18F-FDG PET/CT显像诊断肺部良恶性病变的临床价值探讨

目的 研究18F-FDG PET/CT全身显像在诊断肺部良恶性病变中的临床价值。方法 回顾性分析2007年10月至2009年3月苏州大学附属第一医院行18 F-FDG PET/CT全身显像并发现胸部病变的患者188例,随访至2010年1月,随访9～26个月,评价PET/CT显像诊断肺部占位、纵隔淋巴结、肺门淋巴结和其他良性病变的灵敏性、特异性和准确性。结果 良性病变中最大标准摄取值(SUVmax） ＞2.5者占24.3％（18/74例）,其中包括肺门淋巴结增大6例,纵隔淋巴结7例,肺内结节（＞10 mm）1例,肺部炎症2例,陈旧性肺结核1例,胸膜增生性病变1例。恶性病变中肺内结节(＞10 mm)病灶SUVmax为8.2±5.4,RI为52.4％±39.6％。PET/CT显像诊断肺内结节(＞10 mm)的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为98.2％、80.0％、96.6％、98.2％和80.0％。PET/CT显像诊断肺门 J淋巴结转移的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为92.3％、25.0％、80.8％、85.7％和40.0％。PET诊断纵隔淋巴结转移的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为95.7％、41.7％、84.8％、86.5％和71.4％,其灵敏性和准确性高于CT的70.2％和55.9％。PET显像诊断恶性肺内小结节(＜10 mm)的阳性率为63.2％,低于薄层CT显像。恶性病变治疗后复杳患者6例,病灶摄取18 F-FDG消失4例,平均生存期为(22±5)个月。结论 18F-FDG PET/CT显像在鉴别良恶性肿瘤中有较高的临床应用价值。

The clinic value of (18)F-FDG PET/CT imaging in differentiation of malignant from benign disease in lung

Objective To evaluate the clinic value of 18 F-FDG PET/CT imaging in differentiation of malignant from benign disease in lung. Methods 188 patients underwent 18F-FDG 45 min early and 2 h delayed PET/CT imaging after intravenous injection of 18F-FDG. The standardized uptake value (SUV) and retention index (RI) of region of interesting were calculated. The histological diagnosis or clinical findings in a 12 months follow-up period served as the standard of truth. Results In 114 patients with malignant disease and 74 patients with benign disease, the sensitivity, speciality and accuracy of 18 F-FDG PET/CT imaging in differentiation of malignant from benign lung nodules ( diameter more than 10 mm) were 98.2％,80.0％, and 96.6％, in mediastinal lymph nodes and were 95.7％, 41.7％, and 84.8％, respectively.The sensitivity of 18F-FDG PET imaging for lung nodules (diameter less than 10 mm) was lower than CT.Conclusions Integrated PET/CT imaging provides high sensitivity, specificity and reasonably high accuracy for lung cancer.