^(18)F-FDG PET/CT在恶性胸膜间皮瘤临床诊断及术后评估中的应用研究  

Application of^(18)F-FDG PET/CT in Clinical Diagnosis and Postoperative Evaluation of Malignant Pleural Mesothelioma

作　　者：王家富[1] 韩玥[1] 李津[1] 张琳焓[1] 林琳[1] 高慧棋[1] 韩巍[1] 王丽范[1] 王孟娇 WANG Jiafu;HAN Yue;LI Jin;ZHANG Linhan;LIN Lin;GAO Huiqi;HAN Wei;WANG Lifan;WANG Mengjiao(The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;不详)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《中国医学创新》2022年第23期14-19,共6页Medical Innovation of China

基　　金：黑龙江省卫生健康委课题(2020096)。

摘　　要：目的:分析^(18)F-氟代脱氧葡萄糖(FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)在恶性胸膜间皮瘤(MPM)临床诊断及术后评估中的作用。方法:回顾性分析哈尔滨医科大学附属第一医院2015年4月-2020年3月首诊收治的27例疑似MPM患者的临床资料,所有患者术前均接受^(18)F-FDG PET/CT检查,以术后病理活检结果为金标准,评价^(18)F-FDG PET/CT对MPM的诊断价值;术后随访2年将病理检查确诊的23例MPM患者依据是否发生肿瘤转移分为未复发组(n=12)和复发组(n=11),比较不同分组^(18)F-FDG PET/CT病灶类型分布及显像病灶最大标准摄取值(SUVmax),使用受试者工作特征曲线(ROC)分析SUVmax对MPM预后评估的效能。结果:27例可疑MPM患者病理组织活检最终确诊MPM共23例,上皮型13例,纤维肉瘤型6例,混合细胞型4例。病灶积聚类型:环形13例,结节型6例,不规则环形4例。^(18)F-FDG PET/CT检出MPM共21例,其他胸膜病变6例,其中21例与病检结果相符,准确率为92.59%(25/27),敏感度91.30%,特异度为100%,Kappa值为0.757;^(18)F-FDG PET/CT诊断环型MPM 13例,其中12例与病检结果相符,准确率为91.30%(21/23),敏感度为92.31%(12/13),特异度为90.00%(9/10);结节型病灶检出7例,其中6例与病检结果相符,准确率为95.65%(22/23),敏感度为100%(6/6),特异度为94.12%(16/17);诊断不规则环形3例,其中3例与病检结果相符,准确率为95.65%(22/23),敏感度为75.00%(3/4),特异度为100%(19/19);^(18)F-FDG PET/CT诊断MPM病灶积聚类型环形、结节型和不规则环形的Kappa值分别为0.823、0.893和0.832。复发组^(18)F-FDG PET/CT环形病灶类型占比高于未复发组,且复发组SUVmax明显高于未复发组(P<0.05)。ROC示,当SUVmax值>12.40时预测MPM术后复发的效能较高(P<0.05),其曲线下面积(AUC)为0.886,敏感度为81.82%,特异度为83.33%,约登指数为0.652。结论:^(18)F-FDG PET/CT诊断恶性胸膜间皮瘤和区分不同病灶积聚类型的准确度较高,且环形�Objective:To analyze the role of^(18)F-fluorodeoxyglucose(FDG)positron emission tomography/computed tomography(PET/CT)in the clinical diagnosis and postoperative evaluation of malignant pleural mesothelioma(MPM).Method:The clinical data of 27 patients with suspected MPM who were first diagnosed and treated in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed from April 2015 to March 2020.All patients underwent^(18)F-FDG PET/CT examination before surgery,and the diagnostic value of^(18)F-FDG PET/CT on MPM was evaluated with the postoperative pathological biopsy results as the gold standard.At 2-year follow-up after surgery,23 patients with MPM confirmed by pathological examination were divided into non-recurrence group(n=12)and recurrence group(n=11)according to whether tumor metastasis occurred.The distribution of^(18)F-FDG PET/CT lesion types and the maximum standard uptake value(SUVmax)of imaging lesions were compared among different groups.Receiver operating characteristic curve(ROC)was used to analyze the efficiency of SUVmax on the prognosis of MPM.Result:Pathological biopsy of 27 patients with suspected MPM finally confirmed 23 MPM cases,including 13 cases of epithelial type,6 cases of fibrosarcoma type and 4 cases of mixed cell type.Types of lesion accumulation were shown as annular in 13 cases,nodular in 6 cases and irregular annular in 4 cases.^(18)F-FDG PET/CT detected 21 cases of MPM,6 cases of other pleural lesions,of which 21 cases were consistent with the results of pathological examination,with the accuracy rate,sensitivity,specificity and Kappa value of 92.59%(25/27),91.30%,100%and 0.757.^(18)F-FDG PET/CT diagnosed 13 cases of annular MPM,of which 12 cases were consistent with pathological examination,with the accuracy rate of 91.30%(21/23),sensitivity of 92.31%(12/13)and specificity of 90.00%(9/10).7 cases of nodular lesions were detected,of which 6 cases were consistent with pathological examination,with the accuracy rate,sensitivity and specificity of 95.6

关 键 词：^(18)F-FDG PET/CT检查 恶性胸膜间皮瘤 临床诊断 病理分型 预后 

分 类 号：R734.3[医药卫生—肿瘤] R730.44[医药卫生—临床医学]