MDCT联合18F-FDG PET/CT鉴别孤立结节/肿块型肉芽肿性病变与周围型肺癌

MDCT Combined with ^(18)F-FDG PET/CT Differentiates Isolated Nodular or Mass-Like Granulomatous Lung Diseases and Peripheral Lung Cancer

目的 探讨多排螺旋CT(Multi-detector computed tomography, MDCT)联合^(18)氟-脱氧葡萄糖正电子发射计算机断层成像技术(^(18)F-FDG PET/CT)鉴别孤立结节/肿块型肉芽肿性病变与周围型肺癌的应用价值。方法 纳入2019年1月至2021年6月于本院行MDCT检查诊断为周围型肺癌但病理为肉芽肿性病变31例,及同期经病理证实的周围型肺癌38例。回顾性分析病例的临床及影像学资料,比较两组病变形态学特征、多期扫描CT值、SUV_(max)和SUV_(avg)值差异。受试者工作曲线(Receiver operator characteristics analysis, ROC)评价单一指标和多参数指标联合鉴别肉芽肿性病变与周围型肺癌的效能。结果 ROC曲线分析示,单一指标中,静脉期CT值诊断效能最高(AUC=0.71,P<0.01)。以静脉期CT值30.5为临界值,鉴别肉芽肿性病变和周围型肺癌敏感性37.5%、特异性93.7%。联合指标模型中,以2个形态学特征(形态、分叶)联合4个半定量参数(动脉期CT值、静脉期CT值、SUV_(max)和SUV_(avg)值)联合模型的诊断效能最高(AUC=0.85,P<0.01),特异性62.5%、敏感性100%,明显优于单一半定量参数。结论 联合MDCT(形态学特征及增强各期CT值)及^(18)F-FDG PET/CT(SUV_(max)和SUV_(avg))能提高孤立结节/肿块性肉芽肿性病变和周围型肺癌的鉴别诊断效能,避免过度或延误治疗。

Objective To explore the value of multi-detector computed tomography(MDCT)combined with 18 fluoro-deoxyglucose positron emission tomography(^(18)F-FDG PET/CT)in differentiating isolated nodular or mass-like granulomatous lung diseases(GLD)from peripheral lung cancer(PLC).Methods 31 cases,which was diagnosed as PLC by preoperative MDCT examination but eventually pathologically confirmed as GLD in our hospital from January 2019 to June 2021,were included.Another 38 cases of pathologically confirmed PLC in the same period were also enrolled.The clinical and imaging data of the cases were retrospectively analyzed,and the morphology,multi-phase CT values,SUVmax and SUVavg values of the lesions were compared between the two groups.Receiver Operator Characteristics Analysis(ROC)was used to evaluate the diagnostic performance of single and multi-parameter in differentiating GLD from PLC.Results ROC curve analysis showed that CT value at venous phase(VP)had the highest diagnostic efficiency among single indexes(AUC=0.71,P<0.01).The sensitivity and specificity were 37.5%and 93.7%for differentiating GLD from PLC when the cutoff value of VP CT value was 30.5.Among the combined models,the two morphological features(morphology and lobule)combined with four semi-quantitative parameters including CT value at arterial phase(AP)and VP,SUVmax and SUVavg value had the highest diagnostic efficiency(AUC=0.85,P<0.01)with specificity 62.5%,sensitivity 100%,which was superior to any single semi-quantitative parameter.Conclusion The combination of MDCT(morphological features and CT values at AP and VP)and 18F-FDG PET/CT(SUVmax and SUVavg)can improve the diagnostic performance in differentiating isolated nodules or mass-like GLD from PLC,which helps to avoid overtreatment or delayed treatment.