PET/CT对肺内结节诊断及治疗的临床价值

Clinical value of PET/CT for the diagnosis and management of lung nodules

目的 探讨PET/CT显像对肺内结节诊断和治疗的临床应用价值。方法 因肺内结节行18F FDGPET/CT检查且得到临床或病理证实的患者 2 0例 ,其中结节性质不明者 15例 ,临床或病理确诊为肺癌者 5例。结合其PET/CT检查结果和临床诊断、治疗资料进行分析。结果 (1) 2 0例PET/CT诊断结果与临床随访或病理诊断结果符合 ,总诊断符合率 10 0 %。 15例结节性质不明者经PET/CT检查诊断为良性病变 7例 ,恶性 8例。 11例CT显示单结节病灶 ,PET/CT单病灶显影 3例 ,8例除肺内病灶显影外 ,还可见肺外其他组织显影 ,6例确诊为有肺外转移 ,2例肺内单结节病灶系转移灶。 (2 )PET/CT检查后 ,2 0例患者中 ,16例改变了原治疗方案 ,继续观察 2例 ,抗炎 3例 ,手术 2例 ,局部放疗4例 ,单纯化疗 3例 ,综合治疗 4例。 (3)对 8例放射治疗的患者应用PET/CT融合图像指导放疗定位 ,其中 1例MM5 0适型调强放射治疗 1个疗程后 1.5个月复查PET/CT ,原左侧肺门块状软组织影消失 ,葡萄糖代谢恢复正常。根据 2例手术治疗患者的PET/CT融合图像确定手术路径及切除范围 ,术后病理结果显示 ,手术切口边缘及切除淋巴结均未见癌细胞累及和浸润。结论 对于肺内结节性质 ,PET/CT较单纯CT更容易做出鉴别诊断。PET/CT检查能够更加准确地反映肺癌的临床?

Objective To investigate the clinical value of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) /CT for the diagnosis and management of lung nodules. Methods Twenty patients were evaluated: 15 with suspected cancer and 5 confirmed cancer. PET/CT scans were performed by discovery LS-PET/CT system. Results (1) The diagnostic accuracy of PET/CT was 100% in these 20 patients. Of 15 patients with suspected cancer, 7 were diagnosed as having benign disease and 8 malignant. All the 5 patients with confirmed cancer were all FDG positive. Of 11 single lesions on CT, 3 were positive by PET/CT images, 6 of 8 with positive CT images were diagnosed as having metastasis to the tissue outside the lung and the other 2 were metastatic. (2) After PET/CT scanning, the therapy scheme of 16 out of 20 patients were changed, and continual observation was practiced in 2, 3 were treated by anti-inflammation regimen, 2 by operation, 4 by local radiotherapy, 3 by chemotherapy only, 4 by radiotherapy plus chemotherapy or operation. (3) The radiotherapists made use of PET/CT fusion imaging for positioning in 8 patients who were indicated for radiotherapy. One of them who had received MM50 one course of intensity medulated conformal radiotherapy was re-examined by PET/CT after one and half months, the former parenchymal nodule disappeared and the glucose metabolism returned to normal. Two of them were finally operated after the surgeons have decided an operative approach on estimation of extent of lesion by the PET/CT fusion images. Pathological results showed no cancer cell involvement in the specimen margin or the local lymph nodes. Conclusion (1) PET/CT is better in discriminating malignant from benign lung nodules than CT only. (2) PET/CT scanning facilitates an accurate assessment of response in clinical staging and neoadjuvant therapy scheme of lung cancer. (3) PET/CT fusion imaging provides an accurate biological target for radiotherapy and confirms the operation plan and extent of surgery.