^(18)F-FDG PET/CT联合HRCT对磨玻璃样改变肺腺癌侵袭性的诊断价值  

The Diagnostic Value of^(18)F-FDG PET/CT Combined with High Resolution CT(HRCT)in The Invasion of Lung Adenocarcinoma with Ground Glass Opacity

作　　者：陈洁 陈滨[1] 赵敏[1] 曹一铭 马庆杰[1] CHEN Jie;CHEN Bin;ZHAO Min(Department of Nuclear Medicine,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院核医学科,吉林长春130033

出　　处：《中国实验诊断学》2022年第12期1743-1748,共6页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省教育厅科研项目基金(JJKH20190080KJ)。

摘　　要：目的探讨^(18)F-氟脱氧葡萄糖(FDG)PET/CT联合高分辨CT(HRCT)对磨玻璃样改变肺腺癌侵袭性的诊断价值。方法回顾性分析2016年4月至2018年10月于吉林大学中日联谊医院经组织病理学证实为肺腺癌的52例患者临床资料。所有患者均行^(18)F-FDG PET/CT及HRCT显像,表现为孤立性肺磨玻璃结节(GGN),后经手术切除。按照病灶侵袭程度分为微浸润性腺癌组(MIA)和浸润性腺癌组(IAC)。测量病灶在影像中所表现的形态学定性(结节类型、边缘特征等)、定量参数[GGN直径(D_(GGN))、实性成分比例(CTR)等]及功能学代谢参数(SUV_(max))。采用独立样本t检验、χ^(2)检验比较两组间各参数的差异,基于有意义的^(18)F-FDG PET/CT及HRCT参数构建Logistic回归模型并应用受试者工作特征(ROC)曲线进行分析,比较曲线下面积(AUC)。结果52例患者中,MIA组(14例)和IAC组(38例)的结节类型(P<0.05)、D_(GGN)(14.0 mm vs 20.5 mm,P<0.001)、实性成分直径(2.1 mm vs 8.8 mm,P<0.001)、CTR(14.4%vs 41.9%,P<0.001)及SUV_(max)(1.10 vs 2.34,P<0.001)间的差异均有统计学意义。ROC曲线分析显示SUV_(max)及CTR预测GGN病灶侵袭性的初步阈值分别为1.04(敏感性68.4%,特异性85.7%,准确性71.2%)和0.35(灵敏性71.1%,特异性78.6%,准确性73.1%),AUC分别为0.803、0.835。应用Logistic回归模型分析显示,SUV_(max)、CTR、结节类型联合诊断效能高于单独^(18)F-FDG PET/CT或HRCT影像学检测,灵敏性、阴性预测值及准确度分别为86.8%、76.9%和86.5%。结论^(18)F-FDG PET/CT联合HRCT对磨玻璃样改变肺腺癌侵袭性具有良好的鉴别诊断价值,其中SUV_(max)、CTR与结节类型相结合具有最佳诊断效能。Objective To evaluate the diagnostic value of^(18)F-FDG PET/CT combined with high resolution CT(HRCT)in the invasion of lung adenocarcinoma with ground glass opacity.Methods The clinical data of 52 patients with lung adenocarcinoma confirmed by histopathology in China-Japan United Hospital of Jilin University from April 2016 to October 2018 were retrospectively analyzed.All patients underwent^(18)F-FDG PET/CT and HRCT,which showed solitary ground glass nodules(GGN),and then underwent surgical resection.According to the degree of invasion,it can be divided into two pathological types:minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Morphological qualitative parameters(nodule type、edge features,etc)、quantitative parameters(the diameter of GGN(D_(GGN))、consolidation/tumor ratio(CTR),etc)and functional metabolic parameter(SUV_(max))were compared and analyzed.we performed the Chi-square test and the student t test to compare the differences of parameters between the two groups.A logistic regression model was constructed based on the meaningful^(18)F-FDG PET/CT and HRCT parameters.We also used the receiver operating characteristic(ROC)analysis to compare the area under the curve(AUC).Results Among the 52 patients,IAC cases preferentially manifested as mixed GGN(P<0.05).Significant differences were also found in the D_(GGN),Dsolid,CTR and SUV_(max)between the two groups(14.0 mm vs 20.5 mm,2.1 mm vs 8.8 mm,14.4%vs 41.9%,1.10 vs 2.34,respectively).Feasible preliminary threshold values for CTR were 0.35(sensitivity of 71.1%,specificity of 78.6%and accuracy of 73.1%).Feasible preliminary threshold values for SUV_(max)were 1.04(sensitivity of 68.4%,specificity of 85.7%and accuracy of 71.2%).While areas under the ROC curve were 0.835 for CTR(P<0.05)and 0.803 for SUV_(max)(P<0.05).The corresponding multivariate logistic regression equation was formed.the combination of CTR、SUV_(max)and mixed GGN demonstrated a higher sensitivity of 86.8%,a favourable negative predictive value of 76.9%and accuracy

关 键 词：PET/CT HRCT 肺腺癌 磨玻璃 侵袭性 

分 类 号：R817.4[医药卫生—影像医学与核医学]