18F-FDG PET/CT结合薄层螺旋CT、增强CT和临床资料在孤立性肺空洞中的鉴别诊断价值  

Value of 18 F-FDG PET/CT combined with thin slice spiral CT,enhanced CT and clinical data in the differential diagnosis of solitary pulmonary cavity

作　　者：王珍英 王卫星[2] 马超[2] Wang Zhenying;Wang Weixing;Ma Chao(Department of Nuclear Medicine,the Second Hospital of Longyan City,Longyan 364030,China;Xiamen Key Laboratory for Clinical Transformation of Molecular Imaging in Nuclear Medicine,Department of Nuclear Medicine,Xiamen University Zhongshan Hospital,Xiamen 361004,China)

机构地区：[1]福建省龙岩市第二医院核医学科,364030 [2]厦门大学附属中山医院核医学科,厦门市核医学分子影像临床转化重点实验室,361004

出　　处：《国际放射医学核医学杂志》2021年第10期621-630,共10页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的分析鉴别孤立性肺空洞良恶性的最大标准化摄取值(SUVmax)临界值以及综合影像分析法诊断孤立性肺空洞性质的效能。方法回顾性分析2015年10月至2019年10月于厦门大学附属中山医院行18F-氟脱氧葡萄糖(FDG) PET/CT、薄层螺旋CT和增强CT检查的56例孤立性肺空洞患者的影像资料和临床资料, 其中男性43例、女性13例, 年龄41~82 (54.7±13.4)岁。通过构建和分析受试者工作特征(ROC)曲线, 计算SUVmax的最佳临界值并评价其诊断效能;以组织病理学检查结果和随访结果为参考标准, 结合临床资料计算18F-FDG PET/CT、薄层螺旋CT和增强CT 3种影像学方法以及综合影像分析法(对3种影像学方法的诊断结果进行综合评估)鉴别诊断孤立性肺空洞良恶性的灵敏度、特异度、阳性预测值、阴性预测值和准确率。计量资料的比较采用独立样本t检验, 计数资料的比较采用卡方检验。结果 56例孤立性肺空洞患者中, 恶性病变39例(69.6%), SUV_(max)=7.04±2.3;良性病变17例(30.4%), SUVmax=5.91±2.17, 良恶性病变SUVmax的差异无统计学意义(t=1.714, P=0.092)。ROC曲线分析结果显示, SUVmax的最佳临界值为7.05, ROC曲线下面积为0.652, 95%置信区间:0.494~ 0.809。当SUV_(max)= 7.05时, SUVmax对孤立性肺空洞诊断的灵敏度为46.2%(18/39)、特异度为82.4%(14/17)、阳性预测值为85.7%(18/21)、阴性预测值为40.0%(14/35)、准确率为57.1%(32/56)。综合影像分析法、18F-FDG PET/CT、薄层螺旋CT和增强CT诊断孤立性肺空洞的灵敏度分别为94.9%(37/39)、76.9%(30/39)、82.1%(32/39)和71.8%(28/39);特异度分别为76.5%(13/17)、64.7%(11/17)、35.3%(6/17)和76.5%(13/17);阳性预测值分别为90.2%(37/41)、83.3%(30/36)、74.4%(32/43)和87.5%(28/32);阴性预测值分别为86.7%(13/15)、55.0%(11/20)、46.2%(6/13)和54.2%(13/24);准确率分别为89.3%(50/56)、73.2%(41/56)、67.9%(38/56)和73.2%(41/56)。结论 SUVmax对孤立性肺空洞良恶性的鉴别Objective To analyze the maximum standardized uptake value(SUV_(max))threshold to distinguish benign and malignant solitary pulmonary cavity(SPV)and the efficacy of the comprehensive imaging analysis of SPV.Methods The clinical data of 56 patients with SPV who underwent 18 F-FDG PET/CT,thin slice spiral CT,and enhanced CT in Xiamen University Zhongshan Hospital from October 2015 to October 2019 were analyzed retrospectively.The patients included 43 males and 13 females aged 41–82(54.7±13.4)years old.By constructing and analyzing the receiver operating characteristic(ROC)curve,the optimal SUV max threshold was calculated,and its diagnostic efficiency was evaluated.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and the accuracy rate of 18 F-FDG PET/CT,thin slice spiral CT,enhanced CT,and the comprehensive imaging analysis(comprehensive evaluation of the diagnostic results of the three imaging methods)of benign and malignant SPV were calculated based on the results of the histopathological examination and follow-up along with clinical data.Independent sample t-test was used to compare measurement data,and chi-square test was used to compare counting data.Results Among the 56 patients with SPV,39 cases had malignant lesions(69.6%),SUV_(max)=7.04±2.3,and 17 cases had benign lesions(30.4%),SUV_(max)=5.91±2.17.No significant difference was found in SUV_(max) between benign and malignant lesions(t=1.714,P=0.092).ROC curve analysis shows that the optimal critical value of SUV max was 7.05,the area under the ROC curve was 0.652,and the 95%confidence interval was in the range 0.494–0.809.When SUV_(max)=7.05,the sensitivity,specificity,PPV,NPV,and the accuracy rate were 46.2%(18/39),82.4%(14/17),85.7%(18/21),40.0%(14/35),and 57.1%(32/56),respectively.The sensitivity rates of comprehensive imaging analysis,PET/CT,thin slice spiral CT,and enhanced CT in the diagnosis of SPV were 94.9%(37/39),76.9%(30/39),82.1%(32/39),and 71.8%(28/39);the specificity rates were 76.5%(13/17),64.7

关 键 词：氟脱氧葡萄糖F18 正电子发射断层显像术 体层摄影术 X线计算机 体层摄影术 螺旋计算机 孤立性肺空洞 

分 类 号：R817.4[医药卫生—影像医学与核医学] R563[医药卫生—放射医学]