^(18)F-FDG联合^(18)F-FLT的PET/CT显像对肺结节良恶性鉴别诊断价值

DIFFERETIAL DIAGNOSTIC USES FOR ^(18)F-FLUORODEOX YGLUCOSE AND DEOXY-^(18)F-FLUOROTHYMIDINE PET/CT IMAGING IN PULMONARY LESIONS

目的:观察比较氟-18-2-脱氧-D-葡萄糖(18F-FDG)和氟-18-3-脱氧-3-胸腺嘧啶核苷(18F-FLT)的PET/CT显像在肺结节鉴别诊断中的临床意义和价值。方法:2007-06~2009-12共进行了70例病人肺部有直径小于50mm单发肺结节病灶,其中男50例,女20例,年龄25~82岁,平均年龄58.12±12.89岁;所有病人均行18F-FDG显像,其中30例1wk内行18F-FLT显像。通过病理或密切随访1 a以上得到确切的结果。两显像剂的PET/CT结果进行视觉分析和半定量分析,其中FDG诊断标准采用恶性SUV>2.5;FLT诊断标准采用恶性SUV>2.0。结果:70例病人,其中良性病变40例,恶性病变30例1。8F-FDG、18F-FLT及18F-FDG+18F-FLT对肺结节的诊断的敏感性、特异性、正确率、阳性预测值、阴性预测值分别为90.0%、40%、61.4%、52.9%、84.2%和75.0%、66.7%、70.0%、60.0%、75.0%及90.0%、60%、72.6%、62.8%、88.9%。结论:18F-FDG诊断肺恶性结节的敏感性较18F-FLT高,但特异性、准确率、阳性预测值低;18F-FLT对肺结节良恶性鉴别的特异性较18F-FDG高,但敏感性、阴性预测值低;二者联合诊断可以显著提高肺内恶性结节诊断准确率及阳性预测值。

Objective： To observe and compare the significance and the value of differential diagnostic using for 18F-fluorodeyglucose and deoxy-18F-fluorothymidine PET/CT imaging in pulmonary lesions.Methods：70 patients from Jun 2007 to Dec 2009（20 women,50 men,25~82 years old,mean age of 58.12±12.89 year） were enrolled in this reseach.All of patients performed 18F-FDG PET/CT imaging and of 30 patients performed 18F-FLT imaging.Every patient got definite diagnosis from pathological analysis or follow up.Tumoral uptake was determined by visual assessment and calculation of standardized uptake value（SUV）.To two being apparent to carry on vision analyze and half quantitative analysis separately as PET result of pharmaceutical,among them FDG standard adopts malignant SUV2.5;Absorb2.0,FLT standard adopts malignant SUV2;Absorb1.0.Results：We found 30 malignant and 40 benign lesions.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of FDG-PET,FLT-PET and FDG＋FLT of diagnosis of lung cancer were 90.0%,40%,61.4%,52.9%,84.2%Vs 75.0%,66.7%,70.0%,60.0%,75.0% Vs 90.0%,60%,72.6%,62.8%,88.9%.Conclusion：The diagnostic ability of FLT-PET is superior to that of FDG-PET.The sensitivity of FDG-PET is higher than that of FLT-PET but the specificity of former is lower than that of the later for diagnosis of lung cancer,and the combination of them may increase accuracy.