SPECT/CT符合线路18F-FDG检查与同机CT融合在妇科肿瘤诊断中的作用分析

目的研究妇科肿瘤^18F-FDG符合线路SPECT／CT显像中同机CT融合的作用。方法27例各类妇科肿瘤术后患者共进行28次^18F—FDG符合线路SPECT／CT检查，将其结果与未经过同机CT融合的单纯^18F-FDG图像（AC）读图结果比较，并结合患者2周CT内诊断结果及随访检查进行分析。结果以病例分析，单纯^18F-FDG图像（AC）和CT融合对妇科肿瘤复发和转移的灵敏度、准确率和阳性预测值分别为91．7％、92．9％和100％，二者无统计学意义，但与CT的准确率和阳性预测值比较有统计学意义（P〈0．01）。以病灶分析，^18F-FDG符合线路SPECT／CT检查的灵敏度、准确率和阳性预测值分别为97．4％、97．7％和100％，单纯FDG图像（AC）的相应指标为97．4％、84．1％和86．0％。二者比较准确率和阳性预测值有统计学意义（P〈0．05）。单纯^18F-FDG图像（AC）显像共发现86个病灶，同机CT融合后减少为74个病灶，共11例次检查（39．3％）的单纯^18F-FDG图像（AC）在与同机CT图像融合后其读图结果发生改变，其中6例中的12个病灶因同机CT图像发现其为非恶性病灶摄取而确定为假阳性病灶予以排除。共8例患者（28．6％）的分期和治疗方案在SPECT／CT符合线路FDG检查后发生改变，其中2例患者（7．1％）的分期和诊断与同机CT融合前的单纯^18F-FDG图像（AC）结果不同。结论同机CT融合显著提高了^18F-FDG符合线路SPECT／CT显像对妇科肿瘤检查中病灶诊断的准确率和阳性预测值，并能进一步明确患者诊断、分期，提高^18F-FDG符合线路SPECT／CT显像对患者诊断分期和治疗的影响。

Study on the effect of CT in the 18F-FDG coincidence/CT imaging of the patients with gynecologic malignancies

Objective To study the effect of imaging fusion with CT in the 18F-FDG coincidence/CT imaging of patients with gynecologic malignancies.Methods Twenty-seven patients with gynecologic malignancies after surgical treatment were studied using 18F-FDG coincidence/CT imaging in twenty-eight times.The lesions were identified by images of PET(without imaging fusion of CT) and PET/CT(fusion images of CT and 18F-FDG) respectively with visual and semiquantitative analysis.The results of different kind images were compared with results of dedicated CT taken within 2 weeks.Results In the site-based analysis,images of 18F-FDG coincidence/CT had a sensitivity,accuracy and positive predictive value of 97.4 %,97.7 % and 100 %,respectively,as compared with the performance indices of PET.There was a statistically significant difference between the accuracy and positive predictive value(P < 0.05) of 18F-FDG coincidence and 18F-FDG coincidence/CT for precise characterization of suspected lesions.In the patient-based analysis,18F-FDG coincidence/CT images and 18F-FDG coincidence images had the same sensitivity,accuracy and positive predictive value of 91.7 %?92.9 %and 100 %,respectively.There was a statistically significant difference between the accuracy and positive predictive value(P < 0.01) of 18F-FDG coincidence/CT or 18F-FDG coincidence and dedicated CT for precise characterization of suspected patients.Twenty-two patients had recurrence or metastasis in 74 malignant sites with 18F-FDG coincidence/CT images,compared with 22 patients and 86 malignant sites with 18F-FDG coincidence images.In 11 patients(39.3 %) the imaging results changed because of imaging fusion with CT.Conclusion The results of this study indicate imaging fusion with CT in the 18F-FDG coincidence/CT imaging may significantly improve the accuracy of diagnosis and positive predictive in gynecological malignancies and further lead to clarify the diagnosis,staging and improve the treatment.