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

    摘要
  • 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%），SUVmax=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SUVmax= 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价值有限，综合影像分析法有助于提高孤立性肺空洞诊断的效能。

     

    Abstract:
    Objective To analyze the maximum standardized uptake value (SUVmax) 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 18F-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 SUVmax 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 18F-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%), SUVmax=7.04±2.3, and 17 cases had benign lesions (30.4%), SUVmax=5.91±2.17. No significant difference was found in SUVmax between benign and malignant lesions (t=1.714, P=0.092). ROC curve analysis shows that the optimal critical value of SUVmax 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 SUVmax=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% (11 /17), 35.3% (6/17), and 76.5% (13/17); the PPVs were 90.2% (37/41), 83.3% (30/36), 74.4% (32/43), and 87.5% (28/32); the NPVs were 86.7% (13/15), 55.0% (11/20), 46.2% (6/13), and 54.2% (13/ 24); and the diagnostic accuracy rates were 89.3% (50/56), 73.2% (41/56), 67.9% (38/56), and 73.2% (41/56), respectively.
    Conclusions SUVmax has a limited value in differentiating benign and malignant SPV. Comprehensive imaging analysis helps improve the diagnostic accuracy of SPV.

     

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