正电子发射计算机体层-CT成像鉴别心脏及心包良恶性病变的初步研究

Differentiation of benign from malignant lesions of heart and pericardium： the feasibility of Fluorine-18 fluorodeoxyglucose positron emission tomography CT

目的 探讨氟代脱氧葡萄糖（18F-FDG）PET-CT鉴别诊断心脏、心包病变良恶性的可行性.方法 对23例经病理或临床证实的心脏、心包良恶性病变进行18F-FDG PET-CT扫描,其中恶性病变13例,良性病变10例.测得病灶、心腔（血本底）的最高标准摄取值（SUVmax）及SUVmax病灶/SUVmax心腔比值（lesion/blood）,并观察病灶的内部密度及与周围组织关系.采用两独立样本非参数检验（Mann-Whitney）分析SUVmax及SUVmax lesion/blood良恶性病灶中有无统计学差异.同时分别计算出CT、PET-CT鉴别诊断心脏、心包病变良恶性的敏感度、特异度、阳性预测值和阴性预测值.结果 良性病变及恶性病变SUVmax中位数分别为1.5和6.5,两者之间差异有统计学意义（Z=-3.601,P＜0.01）.良性、恶性病变的SUVmax lesion/blood分别为0.9和3.4,两者之间差异有统计学意义（Z=-3.600,P＜0.01）.病灶SUVmax值以3.5～4.0或SUVmax lesion/blood值以1.3～2.0为PET-CT鉴别心脏、心包病变良、恶性的最佳临界值.单独CT及PET-CT鉴别诊断心脏、心包病变良恶性的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为76.9%（10/13）、100.0%（10/10）、87.0%（20/23）、100.0%（10/10）、76.9%（10/13）和100.0%（13/13）、90.0%（9/10）、95.7%（22/23）、92.9%（13/14）、100.0%（9/9）.结论 18F-FDG PET-CT可用于鉴别诊断心脏、心包病变的良、恶性,并为较为准确的鉴别诊断手段.

Objective To assess the feasibility of integrated 18F-FDG PET-CT for the differentiation of malignancy from benign lesions of heart and pericardium. Methods A total of 23 cases （malignancy∶benign= 13∶10） with cardiac and pericardial lesions confirmed by pathology or clinic were analyzed in the present study. All lesions were evaluated semi-quantitatively using maximum standard uptake values （SUVmax） and SUVmax lesion/blood, and the density of the heart and pericardium lesions and the relationship with surrounding tissues were evaluated. The differences of SUVmax and SUVmax lesion/blood between benign and malignant lesions were analyzed using Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value （PPV） and negative predictive value （NPV） were calculated for CT and PET-CT respectively. Results The maximum SUV showed significant difference between malignancy（6. 5 ） and benign （ 1.5 ） （ Z = - 3. 601, P ＜ 0. 01 ）, the SUVmax Lesion/Blood of malignancy and benign were 3.4 and 0. 9 respectively, also with significant difference（Z = -3. 600, P ＜0. 01 ）. The optimal cut-off value of SUVmax is 3.5-4. 0 and SUVmax Lesion/Blood is 1.3-2. 0. The sensitivity, specificity, accuracy, PPV and NPV of CT and PET-CT were 76. 9％ （ 10/13 ）, 100. 0％ （ 10/10） ,87.0％ （20/23）, 100. 0％ （ 10/10 ）, 76. 9％ （ 10/13 ） and 100. 0％ （ 13/13 ）, 90. 0％ （9/10）, 95.7％（22/23）,92.9％ （13/14）,100.0％ （9/9） respectively. Conclusion 18F-FDG PET-CT can correctly differentiate benignity and malignancy of cardiac and pericardial lesions.