摘要
目的探索如何将病灶SUV_(max)与薄层CT相结合,提高18F-FDG PET/CT对肺孤立性结节的定性诊断准确性。方法回顾性分析267例经手术病理检查或临床随访证实的SPN患者的^(18)F-FDG PET/CT及薄层CT显像结果,依据薄层CT将SPN分为实性结节与非实性结节。分别采用标准1(SUV_(max)≥2.5)和标准2(SUV_(max)结合薄层CT综合分析)诊断肺癌,以病理和临床随访为金标准,分析两种标准对肺孤立性结节的诊断效能。结果采用两种标准诊断肺癌的灵敏度和准确性分别为80.4%、76.4%(标准1)和91.0%、87.2%(标准2)(均P<0.05)。在非实性结节中,良、恶性病灶的SUV_(max)无明显显著性差异(P>0.05),而病灶大小和分叶征、含气支气管征或空泡征以及病灶内有无粗大血管等CT征象对鉴别诊断有意义(均P<0.05)。40例PET表现为低代谢的肺癌患者,均被误诊为良性病变,结合薄层CT图像,纠正了其中50%(20/40)的诊断。采用标准1诊断肺癌,灵敏度为40.0%,而采用标准2诊断肺癌,灵敏度为90%,标准2对非实性结节诊断的灵敏度明显高于标准1(P=0.000),但特异性无显著性差异(75.2%vs 58.3%,P=0.667)。然而,对实性结节,薄层CT对于诊断结果无明显影响(均P>0.05)。结论对于肺孤立性结节,仅依据SUV_(max)≥2.5诊断肺癌,诊断效能并不理想。对非实性结节,须依据SUV_(max)和薄层CT所见进行综合分析。
Objective To investigate whether fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)combined with thin-section CT improves the diagnostic performance for solitary pulmonary nodules(SPNs).Methods A total of 267 patients underwent examinations with ^(18)F-FDG PET/CT and thin-section CT for evaluating the SPNs with undetermined nature,which was further confirmed by pathological examination or clinical follow-up.The performance of two diagnostic criteria based on findings in PET/CT alone(Criterion 1)and in PET/CT combined with thinsection CT(Criterion 2)were compared.Results Thin-section CT provided greater diagnostic information for SPNs in 84.2%of the patients.Compared with Criterion 1,the diagnosis based on Criterion 2 significantly increased the diagnostic sensitivity(80.4%vs 91%,P<0.01)and accuracy(76.4%vs 87.2%,P<0.01)for lung cancer.The lesion size and the CT features including lobulation,air bronchogram,and feeding vessel,but not SUVmax,were all helpful for characterizing non-solid SPNs.Thinsection CT rectified diagnostic errors in 50%(20/40)of the cancerous lesions,which had been diagnosed as benign by PET due to their low metabolism.For non-solid SPNs,Criterion 2 showed a significantly higher diagnostic sensitivity than Criterion 1(90.0%vs 40.0%,P=0.000)but their diagnostic specificity were comparable(75.2%vs 58.3%,P=0.667).For solid nodules,the use of thin-section CT resulted in no significant improvement in the diagnostic performance(P>0.05).Conclusion The combination of PET/CT and thin-section CT creates a synergistic effect for the characterization of SPNs,especially non-solid nodules.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2017年第3期283-289,共7页
Journal of Southern Medical University
基金
Supported by National Natural Science Foundation of China(81071175,81371591)~~
关键词
肺孤立性结节
发射型计算机
体层摄影术
X线计算机
薄层CT
脱氧葡萄糖
solitary pulmonary nodules
positron emission tomography
computed tomography
tomography
X-ray computed
fluorine-18 fluorodeoxyglucose
