目的 探讨贲门癌术后吻合口复发¹⁸F-FDG PET/CT显像效果与形态特点。方法 收集武警江苏总队医院内镜、外科手术及病理证实贲门癌术后吻合口复发52例患者PET/CT、CT影像资料,对照分析贲门癌手术后复发患者PET/CT及CT影像表现。结果 (1)52例贲门癌术后复发¹⁸F-FDGPET/CT显像无摄取3例(5.77%,3/52),有摄取49例(94.23%,49/52),其中片絮状摄取14例(26.92%,14/52),结节状摄取19例(36.54%,19/52,),环状摄取16例(30.77%,16/52,);(2)CT显示吻合口管壁无明显增厚4例(7.69%,4/52),轻度增厚7例(13.46%,7/52),偏心性增厚19例(36.54%,19/52),环状增厚22例(42.31%,22/52);PET/CT与CT两者形态分类上显著相关(r=0.943,P<0.001)。(3)¹⁸F-FDG PET/CT显像片絮状摄取半定量标准值(SUVmax均数、SUVmean均数)与其他摄取形态及总体摄取值比较相对较低,且具有统计学差异(P<0.01)。(4)PET/CT显像明确及疑似诊断贲门癌术后复发45例(86.54%,45/52),未能作出复发诊断7例(13.46%,7/52);CT诊断及疑似诊断贲门癌术后复发41例(78.85%,41/52),未能作出复发诊断11例(21.15%,11/52),诊断结果两者无明显差异(χ²=13.48,P=0.063);PET/CT摄取分型中无摄取、片絮状摄取诊断结果与结节状摄取、环状摄取诊断结果存在一定差异(χ²=27.25,P=0.017,P<0.05)。(5)PET/CT不能明确诊断术后复发无摄取3例及片絮状摄取4例; CT不能明确诊断术后复发为吻合口无明显增厚4例及轻度增厚7例患者。结论 贲门癌术后吻合口复发¹⁸F-FDG PET/CT无摄取及片絮状摄取是诊断中的难点,在实际工作中结合CT吻合口厚度及其形态,对提高贲门癌术后吻合口复发¹⁸F-FDG PET/CT诊断符合率有一定帮助。

Objective To explore the relationships between ¹⁸F-FDG PET/CT imaging and morphology of postoperative recurrence of cardia cancinoma at the anastomotic stoma.Methods PET/CT and CT imaging data of fifty-two patients with postoperative recurrence, who had been confirmed by endoscopy, surgery and pathological examination, was collected and compared.Results Among the fifty-two patients,¹⁸F-FDG PET/CT imaging found no uptake in 3 cases(5.77%,3/52), but found uptake in the other 49 cases (94.23%,49/52). Among these 49 cases, there was patchy uptake in 14 cases(26.92%,14/52),nodular uptake in 19 cases(36.54%,19/52),and annular uptake in 16 cases(30.77%,16/52. CT imaging showed no obvious anastomotic wall thickening in 4 cases(7.69%,4/52), but mild thickening in 7 cases(13.46%,7/52), eccentric thickening in 19 cases(36.54%,19/52),and annular thickening in 22 cases(42.31%,22/52). There were significant correlations between PET/CT and CT in morphological classification (r=0.943,P<0.001).The semi-quantitative standardized uptake value (SUV_max、SUV_mean) of patchy uptake on 18F-FDGPET/CT imaging was relatively lower than that of morphological and overall uptake, and there was significant difference between them(P<0.01).There was no significant difference between PET/CT and CT imaging in the accuracy rate of clear or suspicious diagnosis or in the rate of failure to diagnose postoperative recurrence(86.54%,45/52 versus 78.85%,41/52; 13.46%,7/52 versus 21.15%,11/52, χ²=13.48, P=0.063), but there was difference in diagnosis between no uptake, patchy uptake and nodular uptake, annular uptake in PET/CT imaging(χ²=27.25, P=0.017, P<0.05). PET/CT imaging failed to diagnose postoperative recurrence in 3 cases of no uptake and 4 cases of patchy uptake, compared to 4 cases of no obvious anastomotic wall thickening and 7 cases of mild thickening by CT imanging.Conclusions Postoperative recurrence of cardia cancinoma at the anastomotic stoma is difficult to diagnose in cases of no or patchy uptake in ¹⁸F-FDG PET/CT imaging, but the rate of diagnostic accuracy can be improved when anastomotic thickness and morphology in CT imaging are combined.