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目的 探讨18F-FDG PET/CT显像对炎性肠病(IBD)的临床应用价值.方法 回顾性收集2010年3月至2014年3月经广州南方医院临床确诊为IBD且均在PET中心接受18F-FDG PET/CT显像的患者75例(男46例,女29例,平均年龄38岁),患者1周内均行肠镜检查并测定CRP,其中溃疡性结肠炎(UC)30例,克罗恩病(CD)45例,盲法比较PET/CT诊断结果与同机CT及同期肠镜结果,组间差异行x2或t检验,并将SUVmax与PET/CT显像前或显像后1周内患者CRP水平进行直线相关分析.结果 (1) 18F-FDG PET/CT显像对IBD的病灶检出率为86.7％(65/75),高于腹部CT[73.3％ (55/75)],两者差异有统计学意义(x2=4.167,P＜0.05).(2)65例18F-FDG PET/CT显像阳性病例中,检出受累肠段与肠镜完全符合33例(44.0％,33/75),部分符合24例(32.0％,24/75),不符合8例(10.7％,8/75).其中,18F-FDG PET/CT显像累计检出受累肠段145段,肠镜检出119段;40例出现肠壁全层18F-FDG摄取增高,肠镜检查45.0％ (18/40)的患者仅有轻度黏膜病变表现.(3)75例IBD 患者中,18F-FDG PET/CT显像阳性者65例,临床证实为活动期患者48例,稳定期患者17例,活动期组SUVmax(8.31±4.21)高于稳定期组(6.36±3.15),差异有统计学意义(t=2.033,P＜O.05).活动期组CRP与SUVmax间呈直线相关(r=0.453,P＜0.01).结论 18F-FDG PET/CT显像对IBD具有较高的检出率,对IBD的活动性评估也有一定价值,能显示肠镜检查容易漏诊的上皮下活动性病灶,为指导临床诊断及治疗提供帮助.

Objective To explore the diagnostic value of 18F-FDG PET/CT in the inflammatory bowel diseases (IBD).Methods The clinicopathological data of 75 patients(46 males,29 females;average age 38 years) with IBD confirmed by colonoscopy from March 2010 to March 2014 were reviewed retrospectively.Among the 75 patients,30 were with ulcerative colitis(UC) and 45 were with Crohn's disease (CD).All underwent whole-body 18F-FDG PET/CT imaging.Enteroscope and CRP examination were performed within 1 week before or after PET/CT imaging.The results of 18F-FDG PET/CT were compared with those of located CT and enteroscope (x2,t tests).Linear correlation analysis was used to analyze the relationship between CRP and the SUVmax of lesions presented in IBD.Results (1) 18 F-FDG PET/CT accurately detected 65 patients with IBD,while located CT diagnosed 55 patients with IBD.The diagnostic sensitivities were significantly different:86.7％ (65/75) vs 73.3％ (55/75),x2 =4.167,P＜0.05.(2) Among 65 patients with positive results in 18F-FDG PET/CT,lesions were consistent with those detected by endoscopy in 33 (33/75,44.0％)patients.Results of the 2 methods in 24 patients (24/75,32.0％)were not completely same,those in 8 patients (8/75,10.7％)were totally different.18F-FDG PET/CT detected 145 lesions,while enteroscope only detected 119 lesions.Diffuse high FDG uptake was shown in intestinal wall in 40 of 65 patients,and mild mucosa injury was showed by enteroscope in 18 patients (45.0％,18/40).(3)Fortyeight of 65 patients detected by PET/CT were proven clinically to be in active stage,and the rest were in stable stage.The SUVmax of active stage group (8.31±4.21) was significantly higher than that of the chronic stage group (6.36±3.15;t =2.033,P＜0.05).There was a linear correlation between CRP and SUVmax of patients in active stage(r=0.453,P＜0.01).Conclusions 18F-FDG PET/CT is helpful to assess the activity of IBD and may serve as a supplementary diagnosing tool to detect the lesions under the epithelium of bowel,which are often false-negative by enteroscope.