18F-FDG PET/CT对浸润性肺腺癌磨玻璃结节危险程度的诊断价值

目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT对浸润性肺腺癌磨玻璃结节（GGN）危险程度的诊断价值。 方法 回顾性分析2015年6月至2019年6月于青岛市中心医院经组织病理学检查或随访证实为浸润性肺腺癌的143例患者的临床资料，其中男性54例、女性89例，年龄30~79（60.2±8.9）岁。所有患者均行18F-FDG PET/CT全身显像（其中50例行18F-FDG PET/CT双时相显像）后经手术切除肺孤立性GGN，按腺癌生长模式分为2组:含有贴壁为主型腺癌（LPA）和（或）腺泡为主型腺癌（APA）和（或）乳头为主型腺癌（PPA）病灶的患者归入低危组；含有实体为主型腺癌（SPA）和（或）微乳头为主型腺癌（MPA）病灶的患者归入高危组。分别测量或记录患者以下信息:性别、年龄、病灶位置、径线、密度、最大标准化摄取值（SUV_max）、平均标准化摄取值（SUV_mean）、双时相显像滞留指数（RI）、肿瘤与对侧正常肺本底SUV_max的比值（T/N）、基于SUV_max的肿瘤与对侧正常肺本底的比值变化率（ΔT/N_max）及多层螺旋CT征象。计量资料的组间比较采用独立样本t检验，计数资料的组间比较采用χ2检验；采用多因素非条件Logistic回归分析组间差异有统计学意义的因素，根据其结果进行受试者工作特征（ROC）曲线分析。 结果 143例患者中，低危组（117例）与高危组（26例）的病灶径线（14.33±4.18） mm对（17.61±4.48） mm]、SUV_max（1.32±1.07对2.00±1.25）、SUV_mean（1.07±0.85对1.66±1.11）、双时相显像RI（0.01±0.36对0.20±0.07）、分叶征76.1%（89/117）对92.3%（24/27）]、胸膜尾征39.3%（46/117）对69.2%（18/26）]的差异均有统计学意义（t=?3.242~?2.392，χ2=4.773、6.766，均P<0.05）。行18F-FDG PET/CT双时相显像的50例患者中，低危组（40例）与高危组（10例）的延迟显像SUV_max（1.18±0.63对2.85±1.82）、延迟显像SUV_mean（0.92±0.43对2.72±1.69）、延迟显像T/N（2.55±1.33对5.84±3.83）的差异均有统计学意义（t=?2.867、?3.359、?2.678，均P<0.05）；SUV_mean、病灶径线和胸膜尾征为鉴别诊断低危组和高危组的独立影响因素。ROC曲线分析结果显示，当SUV_max=1.625时，ROC曲线的曲线下面积（AUC）为0.699，鉴别诊断低危组与高危组的灵敏度为57.7%（15/26）、特异度为78.6%（92/117）、准确率为74.8%（107/143）；当SUV_mean=0.845时，AUC为0.698，鉴别诊断二者的灵敏度为80.8%（21/26）、特异度为43.6%（51/117）、准确率为50.3%（72/143）；当病灶径线=13.765 mm时，AUC为0.716，鉴别诊断二者的灵敏度为80.8%（21/26）、特异度为54.7%（64/117）、准确率为59.4%（85/143）；与单独诊断比较，SUV_max+SUV_mean+病灶径线+胸膜尾征+分叶征联合诊断鉴别二者的效能最高。 结论 18F-FDG PET/CT有助于对浸润性肺腺癌GGN危险程度的诊断。

Value of 18F-FDG PET/CT in the diagnosis of risk level of pulmonary invasive adenocarcinoma appearing as ground-glass nodules

Objective To comparatively analyze the 18F-fluorodeoxyglucose (FDG) PET metabolic characteristics and multislice spiral CT imaging features of pulmonary invasive adenocarcinoma appearing as ground-glass nodules (GGN) with different risk levels and to evaluate the value of 18F-FDG PET/CT in the diagnosis of risk levels of GGN. Methods Retrospective analysis was performed on 143 patients (54 males, 89 females, 30?79(60.2±8.9) years old) with pulmonary invasive adenocarcinoma confirmed by histopathological examination or follow-up. All patients underwent 18F-FDG PET/CT whole body imaging (including 50 cases of 18F-FDG PET/CT dual-phase imaging) and surgical resection of solitary GGN of the lung. In accordance with the adenocarcinoma growth pattern, the patients were further divided into two groups. Patients with lesions with lepidic predominant adenocarcinoma and/or acinar predominant adenocarcinoma and/or papillary predominant adenocarcinoma were assigned to the low-risk group, and those with lesions with solid predominant adenocarcinoma and/or micropapillary predominant adenocarcinoma were classified into the high-risk group. The recorded data included gender, age, lesion location, size, density, maximum standardized uptake value (SUV_max), mean standardized uptake value (SUV_mean), retention index (RI) in dual phase imaging, the SUV_max ratio of tumor to contralateral normal lung background (T/N), the rate of change in the ratio of tumor to contralateral normal lung background based on the SUV_max (ΔT/N_max), lobulation sign, spiculation sign, vocule sign, air bronchgram, pleural indentation, and vascular convergence sign. Qualitative factors were analyzed by using independent-sample t test, whereas quantitative variables were analyzed by using χ2 test. Multivariate unconditional Logistic regression analysis was utilized to test the correlation factors with statistical differences before treatment. Receiver operating characteristic (ROC) curve analysis was performed in accordance with the Logistic regression analysis results. Results In 143 patients, lesion size ((14.33±4.18) mm vs. (17.61±4.48) mm), SUV_max (1.32±1.07 vs. 2.00±1.25), SUV_mean (1.07±0.85 vs. 1.66±1.11), RI (0.01±0.36 vs. 0.20±0.07), lobulation (76.1%(89/117) vs. 92.3%(24/27)), and pleural indentation (39.3%(46/117) vs. 69.2%(18/26)) showed statistically significant differences between low-risk group (117 cases) and high-risk group (26 cases) (t=?3.242 to ?2.392; χ2=4.773, 6.766; all P<0.05). In 50 patients underwent 18F-FDG PET/CT dual-phase imaging, delayed imaging SUV_max (1.18±0.63 vs. 2.85±1.82), delayed imaging SUV_mean (0.92±0.43 vs. 2.72±1.69), delayed imaging T/N (2.55±1.33 vs. 5.84±3.83) showed statistically significant differences between low-risk group (40 cases) and high-risk group (10 cases) (t=?2.867, ?3.359, ?2.678; all P<0.05). Among these factors, SUV_mean, lesion size, and pleural indentation were the independent influencing factors for differentiating the two groups. When the value of SUV_max was 1.625, the area under the ROC curve was 0.699. The sensitivity, specificity, and accuracy of differentiating the two groups were 57.7%(15/26), 78.6%(92/117), and 74.8%(107/143), respectively. When the value of SUV_mean was 0.845, the area under the ROC curve was 0.698. The sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 43.6%(51/117), and 50.3%(72/143), respectively. When the lesion size was 13.765 mm, the area under the ROC curve was 0.716, and the sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 54.7%(64/117), and 59.4%(85/143), respectively. The combined diagnosis with SUV_max+SUV_mean+lesion size+pleural indentation+lobulation sign has the highest efficiency in differentiating the two groups compared with single diagnosis. Conclusion In the diagnosis of pulmonary invasive adenocarcinoma appearing as GGN, 18F-FDG PET/CT contributes to risk levels.