^18F-FDG符合线路显像与异机CT图像融合诊断非小细胞肺癌复发转移的价值

Image fusion diagnostic value of ^18F-FDG coincidence image and spiral CT in non-small cell lung cancer recurrence and metastases

目的评价^18F-脱氧葡萄糖（FDG）符合线路显像与异机CT图像融合诊断非小细胞肺癌（NSCLC）术后放化疗后复发转移的价值。方法对可疑复发转移的40例NSCLC患者行^18F-FDG符合线路显像，并于显像前后1周内行CT扫描。用三维（3D）图像融合软件进行图像融合。结果在^18F-FDG符合线路显像与CT扫描相同的范围内，40例患者共检出病灶58处，其中恶性52处，良性6处。融合图像诊断NSCLC复发转移的灵敏度、特异性、准确性、阳性预测值、阴性预测值、阳性似然比及阴性似然比分别为94．23％（49／52），5／6，93．10％（54／58），98．00％（49／50），5／8，5．65及0．07。图像融合灵敏度、准确性明显高于CT。单纯^18F-FDG符合线路显像诊断效能与图像融合无差别，但与CT图像融合可明显提高对病灶的定位诊断（提高44．83％）。结论^18F-FDG符合线路与cT图像融合诊断NSCLC术后放化疗后复发转移灵敏度高，定位准确，值得推广应用。

Objective The aim of this study was to evaluate the clinical value of software based imaging fusion of ^18F-fluorodeoxyglucose （FDG） coincidence study and diagnostic CT in re-staging non-small cell lung cancer （NSCLC）. Methods Forty NSCLC patients were included for re-staging. All had ^18F-FDG coincidence image and diagnostic CT within one week. The software based imaging fusion was done automatically by three-dimension （3D） image fusion software （syngo, Siemens）. The gold standard of lesion identification was either histopathology or clinical follow-up. Results With the help from fusion technique, 58 lesions from 40 NSCLC patients were detected. Of the 58 lesions, 52 were malignant and 6 were benign. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the software based imaging fusion results were 94.23% （49/52）, 5/6, 93.10% （54/58）, 98.00% （49/50）, 5/8, 5.65 and 0.07, respectively. As compared with the resuhs from diagnostic CT, the sensitivity and accuracy in lesions detection were significantly higher with fusion technique. Though no statistical difference between ^18F-FDG coincidence image alone or combined with diagnostic CT （with fusion）, the clinical impact of fusion technique was to improve the localization of lesions up to 44. 83%. Conclusions With the fusion technique, the localization of lesions at lung can be improved. Therefore, the re-staging at T- and N- status for NSCLC can be further improved.