表现为纯磨玻璃密度结节的浸润性肺腺癌的PET—CT特征分析  

Imaging characteristics of lung adenocarcinomas appearing as pure ground-glass nodules on 18F-fluorodeoxyglucose PET-CT

作　　者：葛欢[1] 王振光[2] 刘思敏[2] 李大成[2] 于明明[2] 薛伟[2] 

机构地区：[1]青岛大学医学部,266021 [2]青岛大学附属医院PET—CT中心

出　　处：《中华放射学杂志》2017年第6期422-426,共5页Chinese Journal of Radiology

摘　　要：目的对比分析表现为肺部纯磨玻璃密度结节（pGGN）的浸润癌与非浸润癌的18F-脱氧葡萄糖（FDG）PET代谢特征和容积数据高分辨率重组（VHRCT）形态特点。 方法回顾性分析2010年10月至2016年6月于我院进行18F-FDG PET-CT显像，同时进行胸部诊断性CT扫描和VHRCT，发现的局灶性纯磨玻璃密度结节（pGGN）51例，共52个病灶，病变大小均≤30 mm，经病理或随访确诊后分为浸润癌组（31个）与对照组（21个）。评价内容包括患者年龄、性别、病灶位置、大小、密度、最大标准摄取值（SUVmax）、最大标准摄取值的肿瘤本底比值（T/N）、毛刺征、分叶征、胸膜牵拉征、血管连接征、空泡征、支气管充气征，两组间比较采用独立样本t检验和χ2检验，并对差异有统计学意义的相关因素进行多因素非条件Logistic回归分析，病灶的T/N值对浸润癌组和对照组的鉴别诊断做ROC曲线分析。结果浸润癌组T/N值、SUVmax、密度、大小分别为1.97±0.71、1.16±0.54、－（431±104）HU、（18.48±5.65）mm，对照组分别为1.20±0.28、0.64±0.20、－（533±109）HU、（12.05±5.04）mm，两组间差异有统计学意义（t值分别为-5.40、-4.87、-3.39、-4.21，P值均〈0.05）。浸润癌组出现分叶征、血管连接征分别为21、13个，对照组分别为2、1个，两组间差异有统计学意义（χ2值分别为17.85、7.01，P值均〈0.05）。T/N值、分叶征及血管连接征为鉴别浸润癌组和对照组病灶的独立影响因素，OR值分别为52.547、18.375、72.206。T/N=1.62时，ROC曲线下面积为0.885，鉴别浸润与非浸润癌的敏感度为77.42%，特异度为90.48%，准确性为82.69%。 结论pGGN18F-FDG PET T/N值≥1.62以及形态上出现分叶征和血管连接征时提示浸润癌。ObjectiveTo compare the 18F-FDG PET metabolic characteristics and VHRCT morphological characteristics between invasive and non-invasive adenocarcinoma presenting as pure ground-glass nodules（pGGN）.MethodsFifty-one patients with pGGN from October 2010 to June 2016 were retrospectively enrolled in this study. There were totally 52 lesions with sizes of no more than 30 mm and were grouped depending on pathological and follow-up diagnosis （31 lesions in the invasive adenocarcinoma group and 21 lesions in the non-invasive group）. Clinical and imaging features were analyzed including age, gender, lesion location, size, density, SUVmax, T/N, spiculation, lobulation, pleural indentation, vascular connection signs, vacuole sign and the air bronchogram. T test or χ2-test was used in the comparison of different manifestations between the two groups. Logistic regression analysis on clinical parameters was applied. The ROC curve was used to find the cutoff of T/N.ResultsIn the invasive adenocarcinoma group, T/N, SUVmax, density and size were 1.97±0.71, 1.16±0.54, - （431±104） HU, （18.48±5.65） mm, respectively. In the non-invasive group, T/N, SUVmax, density, size were 1.20±0.28, 0.64±0.20, - （533±109） HU, （12.05±5.04） mm, respectively. The differences of T/N, SUVmax, density and size had statistical significance between the two groups （t=-5.40,-4.87,-3.39,-4.21, P〈0.05） . Lobulation and vascular connection signs in the invasive adenocarcinoma group were found in 21 and 13 cases respectively, while in the non-invasive group, they were present in 2 and 1 case, respectively, which showed significant differences between the two groups （χ2=17.85, 7.01, P〈0.05） . T/N, lobulation, and vascular connection signs were the independent factors for the differentiation of benign and malignant lesions. The ORs were 52.547, 8.375, 72.206, respectively. When T/N=1.62, the area under the ROC curve was 0.885. The sensitivity, specificity and accuracy were 77.42%, 90.48%,82.69%, respectively.Conclusio

关 键 词：肺肿瘤 腺癌 正电子发射断层显像术 脱氧葡萄糖 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]