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前纵隔是胸骨与气管、主动脉及心包前缘的区域,其内可发生多种恶性肿瘤,且好发于成年人,病理类型多样,影像学表现各异,误诊率较高;同时,由于该区域不同类型恶性肿瘤的治疗方法各异,因此早期诊断对该病的临床分期、治疗及预后具有重要意义[1-2]。虽然以往文献中有关于该部位肿瘤的影像学诊断的报道,但有关18F-FDG PET/CT与增强CT在成人原发前纵隔恶性肿瘤中的研究报道较为少见。本研究比较上述2种显像方法在成人原发前纵隔恶性肿瘤中的诊断效能,以提高临床上对该部位病变的诊断水平。
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35例恶性肿瘤中,胸腺癌15例(鳞癌8例、腺癌4例、未分化癌3例)(图1中A~C),淋巴瘤10例(非霍奇金淋巴瘤7例、霍奇金淋巴瘤3例)(图1中D~F),恶性生殖细胞瘤7例(精原细胞瘤3例、未成熟畸胎瘤3例、卵黄囊瘤1例)(图1中G~I),神经内分泌癌(非典型类癌)、恶性黑色素瘤及滑膜肉瘤各1例(表1)。
图 1 成人原发前纵隔恶性肿瘤的增强CT与18F-FDG PET/CT显像图
Figure 1. Enhanced CT and 18F-FDG PET/CT for adult patients with primary malignant tumors of the anterior mediastinum
肿瘤类型 例数 男性/女性(例) 年龄(岁) 胸腺癌 15 11/4 55.3±5.2 淋巴瘤 10 4/6 30.5±4.3 恶性生殖细胞瘤 7 4/3 25.7±3.5 神经内分泌癌 1 0/1 65 恶性黑色素瘤 1 0/1 54 滑膜肉瘤 1 0/1 51 表 1 35例成人原发前纵隔恶性肿瘤的一般临床情况
Table 1. General clinical data of 35 adult patients with primary malignant tumors of the anterior mediastinum
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18F-FDG PET/CT诊断成人原发前纵隔恶性肿瘤的灵敏度、特异度、准确率分别为97.1% (34/35)、93.3% (42/45)、95.0% (76/80),其中,1例神经内分泌癌漏诊为良性病变,2例胸腺瘤及1例淋巴结结核误诊为恶性病变;增强CT诊断的灵敏度、特异度、准确率分别为71.4% (25/35)、77.8% (35/45)、75.0% (60/80),其中,4例胸腺癌漏诊为胸腺瘤,3例恶性生殖细胞瘤、1例淋巴瘤、1例神经内分泌癌及1例滑膜肉瘤均漏诊为良性病变,5例胸腺瘤误诊为胸腺癌,2例结节病误诊为淋巴瘤,2例良性生殖细胞瘤及1例胸腺脓肿误诊为恶性病变。18F-FDG PET/CT对成人原发前纵隔恶性肿瘤诊断的灵敏度、特异度及准确率均高于增强CT,且差异均有统计学意义(χ2=8.612、4.357、12.471,均P<0.05)(表2)。
检查方法 例数 灵敏度 特异度 准确率 真阳性 假阴性 真阴性 假阳性 准确诊断 错误诊断 18F-FDG PET/CT 80 34 1 42 3 76 4 增强CT 80 25 10 35 10 60 20 χ2值 8.612 4.357 12.471 P值 <0.05 <0.05 <0.05 注:表中,FDG:氟脱氧葡萄糖;PET:正电子发射断层显像术;CT:计算机体层摄影术 表 2 18F-FDG PET/CT与增强CT对成人原发前纵隔恶性肿瘤诊断效能的比较(例)
Table 2. Comparison of the sensitivity, specificity and accuracy of 18F-FDG PET/CT and enhanced CT examination for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum (case)
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18F-FDG PET/CT对胸腺癌、淋巴瘤及恶性生殖细胞瘤诊断的准确率分别为93.3%(14/15)、100.0%(10/10)、85.7%(6/7);增强CT诊断的准确率分别为60.0%(9/15)、50.0%(5/10)、28.6%(2/7),前者诊断的准确率均高于后者,且差异均有统计学意义(χ2=4.503、6.333、4.333,均P<0.05)。
18F-FDG PET/CT与增强CT在成人原发前纵隔恶性肿瘤中的诊断价值
Diagnostic value of 18F-FDG PET/CT and enhanced CT for adult patients with primary malignant tumors of the anterior mediastinum
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摘要:
目的 探讨18F-氟脱氧葡萄糖(FDG) PET/CT与增强CT在成人原发前纵隔恶性肿瘤中的诊断价值,以提高对该部位病变的诊断水平。 方法 回顾性分析2016年6月至2019年5月在湖北文理学院附属医院(襄阳市中心医院)经病理证实的成人原发前纵隔肿瘤患者80例(恶性肿瘤35例、良性肿瘤45例),其中,男性46例、女性34例,年龄20~80(45.5±10.2)岁。所有患者均行全身18F-FDG PET/CT及胸部CT平扫+增强扫描,2种检查的间隔时间在2周内。分别计算并采用χ2检验比较18F-FDG PET/CT与增强CT扫描的诊断灵敏度、特异度和准确率,采用χ2检验比较2种检查方法对不同类型恶性肿瘤的诊断效能。 结果 35例恶性肿瘤中胸腺癌15例,淋巴瘤10例,恶性生殖细胞瘤7例,神经内分泌癌、恶性黑色素瘤及滑膜肉瘤各1例。18F-FDG PET/CT诊断成人原发前纵隔恶性肿瘤的灵敏度[97.1%(34/35)]、特异度[93.3%(42/45)]及准确率[95.0%(76/80)]均高于增强CT[71.4%(25/35)、77.8%(35/45)、75.0%(60/80)],且差异有统计学意义(χ2=8.612、4.357、12.471,均P<0.05);18F-FDG PET/CT对胸腺癌、淋巴瘤及恶性生殖细胞瘤诊断的准确率[93.3%(14/15)、100.0%(10/10)、85.7%(6/7)]均高于增强CT[60.0%(9/15)、50.0%(5/10)、28.6%(2/7)],且差异有统计学意义(χ2=4.503、6.333、4.333,均P<0.05)。 结论 18F-FDG PET/CT对成人原发前纵隔恶性肿瘤具有重要的诊断价值,其诊断效能优于增强CT,可作为该病主要的检查方法。 -
关键词:
- 肿瘤 /
- 正电子发射断层显像术 /
- 体层摄影术, X线计算机 /
- 氟脱氧葡萄糖F18 /
- 前纵隔
Abstract:Objective To compare the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT versus enhanced CT in detecting adult patients with primary malignant tumors of the anterior mediastinum and improve the accuracy of diagnosis. Methods A total of 80 adult patients with primary tumors of the anterior mediastinum (35 malignant tumors and 45 benign tumors) confirmed by pathology from June 2016 to May 2019 in Affiliated Hospital of Hubei University of Arts and Science (Xiangyang Central Hospital) were retrospectively analyzed. The patients included 46 males and 34 females aged 20–80 years, with a median age of 45.5±10.2 years. All patients were subjected to whole-body 18F-FDG PET/CT and plain and enhanced-scan thorax CT within a 2-week interval. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT and enhanced CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were calculated and compared by χ2 test. The diagnostic efficiency of 18F-FDG PET/CT versus enhanced CT for different types of adult patients with primary malignant tumors of the anterior mediastinum was also compared by χ2 test. Results Among the 35 malignant tumors, 15 were thymic carcinomas, 10 were lymphomas, 7 were malignant germinomas, 1 was neuroendocrine carcinoma, 1 was malignant melanoma, and 1 was synovial sarcoma. The sensitivity, specificity, and accuracy [97.1%(34/35), 93.3%(42/45), 95.0%(76/80), respectively] of 18F-FDG PET/CT for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum were significantly higher than those of enhanced CT [71.4%(25/35), 77.8%(35/45), 75.0%(60/80), respectively; χ2=8.612, 4.357, 12.471, respectively; all P<0.05]. The diagnostic accuracies of 18F-FDG PET/CT for thymic carcinoma, lymphoma, and malignant germinoma [93.3%(14/15), 100.0%(10/10), 85.7%(6/7), respectively] were significantly higher than those of enhanced CT [60.0%(9/15), 50.0%(5/10), 28.6%(2/7), respectively; χ2=4.503, 6.333, 4.333, respectively; all P<0.05]. Conclusions 18F-FDG PET/CT has significant diagnostic value for adult patients with primary malignant tumors of the anterior mediastinum. The diagnostic efficiency of this technique is better than that of enhanced CT, and it can be used as a main imaging method for the diagnosis of these types of diseases. -
表 1 35例成人原发前纵隔恶性肿瘤的一般临床情况
Table 1. General clinical data of 35 adult patients with primary malignant tumors of the anterior mediastinum
肿瘤类型 例数 男性/女性(例) 年龄(岁) 胸腺癌 15 11/4 55.3±5.2 淋巴瘤 10 4/6 30.5±4.3 恶性生殖细胞瘤 7 4/3 25.7±3.5 神经内分泌癌 1 0/1 65 恶性黑色素瘤 1 0/1 54 滑膜肉瘤 1 0/1 51 表 2 18F-FDG PET/CT与增强CT对成人原发前纵隔恶性肿瘤诊断效能的比较(例)
Table 2. Comparison of the sensitivity, specificity and accuracy of 18F-FDG PET/CT and enhanced CT examination for the diagnosis of adult patients with primary malignant tumors of the anterior mediastinum (case)
检查方法 例数 灵敏度 特异度 准确率 真阳性 假阴性 真阴性 假阳性 准确诊断 错误诊断 18F-FDG PET/CT 80 34 1 42 3 76 4 增强CT 80 25 10 35 10 60 20 χ2值 8.612 4.357 12.471 P值 <0.05 <0.05 <0.05 注:表中,FDG:氟脱氧葡萄糖;PET:正电子发射断层显像术;CT:计算机体层摄影术 -
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