18F-FDG PET/CT双时相显像结合高分辨率CT诊断孤立性肺结节的临床观察

Clinical observation of dual-phase 18F-FDG PET/CT imaging combined with high-resolution CT in the diagnosis of solitary pulmonary nodules

目的分析18F-氟代脱氧葡萄糖正电子发射断层显像/计算机断层显像(18F-FDG PET/CT)双时相显像结合高分辨率CT(HRCT)对孤立性肺结节的诊断价值。方法对136例孤立性肺结节患者临床资料进行回顾分析,以术后病理活组织检查结果为金标准,收集2组患者的18F-FDG PET/CT双时相显像及HRCT诊断结果,比较18F-FDG PET/CT双时相显像中良性和恶性孤立性肺结节的早期标准摄取值(SUV早期)、SUV延期和滞留指数间的差异,分析单纯18F-FDG PET/CT双时相显像和18F-FDG PET/CT双时相显像结合HRCT对孤立性肺结节良恶性的诊断价值,对比2种方法对孤立性肺结节恶性典型征象的检出结果。结果 136例孤立性肺结节患者中,良性病变69例、恶性病变67例。18F-FDG PET/CT双时相显像中,恶性孤立性肺结节的SUV早期、SUV延迟和滞留指数均高于良性孤立性肺结节(P均<0.05)。18F-FDG PET/CT双时相显像结合HRCT对孤立性肺结节的毛刺、分叶、胸膜牵拉、磨玻璃样、血管集束CT等恶性征象检出率高于单纯PET/CT双时相显像(P均<0.05)。18F-FDG PET/CT双时相显像结合HRCT诊断孤立性肺结节的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为96%、93%、99%、98%、93%,单纯18F-FDG PET/CT诊断孤立性肺结节的准确度、灵敏度、特异度、阳性预测值、阴性预测值分别为76%、72%、81%、67%、70%。18F-FDG PET/CT双时相显像结合HRCT诊断孤立性肺结节良恶性的准确度、灵敏度、特异度、阳性预测值、阴性预测值均高于单纯18F-FDG PET-CT双时相显像(P均<0.05)。结论 18F-FDG PET/CT双时相显像结合HRCT对孤立性肺结节良恶性的诊断价值较高,可为临床治疗提供可靠依据。

Objective To evaluate the diagnostic value of dual-phase 18F-FDG PET/CT combined with high-resolution CT(HRCT) in the diagnosis of solitary pulmonary nodules. Methods Clinical data of 136 patients diagnosed with isolated pulmonary nodules were retrospectively analyzed. The outcomes of postoperative pathological biopsy were taken as the gold standard. The diagnostic results of dual-phase 18F-FDG PET/CT combined with HRCT were obtained in two groups. The early-stage standard uptake value(SUV), delayed-stage SUV and retention index between benign and malignant solitary pulmonary nodules in dualphase 18F-FDG PET/CT were statistically compared. The diagnostic values between dual-phase 18F-FDG PET/CT alone and dual-phase 18F-FDG PET/CT combined with HRCT for benign and malignant solitary pulmonary nodules were analyzed. The detection rates of signs of malignant solitary pulmonary nodules were statistically compared between two imaging methods. Results Among 136 patients, 69 cases were diagnosed with benign solitary pulmonary nodules and 69 cases of malignant solitary pulmonary nodules. During dual-phase 18F-FDG PET/CT, the early-stage SUV, delayed-stage SUV and retention index of malignant solitary pulmonary nodules were significantly higher compared with those of benign solitary pulmonary nodules(all P<0.05). The detection rate of dual-phase 18F-FDG PET/CT in combination with HRCT for malignant signs including burr, lobulation, pleural traction, ground glass and vascular bundle CT signs was significantly higher than that of dual-phase 18F-FDG PET/CT alone(all P<0.05). The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of dual-phase 18F-FDG PET/CT in combination with HRCT for solitary pulmonary nodules were 96%, 93%, 99%, 98% and 93%, which were remarkably higher compared with 76%, 72%, 81%, 67% and 70% for dual-phase 18F-FDG PET/CT alone, respectively(all P<0.05). Conclusion Dual-phase 18F-FDG PET/CT imaging combined with HRCT yields high diagnostic value for benign and malignant solitary pulmonary nodules, which can provide reliable basis for clinical treatment.