双探头符合线路^(18)氟-脱氧葡萄糖单光子计算机断层显像术诊断非小细胞肺癌淋巴结转移的初步研究  

Preliminary study of staging mediastinal lymphnode metastasis in non-small cell lung cancer with 18 F-FDG DHC-SPECT/CT

作　　者：张闻瑞[1] 郑健[2] 赵晋华[1] 阮征[2] 孙湘君[3] 何之彦[4] 车文军[1] 汪太松[1] 陆荣华[1] 

机构地区：[1]上海交通大学附属第一医院核医学科,200080 [2]上海交通大学附属第一医院胸外科,200080 [3]上海交通大学附属第一医院病理科,200080 [4]上海交通大学附属第一医院放射科,200080

出　　处：《上海医学》2006年第6期349-352,F0003,共5页Shanghai Medical Journal

摘　　要：目的初步探讨^(18)氟-脱氧葡萄糖(^(18)F-FDG)双探头符合线路(DHC)单光子计算机断层显像术(SPECT)显像与CT同机图像融合对非小细胞肺癌(NSCLC)淋巴结转移分期的诊断价值。方法44例确诊为NSCLC患者1个月内均行^(18)F-FDG DHC-SPECT/CT显像及胸部增强螺旋CT检查,2周内完成外科手术和病理学检查。^(18)F-FDG DHC-SPECT/CT显像经过全能量X线衰减校正,并采用有序子集最大期望值法(COSEM)迭代重建后,将同机CT图像与符合线路图像(正电子发射断层显像术,PET)进行图像融合,获得横断面、矢状面、冠状面三维断层图像。再采用视觉分析法和利用感兴趣区(ROI)技术的半定量分析计算病变淋巴结(L)与周围纵隔组织(N)的摄取比值R(L/N)。将^(18)F-FDG DHC-SPECT/CT显像及胸部增强螺旋CT检查对肺癌淋巴结转移分期的诊断结果均与病理结果进行比较。结果以摄取比值R≥1．5为判断标准,诊断肺癌淋巴结转移的灵敏度为75．0%(15/20例)、特异度为91．7%(22/24例)、准确率为84．1%(37/44例)、阳性和阴性预测值分别为88．2%(15/17例)和81．5%(22/27例)。15例^(18)F-FDG显像为阳性的转移淋巴结的ROI分析最大摄取比值为9．4,最小为1．6。结论^(18)F-FDG DHC-SPECT/CT显像对肺癌的纵隔淋巴结、锁骨上淋巴结转移分期诊断具有较高的灵敏度、特异度和准确率,可为临床制定治疗方案、观察疗效和疾病分期提供重要的临床依据。Objective To evaluate preliminarily the diagnostic significance of ^18F-FDG dual-head coincidence SPECT/ CT（DHC-SPECT/CT） in preoperative mediastinal lymph node staging for NSCLC. Methods Whole body ^18F-FDG DHC-SPECT/CT imaging and enhanced thoracic CT examination were taken in 44 patients with NSCLC one month before thoracotomy with hilar and mediastinal lymph nodes dissection. The histological examination of lymph nodes sampled from thoracotomy was used as the standard for mediastinal lymph node metastasis staging. After intravenous administration of ^18F-FDG, DHC-SPECT scan was performed in 1 ～ 3 bed position with 2D acquisition and COSEM reconstruction. For half-quantitative evaluation, the region of interest （ROI） was placed over the mediastinal lymph nodes with abnormal uptake of radiation activity, and then the uptake ratio（R） of lesion to normal mediastinal region（L/N） was calculated. Results Taking R ≥ 1.5 as the standard, uptake activity was higher than the blood pool of mediastinum on the basis of visual inspection, the outcome should be positive. The sensitivity, specificity and accuracy of DHC-SPECT/CT were 75. 0 % （15/20 ） , 91. 7 % （22/24） , 84. 1 （37/44） respectively. Conclusion DHC-SPECT/CT is an effective modality better than enhanced CT for accurate mediastinal and supraclavicular lymph nodes metastasis staging in patients with NSCLC.

关 键 词：^18氟-脱氧葡萄糖 单光子放射计算机断层显像术/CT 增强CT 图像融合 肺癌 分期 

分 类 号：R734.2[医药卫生—肿瘤] R981.1[医药卫生—临床医学]