首页> 中文期刊> 《南方医科大学学报》 >薄层CT与18F-FDG PET/CT联合运用可提高肺孤立性结节定性诊断的准确性

薄层CT与18F-FDG PET/CT联合运用可提高肺孤立性结节定性诊断的准确性

         

摘要

目的 探索如何将病灶SUVmax与薄层CT相结合,提高18F-FDG PET/CT对肺孤立性结节的定性诊断准确性.方法 回顾性分析267例经手术病理检查或临床随访证实的SPN患者的18F-FDG PET/CT及薄层CT显像结果,依据薄层CT将SPN分为实性结节与非实性结节.分别采用标准1 (SUVmax≥2.5)和标准2(SUVmax结合薄层CT综合分析)诊断肺癌,以病理和临床随访为金标准,分析两种标准对肺孤立性结节的诊断效能.结果 采用两种标准诊断肺癌的灵敏度和准确性分别为80.4%、76.4%(标准1)和91.0%、87.2%(标准2)(均P<0.05).在非实性结节中,良、恶性病灶的SUVmax无明显显著性差异(P>0.05),而病灶大小和分叶征、含气支气管征或空泡征以及病灶内有无粗大血管等CT征象对鉴别诊断有意义(均P<0.05).40例PET表现为低代谢的肺癌患者,均被误诊为良性病变,结合薄层CT图像,纠正了其中50%(20/40)的诊断.采用标准1诊断肺癌,灵敏度为40.0%,而采用标准2诊断肺癌,灵敏度为90%,标准2对非实性结节诊断的灵敏度明显高于标准1(P=0.000),但特异性无显著性差异(75.2%vs58.3%,P=0.667).然而,对实性结节,薄层CT对于诊断结果无明显影响(均P>0.05).结论 对于肺孤立性结节,仅依据SUVmax≥2.5诊断肺癌,诊断效能并不理想.对非实性结节,须依据SUVmax和薄层CT所见进行综合分析.%Objective To investigate whether fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) combined with thin-section CT improves the diagnostic performance for solitary pulmonary nodules (SPNs).Methods A total of 267 patients underwent examinations with 18F-FDG PET/CT and thin-section CT for evaluating the SPNs with undetermined nature,which was further confirmed by pathological examination or clinical follow-up.The performance of two diagnostic criteria based on findings in PET/CT alone (Criterion 1) and in PET/CT combined with thin-section CT (Criterion 2) were compared.Results Thin-section CT provided greater diagnostic information for SPNs in 84.2% of the patients.Compared with Criterion 1,the diagnosis based on Criterion 2 significantly increased the diagnostic sensitivity (80.4% vs 91%,P<0.01) and accuracy (76.4% vs 87.2%,P<0.01) for lung cancer.The lesion size and the CT features including lobulation,air bronchogram,and feeding vessel,but not SUVmax,were all helpful for characterizing non-solid SPNs.Thin-section CT rectified diagnostic errors in 50% (20/40) of the cancerous lesions,which had been diagnosed as benign by PET due to their low metabolism.For non-solid SPNs,Criterion 2 showed a significantly higher diagnostic sensitivity than Criterion 1 (90.0% vs 40.0%,P=0.000) but their diagnostic specificity were comparable (75.2% vs 58.3%,P=0.667).For solid nodules,the use of thin-section CT resulted in no significant improvement in the diagnostic performance (P>0.05).Conclusion The combination of PET/CT and thin-section CT creates a synergistic effect for the characterization of SPNs,especially non-solid nodules.

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