PET/CT显像在肺癌诊断及分期中的初步应用

The preliminary clinical application of PET/CT on the diagnosis and staging of lung cancer

目的 探讨PET CT显像用于肺癌诊断及分期的价值。方法 肺癌患者4 6例,其中初诊者35例,治疗后者11例。所有患者皆行1 8F 脱氧葡萄糖(FDG)PET CT显像。图像经图像融合后,进行PET CT融合图像、PET图像和CT图像帧对帧对比分析。结果 ①35例肺癌初诊者,肺癌病灶PET CT检出灵敏度10 0 % ,除1例肺泡癌呈双肺弥漫性浓聚外,其他皆表现为结节状或团块状病灶,病灶直径介于0 8～9 4cm ,标准摄取值为4 6±1 94。PET所见高代谢病灶与CT所见占位性病变位置及形态基本匹配。PET CT在病灶定性、边界确定、显示病灶对周围组织的侵犯及在区分肺癌与肺不张、阻塞性肺炎、胸腔积液方面优于单纯PET和CT。11例肺癌治疗后患者中,9例双肺未见恶性肿瘤存在,另2例PET CT发现双肺转移。②在转移灶的检出方面,PET CT优于单纯PET和CT ,灵敏度分别为95 2 %、90 4 %、73 8%。PET和CT对病灶的检出有互补性,PET在小淋巴结转移灶、胸膜转移、骨转移和肾上腺转移检出及定性方面优于CT ,而CT对肺内小转移灶检出优于PET。结论 PET CT显像在肺癌诊断和分期方面优于单纯CT和PET。

Objective To evaluate the clinical value of PET/CT on the diagnosis and staging of lung cancer. Methods 46 lung cancer patients including 35 pre treatment and 11 post treatment cases. PET/CT fusion images, PET images and CT images of the same patient were analyzed frame by frame. Results ①The sensitivity of PET/CT in 35 pre treated cases reached 100%. Except one case of alveolar carcinoma showed a diffuse uptake in both lungs, the other patients displayed as hypermetabolic nodular or mass lesions with the size around 0.8～9 4 cm and the standardized uptake value (SUV) 4.6±1.94. The position of hypermetabolic lesion of PET finding were all concordant to CT. PET/CT was superior to PET and CT in final diagnosis, delineating the border, detecting tumor invasion and in differentiating lung cancer from atelectasis, obstructive pneumonitis and pleural effusion. Among 11 post treated cases, no malignancy was seen in 9 cases and in two cases with metastases in both lungs, the lesions were dectected definitely by PET/CT. ②For the staging, PET/CT was also superior to PET and CT alone with the sensitivity of 95.2%(PET/CT), 90.4%(PET), 73.8%(CT)respectively. PET and CT were complemental each other in the detection of the lesions. Obviously, PET was superior to CT in dectection of samll lymph node metastases, pleura, bone and adrenal metastases. CT was better than PET in detection of small lung metastases. Conclusions PET/CT is superior to PET and CT alone in the diagnosis and staging of lung cancer. PET and CT can complement each other.