40岁以下肺内孤立性结节~(18)F-FDG PET-CT分析

目的探讨~(18)F-FDG PET-CT对于40岁以下肺内孤立性结节良恶性鉴别诊断的价值及可能存在的问题。方法回顾2005年7月~2016年6月经病理证实的肺内孤立性结节40岁以下患者PET-CT资料共40例,其中良性病变16例,最大SUV 0.3~12.1,恶性病变24例,最大SUV 2.0~17.8,并分析其定性诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率。结果40例病例PET-CT诊断敏感度为87.5%,特异度为25.0%,阳性预测值为63.6%,阴性预测值为57.1%,准确率60.0%。其中良性病变有结核(8例)、炎性假瘤(3例)、隐球菌病(2例)、错构瘤(1例)、硬化性肺泡细胞瘤(1例)及肺泡上皮增生活跃伴炎性细胞浸润(1例);恶性病变有腺癌(18例)、鳞癌(3例)、神经内分泌癌(1例)及腺鳞癌(2例)。结论对于发现孤立性肺结节的40岁以下患者,~(18)F-FDG PET-CT肺癌诊断的敏感性较高,但特异性较低,提示PET-CT在鉴别这一年龄阶段的孤立性肺结节良恶性方面作用可能有限。亟需针对性地总结经验教训,注重对CT及PET图像的分析,适当应用CT增强、HRCT、双时相显影及非~(18)F-FDG示踪剂显像,以有效提高PET-CT在这一领域的诊断效能。

Analysis of 18F-FDG PET-CT for solitary lung lesion in patients under 40 years of age

Objective To evaluate the diagnostic value of 18F-FDG PET-CT in differentiating solitary lung lesion in patients under 40 years of age.Methods From July 2006 to June 2016,the 18F-FDG PET-CT of 40 patients with histologically confirmed benign lung lesions (16,SUVmax 0.3-12.1) and lung carcinoma (24,SUVmax 2.0-17.8) was reviewed.Results The diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of solitary lung lesion were 87.5％,25.0％,63.6％,57.1％,and 60.0％,respectively.The 16 benign lesions were tuberculosis (8),inflammatory pseudotumor (3),cryptococcosis (2),hamartoma (1),sclerosing pneumocytoma (1),and active alveolar epithelial hyperplasia (1).The 24 malignancy included pulmonary adenocarcinoma(20),squamous cell carcinoma (4),adenosquamous carcinoma (2),and neuroendocrine carcinoma (1).Conclusion 18F-FDG PET-CT has high sensitivity and low specificity for diagnosing solitary pulmonary lesion in patients under 40 years of age.