18F-FDG PET/CT与增强CT在成人原发前纵隔恶性肿瘤中的诊断价值

Diagnostic value of 18F-FDG PET/CT and enhanced CT for adult patients with primary malignant tumors of the anterior mediastinum

目的探讨18F-氟脱氧葡萄糖(FDG)PET/CT与增强CT在成人原发前纵隔恶性肿瘤中的诊断价值,以提高对该部位病变的诊断水平。方法回顾性分析2016年6月至2019年5月在湖北文理学院附属医院(襄阳市中心医院)经病理证实的成人原发前纵隔肿瘤患者80例(恶性肿瘤35例、良性肿瘤45例),其中,男性46例、女性34例,年龄20~80(45.5±10.2)岁。所有患者均行全身18F-FDG PET/CT及胸部CT平扫+增强扫描,2种检查的间隔时间在2周内。分别计算并采用χ2检验比较18F-FDG PET/CT与增强CT扫描的诊断灵敏度、特异度和准确率,采用χ2检验比较2种检查方法对不同类型恶性肿瘤的诊断效能。结果35例恶性肿瘤中胸腺癌15例,淋巴瘤10例,恶性生殖细胞瘤7例,神经内分泌癌、恶性黑色素瘤及滑膜肉瘤各1例。18F-FDG PET/CT诊断成人原发前纵隔恶性肿瘤的灵敏度[97.1%(34/35)]、特异度[93.3%(42/45)]及准确率[95.0%(76/80)]均高于增强CT[71.4%(25/35)、77.8%(35/45)、75.0%(60/80)],且差异有统计学意义(χ2=8.612、4.357、12.471,均P<0.05);18F-FDG PET/CT对胸腺癌、淋巴瘤及恶性生殖细胞瘤诊断的准确率[93.3%(14/15)、100.0%(10/10)、85.7%(6/7)]均高于增强CT[60.0%(9/15)、50.0%(5/10)、28.6%(2/7)],且差异有统计学意义(χ2=4.503、6.333、4.333,均P<0.05)。结论18F-FDG PET/CT对成人原发前纵隔恶性肿瘤具有重要的诊断价值,其诊断效能优于增强CT,可作为该病主要的检查方法。

Objective To compare the diagnostic value of 18F-fluorodeoxyglucose(FDG)PET/CT versus enhanced CT in detecting adult patients with primary malignant tumors of the anterior mediastinum and improve the accuracy of diagnosis.Methods A total of 80 adult patients with primary tumors of the anterior mediastinum(35 malignant tumors and 45 benign tumors)confirmed by pathology from June 2016 to May 2019 in Affiliated Hospital of Hubei University of Arts and Science(Xiangyang Central Hospital)were retrospectively analyzed.The patients included 46 males and 34 females aged 20–80 years,with a median age of 45.5±10.2 years.All patients were subjected to whole-body 18F-FDG PET/CT and plain and enhanced-scan thorax CT within a 2-week interval.The sensitivity,specificity,and accuracy of 18F-FDG PET/CT and enhanced CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were calculated and compared by χ2 test.The diagnostic efficiency of 18F-FDG PET/CT versus enhanced CT for different types of adult patients with primary malignant tumors of the anterior mediastinum was also compared by χ2 test.Results Among the 35 malignant tumors,15 were thymic carcinomas,10 were lymphomas,7 were malignant germinomas,1 was neuroendocrine carcinoma,1 was malignant melanoma,and 1 was synovial sarcoma.The sensitivity,specificity,and accuracy[97.1%(34/35),93.3%(42/45),95.0%(76/80),respectively]of 18F-FDG PET/CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were significantly higher than those of enhanced CT[71.4%(25/35),77.8%(35/45),75.0%(60/80),respectively;χ2=8.612,4.357,12.471,respectively;all P<0.05].The diagnostic accuracies of 18F-FDG PET/CT for thymic carcinoma,lymphoma,and malignant germinoma[93.3%(14/15),100.0%(10/10),85.7%(6/7),respectively]were significantly higher than those of enhanced CT[60.0%(9/15),50.0%(5/10),28.6%(2/7),respectively;χ2=4.503,6.333,4.333,respectively;all P<0.05].Conclusions 18F-FDG PET/CT has significant diagnostic value for adult patients with primary malignant tumors of the anterior mediastinum.The diagnostic efficiency of this technique is better than that of enhanced CT,and it can be used as a main imaging method for the diagnosis of these types of diseases.