^(18)F-FDG PET/CT在肺孤立实性结节良恶性鉴别诊断中的价值分析

Value of ^(18)F⁃FDG PET/CT in the differential diagnosis of benign and malignant pulmonary solitary solid nodules

目的分析良恶性肺孤立实性结节(pulmonary solitary solid nodule,PSSN)的临床资料及^(18)F-氟脱氧葡萄糖正电子发射型计算机断层(^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography,^(18)F-FDG PET/CT)影像特征差异,以提高PSSN良恶性鉴别诊断的意义。方法选择2015年1月至2023年6月我院收治行^(18)F-FDG PET/CT检查的PSSN患者312例,病理结果恶性211例为观察组,良性101例为对照组,计算^(18)F-FDG PET/CT诊断PSSN良恶性的灵敏度、特异度、准确率、阳性预测值、阴性预测值。比较两组临床资料、影像学特征差异,进行PSSN良恶性相关性分析。确定SUV_(max)最佳诊断临界值,绘制ROC曲线判断模型诊断意义。结果采用^(18)F-FDG PET/CT诊断PSSN恶性灵敏度80.59%,特异度73.33%,准确率78.85%,阳性预测值90.52%,阴性预测值54.46%。两组年龄及^(18)F-FDG PET/CT影像学特征(结节最大径、毛刺征、分叶征、胸膜牵连、空泡征、血管集束征、空气支气管征、SUV_(max))差异有统计学意义(P<0.05)。指标与PSSN良恶性正相关(P<0.05),相关系数分别为0.277、0.301、0.139、0.222、0.265、0.224、0.191、0.133、0.474。二元Logistic回归分析显示,PSSN良恶性与空泡征、血管集束征、SUV_(max)差异具有统计学意义(P<0.05)。SUV_(max)=3.3为临界值诊断PSSN良恶性灵敏度86.29%,特异度56.20%,准确率73.08%,阳性预测71.56%,阴性预测76.24%。结论PSSN最佳SUV_(max)诊断临界值3.3可提高^(18)F-FDG PET/CT诊断PSSN良恶性的灵敏度及阴性预测。结合临床资料及^(18)F-FDG PET/CT影像特征综合分析可提高PSSN良恶性鉴别诊断的意义。

Objective The clinical data of benign and malignant pulmonary solitary solid nodule(PSSN)and the differences of ^(18)F⁃FDG PET/CT image characteristics were analyzed to improve the differential diagnosis of benign and malignant PSSN.Methods Data of 312 patients were examined on ^(18)F⁃FDG PET/CT in our hospital from January 2015 to June 2023.The pathological results showed that 211 patients with malignant were in the observation group and 101 patients with benign were in the control group.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of ^(18)F⁃FDG PET/CT in the diagnosis of benign and malignant PSSN were calculated.The clinical data and imaging characteristics of the two groups were compared.The benign and malignant correlation of PSSN was analyzed.The optimal diagnostic critical value of SUV_(max) was determined,and ROC curve was drawn to judge the diagnostic value of the model.Results ^(18)F⁃FDG PET/CT was used to diagnose benign and malignant PSSN with 80.59%sensitivity,73.33%specificity,78.85%accuracy,90.52%positive predictive value and 54.46%negative predictive value.There were significant differences in age and ^(18)F⁃FDG PET/CT imaging features(maximum nodule diameter,burr sign,lobular sign,pleural involvement,vacuole sign,vascular cluster sign,air bronchial sign and SUV_(max))between the two groups(P<0.05).The above data were positively correlated with the benign and malignant correlation of PSSN (P<0.05), and the correlation coefficients were 0.277, 0.301, 0.139, 0.222, 0.265,0.224, 0.191, 0.133, 0.474, respectively. Binary Logistic regression analysis of the above data and PSSNbenign and malignant showed that there were statistically significant differences between benign and malignantPSSN and vacuole sign, vascular cluster sign and SUV_(max) (P<0.05).The critical value of SUV_(max)= 3.3 was86.29% sensitivity, 56.20% specificity, 73.08% accuracy, 71.56% positive predictive value and 76.24%negative predictive value in the diagnosis of benign and malignant PSSN. Conclusion The optimal SUV_(max)diagnostic critical value 3.3 of PSSN can improve the sensitivity and negative predictive value of ^(18)F⁃FDG PET/CT in the diagnosis of benign and malignant PSSN. Combined with clinical data and ^(18)F⁃FDG PET/ CT imagefeatures, it can improve the differential diagnosis value of benign and malignant PSSN.