基于^(18)F-FDG PET-CT的3种方法对孤立性肺结节的定性诊断价值比较

Comparison of qualitative diagnostic value of 3 methods based on^(18)F-FDG PET-CT for solitary pulmonary nodules

目的对比基于^(18)F-FDG PET-CT的3种方法(阈值法、视觉法、CT法)对孤立性肺结节(SPN)的定性诊断价值。方法回顾性分析2015年1月至2019年1月山西省肿瘤医院行^(18)F-FDG PET-CT且符合肺部影像数据和报告系统1.1(Lung-RADS1.1)分级标准2~4级的226例SPN患者的临床特征、病理结果、CT征象及最大标准摄取值(SUV_(max)),采用受试者工作特征(ROC)曲线分析比较阈值法(依据SUV_(max))、视觉法[依据纵隔血池氟代脱氧葡萄糖(FDG)摄取程度或肝血池FDG摄取程度]、CT法(依据Lung-RADS1.1分级标准)对SPN的诊断效能。将3种方法中诊断准确度最高的方法相结合作为PET-CT综合诊断法,比较PET-CT综合诊断法与3种方法之间的诊断效能。结果226例SPN患者中,病理诊断恶性174例,良性52例。ROC曲线分析显示,在CT法中,方法2(将Lung-RADS1.1分级4A级及以下定为良性,4B级及以上定为恶性)诊断SPN良、恶性的AUC为0.622,灵敏度为87.93%,准确度为76.11%,诊断效能高于方法2。阈值法中,方法1(将SUV_(max)≥2.5的实性SPN和SUV_(max)≥1.14的磨玻璃SPN定为恶性,其余定为良性)诊断SPN良、恶性的AUC为0.675,灵敏度为85.06%,准确度为76.99%,诊断效能高于阈值法和视觉法中的其他方法。将CT法诊断方法2及阈值法诊断方法1结合形成PET-CT综合诊断法,其诊断SPN良、恶性的AUC为0.652,灵敏度为97.70%,准确度为82.74%,诊断效能高于其他方法。结论基于^(18)F-FDG PET-CT的阈值法、视觉法及CT法对SPN的负性诊断价值相似,但将CT法与阈值法结合后,其诊断效能明显提高。

Objective To compare the value of 3 methods(threshold method,visual method and CT method)based on^(18)F-FDG PET-CT for qualitative diagnosis of solitary pulmonary nodules(SPN).Methods The clinical characteristics,pathological results,CT signs and maximum standardized uptake value(SUV_(max))of 226 SPN patients who underwent^(18)F-FDG PET-CT and met lung imaging reporting and data system(Lung-RADS1.1)grading criteria grade 2-4 in Shanxi Province Cancer Hospital from January 2015 to January 2019 were retrospectively analyzed,and the diagnostic efficacy of threshold method(according to SUV_(max)),visual method[according to the degree of fluorodeoxyglucose(FDG)uptake in the mediastinum or liver blood pool]and CT method(according to Lung-RADS1.1 grading criteria)for SPN were compared by using receiver operating characteristic(ROC)curve.The highest diagnostic accuracy of CT method and the highest diagnostic accuracy of threshold method and visual method were combined as PET-CT comprehensive diagnosis method,and the diagnostic efficiency of which was compared with the other methods.Results Among the 226 patients with SPN,174 cases were malignant and 52 cases were benign in pathology.ROC curve analysis showed that the area under the curve(AUC)of CT method 2(defined Lung-RADS1.1 grade 4A and below as benign,grade 4B and above as malignant)in CT methods for qualitative diagnosis of SPN was 0.622,the sensitivity was 87.93%,and the accuracy was 76.11%,the diagnostic efficiency was higher than method 2.The AUC of the threshold method 1(defined solid nodules that SUV_(max)≥2.5 and ground-glass nodules that SUV_(max)≥1.14 as malignant,the others as benign)in threshold methods for qualitative diagnosis of SPN was 0.675,the sensitivity was 85.06%,and the accuracy was 76.99%,the diagnostic efficiency was higher than other methods in the threshold methods and visual methods.The AUC of PET-CT comprehensive diagnosis method(combination of CT method 2 and threshold method 1)for qualitative diagnosis of SPN was 0.652,the sensitivity was 97.70%,and the accuracy was 82.74%,the diagnostic efficiency was higher than other methods.Conclusions There is no significant difference among threshold method,visual method and CT method based on^(18)F-FDG PET-CT in qualitative diagnosis of SPN.The diagnostic efficiency of combining CT method with threshold method is significantly improved.