氟脱氧葡萄糖F18正电子发射体层摄影术在肺癌诊断及分期中的价值

The application of ^(18)F-fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer

目的 探讨氟脱氧葡萄糖F18正电子发射体层摄影术(18FFDGPET)在肺癌诊断及分期中的价值。方法 94例疑诊为肺部肿瘤的患者进行了CT、18FFDGPET全身或局部检查,并对这些患者手术切除及活检的组织标本及痰液、胸腔积液的细胞标本进行了病理学检查。18FFDGPET图像分析采取单纯标准摄取值(SUV)法及目测与SUV值结合两种方法进行。SUV值法判定标准为:SUV值>25为恶性病灶,SUV值≤25为良性病灶;目测与SUV值结合法:根据病灶18FFDG摄取量与纵隔血池结构相比,并考虑SUV值、病变大小、形态及病史资料做出诊断。以病理及试验性治疗结果为确诊标准,分别计算18FFDGPET及CT在病变的定性、纵隔淋巴结转移、全身远端转移方面的敏感性、特异性、准确性、阳性预测值及阴性预测值,同时对18FFDGPETSUV值法与目测结合SUV值法的诊断效能进行比较。结果 (1)确诊情况:本组58例患者肺部病灶经组织病理学或细胞病理学检查证实为恶性;36例经病理检查或试验治疗证实为良性。(2)定性诊断:CT对肺部肿块定性诊断的敏感性、特异性、准确性、阳性及阴性预测值分别为:69%、65%、68%、82%、49%;18FFDGPET单纯SUV法分别为91%、89%、90%、93%和87%,目测+SUV值法分别为95%、94%、95%、97%和92%。(3)

Objectie To study the clinical alue of 18F-fluorodeoxyglucose(FDG) positron emission tomography(PET) in the diagnosis and staging of lung cancer. Methods Ninety-four patients with lung nodular changes were examined by CT, 18F-FDG PET and pathology, cytology. 18F-FDG PET images were analyzed by semi-quantitatie standard uptake alue (SU) only and (or) SU plus isual obseration. Focuses with a SU>2.5 were judged as malignant changes, while SU≤2.5 was judged as benign. SU plus isual analysis, based on the focal SU, the nodular size and shape, and clinical data, was carried out by two nuclear doctors. CT imaging was interpreted by two radiological doctors. The sensitiity, specificity, accuracy, positie predictie and negatie predictie alues of 18F-FDG PET and CT in the diagnosis, and in the ealuation of lymphatic metastasis and remote metastasis of lung lesions were calculated. The diagnostic efficiency of the two methods (SU or isual plus SU method) was compared. Results (1) 58 cases were confirmed to be malignant by surgery or pathological examination, while 36 cases were proed benign by pathology or empirical therapy. (2) The sensitiity, specificity, accuracy, positie and negatie predictie alues were 69%, 65%, 68%, 82% and 49% respectiely for CT;and 91%, 89%, 90%, 93% and 87% respectiely for SU analysis;and 95%, 94%, 95%, 97% and 92% respectiely for isual plus SU methods. (3) Among 34 patients with mediastinal lymph node inolement confirmed by pathology, 18F-FDG PET detected 30 cases, while CT detected only 18 cases (P<0.01). (4) 18F-FDG PET reealed 19 cases with distant metastases, while CT only discoered 8 cases with distant metastases. As a result, the therapy was modified by PET examination in 14 patients. Conclusion 18F-FDG PET imaging is of important clinical alue in the diagnosis of lung lesions and the staging of malignancy.