^18F-FLT联合18F—FDG PET／CT显像对纵隔淋巴结良恶性的诊断价值

Diagnostic value of SF-FLT and lSF-FDG PET/CT imaging for benign and malignant mediastinal lymph nodes

目的评价^18F—FLT联合^18F—FDG PET／CT显像对肺部恶性肿瘤患者纵隔淋巴结良恶性的诊断价值。方法回顾性分析2009年4月至2011年10月全国11个PET／CT中心^18F-FTJT与^18F—FDG PET／CT显像的患者资料，选择行肺部恶性肿瘤切除和纵隔淋巴结清扫、获得病理检查结果的患者共41例，其中男28例，女13例，年龄（56．1±12．2）岁。对^18F—FLT与^18F-FDGPET／CT淋巴结的显像结果分别进行视觉分析和半定量分析，采用，检验比较各方法的诊断效能。结果（1）41例患者手术共检出533枚淋巴结，经病理检查证实恶性192枚，良性341枚（炎性增生淋巴结或正常淋巴结）；（2）以^18F-FDGSUV≥2．5和^18F—FLTSUV≥2．0为诊断恶性淋巴结的阈值^18F—FDG和^18F—FIJTPET／CT对纵隔淋巴结良恶性诊断的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为91．67％（176／192）、80．94％（276／341）、84．80％（452／533）、73．03％（176／241）、94．52％（276／292）和81．25％（156／192）、92．96％（317／341）、88．74％（473／533）、86．67％（156／180）、89．80％（317／353），两者灵敏度、特异性及阳性预测值差异均有统计学意义（，=8．897、21．722和11．495，均P〈0．05），准确性和阴性预测值差异均无统计学意义（X2=3．604和3．712，均P〉0．05）；^18F—FDG联合^18F—FLT诊断纵隔淋巴结的灵敏度、特异性、准确性、阳性预测值及阴性预测值则分别提高至93．75％（180／192）、94．43％（322／341）、94．18％（502／533）、90．45％（180／199）、96．41％（322／334）。结论^18F-FDG诊断纵隔淋巴结良恶性的灵敏度高于^18F—FLT，但特异性及阳性预测值明显低于FLT，两者联合诊断可明显提高诊断准确性。

Objective To evaluate the diagnostic value of ISF-FDG combined with ＇SF-FLT PET/ CT imaging for benign and malignant mediastinal lymph nodes in patients with lung malignant tumors. Methods Forty-one patients from 11 PET/CT centers with lung malignant tumors underwent IS F-FLT and IS F-FDG PET/CT imaging from April 2009 to October 2011. The patients were made up of 28 males and 13females with a mean age （56.1± 12.2） y. The gold standard for diagnosis was histopathology. The results of lSF-FLT and IaF-FDG PET/CT images were analyzed by visual and semi-quantitative analysis. X2 test was used to analyze diagnosis efficacy. Results （ 1 ） A total of 533 mediastinal lymph nodes were obtained and histopathologically confirmed. There were 192 malignant lymph nodes and 341 benign lymph nodes （ either inflammatory hyperplasia or normal lymph nodes）. （2） When ISF-FDG SUV i〉2.5 and lSF-FLT SUV t〉 2. 0 were used as the threshold for the malignant lesion, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of lSF-FDG and lSF-FLT were 91.67% （176/192） vs 81.25% （156/192）, 80.94% （276/341） vs 92.96% （ 317/341 ）, 84.80% （452/533） vs 88.74% （473/533）, 73.03% （ 176/241 ） vs 86.67% （ 156/180）, 94.52% （276/292） vs 89.80% （317/353）, respectively. There were significant differences in sensitivity, specificity and positive predictive value （X2 = 8. 897, 21. 722, 11. 495, all P 〈0.05）, while there were no significant differences in accuracy and negative predictive value （X2 = 3. 604, 3. 712, both P 〉 0.05 ）. The combination of dual-tracer PET/CT improved the sensitivity, specificity, accuracy, positive predictive value and negative predictive value up to 93.75% （180/192）, 94.43% （322/341）, 94.18% （502/533）, 90.45% （180/199） and 96.41% （322/334）. Conclusions ~s F-FDG PET had a higher sensitivity in diagnosis of benign and malignant mediastinal lymph nodes than is F-FLT, but 18 F-FLT had a higher specificity and positive predictive value. Dual tracer PET/ CT using is F-FDG and 18 F-FLT could improve the diagnostic accuracy of mediastinal lymph nodes.