Objective To investigate the value of water enema 18F-fluorodexyglucose positron emission tomography and computed tomography (18F-FDG PET-CT) in incidental finding of hypermetabolism focus in the colon and rectum for differential diagnosis of benign or malignant lesions.Methods From June 2010 to December 2012 in our hospital,77 patients were found incidentally with uncertain hypermetabolism focuses in the colon and rectum during PET-CT examination.Water enema 18F-FDG PET-CT was performed to classify the lesions.According to the pathological examination and clinical follow-up,these cases were divided into malignant disease (including advanced colorectal adenoma),benign adenoma,inflammation and physiological uptake.Radioactive uptake level (SUVmax) and change of water enema imaging (retention index,RI) of hypermetabolism focus were compared between groups.Result Of these 77 cases,23 were malignant diseases,16 benign adenoma,7 inflammation and 31 physiological uptake.The difference of average SUVmax was not statistically significant between benign and malignant lesions as well as physiological uptake (P＞0.05).But the difference of RI was statistically significant between neoplastic lesions and inflammation(P＜0.05).The accuracy of water enema 18F-FDG PET-CT in diagnosing non-neoplastic uptake was 100％,and the sensitivity,specificity and accuracy in differentiation of malignancy form benign lesions were 95.6％,96.3％,and 96.1％ respectively.Conclusions The incidental focal colorectal 18F-FDG uptake in PET-CT may indicate potential colorectal malignant lesions and adenoma.Water enema can effectively differentiate the physiological uptake and predict benign lesions or malignancy in the colon and rectum colorectum with good accuracy.%目的 探讨温水保留灌肠对18氟-脱氧葡萄糖正电子发射计算机断层成像术(18F-FDGPET-CT)检查意外发现的结直肠高代谢灶鉴别良恶性的诊断价值.方法 2010年6月至2012年12月间在中山大学附属第六医院行PET-CT检查时意外发现有77例患者结直肠存在性质不明的高代谢灶,予以行温水保留灌肠PET-CT扫描,根据最终的诊断分为恶性病变(包括结直肠癌和恶性腺瘤)、良性病变(包括良性腺瘤和炎性病变)和生理性摄取,对高代谢灶的放射性摄取程度(最大标准摄取值,SUVmax)和灌肠前后SUVmax的变化(滞留指数,RI)进行组间比较.结果 77例患者行温水保留灌肠PET-CT扫描后,诊断结直肠恶性病变23例,良性腺瘤16例,炎性病变7例,生理性摄取31例.恶性与良性病变常规SUVmax及RI比较,差异均无统计学意义(均P＞0.05).肿瘤性病变与非肿瘤性摄取之间SUVmax的差异均无统计学意义(均P＞0.05);但肿瘤性病变与炎性病变之间的RI差异有统计学意义(P＜0.05).温水保留灌肠PET-CT对结直肠生理性摄取诊断的准确性为100％,对结直肠良、恶性病变判断的灵敏度为95.6％,特异度为96.3％,准确性为96.1％.结论 温水保留灌肠PET-CT有助于常规PET-CT意外发现的结直肠高代谢灶中良恶性病变的鉴别,有效排除肠道生理性摄取的影响,避免不必要的结肠镜检查.
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