緩瀉劑的使用是否影響18F-FDG-PET/CT在腸道系統中的判讀

Application of Laxative in Detection of Colon Lesion by 18F-FDG-PET/CT

張雅玲(Yea-Ling Chen)

指導教授 ： 丘周萍

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

目的:
癌症是全世界各地方死亡的主要原因其中之一。準確的診斷分期與再分期是癌症病患者的最佳治療管理的環其中一個節，正子斷層造影(Positron Emission Tomography/Copmuted Tomography)，以下簡稱PET/CT，但對於正子斷層掃描而言，仍然避免不了偽陽性或偽陰性，腸道的收縮發炎或是平滑肌主動收縮等等，都有可能會大量吸收葡萄糖正子的藥品，所以很容易造成偽陽性，造成影像上的判讀困難，腸道的生理攝取增加，可能會受到便秘與腸道的蠕動與平滑肌的收縮之間的關係與葡萄糖的代謝有關，因此我們想藉由瀉劑的使用，減少因便秘所引起的腸道平滑肌的收縮或蠕動，造成的腸道FDG藥物攝取的增加，以減少腸道生理上的攝取，造成影像上腸道的FDG的攝取造成對於腸道影像的誤判，以利醫師對影像的判斷協助，如果可以在檢查前使用一些方式來降低腸道上影像的偽陽性，協助減少醫師在腸道影像判讀上的難處。
材料與方法:
本研究共計收受共202位，依受檢的次序分成未服用瀉劑與服用瀉劑兩組，未服用瀉劑的人共計109位；服用瀉劑的人共計93位，經由有經驗之核子醫學專科醫師判讀後，依腸道分別統計升結腸、橫結腸、降結腸、乙狀結腸、直腸五段腸道的SUV值，分別統計，1、性別與各腸道SUV值是否有影響，2、年齡與各腸道SUV值間是否有影響，3、其SUV值來判斷未服用瀉劑與服用瀉劑腸道SUV值是否有差異。利用正子掃描的生理功能影像加上電腦斷層提供的人體解剖影像，判讀18F-FDG在人體的代謝分佈，與瀉劑(Klean-prep)的使用，減少因便秘所引起的腸道平滑肌的收縮或蠕動增加所造成的腸道18F-FDG藥物活性攝取的增加，以減少腸道生理上的攝取，由統計軟體SPSS2以描述性統計分析各變項之分布情形。最後以無母數分析Kruskal Wallisru、Mann-Whitney U進行相關檢定。
結果:
採用Mann-Whitney U(P<0.05)，檢定其性別是否會干擾影響其各腸道間SUV值的攝取，，發現性別與各腸道間SUV max間，不論是否有使用瀉劑，發現其性別與各腸道間SUV mas間的P value全部皆>0.05，故由此可見，性別並不會干擾其腸道間SUV的攝取，由此可發現年齡並不會影響SUV在腸道影像的判斷；採用Kruskal Wallisru檢定(P<0.05)，檢定其年齡是否會干擾影響其各腸道間SUV值的攝取，群組中將其年齡分為三個組別，不論是否有使用瀉劑，發現其年齡與各腸道間SUV mas間的P value全部皆>0.05，故由此可見，年齡並不會干擾其腸道間SUV的攝取，由此可發現年齡並不會影響SUV在腸道影像的判斷；採用Mann-Whitney U檢定(P<0.05)，檢定其緩瀉劑的使用是否會干擾影響其各腸道間SUVmax值的攝取，發現瀉劑的使用與各腸道間SUVmax間的P value全部皆<0.05，未使用緩瀉劑的肝臟SUVmax (SUVmax:2.6±0.3)與大腿SUVmax (SUVmax:0.9±0.1)與使用瀉劑後肝臟SUVmax (SUVmax:2.6±0.3)與大腿SUVmax (SUVmax:0.9±0.1)在各組間數值均無特殊變化，故可以了解，瀉劑的使用並不影響其他器官的SUVmax值的攝取。且瀉劑的使用確實可以改善各腸道間SUV值的攝取，SUVmax值的攝取有明顯的下降(P<0.05)，由此可證實，瀉劑的使用能使腸道的SUV值下降，減少因腸道的便祕與腸道的蠕動與平滑肌的收縮而造成的SUVmax值升高，而改善腸道的定性影像。

關鍵字

葡萄糖正子掃描 ； 瀉劑 ； 大腸癌

並列摘要

Purpose:
Cancer is the leading cause of death worldwide. Accurate localization of malignant tumor is the important part of treatment planning for the patient of cancer. Fluorine-18- fluorodeoxy glucose (18F-FDG) positron emission tomography/computed tomography (18F-FDG PET/CT) has been proved useful for the detection, staging and restaging of several malignancies. Unfortunately, 18F-FDG PET/CT PET / CT still could not avoid the false positives and false negatives. There are some organs and tissues will have high uptake of 18F-FDG and cause false positive result, such as the inflammatory tissue, genitourinary tract, intestine, muscle, and so on. The reason of intestinal uptake of 18F-FDG may be due to constipation, increased peristalsis of gastrointestinal tract or contraction of intestinal smooth muscle. Therefore, we try to use laxatives to reduce those conditions and hope to decrease intestinal uptake of 18F-FDG. If we can use this method to reduce the intestinal uptake of 18F-FDG and eliminate the false positive of image before examination, it will assist physician to solve the difficulties of image diagnosis.

Materials and Methods:
In this study, we collect 202 subjects to divide into“ not taking laxatives group” and “taking laxatives group”. There are 109 people not taking laxatives and 93 people taking laxatives. Through the physicians of the nuclear medicine who are experienced diagnose. We count the SUV value of colon, descending colon, sigmoid colon and rectum. Then we generalize following three points: 1. Whether the gender will affect the value of each intestinal SUV. 2. Whether the age will affect the value of each intestinal SUV. 3. Whether the taking laxatives will affect the value of each intestinal SUV. The use of positron scanned images plus physiological functions of human anatomy and CT images provided interpretation of 18F-FDG in the body's metabolic profile, using laxatives (Klean-prep), and reduce shrinkage caused by constipation or intestinal smooth muscle increase intestinal motility caused by 18F-FDG uptake increased pharmaceutically active, in order to reduce the intake of intestinal physiology, the statistical software SPSS2 descriptive statistical analysis of the distribution of the various variables. Finally, we use nonparametric analysis Kruskal Wallisru and Mann-Whitney U to confirm.

Result:
We use Mann-Whitney U (P <0.05) to test whether that gender will affect the uptake of intestinal SUV values. We found between gender and among the various intestinal SUV max all are> 0.05, regardless of whether they have used laxatives. It proves that gender does not interfere with their intestinal uptake between the SUV. It can be found that the age does not affect the reading in the intestinal SUV. We use Kruskal Wallisru test (P <0.05) to judge whether age would be interference between the value of its SUV intestinal uptake. The group is divided into three age groups, regardless of whether they have used laxatives, then we found age and among intestinal P value SUV mas between all are> 0.05. It shows that the age does not interfere with their gut SUV between intake. It can be found that the age does not affect the reading in the intestinal SUV. We use Mann-Whitney U test (P <0.05) to judge whether it would interfere with the use of laxatives affect uptake among its various intestinal SUV max values. We found between the use of laxatives and various intestinal P value SUV max are all <0.05. Unused laxatives liver SUV max (SUV max: 2.6 ± 0.3) and thigh SUV max (SUV max: 0.9 ± 0.1) and liver SUV max (SUV max: 2.6 ± 0.3) after use of laxatives and thigh SUV max (SUV max: 0.9 ± 0.1). There were no specific changes in the value of each group. It can be understood that the use of laxatives does not affect the intake of other organs SUV max values. In addition, the use of laxatives can really improve the uptake of intestinal SUV values uptake SUV max values significantly decreased (P <0.05). Thus verifiable, laxatives can make use of intestinal SUV value decreased to reduce SUV max value due to the contraction of smooth muscle of the intestinal motility and constipation and intestinal tract caused by increased and improved intestinal qualitative images.

並列關鍵字

FDG ； PET ； laxatives ； colorectal cancer

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