摘要
目的研究孤立性肺结节(SPN)18 F-脱氧葡萄糖(18 F-fluorodeoxyglucose,18 F-FDG)PET/CT影像特征,评价PET/CT双时相显像联合薄层CT扫描对SPN的诊断价值。方法34例SPN患者,其中男24例,女10例,年龄44~70岁。所有患者均同期行^18F-FDG PET/CT显像及延迟显像,且每个病灶均进行薄层CT扫描后重建,PET/CT图像由3位有经验的放射专业医师和核医学专业医师对病灶的形态学特点及最大标准摄取值(maximum standardized uptake value,SUV max)和SUV max变化率(ΔSUV)综合分析后做出诊断,所有患者最终均经组织病理学证实,并用受试者工作特征(receiver operating characteristic,ROC)曲线评价SUVmax、ΔSUV和SUVmax联合薄层CT对SPN的诊断效能。结果34例患者中恶性病变24例,其中腺癌13例(1例细支气管肺泡癌),鳞癌7例,小细胞肺癌1例,3例病理类型不详;良性病变10例,其中结核2例、炎性假瘤3例、隐球菌感染1例、错构瘤1例,非特异性炎症3例,PET/CT诊断SPN的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为:95.83%(23/24)、40%(4/10)、79.41%(27/34)、79.31%(23/29)和80%(4/5);SUV max对SPN诊断效能的ROC曲线下面积(area under curve,AUC)为0.721最佳诊断阈值为SUV max≥3.16(灵敏度81.63%,特异性71.20%,准确性78.48%),SUVmax+CT的AUC为0.856,其诊断SPN的灵敏度、特异性及准确性分别为87.73%、79.62%和83.65%,SUVmax+CT的AUC大于SUV max的AUC,差异有明显统计学意义(Z=4.38,P<0.05),ΔSUV的AUC为0.498,无诊断价值。结论^18F-FDG PET/CT显像对孤立性肺结节(SPN)的定性诊断有较高的灵敏度(95.83%)和准确性(79.41%),但特异性较低(40%),SUV max最佳诊断阈值为≥3.16,ΔSUV不能作为单独诊断SPN的指标,SUV max联合薄层CT形态学特征,可有效提高诊断SPN的准确性。
Objective To evaluation of the diagnosis value and imaging characteristics of dual time point ^18F-FDG PET/CT imaging combined with thin-slice CT scan for solitary pulmonary nodules(SPN).Methods 34 patients of SPN were enrolled in the study.24 of 34 patients were male and the others were female,with age range 44-70 years.All patients underwent ^18F-FDG PET/CT imaging and thin CT scan,additionally,all patients underwent ^18F-FDG PET/CT delayed scan.Three experience radiologists and nuclear medicine doctors worked together and analyzed ^18F-FDG PET/CT evidence of the early and delay maximum standardized uptake value(SUV max)and△SUV and morphological signs in CT,such as short speculation,acanthi,lobulation.The final diagnoses were confirmed by histopathology,and used receiver operating characteristic curve(ROC)to evaluate the diagnostic performance of SUVmax,ΔSUV and SUVmax combined with thin-slice CT scan(SUVmax+CT)for SPN.Results Among 34 patients of SPN,24 were malignants,and 10 were benigns.The 24 malignants including 13 adencarcinoma,7 squamous carcinoma,1 small cell lung cancer and pathocategory of remaining cases were unknown.The benigns including 2 tuberculosis,3 inflammatory pseudotumor,1 Cryptococcus pneumonia,1 harmatoma and 3 non-specificity pneumonia.The sensitivity,specificity,accuracy,positive predictive values and negative predictive value of ^18F-FDG PET/CT for SPN were 95.83%(23/24),40%(4/10),79.41%(27/34),79.31%(23/29)and 80%(4/5),respectively.The area under the curve(AUC)of SUVmax for SPN diagnostic performance was 0.721.The optimal diagnostic threshold was SUVmax≥3.16(sensitivity 81.63%,specificity 71.20%,accuracy 78.48%).The AUC of SUVmax+CT was 0.856,and the sensitivity,specificity and accuracy of the diagnosis of SPN were 87.73%,79.62%and 83.65%,respectively.The AUC of SUVmax+CT was significantly greater than the AUC of SUVmax alone(Z=4.38,P<0.05).AUC ofΔSUV was 0.498,showed no diagnostic value.Conclusion ^18F-FDG PET/CT imaging shows a high sensitivity and accuracy for the diagnosis of SPN,but the specificity is relatively low.SUVmax combined with thin-slice CT morphological features can effectively improve the accuracy of SPN diagnosis.
作者
朱峰
刘德峰
王冠民
丁雪梅
徐亚平
孟涛
ZHU Feng;LIU De-feng;WANG Guan-min;DING Xue-mei;XU Ya-ping;MENG Tao(PET/CT Center,Xuzhou Central Hospital,Xuzhou 221009,China)
出处
《标记免疫分析与临床》
CAS
2019年第12期2079-2083,共5页
Labeled Immunoassays and Clinical Medicine
