18F-FDG PET/CT在基于不同影像的肺孤立性结节中的诊断效率比较

摘要

目的 比较分析18F-脱氧葡萄糖正电子发射体层摄影术(FDG PET)/CT在以CT影像为基础和PET影像为基础的肺孤立性结节中的诊断价值.方法 收集2004年8月至2007年10月行全身PET/CT显像的肺孤立性结节患者140例病例资料进行回顾性分析.每例患者均通过手术或穿刺获取明确病理检查结果 .根据图像结果 是否存在肺外病灶将患者分成两组(PET组和CT组),比较18F-FDG PET/CT在两组患者中的诊断效率.结果 140例患者中仅在肺内病灶中出现异常18F-FDG摄取86例,在肺外(包括肺门、纵隔及远处)出现不同程度18F-FDG摄取54例.PET组的诊断灵敏度、特异度和准确度分别为74%、60%和69.8%,CT组的诊断灵敏度、特异度和准确度分别为82%、63%和78.6%. PET组的ROC曲线下面积为0.699±0.058(95%信区间:0.585～0.814),CT组的ROC曲线下面积为0.763±0.048(95%可信区间:0.670～0.856),两组比较差异有统计学意义.将患者年龄、病灶大小、病灶结构特征(分叶、毛刺及牵拉)及平均标准摄取值(SUV)等特征应用logisitic回归建立方程后,PET组的诊断灵敏度、特异度和准确度分别为82%、80%和81.4%,CT组的诊断灵敏度、特异度和准确度分别为85%、78%和83.6%.结论 18F-FDG PET/CT对于肺孤立性结节的诊断价值明显受到结节病灶以外所获取的信息如肺门淋巴结、纵隔淋巴结和远处转移灶的影响;对于以PET信息为基础的肺孤立性结节,其诊断价值有限,结合CT结构信息,可以明显改善诊断效率.%Objective To compare the diagnosis efficiency of 18 F-FDG PET/CT images based on different solitary pulmonary nodules.Methods To retrospectively collect 140 cases with solitary pulmonary nodules in our hospital from August 2004 to Octo ber 2007.Each patient underwent the wholebody PET/CT imaging.Each patient underwent surgical or needle biopsy to obtain a clear pathology.All patients according to image results whether there were lesions beyond pulmonary were divided into two groups (PET group and CT group) for comparing the diagnosis efficiency of 18 F-FDG PFT/CT between the two groups.Results Of 140 cases , 86 cases of lung lesions only in the abnormal 18 F-FDG uptake, 54 cases were pulmonary( including hilar, mediastinal, and dis tant) were different degrees 18 F-FDG uptake.In( PET group, the sensitivity, specificity and accuracy were 74％, 60％ and 69.8％ , in CT group,the sensitivity,specificity and accuracy were 82％ ,63％ and 78.6％. In PET group, the area under the ROC curve was 0.699±0.058(95％ CI: 0.585-0.814) , in CT group, the area under the ROC curve was 0.763±0.048( 95％ CI: 0.670 - 0.856) ,which showing significant difference between the two groups.Applying logisitic regression analysis with age, tumor size, structural characteristics and lesion characteristics such as average SUV after,in PET group, the sensitivity, specificity and accuracy were 82％ ,80％ and 81.4％ ,in CT group, the diagnostic sensitivity, specificity and accuracy wer 85％ , 78％ and 83.6％ respectively.Conclusion 18 F-FDG PET/CT for the diagnosis of solitary pulmonary nodule was obviously affected by the obtained information such as hilar lymph nodes.mediastinal lymph node and distant metastases exist.For solitary pulmonary nodules based on PET images , the diagnortic value; limited.The efficiency of diagnosis could be significowthly improred combining with structural information of CT.