   有 7 (33.3)
      男 9 (42.9)   无 11 (52.4)
      女 12(57.1)   不详 3 (14.3)
    红细胞(×109/L) 4.2 (1.3, 5.4) 骨折
      下降 7(36.8)   有 0 (0)
      正常或升高 12(63.2)   无 21 (100)
    血小板(×109/L) 212.7±115.3 原发灶部位
      下降 4(21.1)   上1/3 4 (19.0)
      正常或升高 15(78.9)   中1/3 6 (28.6)
    白细胞(×109/L) 7.9±2.2   下1/3 11 (52.4)
      升高 4(21.1) 淋巴结转移
      正常 15(78.9)   区域 2 (9.5)
    血钙(mmol/L) 2.2±0.1   远处 14 (66.7)
      下降 4(21.1)   无 5 (23.8)
      正常 15(78.9) 远处转移(n)
    ALP (U/L) 173.6 (44.9, 926.4)   肝 5
      升高 11 (57.9)   肾上腺 4
      正常 8 (42.1)   卵巢 4
    LDH (U/L) 238.6 (123.5, 1176.9)   肺 1
      升高 7(36.8)   腹膜 6
      正常 12(63.2)
    ALP: 碱性磷酸酶; LDH: 乳酸脱氢酶; 服从近似正态分布的计量资料以均数±标准差表示, 不服从近似正态分布的资料以中位数(四分位数间距)表示.
    下载: 导出CSV

    表  2  21例胃癌骨转移患者临床、病理特征在定性、半定量参数间差异

    Table  2.   Differences in clinical and pathological characteristics between qualitative and semiquantitative parameters in 21 cases gastric cancer patients with bone metastasis.

    因素 骨转移灶 原发灶SUVmax 中位SUVmax
    骨转移类型 SUVmax 骨转移灶 原发灶
    H/χ2 P t/Z/H P t/Z/H P χ2 P χ2 P
    年龄 4.781 0.112 -1.830 0.072 -3.310 0.001 5.838 0.030 10.831 0.002
    性别 2.099 0.504 -1.990 0.049 -1.421 0.155 5.743 0.030 0.398 0.670
    组织分化 0.189 0.189 0.803 0.433 -1.545 0.122 0.220 1.000 5.495 0.057
    Lauren分型 5.120 0.217 6.326 0.034 2.204 0.332 5.143 0.076 2.397 0.302
    Soloway分级 7.793 0.117 6.070 0.041 4.121 0.217 4.093 0.086 1.440 0.487
    淋巴结转移 0.245 1.000 1.487 0.153 0.226 0.823 0.153 1.000 2.759 0.149
    远处淋巴结转移 0.170 1.000 1.111 0.280 -0.054 0.958 0.095 1.000 2.386 0.183
    远处转移 1.357 0.598 -0.048 0.962 -1.350 0.177 0.064 1.000 0.398 0.670
    红细胞 2.645 0.391 0.960 0.350 -0.845 0.432 2.100 0.350 0.095 0.953
    血小板 2.454 0.368 -0.550 0.305 -1.576 0.133 3.958 0.138 4.293 0.064
    白细胞 1.619 0.777 -0.800 0.469 0.000 1.000 3.026 0.220 0.019 0.990
    血钙 2.454 0.368 -0.105 0.307 -1.400 0.185 1.017 0.582 1.017 0.582
    ALP 6.807 0.056 -0.304 0.765 -1.651 1.109 2.048 0.359 1.273 0.529
    LDH 6.823 0.047 -0.772 0.451 -2.028 0.045 4.250 0.650 4.866 0.057
    原发灶部位 2.048 0.689 3.299 0.196 1.850 0.186 1.775 0.412 10.066 0.007
    骨转移类型 - - 3.316 0.195 1.636 0.201 1.775 0.412 3.091 0.133
    原发灶SUVmax 4.187 0.122 - - - - - - - -
    下载: 导出CSV
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  • 收稿日期:  2021-11-26
  • 网络出版日期:  2022-03-29
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