Pankreatik kitlelerde 18F FDG PET/BT ile metabolik karekterizasyonun ve 18F FDG dağılımının klinik önemi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada pankreatik kitle nedeniyle onkolojik PET/BT tetkiki yapılan olgularda mevcut metabolik-klinik faktörlerin ve çekim parametrelerinin; tüm vücut 18F FDG dağılımına, tümör odaklarının saptanmasına olası etkisi ve 18F FDG PET/BT tetkikinin sensitivite değerine katkısı incelemek amaçlandı. Gereç ve Yöntem: Ege Üniversitesi Nükleer Tıp Anabilim Dalı'na Temmuz 2012- Ocak 2019 tarihleri arasında pankreatik kitle saptanarak metabolik karekterizasyon amacıyla yönlendirilen hastalar, patolojik ve radyolojik bulguları eşliğinde retrospektif olarak incelendi. Olgular lezyonlarına göre benign tanılı, pankreatik adenokarsinom tanılı ve karaciğer metastazı olanlar olarak gruplandı. Her hastadan çalışmaya yanlızca bir pankreatik lezyon ve metastazı mevcut ise bir karaciğer metastazı dahil edildi. Hastalara ait çekim parametreleri, lezyonların ve fizyolojik dağılım alanlarının SUVmax değerleri, hastalara ait laborotuvar ve görüntüleme parametreleri not edildi. Data analizi IBM SPSS Statistics 22.0 Programı kullanılarak yapıldı. Bulgular: Çalışmada 162 olgu mevcut olup benign tanı alanlar 17, adenokarsinom tanısı alanlar 145, karaciğer metastazı olanlar ise 47 hastadan oluşmaktaydı. Adenokarsinom tanılı hasta grubu içerisinde 9 hastanın primer pankreatik lezyonu 18F FDG tutulumu göstermemişti. Benign pankreatik lezyonların SUVmax ortanca değeri 4,2 (1-10,7), malign olanların ise 9,6 (1,5-65) idi. Karaciğer metastazı olan olgu grubu içerisinde ise 13 hastada bir santimetreden büyük boyutta 18F FDG PET/BT tetkikinde saptanamamış karaciğer metastazı ile uyumlu lezyon mevcuttu. Saptanamayan tümöral lezyon varlığı bulunan olguların kan glukoz değerlerinin yüksek, SUVmax serebrum değerlerinin düşük olduğu tespit edildi (p<0,001). SUVmax serebrum değerinin saptanamayan primer veya metastatik lezyon varlığını ön gördüğü değer tüm hasta grubu için 8,2, kan glukoz düzeyi 120 mg/dl olan olgular için 7,2 olarak belirlendi. Tetkikin pankreatik lezyonları saptamasında sensitivitesi tüm hasta grubunda %94, kan glukoz düzeyi 120 mg/dl'den yüksek hastalarda ise %90 olarak belirlendi. Kan glukoz düzeyine göre SUVmax serebrum eşik değerleri altında kalan hastalar çalışmadan dışlandığında, tetkikin panreas lezyonlarını saptamadaki sensitivite değeri sırasıyla %98-%95 olarak hesapandı. Sonuç: Benign ve malign pankreatik lezyonların SUVmax değerlerinin istatistiksel olarak birbirinden farklı olduğu gösterilmiş olmakla birlikte iki grup arasında değer aralıklarının kısmen örtüştüğü gözlendi. Çalışmamızda pankreatik adenokarsinomlarda 18F FDG tutulumunun kan glukoz düzeyinden etkilendiği olgularda SUVmax serebrum değerinin de benzer şekilde etkilendiği ve kan glukozu yükselen hastalarda SUVmax serebrum düzeyine göre yanlış negatif olguların tahmin edilebileceği gösterildi. Bu bilgiler ışığında literatürde bildirilen tetkikler arasındaki sensitivite farklılıklarının nedeninin açıklanabileceği sonucuna varıldı.
Aim: The aim of this study was to research the role of possible effect of current metabolic-clinical factors and scan parameters on 18F FDG distribution, detection of tumor foci and to investigate contribution to the sensitivity of 18F FDG PET/CT in cases which 18F FDG PET/CT perfomed for initial evaluation of pancreatic mass. Materials and Methods: Patients which referred to Ege University Department of Nuclear Medicine for metabolic characterization of pancreatic mass between July 2012 and January 2019, were retrospectively evaluated with pathological and radiological findings. The cases were grouped as benign, pancreatic adenocarcinoma and cases with liver metastasis. From each patient, only one pancreatic lesion and one liver metastasis if detected were included. Scan parameters of patients, SUVmax values of lesions and physiological distribution areas, laboratory and imaging parameters of patients were noted. Data analysis was performed using IBM SPSS Statistics 22.0 Program. Findings: The study included 162 patients with 17 benign, 145 patients with adenocarcinoma and 47 patients with liver metastasis. In the patient group diagnosed with adenocarcinoma, primary pancreatic lesion of 9 patients did not show 18F FDG uptake. The median SUVmax of benign pancreatic lesions was 4.2 (1-10.7) and the SUVmax of malignant pancreatic lesions was 9.6 (1.5-65). In the patient group with liver metastasis, 13 patients had a lesion larger than one centimeter and compatible with liver metastasis that could not be detected in 18F FDG PET / CT scan. Blood glucose values were higher and SUVmax cerebrum values were found to be lower in patients with undetectable tumor lesions. (p<0,001). The SUVmax cerebrum value which predicted the presence of primary or metastatic lesions that could not be detected was 8.2 for the whole patient group, and 7.2 for the patients with blood glucose levels of higher than 120 mg/dl. Sensitivity of PET / CT for detection of primary pancreatic malignancy calculated and found to be 94% for the whole patient group, and 90% for the patients with blood glucose levels higher than 120 mg / dl. When patients with values below SUVmax cerebrum thresholds based on blood glucose levels were excluded from the study, the sensitivity of the examination was calculated as 98% -95%, respectively, Results: Although SUVmax values of benign and malignant pancreatic lesions were shown to be statistically different from each other, it was observed that the value ranges were partially overlapping between the two groups. In our study, it was shown that among the pancreatic adenocarcinomas, SUVmax cerebrum value was similarly affected in cases which 18F FDG uptake was affected by blood glucose levels, and false negative cases could be predicted according to SUVmax cerebrum level in patients with elevated blood glucose levels. In the light of this information, it was concluded that the reason for the differences in sensitivity between the studies reported in the literature can be explained.
Aim: The aim of this study was to research the role of possible effect of current metabolic-clinical factors and scan parameters on 18F FDG distribution, detection of tumor foci and to investigate contribution to the sensitivity of 18F FDG PET/CT in cases which 18F FDG PET/CT perfomed for initial evaluation of pancreatic mass. Materials and Methods: Patients which referred to Ege University Department of Nuclear Medicine for metabolic characterization of pancreatic mass between July 2012 and January 2019, were retrospectively evaluated with pathological and radiological findings. The cases were grouped as benign, pancreatic adenocarcinoma and cases with liver metastasis. From each patient, only one pancreatic lesion and one liver metastasis if detected were included. Scan parameters of patients, SUVmax values of lesions and physiological distribution areas, laboratory and imaging parameters of patients were noted. Data analysis was performed using IBM SPSS Statistics 22.0 Program. Findings: The study included 162 patients with 17 benign, 145 patients with adenocarcinoma and 47 patients with liver metastasis. In the patient group diagnosed with adenocarcinoma, primary pancreatic lesion of 9 patients did not show 18F FDG uptake. The median SUVmax of benign pancreatic lesions was 4.2 (1-10.7) and the SUVmax of malignant pancreatic lesions was 9.6 (1.5-65). In the patient group with liver metastasis, 13 patients had a lesion larger than one centimeter and compatible with liver metastasis that could not be detected in 18F FDG PET / CT scan. Blood glucose values were higher and SUVmax cerebrum values were found to be lower in patients with undetectable tumor lesions. (p<0,001). The SUVmax cerebrum value which predicted the presence of primary or metastatic lesions that could not be detected was 8.2 for the whole patient group, and 7.2 for the patients with blood glucose levels of higher than 120 mg/dl. Sensitivity of PET / CT for detection of primary pancreatic malignancy calculated and found to be 94% for the whole patient group, and 90% for the patients with blood glucose levels higher than 120 mg / dl. When patients with values below SUVmax cerebrum thresholds based on blood glucose levels were excluded from the study, the sensitivity of the examination was calculated as 98% -95%, respectively, Results: Although SUVmax values of benign and malignant pancreatic lesions were shown to be statistically different from each other, it was observed that the value ranges were partially overlapping between the two groups. In our study, it was shown that among the pancreatic adenocarcinomas, SUVmax cerebrum value was similarly affected in cases which 18F FDG uptake was affected by blood glucose levels, and false negative cases could be predicted according to SUVmax cerebrum level in patients with elevated blood glucose levels. In the light of this information, it was concluded that the reason for the differences in sensitivity between the studies reported in the literature can be explained.
Açıklama
Anahtar Kelimeler
Fluorodeoksiglukoz F18, Pozitron Emisyon Tomografi Bilgisayarlı Tomografi, Pancreas, Adenokarsinoma, Fluorodeoxyglucose F18, Positron Emission Tomography Computed Tomography, Pancreas, Adenocarcinoma
