^(11)C胆碱-正电子发射体层显像在肺部病变诊断中的应用

Value of carbon-11 choline positron emission tomography in patients with pulmonary abnomalities

目的探讨11C胆碱-正电子发射体层显像(CH-PET)在肺部病变诊断中的价值。方法2002年9月—2004年12月对39例胸部CT发现肺部结节或团块样病变的患者行CH-PET检查,CH-PET结果采用目测法判读,采用半定量分析法测量显影病灶标准摄取值(SUV),结果同病理诊断及随访结果对照。结果恶性肿瘤24例、炎症病灶3例、肺囊肿1例在CH-PET中显影,细支气管肺泡癌3例、肾透明细胞癌与结肠腺癌肺转移各1例、机化性肺炎3例、新型隐球菌病1例、硬化性血管瘤及错构瘤各1例未显影,CH-PET对肺部恶性病灶定性诊断的灵敏度为83%(24/29)、特异度为60%(6/10)、准确率为77%(30/39)。鳞癌与腺癌SUVmax与SUVmean比较,差异有统计学意义(Z值分别为-2.937,-2.887,P均<0.01)。17例肺癌患者手术切除直径大于1.0cm的肺门、纵隔淋巴结共70处,CH-PET定性诊断的灵敏度为86%(25/29)、特异度为90%(37/41)、准确率为89%(62/70)。25例肺癌患者CH-PET所扫描的范围内发现7处肺外转移。5例行脑显像者正确检出2例脑转移。结论CH-PET可用于肺部结节或团块样病变的定性诊断,但仍然有局限性;可准确定性肺癌患者肺门、纵隔肿大淋巴结。

Objective To assess the value of carbon-11 choline（CH） positron emission tomography （PET） in patients with pulmonary nodules. Methods From September 2002 to December 2004, 39 patients with pulmonary nodules were imaged with CH-PET. CH-PET data was analyzed by visual method and semiquatitative method. When pulmonary nodules with abnormal CH uptake appeared in PET scans confirmed by visual method, their maximum and mean standard uptake value （SUVmax and SUVmean） were measured using semiquantitative method. Diagnoses were confirmed by surgery or biopsy and follow-up survey. Results Twenty-four cancerous and 3 inflammatory nodules and 1 bronchogenic cyst were detected by CH-PET and were diagnosed malignant with visual method. Three bronchial alveolar carcinoma, 2 metastatic tumor from kidney and colon, 3 fibrous nodules, 1 cryptococcosis, 1 harmatoma and 1 sclerosing hemangioma showed nothing abnormal in PET scans. For identification of pulmonary nodules with CH-PET, the sensitivity was 89% （24/29）, the specificity was 60% （6/10） , and the accuracy was 77% （30/39）. There were differences in SUV between 8 squamous cell carcinomas and 9 adenocarcinomas （ Z = - 2. 937, - 2. 887, P 〈 0.01 ）. In diagnosing 70 resected enlarged lymph nodes beyond 1 cm in 17 lung cancer patients, CH-PET had the sensitivity of 86% （25/29）, the specificity of 90% （37/41）, and the accuracy of 89% （62/70）. CH-PET confirmed 7 distant metastases in 25 lung cancer patients. In 5 cases suspected brain metastases CH-PET identified 2 cases positive correctly. Conclusions CH-PET can confirm malignant pulmonary nodules, but still there were false positive and false negative cases. CH-PET can evaluate N stage effectively in patients with lung cancer. CH-PET can depict brain metastases accurately.