^(11)C-胆碱PET-CT双时相显像诊断纵隔疾病  

The value of dual time point ^(11)C-choline PET-CT in differentiating malignant from benign lesion of mediastinum

作　　者：彭忠民[1] 刘奇[1] 刘庆伟[2] 姚树展[2] 孟龙[1] 刘倩[1] 陈景寒[1] 

机构地区：[1]山东省立医院胸外科,济南250021 [2]PET-CT中心

出　　处：《中华医学杂志》2007年第47期3317-3320,共4页National Medical Journal of China

基　　金：山东省优秀中青年科学家基金(2004BS03018)

摘　　要：目的探讨^(11)C-胆碱 PET-CT 双时相显像技术在纵隔疾病诊断中的应用价值。方法对经普通影像学检查难以确诊的35例中纵隔病灶患者4周内进行 CT、PET-CT 及电视纵隔镜检查。应用^(11)C-胆碱作为 PET 示踪剂,应用标准摄取值(SUV 值)及两次显像的变化(ASUV)作为 PET 检测指标,并与电视纵隔镜活检病理结果对照。注射^(11)C-胆碱5～10 min 后初次采集发射图像,25～30 min再次采集发射图像。结果35例纵隔病灶经电视纵隔镜活检,诊断为结节病的患者11例,结核6例,淋巴瘤5例,纵隔原发或转移癌11例(肺癌伴有纵隔淋巴结转移的患者8例,另3例无原发灶证据),肺癌纵隔淋巴结肿大病理为反应性增生2例。根据良、恶性分类,19例良性病灶早期显像的 SUV 值为5.11(2.9～8.3),延迟显像后为4.99(2.2～9.3),ASUV 为-0.12(-0.9～1.0)。16例恶性病灶早期显像的 SUV 值为6.17(3.2～9.8),延迟显像后为6.48(3.0～11.2),ASUV 为0.31(-0.4～1.4)。良恶性病灶早期显像的 SUV 值差异无统计学意义(F=0.505,P=0.09);两者的ASUV 差异有统计学意义(F=1.939,P=0.04),ΔSUV 为负值倾向于良性疾病,正值倾向于恶性疾病。CT、初次 PET-CT、双时相 PET 显像及电视纵隔镜对纵隔肿物良恶性的诊断正确率分别为54.3%(19/35)、74.3%(26/35)、82.9%(29/35)及100%(35/35)。纵隔镜检查优于双时相 PET 显像(x^2=6.563,P=0.010);双时相 PET 显像优于 CT(x^2=6.629,P=0.010)。结论对纵隔良、恶性疾病的鉴别诊断,电视纵隔镜准确可靠,单纯 CT 及单次 PET(SUV 值)显像有较高误诊率,PET-CT 两次显像可提高诊断的正确性,对良、恶性病灶的鉴别上有一定价值。Objective To evaluate the value of dual time point ^11C-choline PET-CT in differentiating malignant from benign lesions of mediastinum. Methods Thirty-five patients with mediastinal diseases, including 8 non-small cell lung cancer or highly suspected lung cancer patients with mediastinal lymphadenectasis, were subject to CT, dual time point PET-CT and videomediastionoscopy within four weeks. 11 C-chollne was used as PET tracers to visualize various masses. The imaging protocol included the first PET scanning 5 - 10 min after the-injection of 370 MBq 11 C-choline and then a second PET scanning 25 - 30 min later. The PET data were evaluated using the standardized uptake value （SUV） and the difference between the two point （ASUV）. Then the results were analyzed in accordance with the pathologic data. Results Eleven of the 35 patients with mediastinal diseases were diagnosed as with sareoidosis, 6 with tuberculosis, 5 with lymphoma, 11 with nodal metastasis （8 had their modes from the lung and the primary lesions of the other 3 failed to be identified） , and 2 with lung cancer with reactive hyperplasia lymph node. The SUV of the delayed images of the 16 malignant lesions was 6.48 （3.0 - 11.2）, higher than that of the early images [6. 17 （3.2-9.8）1 with a ASUV of 0.31（ -0.4 - 1.4）. The value of SUV of delayed images of the 19 benign lesions was 4.99 （ 2. 2 - 9. 3 ） , lower than that of early images [ 5. 11 （ 2. 9 - 8. 3 ） 1 with aASUV of -0. 12 （ -0. 9 - 1.0） . TheASUV of the benign lesions was significantly lower than that of the malignant lesions （ F = 1. 939, P = 0.04 ）. The accuracy rates of diagnosis of mediastinal masses of CT, first-time PET-CT, dual time point PET-CT, and videomediastinoscopy were 54.3% （19/35）, 74. 3% （26/35）, 82. 9% （29/35）, and 100% （35/35） respectively. Conclusion With a high diagnostic yield, videomediastinoscopy remains the gold standard in differentiation of malignant and benign lesions located in the middle mediastinum. Dual time

关 键 词：纵隔疾病 纵隔镜检查 体层摄影术 发射型计算机 肺肿瘤 

分 类 号：R817.4[医药卫生—影像医学与核医学]