^(18)F-脱氧葡萄糖符合线路显像对胸腔积液的诊断价值

Value of fluorine-18 fluorodeoxyglucose dual-head coincidence imaging to the diagnosis of pleural effusion

目的探讨^(18)F-脱氧葡萄糖(fluorine-18fluorodeoxyglucose,^(18)F-FDG)符合线路显像对胸腔积液病因及性质鉴别诊断的价值。方法 48例胸腔积液患者,经X线片、CT或MRI检查及胸腔积液常规生化检查等未明确病因而行^(18)F-FDG符合线路显像,与组织病理结果进行对照,分析^(18)F-FDG符合线路显像的诊断效能。结果 48例中组织病理结果证实恶性肿瘤33例,良性疾病15例;33例恶性肿瘤患者中恶性胸腔积液26例、良性胸腔积液7例,良性疾病患者胸腔积液均为良性;与组织病理结果对照,33例恶性肿瘤者中^(18)F-FDG符合线路显像准确诊断29例,2例肺腺癌及1例多发性骨髓瘤、1例卵巢癌胸膜转移误诊为良性;15例良性疾病者中^(18)F-FDG符合线路显像准确诊断12例,胸膜炎和胸膜结核各1例被误诊为胸膜间皮瘤,1例肺肉芽肿性炎伴胸膜炎误诊为肺癌并胸膜转移;26例恶性胸腔积液中,18 F-FDG符合线路准确诊断23例,2例肺腺癌及1例卵巢浆液性腺癌胸膜转移未被检出;22例良性胸腔积液中,2例胸膜炎及1例胸膜结核被误诊为恶性胸腔积液;^(18)F-FDG符合线路显像诊断恶性肿瘤的敏感度为87.88%、特异性为80.00%、准确性为85.42%、阳性预测值为90.63%、阴性预测值为70.58%;诊断恶性胸腔积液的灵敏度为88.46%、特异性为86.36%、准确性为87.50%、阳性预测值为88.46%、阴性预测值为86.36%。结论 ^(18)F-FDG符合线路显像在不明原因胸腔积液患者原发病的诊断、胸腔积液良、恶性的鉴别诊断中具有较高价值。

Objective To explore the value of fluorine-18 fluorodeoxyglucose（^（18）F-FDG）dual-head coincidence imaging to the diagnosis and differential diagnosis of pleural effusion. Methods ^（18）F-FDG dual-head coincidence imaging examination Forty-eight patients with pleural effusion not confirmed by X-ray,CT, MRI or routine biochemical examination received and the result were compared with the histopathologic results to analyze its diagnostic efficacy.Results The histopathologic results confirmed 33 patients with malignant tumor and 15 patients with benign diseases out of 48 patients.In 33 malignant patients,26 were confirmed malignant pleural effusion and 7 were benign pleural effusion.All 15 patients with benign diseases were confirmed benign pleural effusion.Compared with the histopathologic results,in 33 patients with malignant diseases,29 were diagnosed by ^（18）F-FDG dual-head coincidence imaging,and 2patients with lung adenocarcinoma,1 with multiple myeloma and 1with ovarian cancer with pleural metastases were misdiagnosed with benign diseases.In 15 patients with benign diseases,12 were diagnosed by ^（18）F-FDG imaging,1with pleurisy and 1with pleural tuberculosis were misdiagnosed with pleural mesothelioma,1 with pulmonary granulomatous inflammation with pleurisy was misdiagnosed with lung cancer with pleural metastasis.In 26 patients with malignant pleural effusion,23 were diagnosed by ^（18）F-FDG imaging,2 with lung adenocarcinoma and 1 with ovarian serous adenocarcinoma with pleural metastasis were not detected.In 22 patients with benign pleural effusion,2 with pleurisy and 1 with pleural tuberculosis were misdiagnosed with malignant pleural effusion.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ^（18）F-FDG dual-head coincidence imaging for malignant tumors were 87.88%,80.00%,85.42%,90.63% and 70.58%,respectively,and for malignant pleural effusion were 88.46%,86.36%,87.50%,88.46% and 86.36%,respectively.Conclusion ^（18）F-FDG dual-head coincidence imaging has a great value to the diagnosis of the primary disease of unexplained pleural effusion,and to the differentiate diagnosis of benign and malignant pleural effusion.