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近年来,肺癌的发病率居高不下,其中孤立性肺结节(solitary pulmonary nodules,SPN)的良恶性鉴别一直为诊断的难点,目前众多的影像学检查方法中,18F-FDG PET/CT的临床应用较为广泛,但其诊断肿瘤的特异性欠佳,结核及炎症的18F-FDG高摄取常在诊断中造成假阳性。近来关于18F-胸腺嘧啶核苷(3′-deoxy-3′-18F-fluorothymidine,18F-FLT)PET/CT的报道渐多,18F-FLT属于核酸代谢显像剂,能反应细胞核酸合成补偿途径的活跃程度和细胞增殖情况[1-2]。如何运用两种显像剂及不同的诊断方法提高诊断效能备受关注,为此,笔者选取了40例均行18F-FDG和18F-FLT PET/CT显像的SPN患者,采用不同的诊断方法并与“金标准”比对,分析比较其对肺部良恶性肿瘤的诊断效能。
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18F-FDG SUVmax、18F-FLT SUVmax及18F-FLT SUVmax/同层面椎体SUVmax的ROC曲线下面积分别为0.687、0.821、0.817。
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以18F-FDG SUVmax > 2.5、18F-FLT SUVmax > 2.0为恶性诊断标准、18F-FDG PET/CT视觉评分法、18F-FLT PET/CT视觉评分法4种诊断方法的灵敏度、特异度、准确率、阳性预测值及阴性预测值的结果见表 1。
诊断方法 灵敏度 特异度 准确率 阳性预测值 阴性预测值 18F-FDG SUVmax > 2.5 88.2(15/17) 73.9(17/23) 80.0(32/40) 71.4(15/21) 89.4(17/19) 18F-FLT SUVmax > 2.0 58.8(10/17) 82.6(19/23) 72.5(29/40) 71.4(10/14) 73.1(19/26) 18F-FDG PET/CT视觉分析评分 94.1(16/17) 91.3(21/23) 92.5(37/40) 88.9(16/18) 95.5(21/22) 18F-FLT PET/CT视觉分析评分 88.2(15/17) 65.2(15/23) 75.0(30/40) 65.2(15/23) 88.2(15/17) 表 1 4种诊断方法的诊断效能结果(%)
Table 1. The results of diagnostic efficiency of the four diagnostic methods(%)
在17例肺癌、23例良性病变中,18F-FDG PET/CT视觉评分法得出真阳性16例,真阴性21例,假阳性2例,假阴性1例;18F-FLT PET/CT视觉评分法得出真阳性15例,真阴性15例,假阳性8例,假阴性2例。具体典型病例见图 1和图 2。
18F-FDG和18F-FLT PET/CT不同诊断方法在肺部单发结节中的临床价值分析
Differential diagnosis protocols of 18F-FDG and 18F-FLT PET/CT for solitary pulmonary nodules
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摘要: 目的探讨18F-FDG和18F-胸腺嘧啶核苷(FLT)PET/CT不同的诊断方法对肺部单发结节的诊断价值。方法对40例发现肺部单发结节的患者行18F-FDG和18F-FLT PET/CT显像,所有病例均经病理或密切随访确诊,应用受试者工作特征(ROC)曲线比较18F-FDG SUVmax、18F-FLT SUVmax、18F-FLT SUVmax/同层面椎体SUVmax对肺部恶性肿瘤的诊断价值;18F-FDG和18F-FLT PET/CT两种显像结果均行视觉分析和半定量分析,比较不同诊断方法的诊断效能。结果18F-FDG SUVmax、18F-FLT SUVmax及18F-FLT SUVmax/同层面椎体SUVmaxROC曲线下面积分别为0.687、0.821和0.817。以18F-FDG SUVmax > 2.5、18F-FLT SUVmax > 2.0为恶性诊断标准、18F-FDG PET/CT视觉分析评分法、18F-FLT PET/CT视觉分析评分法4种方法诊断肺癌的灵敏度、特异度和准确率分别为88.2%、73.9%和80.0%;58.8%、82.6%和72.5%;94.1%、91.3%和92.5%;88.2%、65.2%和75.0%。结论18F-FLT SUVmax及18F-FLT SUVmax/同层面椎体SUVmax单独诊断肺部恶性肿瘤的价值较18F-FDG SUVmax高,且前两者可替换使用。18F-FDG PET/CT视觉评分法在肺部单发结节良恶性的诊断中效能最佳。Abstract: Objective To investigate the diagnostic values of 18F-FDG and 3′-deoxy-3′-18F-fluorothymidine(18F-FLT) PET/CT for solitary pulmonary nodules. Methods 18F-FDG and 18F-FLT PET/CT imaging were performed in 40 patients with solitary pulmonary nodules. All cases were confirmed by pathology or follow-up. The diagnostic values of 18F-FDG SUVmax, 18F-FLT SUVmax, and 18F-FLT/the same level of vertebral SUVmax for pulmonary malignant tumor were compared using the receiver operating characteristic(ROC) curves. 18F-FDG and 18F-FLT imaging results were analyzed by visual observation and semi-quantitative analysis. The diagnostic efficiencies of the different diagnostic methods were compared. Results Areas under the ROC curves of 18F-FDG SUVmax, 18F-FLT SUVmax, and 18F-FLT/ same level of vertebral SUVmax were 0.687, 0.821, and 0.817, respectively. The diagnostic sensitivities, specificities, and accuracies of tested diagnostic tools were as follows:18F-FDG SUVmax > 2.5 as the malignant diagnostic criteria, 88.2%, 73.9% and 80.0%; 18F-FLT SUVmax > 2.0 as the malignant diagnostic criteria, 58.8%, 82.6% and 72.5%; 18F-FDG PET/CT visual analysis of scoring method, 94.1%, 91.3% and 92.5%; and 18F-FLT PET/CT for visual analysis of scoring method 88.2%, 65.2% and 75.0%. Conclusions 18F-FLT SUVmax and 18F-FLT/vertebral SUVmax showed higher accuracies in diagnosing solitary pulmonary modules compared with 18F-FDG SUVmax. 18F-FDG PET/CT visual scoring method was the most effective in diagnosing solitary pulmonary nodules.
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表 1 4种诊断方法的诊断效能结果(%)
Table 1. The results of diagnostic efficiency of the four diagnostic methods(%)
诊断方法 灵敏度 特异度 准确率 阳性预测值 阴性预测值 18F-FDG SUVmax > 2.5 88.2(15/17) 73.9(17/23) 80.0(32/40) 71.4(15/21) 89.4(17/19) 18F-FLT SUVmax > 2.0 58.8(10/17) 82.6(19/23) 72.5(29/40) 71.4(10/14) 73.1(19/26) 18F-FDG PET/CT视觉分析评分 94.1(16/17) 91.3(21/23) 92.5(37/40) 88.9(16/18) 95.5(21/22) 18F-FLT PET/CT视觉分析评分 88.2(15/17) 65.2(15/23) 75.0(30/40) 65.2(15/23) 88.2(15/17) -
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