18F-FDG PET-CT联合同机HRCT对肺孤立性单纯性磨玻璃结节的诊断价值研究

目的探讨18F-FDG PET-CT双时相显像联合同机HRCT对肺内孤立单纯性磨玻璃结节的诊断与鉴别诊断价值。方法回顾性分析38例肺孤立单纯性磨玻璃样结节(28例恶性,10例良性)的HRCT征象及18F-FDG PET/CT常规显像最大标准摄取值(SUVmax)、双时相显像滞留指数(RI)、双时相显像基于最大标准摄取值的肿瘤本底比值(T/N)的变化率(△T/Nmax),分别分析不同标准对肺孤立性单纯性磨玻璃结节的诊断效能,将诊断效能最好的指标与HRCT相联合分析其诊断效能;统计学方法采用SPSS 13.0软件。结果 HRCT对肺孤立性单纯性磨玻璃结节的诊断敏感性、特异性、准确性分别为88.5%、50%、76.3%。良恶性肺孤立性单纯性磨玻璃结节常规显像与延迟显像的SUVmax、RI及△T/Nmax之间差异均有明显统计学意义。以SUVmax≥1.0为评判指标对单纯性磨玻璃结节的诊断敏感性、特异性、准确性分别为75.0%、90.0%、78.9%。以RI≥5%为评价标准,其诊断敏感性、特异性、准确性分别为50%、90%、60.5%。△T/Nmax≥5%为评判标准的诊断敏感性、特异性、准确性分别为71.4%、90.0%、76.3%。常规显像SUVmax≥1.0联合HRCT、△T/Nmax≥5%联合HRCT,在特异性保持不变的情况下,对肺孤立性单纯性磨玻璃结节的诊断敏感性及准确性均有所提高,分别为89.3%和89.5%、85.7%和86.8%。结论对于肺内孤立单纯性磨玻璃结节,SUVmax≥1.0、△T/Nmax≥5%具有更高的临床诊断效能。将两者与同机HRCT相联合可以提高诊断敏感性及准确性。     

18F-FDGPET／CT联合腹部增强CT对诊断胰腺癌及评估肿瘤可切除性的临床应用

目的评价18F-脱氧葡萄糖（FDG）PET／CT联合腹部增强CT对诊断胰腺癌、鉴别诊断胰腺良恶性病变以及评估肿瘤可切除性的临床应用价值。方法回顾性分析行18F—FDGPET／CT和腹部增强CT检查并经病理检查或临床等方法证实的48例原发性胰腺病变患者的资料,其中胰腺癌34例,胰腺良性病变14例。对胰腺癌和胰腺良性病变患者最大标准摄取值（SUVmax）进行t检验;比较分析单独PET、腹部增强CT、PET／CT、PET／CT联合腹部增强CT4种方法的图像特征和诊断价值,对灵敏度和准确性进行x2检验,对特异性进行Fisher确切概率法检验。结果34例胰腺癌患者与14例胰腺良性病变患者的SUVmax（5．91±2．90和2．24±1．13）差异有统计学意义（t=4．56,P〈0．01）。PET／CT联合腹部增强CT诊断胰腺癌的灵敏度、特异性和准确性分别为97．1％（33／34）、92．9％（13／14）和95．8％（46／48）,与单纯PET的88．2％（30／34）、64．3％（9／14）和81．2％（39／48）相比,x2=0．863和P=0．352,P=0．038,X2=5．031和P=0．024;与腹部增强CT的76．5％（26／34）、71．4％（10／14）和75．0％（36／48）相比,x2=6．274和P=0．012,P=0．042,x2=8．362和P=0．003;与PET／CT的88．2％（30／34）、78．6％（11／14）和85．4％（41／48）相比,x2=0．863和P=0．352,P=0．048,x2=3．928和P=0．047。PET／CT全身显像几乎发现了全部转移灶,使14例胰腺癌患者避免了不必要的外科手术;PET／CT可对单独PET显像诊断的胰腺癌患者胰腺外假阳性病灶进行正确诊断,使1例胰头癌患者分期下调,进行了外科手术。腹部增强CT通过多期显像,可以准确判断肿瘤对胰腺周围主要血管的侵犯程度,腹部增强CT按血管受侵程度评估肿瘤可切除性的准确性为83．3％（15／18）,不可切除的准确性为9／9。结论PET／CT联合增强CT对于诊断胰腺癌、鉴别胰腺良恶性病变及评估肿瘤的可切除性准确性有一定临床价值。     

^18F-FDG PET／CT双时相显像对肺部病灶的定性诊断价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT双时相显像在肺部病灶良恶性鉴别诊断中的临床应用价值。方法78例临床疑诊肺癌患者,均行早期和延迟^18F—FDG PET／CT显像。计算早期及延迟显像最大标准摄取值（SUVmax）,并计算2次显像SUVmax变化率（ASUV）。以SUVmax〉2．5和ASUV〉20％作为诊断肺癌的标准。患者最终诊断均经组织病理学、细菌学或治疗后随访证实。采用SPSS13．0软件,SUV组间比较用t检验,用受试者工作特征（ROC）曲线评价SUVmax、ASUV对肺部病灶的定性诊断价值。结果（1）78例患者中肺癌60例,良性病变18例（增殖性病变16例,占88．89％）。肺癌组（9．92±5．33和7．94±4．17,t=10．19）和良性病变组（8．54±6．61和7．21±5．74,t=8．23,P均〈0．01）延迟SUVmax均明显高于早期SUVmax;肺癌组与良性病变组间早期和延迟显像SUVmax差异均无统计学意义（t=0．60和-0．91,P均〉0．05）;肺癌组与良性病变组ASUV差异也无统计学意义[（26．04±14．73）％和（18．09±24．09）％,t=1．67,P〉0．05]。18例良性病变患者中有2例延迟显像SUVmax较早期减低,而肺癌患者延迟显像SUVmax均无减低。（2）以SUVmax〉2．5和ASUV〉20％为诊断肺癌的标准,其灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为93．33％（56／60）和63．33％（38／60）、22．22％（4／18）和50．00％（9／18）、76．92％（60／78）和60．26％（47／78）、80．00％（56／70）和80．85％（38／47）、50．00％（4／8）和70．97％（22／31）;根据SUVmax和ASUV得到的ROC曲线下面积分别为0．61（Z=1．38,P〉0．05）和0．56（Z=0．65,P〉0．05）,差异均无统计学意义。结论对肺部病灶临床疑诊为肺癌的患者,如良性病变以增殖性病变为主,则^18F—FDG PET双时相显像良恶性鉴别诊断临床应用价值不大;但延迟SUVmax减低可能?     

孤立性肺病变18F-FDG PET/CT显像诊断价值及误诊原因分析

目的 探讨18F-FDG PET/CT显像对孤立性肺病变的诊断价值及误诊原因.方法 回顾分析32例孤立性肺部病变患者18F-FDG PET/CT显像结果.将PET/CT结果与病理检查结果进行对比,评价18F-FDG PET/CT显像在孤立性肺部病变诊断中的价值,并分析其误诊原因.应用SPSS 16.0软件行统计学分析,SUVmax及SUVmax变化率(△SUVmax)与病灶直径大小关系采用Pearson相关分析.结果 32例孤立性肺部病变中,恶性病变22例,良性病变10例.18F-FDG PET/CT对68.75％( 22/32)患者进行了准确定性诊断.18F-FDG PET/CT显像假阴性5例,假阳性5例.22例肺部恶性病变中,6例恶性病变早期SUVmax ＜2.5,5例恶性病变△SUVmax＜15％.10例肺部良性病变中,2例良性病变早期SUVmax≥2.5,4例良性病变△SUVmax≥15％.良恶性病变SUVmax及△SUVmax有交叉.32例肺部病变中,孤立性肺部病变最大直径≤3 cm共26例,最大直径＞3 cm共6例,平均(1.98±1.08) cm.SUV max与病变直径大小呈正相关(r=0.690,P＜0.01),△SUVmax与病灶直径大小无相关性(r=-0.081,P＞0.05).结论 18F-FDG PET/CT在肺部孤立性病变定性诊断中有重要临床价值,但单纯依靠SUV max存在不足,应将PET与CT综合分析.     

18F-FDG PET/CT显像诊断心包恶性病变的价值

目的 评价18F-脱氧葡萄糖（FDG）PET/CT对心包恶性病变的诊断价值.方法 对23例心包积液患者进行18F-FDG PET/CT显像,并采用两独立样本非参数检验分析良恶性病灶最大标准摄取值（SUVmax）差异有无统计学意义.结果 经病理检查证实恶性心包积液14例,良性心包积液9例.1例PET/CT假阴性,2例PET/CT假阳性.18F-FDG PET/CT鉴别诊断良恶性心包积液的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为92.9%（13/14）、7/9、87.0%（20/23）、86.7%（13/15）和7/8.良、恶性病变的SUVmax中位值分别为2.2和6.0,两者间比较差异有统计学意义（z=-3.279,P=0.001）.结论 18F-FDG PET/CT是评价心包恶性病变较好的无创性手段,对良恶性心包积液的诊断与鉴别诊断有一定临床价值.     

双时相18F-FDG PET显像用于肿瘤良恶性鉴别诊断

目的探讨双时相^18F-FDG PET显像在肿瘤良恶性鉴别中的临床价值。方法52例单次显像难以鉴别病变性质的患者行双时相全身^18 F-FDG PET／CT显像，将显像结果与病理学检查结果对照。结果43例延迟显像SUV升高的患者中有39例经病理检查证实为恶性病变，4例为良性病变；9例延迟显像SUV降低的患者中有7例经病理检查证实为良性病变，2例为恶性病变。灵敏度为95．1％，准确性为88．5％，特异性为63．6％，阳性预测值为90．7％，阴性预测值为7／9例。结论双时相^18F—FDG PET对良恶性病变的鉴别具有较高的灵敏度和准确性。     

^18F—FDGPET／CT在肺癌肾上腺转移瘤诊断中的应用价值

目的探讨^18F-FDG PET/CT对肺癌肾上腺转移的诊断价值。方法回顾性分析在我院行^18 F-FDG PET/CT检查并诊断肾上腺转移瘤及良性病变48例肺癌患者的^18F-FDG PET/CT显像资料,分别测量肾上腺病灶（共63个）的大小（短径）、CT值及SUVmax,采用t检查及χ^2检验对各组数据进行统计学分析,采用ROC（receiver operator characteristic curve）曲线分析确定SUVmax区分肾上腺转移瘤与良性病变的最佳临界点。结果 163个病灶最终确诊46个为肾上腺转移瘤,17个为良性病变,肾上腺转移瘤与良性病变的大小分别为（2.01±1.09）cm、（1.57±0.73）cm,差异无统计学意义（t=1.472,P=0.146）;两组病灶的CT值分别为（31.69±9.98）HU、（9.80±3.98）HU,差异有统计学意义（t=7.666,P=0.000）;肾上腺转移瘤的SUVmax为8.86±5.05,良性病变的SUVmax为2.41±0.81,差异有统计学意义（t=4.889,P=0.000）。肾上腺转移瘤左右侧分布比例为：左侧50%（17/34）,右侧14.7%（5/34）,差异有统计学意义（χ^2=9.676,P=0.002）;2以肾上腺病灶SUVmax与正常肝脏的SUVmax的比值〉1作为诊断标准,PET/CT对肺癌肾上腺转移的灵敏度、特异性及准确性分别为93.5%（43/46）、76.5%（13/17）及88.9%（56/63）,阳性预测值为91.5%（43/47）,阴性预测值为81.3%（13/16）。ROC曲线分析,以SUVmax〉3.5作为诊断标准,则灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为93.5%（43/46）、88.2%（15/17）、92.1%（58/63）、95.6%（43/45）,和83.3%（15/18）。结论 18F-FDG PET/CT对肺癌肾上腺转移的诊断具有较高的灵敏度、特异性及准确性;以SUVmax〉3.5作为诊断标准,可较好的诊断出肾上腺转移瘤和肾上腺良性病变。     

PET/CT及其他影像手段对胰腺癌诊断的比较研究

目的:探讨18F-脱氧葡萄糖(FDG)PET/CT显像、增强CT和综合手段对胰腺癌的诊断和鉴别诊断价值。方法:对经病理和临床等综合手段证实的32例胰腺病变的患者进行回顾性分析。分别观察胰腺病变的CT形态、密度、强化程度、胰胆管扩张、转移以及PET显像胰腺病灶感兴趣区(ROI)标准摄取最大值(SUVmax)。结合临床和病理诊断结果,分别比较分析单纯PET、单纯CT平扫、增强CT、PET/CT和综合手段对胰腺疾患诊断的敏感性、特异性、准确性。结果:32例胰腺病变中,胰腺恶性肿瘤26例,其中20例为胰腺癌,3例为胰腺癌手术后复发,2例为胰腺转移癌,1例为交界性肿瘤(潜在恶性);良性病变为6例,其中5例为肿块性慢性胰腺炎,1例为急性胰腺炎。胰腺周围和腹膜后淋巴结转移8例,腹膜及肠系膜转移4例,肝脏转移7例,骨转移2例,其他部位转移2例。单纯PET、单纯CT、增强CT、PET/CT和综合手段对胰腺疾患诊断的敏感性分别为88.5%、73.1%、84.6%、92.3%、96.2%,特异性分别为66.7%、33.3%、66.7%、66.7%、83.3%,准确性分别84.4%、65.6%、81.3%、87.5%、93.8%。结论:18F-FDG PET/CT较单纯PET、单纯CT、增强CT对胰腺疾患的诊断价值高,综合手段能提高诊断的敏感性、特异性、准确性。     

~(18)F-FDG PET/CT显像对甲状腺病变的应用价值研究

目的初步分析和探讨~(18)F-FDG PET/CT显像对甲状腺病变的评估价值。方法回顾性分析2014年10月～2017年10月检查发现甲状腺病变并有明确病理结果的18例患者资料,以同一患者对侧正常甲状腺或周围颈部血池为健康对照组,分别对甲状腺恶性病变组、良性病变组和健康对照组的SUVmax进行统计并进行差异性分析,对甲状腺良、恶性病变SUVmax行ROC曲线分析,同时观察病灶的CT形态及密度改变,综合分析并计算PET、PET/CT诊断甲状腺病变的效能指标。结果 1)18例患者共21个病灶,恶性病变14个,良性病变7个,甲状腺恶性病变组、良性病变组和健康对照组的SUVmax分别为10.12±9.42、5.47±2.97和1.43±0.38,甲状腺恶性病变组与良性病变组SUVmax差异无统计学意义(F=0.635,P=0.435),甲状腺恶性、良性病变组与健康对照组SUVmax差异均有统计学意义(F=10.748和18.270,均有P0.01);2)分析甲状腺良、恶性病变SUVmax的ROC,该指标的AUC为0.515(0.70),诊断准确性不高;3)~(18)F-FDG PET扫描诊断甲状腺良、恶性病变的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别71.43%(10/14)、42.86%(3/7)、71.43%(10/14)、42.86%(3/7)、61.90%(13/21),而~(18)F-FDG PET/CT扫描的诊断效能分别为92.86%(13/14)、71.43%(5/7)、86.67%(13/15)、83.33%(5/6)、85.71%(18/21)。~(18)F-FDG PET扫描诊断甲状腺良、恶性病变的功效与标准组一致性很差(Kappa=0.143,μ=0.644,P=0.513),而~(18)F-FDG PET/CT扫描与标准组基本一致(Kappa=0.762,μ=4.792,P0.01)。结论 ~(18)F-FDG PET/CT显像中SUVmax不能作为甲状腺病变良恶性鉴别诊断指标,同时结合PET代谢特点和CT形态学改变,可以初步诊断甲状腺病变性质,并且能为临床提供更多信息如转移或者合并其他良恶性疾病。     

18F-FDG PET显像对胰腺良恶性病变鉴别诊断的作用

目的探讨18F-脱氧葡萄糖(FDG) PET显像对胰腺良恶性病变鉴别诊断的价值.方法临床疑胰腺病变患者30例,其中胰腺恶性肿瘤20例胰腺癌15例,胰腺癌切除术后复发3例,低恶性胰岛细胞瘤、癌肉瘤各1例;胰腺良性病变10例,均为慢性胰腺炎,其中3例并假性囊肿形成.除8例慢性胰腺炎为临床、放射学随访3～12个月外,余均由组织病理学检查证实.静脉注射18F-FDG 222～296 MBq 1 h后行PET显像.测定肿瘤体积和标准摄取值(SUV),并与PET检查前2周内CT(25例)、MRI(8例)结果对照.结果 20例胰腺恶性肿瘤中19例肿瘤明显摄取18F-FDG,平均SUV 4.91±3.65.10例慢性胰腺炎中9例病灶轻度或无摄取18F-FDG,平均SUV 1.70±1.12(t=2.69,P=0.012).4例肿瘤病灶直径≤3 cm,SUV 2.75±0.63;6例3.1～5 cm,SUV 4.59±3.06;10例>5 cm,SUV 5.46±2.29(χ2=9.02,P=0.011).1例PET假阳性为慢性胰腺炎并假性囊肿,SUV 4.82;1例PET假阴性为胰头癌术后复发,病灶SUV 2.1.以SUV 2.5为胰腺良恶性病变的判断阈值,18F-FDG PET显像诊断胰腺癌灵敏度、特异性和准确性分别为95.0%、90.0%、93.3%,明显高于CT(75.0%、55.6%、68.0%,χ2=5.89,P=0.015).结论 18F-FDG PET显像诊断胰腺癌灵敏度、特异性较高,尤其适于胰腺癌术前分期和术后复发、转移的探查.     

18F-FDG PET显像在胰腺恶性病变鉴别诊断及转移灶探查中的应用价值

目的研究18F-FDGPET显像在胰腺恶性肿瘤诊断与鉴别诊断中的应用价值。方法 40例临床疑为胰腺恶性病变的患者均行18F-FDGPET显像,对显像结果进行目测法及SUV值半定量分析,并结合CT,MRI等影像学检查进行综合诊断,最后诊断根据手术病理或经4个月以上随访证实。结果如果以SUV为2.5作为鉴别诊断胰腺病灶良恶性的阈值,24例证实为胰腺癌患者中18F-FDGPET显像正确诊断22例,16例胰腺良性病变患者18F-FDGPET检出13例,其灵敏度、特异度及准确性分别为91.7%（22/24）,81.3%（13/16）及87.5%（35/40）;而结合CT,MRI等其他检查结果进行综合诊断,其诊断灵敏度、特异度及准确性分别为91.7%（22/24）、87.5%（14/16）及90%（36/40）。恶性病变的SUV平均值为4.6±2.6,良性病变的SUV平均值为2.3±1.5,良恶性病变间SUV平均值差异有统计学意义（P〈0.01）。在转移灶的检出中,18F-FDGPET显像发现了全部38处转移灶,并发现6处CT,MRI未能发现的远处转移病灶,排除了1例CT认为是胰周转移性淋巴结肿大的病例。结论 18F-FDGPET对鉴别诊断胰腺良恶性肿瘤的灵敏度、特异性较高,尤其在远处转移灶的探查中有较高应用价值。     

The Clinical Role of Dual-Time-Point 18F-FDG PET/CT in Differential Diagnosis of the Thyroid Incidentaloma

Thyroid incidentalomas are common findings during imaging studies including ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for cancer evaluation. Although the overall incidence of incidental thyroid uptake detected on PET imaging is low, clinical attention should be warranted owing to the high incidence of harboring primary thyroid malignancy. We retrospectively reviewed 2,368 dual-time-point ¹⁸F-FDG PET/CT cases that were undertaken for cancer evaluation from November 2007 to February 2009, to determine the clinical impact of dual-time-point imaging in the differential diagnosis of thyroid incidentalomas. Focal thyroid uptake was identified in 64 PET cases and final diagnosis was clarified with cytology/histology in a total of 27 patients with ¹⁸F-FDG-avid incidental thyroid lesion. The maximum standardized uptake value (SUVmax) of the initial image (SUV1) and SUVmax of the delayed image (SUV2) were determined, and the retention index (RI) was calculated by dividing the difference between SUV2 and SUV1 by SUV1 (i.e., RI = [SUV2 - SUV1]/SUV1 × 100). These indices were compared between patient groups that were proven to have pathologically benign or malignant thyroid lesions. There was no statistically significant difference in SUV1 between benign and malignant lesions. SUV2 and RI of the malignant lesions were significantly higher than the benign lesions. The areas under the ROC curves showed that SUV2 and RI have the ability to discriminate between benign and malignant thyroid lesions. The predictability of dual-time-point PET parameters for thyroid malignancy was assessed by ROC curve analyses. When SUV2 of 3.9 was used as cut-off threshold, malignancy on the pathology could be predicted with a sensitivity of 87.5 % and specificity of 75 %. A thyroid lesion that shows RI greater than 12.5 % could be expected to be malignant (sensitivity 88.9 %, specificity 66.3 %). All malignant lesions showed an increase in SUVmax on the delayed images compared with the initial images. But in the group of benign lesions, 37.5 % (6/16) showed a decrease or no change in SUVmax. Dual-time-point ¹⁸F-FDG PET/CT, obtaining additional images 2 h after injection, seems to be a complementary method for the differentiation between malignancy and benignity of incidental thyroid lesions.     

Diagnostic usefulness of FDG PET for pancreatic mass lesions

The purpose of this study was to investigate the feasibility of [18F]2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) in patients with a pancreatic mass by comparing the results with those of X-ray computed tomography (CT) and magnetic resonance (MR) imaging. METHODS: Eighty-six patients with pancreatic lesions, included 65 malignant tumors and 21 benign masses (55 masses were proven histologically and the others were diagnosed clinically), were studied. The diagnostic factors of CT and MR imaging were evaluated, and those of FDG PET were also evaluated for malignant and benign masses by visual interpretation and quantitative interpretation with the standardized uptake value (SUV) and SUVgluc which was designed to reduce the effects of a high blood sugar level. Visual interpretations were evaluated only in FDG PET images, and quantitative interpretations were evaluated by referring to CT and/or MR imaging. The correlation between SUV and the degree of histological differentiation in pancreatic ductal adenocarcinoma was investigated. RESULTS: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for CT imaging were 91, 62, 88, 68 and 84%, and for MR imaging 78, 70, 88, 54 and 76%, respectively. In visual interpretation of FDG PET images, the sensitivity, specificity, PPV, NPV and accuracy were 82, 81, 93, 59 and 81%, respectively. Significant differences between malignant and benign lesions existed in SUV and SUVgluc (p < 0.0001, each). With the cutoff value of SUV as 2.1 and SUVgluc as 2.2, the accuracy of diagnosis was maximal. With that cutoff value, the sensitivity, specificity, PPV, NPV and accuracy for SUV were 89, 76, 92, 70 and 86%, and for SUVgluc 91, 76, 92, 73 and 87%, respectively. The sensitivity and NPV of SUVgluc were higher than those of SUV, which suggests that SUVgluc may be more useful in reducing the number of overlooked malignant tumors. The specificity and PPV of FDG PET were superior to those of CT and MR imaging. There were no significant differences between the SUVs of moderately differentiated adenocarcinomas and those of well differentiated adenocarcinomas. CONCLUSION: To improve the diagnostic procedure for classifying masses, FDG PET with not only SUV but also SUV corrected by the blood sugar level is required in addition to morphological diagnosis by CT and/or MR imaging.     

PET／CT在诊断胃癌与胃良性病灶中的价值

目的：探讨18 F-FDG PET/CT检查在胃癌与胃良性病灶中的鉴别诊断价值。方法回顾性分析138例疑似胃部恶性病变患者行18 F-FDG PET/CT检查。影像经处理、勾画感兴趣区获得良恶性病灶SUVmax诊断效能ROC曲线,将检查结果与病理及随访结果比较。评价SUVmax、PET/CT对恶性病灶的检出效能。统计学方法包括t检验、Z检验和Kappa一致性检验。结果138个胃部病灶病理诊断胃癌占63．0％（87/138）,胃良性病灶占37．0％（51/138）,胃癌组SUVmax明显高于良性组（t＝5．642,P＝0．001）,差异有统计学意义。胃癌组的胃壁厚度大于良性组（t＝7．575,P＝0．001）,差异有统计学意义;SUVmax、PET/CT诊断恶性病灶的 ROC、AUC（95％ CI）分别为0．857（0．757～0．916）和0.908（0．847～0．969）,PET/CT 明显大于SUVmax （ Z ＝5．242,P ＝0．001）。PET/CT 诊断胃良恶性病变,诊断效能ROC曲线发现阈值为2．97时,SUVmax、PET/CT诊断的灵敏度和特异性分别为92．0％、52．9％和95．4％、92．2％。与病理诊断比较,SUVmax诊断的一致性较中等（Kappa＝0．466,P ＝0．001）,PET/CT 的一致性极好（Kappa＝0．827,P＝0．001）。与SUVmax比较,PET/CT诊断的灵敏度由90．8％（79/87）提高到95．4％（80/87）,差异无统计学意义（χ2＝0．073, P ＝0．787）,特异性从52．9％（27/51）上升到92．2％（47/51）,差异有统计学意义（χ2＝19．691, P ＝0．001）。PET/CT与SUVmax比较,PET/CT诊断胃印戒细胞癌和黏液腺癌与其它细胞类型癌的灵敏度分别为75．0％（12/16）和95．1％（58/61）,（ t ＝1．845,P ＝0．074）,两组的SUVmax差异性无统计学意义（ Z ＝-1．463,P ＝0．144）。结论与SUVmax相比,PET/CT对诊断胃癌与胃良恶性病灶有较高的灵敏性和特异性,对于病理类型为胃黏液腺癌和印戒细胞癌时,PET/CT诊断的假阴性高。对恶性肿瘤远?     

18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在诊断乳腺癌及其区域淋巴结转移中的临床价值.方法 对27例疑原发性乳腺癌及经临床随访(＞12个月)证实的12例单发乳腺良性病变患者行18F-FDG PET/CT显像,患者均为女性.对显像结果分别行定性、半定量分析.27例疑乳腺癌患者均行手术治疗.结果 疑乳腺癌患者术后病理检查示24例为乳腺癌,共25个病灶;良性病灶7个.18F-FDG PET/CT显像定性分析诊断乳腺癌的灵敏度为76.0%(19/25),特异性为94.7%(18/19);以最大标准摄取值(SUVmax)＞2.5为界值,18F-FDG PET/CT诊断乳腺癌的灵敏度为72.0%(18/25),特异性为63.2%(12/19);以病灶SUVmax大于对侧正常乳腺腺体SUVmax的-x+2s为界值,PET/CT诊断乳腺癌的灵敏度为96.0%(24/25),特异性为63.2%(12/19),其灵敏度明显高于前2种分析方法(X2=4.15,4.14;P均＜0.05).定性方法的特异性明显高于半定量分析(X2值均为5.7,P均＜0.05).23例行区域淋巴结廓清术的患者病理检查示10例有淋巴结转移.18F-FDGPET/CT定性诊断乳腺癌区域淋巴结转移的灵敏度为60.0%(6/10),特异性为84.6%(11/13);以SUVmax＞2.5为界值,18F-FDG PET/CT诊断淋巴结转移的灵敏度为60.0%(6/10),特异性为92.3%(12/13).结论 在18F-FDG PET/CT诊断乳腺癌中,以病灶SUVmax大于正常乳腺腺体sUVmax的-x+2s为界值的半定量分析有较好的灵敏度;定性分析的诊断特异性优于半定量分析.     

Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma.

This study had two purposes: to optimize the semiquantitative interpretation of 18F-fluorodeoxyglucose (FDG) PET scans in the diagnosis of pancreatic carcinoma by analyzing different cutoff levels for the standardized uptake value (SUV), with and without correction for serum glucose level (SUV(gluc)); and to evaluate the usefulness of FDG PET when used in addition to CT for the staging and management of patients with pancreatic cancer. METHODS: Sixty-five patients who presented with suspected pancreatic carcinoma underwent whole-body FDG PET in addition to CT imaging. The PET images were analyzed visually and semiquantitatively using the SUV and SUV(gluc). The final diagnosis was obtained by pathologic (n = 56) or clinical and radiologic follow-up (n = 9). The performance of CT and PET at different cutoff levels of SUV was determined, and the impact of FDG PET in addition to CT on patient management was reviewed retrospectively. RESULTS: Fifty-two patients had proven pancreatic carcinoma, whereas 13 had benign lesions, including chronic pancreatitis (n = 10), benign biliary stricture (n = 1), pancreatic complex cyst (n = 1) and no pancreatic pathology (n = 1). Areas under receiver operating characteristic curves were not significantly different for SUV and SUV(gluc). Using a cutoff level of 3.0 for the SUV, FDG PET had higher sensitivity and specificity than CT in correctly diagnosing pancreatic carcinoma (92% and 85% versus 65% and 61%). There were 2 false-positive PET (chronic pancreatitis, also false-positive with CT) and 4 false-negative PET (all with true-positive CT, abnormal but nondiagnostic) examinations. There were 5 false-positive CT (4 chronic pancreatitis and 1 pancreatic cyst) and 18 false-negative CT (all with true-positive FDG PET scans) examinations. FDG PET clarified indeterminate hepatic lesions or identified additional distant metastases (or both) in 7 patients compared with CT. Overall, FDG PET altered the management of 28 of 65 patients (43%). CONCLUSION: FDG PET is more accurate than CT in the detection of primary tumors and in the clarification and identification of hepatic and distant metastases. The optimal cutoff value of FDG uptake to differentiate benign from malignant pancreatic lesions was 2.0. Correction for serum glucose did not significantly improve the accuracy of FDG PET. Although FDG PET cannot replace CT in defining local tumor extension, the application of FDG PET in addition to CT alters the management in up to 43% of patients with suspected pancreatic cancer.     

标准摄取值诊断肺占位病变的价值

目的：探讨单纯标准摄取值（SUV）及综合判断在肺内占位病变诊断中的价值。方法：行PET检查并经病理检查证实的肺部占位病变患者共80例，对其PET显像结果进行分析。结果：单纯SUV诊断的准确性、灵敏度、特异性分别为72．5％，76．0％，65．0％；综合判断的准确性、灵敏度、特异性分别为88．8％，90．0％，84．6％。结论：依据SUV结合临床资料进行综合判断，可显著提高PET显像鉴别肺部良恶性病变的准确性。     

^18F-FDGPET／CT影像特征对甲状腺结节的诊断效能

目的研究甲状腺结节^18F-FDGPET／CT影像特征对甲状腺结节良恶性的鉴别诊断效能。方法回顾性研究68例[男24例,女44例,平均年龄（52．8±10．58）岁]2006年1月至2012年12月间经PET／CT检查发现甲状腺结节且有术后病理结果的患者,分析其PET／CT图像特征并获得特征参数,包括结节边界清晰度、密度均匀性、钙化情况、包膜情况、平均CT值、结节大小及SUVmax。以术后病理结果为“金标准”,采用Mann-Whitney u检验、x^2检验及ROC曲线对各参数的诊断效能进行统计分析。结果68例患者中,病理结果显示恶性18例,良性50例。结节密度是否均匀、有无钙化灶、有无包膜对于甲状腺结节良恶性鉴别均无统计学意义（x^2=0．21、0．01、0．43,均P〉0．05）,结节平均CT值及结节大小亦无鉴别意义（均AUC〈0．5）。结节边界是否清晰对良恶性结节鉴别有统计学意义（x^2=8．06,P〈0．05）,其诊断灵敏度、特异性及准确性分别为55．6％（10／18）、80．0％（40／50）和73．5％（50／68）。良性结节SUVmax为3．16±1．84,恶性结节SUVmax为8．53±7．09,差异有统计学意义（u=-4．281,P〈0．01）。以SUVmax为评价指标,其ROC的AUC为0．841（95％CI：0．726—0．955）,最大约登指数（0．562）对应SUVmax为4．25,其诊断灵敏度、特异性及准确性分别为72．2％（13／18）、84．0％（42／50）和80．9％（55／68）。结论可依据^18F—FDGPET／CTSUVmax对甲状腺结节良恶性进行判断,但同机CT影像特征价值有限。     

PET/CT联合高分辨超声对甲状腺偶发病灶良恶性鉴别诊断的价值

目的 探讨PET/CT联合高分辨超声(US)对甲状腺偶发病灶良、恶性的鉴别诊断价值.方法 对73个PET/CT检出的甲状腺偶发病灶病理确诊前PET/CT和US诊断意见按3分法(0分,良性可能;1分,无明确定性;2分,恶性可疑)分类,并测定病灶长径和SUVmax.以病理诊断为“金标准”,评价SUVmax、PET/CT、US、PET/CT联合US( PET/CT+US)对恶性病灶的检出效能.统计学检验包括t检验、Z检验、x2检验和Kappa一致性检验.结果 73个甲状腺偶发病灶病理确诊恶性病灶占59％(43/73),良性病灶占41％(30/73).恶性病灶SUVmax (7.0±8.1)高于良性病灶(4.1±3.8;t=2.062,P=0.043),长径小于良性病灶[(2.0±1.1) cm比(2.7±1.4) cm;t=2.628,P=0.011].SUVmax、PET/CT、US及PET/CT+ US诊断恶性病灶的ROC AUC(95％CI)分别为0.580(0.448-0.713)、0.763 (0.647～0.878)、0.905(0.826～0.983)和0.909(0.840～0.979),PET/CT AUC明显大于SUVmax(Z=2.033,P=0.042),US、PET/CT+US也明显大于PET/CT(Z值分别为1.992和2.112,P均＜0.05)和SUVmax(Z值分别为4.120和4.276,P均＜0.001).最佳阈值下,SUVmax、PET/CT、US、PET/CT+US诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为42％(18/43)、83％(25/30)、59％(43/73)、78％(18/23)、50％(25/50),79％(34/43)、80％(24/30)、79％(58/73)、85％(34/40)、73％(24/33),84％(36/43)、90％(27/30)、86％(63/73)、92％(36/39)、79％(27/34)和98％(42/43)、67％(20/30)、85％(62/73)、81％(42/52)、95％(20/21).与病理诊断比较,SUV.诊断的一致性较差(Kappa=0.229,P=0.023),PET/CT的一致性中等(Kappa=0.582,P＜0.001),US和PET/CT+US的一致性好(Kappa值分别为0.668和0.674,P均＜0.001).PET/CT+US与PET/CT比较,灵敏度从79％(34/43)提高到98％(42/43),差异有统计学意义(x2=6.125,P=0.008),而特异性差异无统计学意义(从80％降低到67％;x2=2.250,P＞0.05).结论 联合高分辨US能明显提高18F-FDG PET/CT对甲状腺偶发病灶良、恶性的鉴别诊断效能.