^18F-FDG PET／CT 结合 HRCT 对肺微浸润性腺癌的诊断价值

目的：^18 F-FDG PET/CT结合 HRCT 对肺微浸润性腺癌（minimally invasive adenocarcinoma ，MIA）的诊断价值。方法搜集经手术病理证实28例肺 MIA 患者的^18 F-FDG PET/CT 及 HRCT 影像资料，患者均先行^18 F-FDG PET/CT显像，后行HRCT扫描检查，分析其形态学表现及放射性分布，同时测量其SUVmax值，分析PET/CT、HRCT、PET/CT结合 HRCT三者的准确率。结果28例患者中，18 F-FDG PET 显像有19例出现高于肺本底的局灶性异常放射性摄取增高影，以SUVmax＞2．5为标准，诊断MIA的灵敏度为32．1％（9/28）。HRCT 病灶显示磨玻璃密度结节27例（96．4％），其中单纯磨玻璃密度结节10例，混杂磨玻璃密度结节17例，单纯实性密度结节1例；病灶出现边缘分叶征18例（64．3％），毛刺征20例（71．4％），空泡征或支气管充气征21例（75％），胸膜凹陷征12例（42．9％），血管集束征10例（35．7％），圆形结节征13例（46．4％）。PET/CT、HRCT、PET/CT结合 HRCT 三者的准确率分别为71．4％、82.1％和96．4％。结论^18 F-FDG PET/CT诊断MIA易出现假阴性，PET/CT结合HRCT有利于提高诊断准确率。

Diagnostic value of combined ^18F-FDG PET/CT and HRCT for minimally invasive pulmonary adenocarcinoma

Objective To evaluate the diagnostic value of combined ^18 F-FDG PET/CT and HRCT for minimally invasive adenocarcinoma（MIA） .Methods The ^18F-FDG PET/CT images of 28 cases with pathologically confirmed MIA were studied .All were followed up by HRCT study .The morphological and radioactive findings of the lesions were reviewed , and the maximum standard uptake values （SUVmax） were measured .The diagnostic accuracy of PET/CT ,HRCT ,and combined PET/CT and HRCT were analyzed .The synergistic effect of combined PET/CT and HRCT were investigated . Results ^18 F-FDG PET imaging showed local abnormal radioactive uptake in 19 of 28 cases .When SUVmax of 2 .5 was employed as criteria in the diagnosis of MIA ,the sensitivity of ^18 F-FDG PET imaging was 32 .1% .Of the total of 28 cases ,10 had ground glass opacity （GGO） changes ,17 exhibited mixed nodules with GGO changes around the lesions ,and 1 case presented with solid nodules .HRCT showed that the lesions were showing lobulation in 18 cases （64 .3% ） ,spiculation in 20 cases （71 .4% ） ,vacuolar changes or air bronchogram in 21 cases （75% ） ,pleural indentation in 12 cases （42.9% ） ,vascular convergence in 10 cases （35 .7% ） ,and round nodule in 13 cases （46 .4% ） .The diagnostic accuracy of PET/CT ,HRCT ,and combined PET/CT and HRCT for MIA was 71 .4% ,82 .1% and 96 .4% respectively .Conclusion The false negative rate and the misdiagnosis rate were high in the diagnosis of MIA with routine PET /CT imaging .Combi-ning ^18 F-FDG PET/CT with HRCT was reasonable and practicable ,which had synergistic effect in diagnosing MIA and could greatly improve the diagnostic accuracy .