Objective To investigate diagnostic value of PET/CT in benign and malignant lesions of the stomach .Meth-ods One hundred and thirty-eight patients with 18 F-FDG accumulations in gastrointestinal tract were correlated with endo-scopic and histopathologic findings .The accuracies of SUVmax and PET/CT for differentiating malignant from benign le-sions were compared by ROC curve analysis ,with a Z test to compare the AUC .The Kappa test ,t-test and Z-test andχ² test were also used .Results Among the 138 stomach lesions ,there were 63% (87/138) malignant and 40% (51/138) be-nign lesions .SUVmax threshold value was 2 .97 ,sensitivity was 92.0% and specificity was 52.9% ;The SUVmax of Gastric malignant lesions was higher than that of benign lesions group ( t=5 .642 ,P=0 .001) ,the difference was statis-tically significant ;The Gastric wall thickness of malignant lesions was higher than that of benign lesions group (t =7.575 ,P =0.001) ,the difference was statistically significant ;To differentiate malignant from benign gastric lesions ,the AUC of SUVmax was 0.857 (95% CI 0.757~0 .916) .After analyzing the features of PET and CT images ,the AUC of PET/CT significantly was improved to 0.908(0.847~0.969) .The sensitivity ,specificity were 92.0% ,52.9% for SUV-max and 95 .4% ,92 .2% for PET/CT ,respectively .Agreement was fair for SUVmax (Kappa=0 .466 ,P=0 .001) ,and good for PET/CT (Kappa=0 .827 ,P =0 .001) .Compared with SUVmax ,the sensitivity of PET/CT was no statistical difference (χ²=0 .073 ,P =0 .787) ,while ,the specificity was significantly higher (χ²=19 .691 ,P =0 .001) .The sensi-tivity of PET/CT in detecting the mucinous adenocarcinoma and signet-ring cell carcinoma and other type cell carcinoma were 75% (12/16) and 95 .1% (58/61) respectively ,(t =1 .845 ,P =0.074) the difference was no statistically significant (Z=-1 .463,P =0.144) .Conclusion There is a higher sensitivi-ty ,specificity in these patients with examination of PET/CT than that of SUVmax ,when detecting the mucinous adeno-carcinoma and signet-ring cell carcinoma .There is a higher false negative in these patients with examination of PET/CT than in other type cell carcinoma .The clinical application value has been revealed that 18 F-FDG PET/CT in the diagnosis of benign and malignant lesions of stomach ,and qualitative advantage to stomach benign and malignant lesions of the diag-nosis and treatment of project establishment was of great help .%目的：探讨18 F-FDG PET/CT检查在胃癌与胃良性病灶中的鉴别诊断价值。方法回顾性分析138例疑似胃部恶性病变患者行18 F-FDG PET/CT检查。影像经处理、勾画感兴趣区获得良恶性病灶SUVmax诊断效能ROC曲线，将检查结果与病理及随访结果比较。评价SUVmax、PET/CT对恶性病灶的检出效能。统计学方法包括t检验、Z检验和Kappa一致性检验。结果138个胃部病灶病理诊断胃癌占63．0％（87/138），胃良性病灶占37．0％（51/138），胃癌组SUVmax明显高于良性组（t＝5．642，P＝0．001），差异有统计学意义。胃癌组的胃壁厚度大于良性组（t＝7．575，P＝0．001），差异有统计学意义；SUVmax、PET/CT诊断恶性病灶的 ROC、AUC（95％ CI）分别为0．857（0．757～0．916）和0.908（0．847～0．969），PET/CT 明显大于SUVmax （ Z ＝5．242，P ＝0．001）。PET/CT 诊断胃良恶性病变，诊断效能ROC曲线发现阈值为2．97时，SUVmax、PET/CT诊断的灵敏度和特异性分别为92．0％、52．9％和95．4％、92．2％。与病理诊断比较，SUVmax诊断的一致性较中等（Kappa＝0．466，P ＝0．001），PET/CT 的一致性极好（Kappa＝0．827，P＝0．001）。与SUVmax比较，PET/CT诊断的灵敏度由90．8％（79/87）提高到95．4％（80/87），差异无统计学意义（χ²＝0．073， P ＝0．787），特异性从52．9％（27/51）上升到92．2％（47/51），差异有统计学意义（χ²＝19．691， P ＝0．001）。PET/CT与SUVmax比较，PET/CT诊断胃印戒细胞癌和黏液腺癌与其它细胞类型癌的灵敏度分别为75．0％（12/16）和95．1％（58/61），（ t ＝1．845，P ＝0．074），两组的SUVmax差异性无统计学意义（ Z ＝-1．463，P ＝0．144）。结论与SUVmax相比，PET/CT对诊断胃癌与胃良恶性病灶有较高的灵敏性和特异性，对于病理类型为胃黏液腺癌和印戒细胞癌时，PET/CT诊断的假阴性高。对恶性肿瘤远处转移，提供有临床价值的信息，及时改变治疗方案。
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