目的 探讨18氟标记的氟脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像/电子计算机断层扫描(PET/CT)显像在胃癌治疗后随访中的价值,分析其对胃癌治疗后临床再分期及治疗决策的影响.方法 选取我院收治的胃癌治疗后患者55例,分别于静脉注射18F-FDG 后60 min及120 min行PET/CT早期及延迟显像.延迟显像于患者饮水使胃适度充盈后进行.必要时行增强CT检查.分别从肿瘤复发、淋巴结转移及淋巴结外转移3个方面评价18F-FDG PET/CT显像在胃癌治疗后随访中的价值,分析18F-FDG PET/CT显像对临床再分期及治疗决策的影响.分别测量胃癌复发与吻合口炎症早期及延迟显像最大标准化摄取值(SUVmax)及SUVmax变化率(△SUVmax%),评价饮水胃充盈后18F-FDG PET/CT延迟显像的价值.所有患者的诊断以病理组织学检查结果为金标准.采用SAS 9.13统计学软件进行统计分析.结果 (1)18F-FDG PET/CT诊断胃癌复发的准确性96.4%(53/55)高于CT(85.5%),诊断淋巴结转移的灵敏度(92.0%)、准确性(96.4%)、阴性预测值(93.8%)均高于CT(60.0%、81.8%、75.0%),诊断淋巴结外转移的灵敏度(81.8%)、准确性(90.9%)均高于CT(45.5%、76.4%),差异均有统计学意义(P＜0.05).(2)18F-FDG PET/CT显像使34.5%(19/55)的患者TNM分期发生改变,21.8%(12/55)的患者治疗方案改变.(3)胃癌复发患者及吻合口炎症患者△SUVmax%分别为(22.8±9.8)%、(8.6±13.3)%,差异有统计学意义(P＜0.05).结论 18F-FDG PET/CT显像可早期探测胃癌复发、转移,将成为胃癌治疗后有效的监测手段;且18F-FDG PET/CT显像对临床再分期及合理治疗决策的制定具有重要指导作用;饮水胃充盈后18F-FDG PET/CT延迟显像有助于肿瘤复发与吻合口炎症的鉴别.%Objective To investigate the value of 18F - fluorodeoxyglucose positron emission tomography/computed tomography (18F - FDG PET/CT ) in the follow - up of post - treatment patients with gastrie cancer and to investigate the impact of 18F - FDG PET/CT on the clinical restaging and therapeutic regimens. Methods A retrospective study was conducted in 55 post - treatment patients with gastric cancer. 18F - FDG PET/CT scan was performed at 60 min ( early phase ) and 120 min ( delayed phase ) after 18F - FDG administration. 18F - FDG PET/CT of delayed phase was undertaken after gastric filling with moderate water. If necessary, enhanced CT was also performed. The value of 18F - FDG PET/CT in the follow - up of post - treatment patients with gastric cancer was evaluated hased on recurrence, lymph node metastases and lymph node external metastases respectively, and it was compared with CT. Meanwhile, the impact of 18F - FDG PET/CT on the restaging and treatment decision was also analyzed in this study. Additionally, the maximum of standardized uptake value ( SUVmax ) of early and delayed phases in the anastomotic stoma was measured, and the percentage change of SUVmax ( △ SUVmax% ) was also calculated in this stud-y. Tumor recurrence and/or metastases were finally confirmed by pathology. Data was analyzed with SAS 9. 13. Results ( 1 ) The accuracy of 18F - FDG PET/CT in the diagnosis of gastric recurrence was 96. 4% ( 53/55 ), which was significantly higher than CT(85.5%) .In the detection of lymph node metastases, the sensitivity, accuracy and negative predictive value ( NPV ) of 18F - FDG PET/CT ( 92. 0% , 96. 4% and 93. 8% ) showed statistically significant differences compared with CT ( 60. 0% , 81. 8% and 75. 0% ) . In addition, the sensitivity and accuracy of 18F - FDG PET/CT in detecting lymph node external metasta-ses were 81. 8% and 90. 9% , significantly higher than CT ( 45. 5% , 76. 4% ) . ( 2 )18F - FDG PET/CT changed the TNM stage in 34. 5% ( 19/55 ) cases, and the therapeutic strategies of 21. 8% ( 12/55 ) cases were changed due to PET/CT findings. ( 3 ) ASUVmax% was ( 22. 8 ±9. 8 )% and ( 8. 6 ± 13. 3 )% in gastric recurrence and the anastomotic inflammation with statistically significant differences between the two groups ( P <0. 05 ) . Conclusion 18F - FDG PET/CT is a superior post -operative surveillance modality in the diagnosis of recurrence and metastases in post - treatment patients with gastric cancer compared with CT. 18F - FDG PET/CT has great impact on the clinical restaging and proper re - treatment regimens. 18F - FDG PET/ CT of delayed phase after gastric filling with water may be one of the best ways in discriminating the recurrence from the inflammation in anastomotic stoma.
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