PET/CT诊断孤立性肺结节的价值  

The value of PET/CT in the diagnosis of solitary pulmonary nodules

作　　者：关建中[1] 刘翠玉[1] 谢立旗[1] 倪诚凯[1] 叶勇[1] 陈燚[1] 

机构地区：[1]中国人民解放军第401医院影像中心,山东青岛266071

出　　处：《医学影像学杂志》2014年第9期1512-1516,共5页Journal of Medical Imaging

摘　　要：目的评价PET/CT在鉴别诊断孤立性肺结节(SPNs)的价值。方法经病理或临床随访证实的143例SPNs均行PET/CT扫描,根据结节PET的代谢特点进行PET诊断,根据CT的形态学特点进行CT诊断,PET/CT则结合PET的代谢特点及CT的形态学特点进行综合判定SPNs的性质。结果恶性SPNs的最大标准摄取值(SUVmax)(mean 6.08±4.57,n=120)明显高于良性结节(mean 2.73±2.16,n=23),并且有统计学意义(t’=5.45,P<0.001)。低分化、中分化恶性肿瘤的SUVmax(mean 8.46±4.29,5.67±4.57)均明显高于高分化恶性肿瘤(mean 3.22±4.58),并且有统计学意义(t’=6.16,P<0.001;t’=2.86,P<0.01);低分化恶性肿瘤的SUVmax(mean 8.46±4.29)明显高于中分化恶性肿瘤(mean 5.67±4.57),并且有统计学意义(t’=3.01,P<0.01)。PET/CT诊断恶性SPNs的敏感度、特异度、准确度、阳性预测值、阴性预测值(96.7%、73.9%、93%、95.1%、81%)均较单独利用CT(86%、72.7%、83.9%、94.5%、48.5%)和单独利用PET(80.8%、52.2%、76.2%、89.8%、34.3%)高。结论 PET/CT可以提高诊断孤立肺结节的准确度及把握度。Objective To evaluate the value of PET/CT in the differential diagnosis of solitary pulmonary nodules （SPNs） compared with the use of PET alone or CT alone. Methods 143 solitary pulmonary nodules were examined with 18F-FDG PET/CT, all of which were proven pathologically or clinical follow-up. The diagnosis of PET relied on the me- tabolism feature of PET and the diagnosis of CT relied on morphology feature of CT during quiet respiration. The diagno- sis of PET/CT relied on combination of the metabolism feature of PET and morphology feature of CT. Diagnostic effica- cies were compared for three different approaches： consideration of CT findings only, PET findings only, and both PET and CT findings. Results The maximal standard uptake value （SUVmax） of malignant SPN （mean 6.08±4.57,n=120） were significantly higher than those of benign SPNs （mean 2.73 ± 2.16, n= 23） （ t＇= 5.45, P 〈0.001）. The SUVmax of poorly differentiated, moderately differentiated malignancies （mean 8.46±4.29,5.67 ±4.57） were respectively signifi- cantly higher than those of well-differentiated malignancies （mean 3. 22±4.58） （ t＇=6.16, P〈0.001; t＇ =2.86, P〈0.01） ; the SUVmax of poorly differentiated malignancies （mean 8. 46±4.29） were respectively significantly higher than those of moderately differentiated malignancies （mean 5. 67±4.57） （ t＇ =3.01, P〈0.01）. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT for malignant SPNs were 96.7 %, 73.9 %, 93%, 95.1%, 81% respectively, accordingly, 86%, 72.7%, 83.9%, 94.5%, 48.5% for CT alone and 80.8%, 52.2%, 76.2%, 89.8%, 34.3% for PET alone. Conclusion Compared with CT alone or PET alone, integrated PET/ CT can improve the degree of accuracy and certainty in diagnosing solitary pulmonary nodules.

关 键 词：孤立性肺结节 体层摄影术 X线计算机 发射单光子计算机断层扫描仪 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563[医药卫生—放射医学]