^(18)F-FDG PET/CT原发灶摄取相对值及代谢参数对NSCLC纵隔淋巴结转移的预测价值  

Value of ^(18)F-FDG PET/CT Relative Uptake Value and Metabolic Parameters of the Primary Tumor for Predicting Mediastinal Lymph Node Metastasis in Non-Small Cell Lung Cancer

作　　者：朱俊辉 李思叶 黄子康 王静 周伟[2] 陈薏帆 朱玉春[2] ZHU Junhui;LI Siye;HUANG Zikang(Medical College of Jiangsu University,Zhenjiang,Jiangsu Provnice 212013,P.R.China)

机构地区：[1]江苏大学医学院,镇江212013 [2]江苏大学附属昆山医院,211166 [3]南京医科大学姑苏学院,昆山2153004

出　　处：《临床放射学杂志》2023年第10期1584-1589,共6页Journal of Clinical Radiology

基　　金：2023年度江苏大学医教协同创新基金(一般项目)立项项目(编号:JDYY2023060);昆山市第一人民医院2022年度广仁基金科研课题(临床研究专项)(编号:KRY-YN2022001);2023年昆山市级科技专项(社会发展)指导性项目(编号:KSZ2311);2019昆山市重点专科培育项目(编号:昆卫[2020]3号)。

摘　　要：目的探讨基于氟代脱氧葡萄糖(18F-FDG)PET/CT原发灶摄取相对值及代谢参数对非小细胞肺癌(NSCLC)纵隔淋巴结转移的预测价值。方法回顾性分析行手术和系统淋巴结清扫并经病理确诊的80例NSCLC患者的资料,分为淋巴结转移组与未转移组。测量原发灶最大径、最大标准化摄取值(SUV_(max))、平均标准化摄取值(SUV_(mean))、原发灶SUV_(max)与纵隔血池SUV_(mean)的比值(SUR_(blood))、原发灶SUV_(max)与肝脏SUV_(mean)的比值(SUR_(liver)),以相对阈值法(40%为阈值)测量肿瘤代谢体积(MTV)及糖酵解总量(TLG),采用单因素及多因素Logistic回归分析纵隔淋巴结转移的危险因素,通过受试者工作特征(ROC)曲线分析各参数预测纵隔淋巴结转移的诊断效能。结果80例患者中,淋巴结转移者28例(35.0%),淋巴结未转移者52例(65.0%)。淋巴结转移组原发灶最大径、SUV_(max)、SUV_(mean)、SUR_(blood)、SUR_(liver)、MTV及TLG均大于淋巴结未转移组,差异具有统计学意义(Z=-2.845~-3.752,P均<0.01),淋巴结转移且原发灶位于中央者的比例多于淋巴结未转移者(60.7%与21.2%),差异具有统计学意义(χ^(2)=12.520,P<0.001)。多因素Logistic回归分析显示SURblood是NSCLC患者淋巴结转移的独立危险因素[比值比(OR)=1.278,95%CI:1.041~1.568,P=0.019]。ROC曲线分析显示各参数对淋巴结转移均具有良好的预测价值,其中以SUR_(blood)的诊断效能最大,曲线下面积(AUC)为0.755(95%CI:0.648~0.863),最佳截止值为3.42,灵敏度为96.4%,特异度为44.2%。结论18F-FDG PET/CT原发灶摄取相对值及代谢参数对NSCLC患者纵隔淋巴结转移具有良好的预测效能,其中SUR_(blood)是预测纵隔淋巴结转移的独立预测因子,且SUR_(blood)预测效能最大,具有较大的临床应用价值。Objective To investigate the value of ^(18)F-FDG PET/CT relative uptake value and metabolic parameters of the primary tumor for predicting mediastinal lymph node metastasis in non-small cell lung cancer.Methods The data of 80 pathologically proven non-small cell lung cancer(NSCLC)patients who underwent surgery and systemic lymph node dissection were retrospectively analyzed.According to the pathological results,patients were divided into lymph node metastasis group and non-metastasis group.The maximum diameter,maximum standardized uptake value(SUV_(max)),average standardized uptake value(SUV_(mean))of the primary tumor were measured.Tumor SUV_(max)to blood SUV_(mean)and tumor SUV(max)to liver SUV_(mean)were calculated.Metabolic tumor volume(MTV)and total lesion glycolysis(TLG)were calculated by the fixed%SUV_(max)threshold method(MTVq%and TLGq%,q=40).The risk factors of mediastinal lymph node metastasis were determined through univariate and multivariate Logistic regression analysis.The ROC curves evaluated the value of each parameter in predicting mediastinal lymph node metastasis.Results A total of 80 patients were included in the study.28 of them(35.0%)had mediastinal lymph node metastasis and 52 of them(65.0%)did not have.Significantly higher values of the maximum diameter,SUV_(max),SUV_(mean),SUR_(blood),SUR_(liver),MTV,TLG of the primary tumor were found in patients with mediastinal lymph node metastasis(Z=-2.845--3.752,P<0.01 for all).The proportion of patients who had central primary lesion with lymph node metastasis was significantly higher than those without lymph node metastasis(60.7%vs.21.2%)(χ^(2)=12.520,P<0.001).The multivariate analysis showed that SUR(blood)(odds ratio,21.278,95%CI:1.041-1.568,P=0.019)was the independent risk factor for mediastinal lymph node metastasis in NSCLC.Receiver operating characteristic(ROC)analysis showed that all parameters had important value for the evaluation of lymph node metastasis.The best diagnostic efficiency was SUR(blood)with the optimal cut-off value of 3.42

关 键 词：非小细胞肺癌 纵隔淋巴结 正电子发射断层成像/X线计算机体层成像 标准化摄取值 代谢参数 

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