^(18)F-FDG符合线路SPECT与CT显像在肺孤立性结节诊断中的价值

Comparison of ^(18)F-FDG SPECT coincidence and CT imaging in diagnosing solitary pulmonary nodules

目的:探讨18F-FDG符合线路单光子发射型计算机断层显像(single photon emission computer tomographic,SPECT)及计算机断层显像(Computed Tomography,CT)对鉴别肺孤立性结节(solitary pulmonary nodules,SPN)为良、恶性病变的价值。方法:回顾性分析具备同期SPECT及CT影像检查并经病理确诊的SPN病例117例,将SPECT及CT的判断结果与病理结果进行比较。结果:以病理诊断恶性SPN 93例,良性SPN 24例为"金标准";SPECT诊断恶性SPN 77例,良性SPN 40例,其中,假阳性6例,假阴性22例;CT诊断恶性SPN 98例,良性SPN 19例,其中,假阳性14例,假阴性9例。SPECT检查的灵敏度、特异度、正确率、阳性预测值、阴性预测值、Youden指数为76.34%(71/93)、75.00%(18/24)、76.1%(89/117)、92.70%(71/77)、45.00%(18/40)、51.3%;CT检查的灵敏度、特异度、正确率、阳性预测值、阴性预测值、Youden指数为90.32%(84/93)、41.67%(10/24)、80.3%(94/117)、85.71%(84/98)、52.63%(10/19)、32.0%。SPECT对确诊SPN的特异度、阳性预测值、Youden指数均高于CT,差异有统计学意义(P<0.05)。结论:CT检出恶性病变的能力好于SPECT,SPECT确定良性病变的能力强于CT,总体上SPECT对SPN的确定诊断有较好的临床应用价值。

Objective： To evaluate the value of 18F-fluorodeoxyglucose（FDG） SPECT coincidence and CT imaging in diagnosis of solitary pulmonary nodules（SPN）.Methods： 117 cases of patients who were confirmed SPN by pathological diagnosis were analyzed retrospectively.All cases were received SPECT coincidence and CT imaging.The results were compared with pathological results.Results： 93 patients were proved to be malignant by pathological diagnosis and 24 patients were benign.77 cases were diagnosed as cancer by 18F-FDG SPECT coincidence imaging,and 40 cases were diagnosed as benign lesions.There were 6 false positive cases and 22 false negative cases.98 cases were diagnosed as cancer by CT,and 19 cases were diagnosed as benign lesions.There were 14 false positive cases and the 9 false negative cases.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index of 18F-FDG SPECT for the diagnosis of SPN were 76.34%（71/93）,75.00%（18/24）,76.1%（89/117）,92.70%（71/77）,45.00%（18/40）,51.3%;The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index of CT for the diagnosis of SPN were 90.32%（84/93）,41.67%（10/24）,80.3%（94/117）,85.71%（84/98）,52.63%（10/19）,32.0%.The specificity,positive predictive value and Youden index of 18F-FDG SPECT were higher than CT,the differences were statistically significant（P0.05）.Conclusion： The ability of 18F-FDG SPECT in confirming benign disease is more powerful than CT.Then CT is more powerful in confirming malignant than SPECT.The 18F-FDG SPECT coincidence imaging has a big value in clinical application.