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肺腺癌具有高度异质性,包括4种类型,分别为浸润前病变、微浸润性肺腺癌、浸润性肺腺癌和浸润性肺腺癌变异亚型。其中,浸润性肺腺癌按生长模式的不同可分为5种亚型,分别为贴壁为主型腺癌(lepidic predominant adenocarcinoma, LPA)、腺泡为主型腺癌(acinar predominant adenocarcinoma, APA)、乳头为主型腺癌(papillary predominant adenocarcinoma, PPA)、实体为主型腺癌(solid predominant adenocarcinoma, SPA)和微乳头为主型腺癌(micropapillary predominant adenocarcinoma, MPA),这些组织学亚型与患者预后密切相关,其中SPA、MPA的恶性程度比LPA、APA、PPA更高,肺腺癌组织学分型出现SPA、MPA则趋向预后更差[1-3]。多层螺旋CT(multislice spiral CT, MSCT)因在呈现肺结节细节上的独特优势,已被广泛应用于各类肺结节的诊断。18F-FDG PET/CT在肿瘤的诊断与鉴别诊断中具有常规影像学检查无法替代的优势。肿瘤是机体在各种致瘤因子的作用下,局部组织细胞增生所形成的新生物,且其异常增殖需要摄取大量葡萄糖,因此相比正常组织,肿瘤对显像剂的摄取更高。在MSCT上表现为磨玻璃结节(ground-glass nodule,GGN)的浸润性肺腺癌,因其检出率逐年上升、鉴别诊断存在一定难度而受到越来越多的重视。本研究将18F-FDG PET/CT的2种检查手段(PET和MSCT)充分结合起来,从18F-FDG PET代谢参数、MSCT征象特点及二者联合上探讨对浸润性肺腺癌GGN的危险程度的诊断价值,并将影像资料与组织学亚型进行对照,以期及时发现含有SPA和(或)MPA的浸润性肺腺癌高危病灶,为临床治疗决策提供更准确的信息。
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由表1可知,在143例患者中,高危组26例、低危组117例。高危组男性15例(57.7%)、女性11例(42.3%);低危组男性39例(33.3%)、女性78例(66.7%),2组患者性别的差异无统计学意义(P>0.05)。另外,2组患者年龄、病灶位置的差异亦均无统计学意义(均P>0.05)。
参数 高危组(n=26) 低危组(n=117) 检验值 P值 性别(男/女,例) 15/11 39/78 χ2=3.071 0.084 年龄( ±s,岁)$\bar x $ 60.81±7.78 60.13±9.20 t=0.814 0.420 病灶位置(例) χ2=3.713 0.449 左肺上叶 5 26 左肺下叶 8 17 右肺上叶 9 44 右肺中叶 0 5 右肺下叶 4 25 病灶径线( ±s,mm)$ \bar x $ 17.61±4.48 14.33±4.18 t=−3.242 0.002 病灶密度( ±s,HU)$ \bar x $ −308.37±221.37 −352.45±187.79 t=−0.944 0.353 SUVmax( ±s)$\bar x $ 2.00±1.25 1.32±1.07 t=−2.568 0.012 SUVmean( ±s)$\bar x $ 1.66±1.11 1.07±0.85 t=−2.392 0.023 T/N( ±s)$\bar x $ 3.37±1.80 2.56±2.59 t=−1.391 0.168 MSCT征象[例(%)] 分叶征 24(92.3) 89(76.1) χ2=4.773 0.030 毛刺征 7 (26.9) 13(11.1) χ2=1.878 0.171 空泡征 9 (34.6) 43(36.8) χ2=0.000 0.993 支气管气相 9 (34.6) 46(39.3) χ2=0.112 0.744 胸膜尾征 18(69.2) 46(39.3) χ2=6.766 0.010 血管集束征 25(96.2) 92(78.6) χ2=3.542 0.063 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;T/N为肿瘤与对侧正常肺本底SUVmax的比值;MSCT为多层螺旋计算机体层摄影术 表 1 浸润性肺腺癌磨玻璃结节低危组与高危组患者的临床资料和影像学特征的比较
Table 1. Analysis of the clinical data and imaging features of the low-risk and high-risk groups with pulmonary invasive adenocarcinoma appearing as ground-glass nodules
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143例浸润性肺腺癌患者病灶径线为8.20~26.74(15.10±4.46) mm。117例低危组患者中,40例(34.2%)表现为pGGN、77例(65.8%)表现为mGGN;26例高危组患者均表现为mGGN。由表1可知,高危组的病灶径线、SUVmax、SUVmean均高于低危组,且差异均有统计学意义(均P<0.05);2组在病灶密度、T/N间的差异均无统计学意义(均P>0.05)。高危组的病灶出现分叶征、胸膜尾征的比例高于低危组,且差异均有统计学意义(均P<0.05);2组在毛刺征、空泡征、支气管气相、血管集束征之间的差异均无统计学意义(均P>0.05)。典型病例的18F-FDG PET/CT显像图见图1、2。
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多因素非条件Logistic回归分析结果显示,SUVmean、病灶径线和胸膜尾征为鉴别诊断低危组与高危组的独立影响因素(表2)。ROC曲线分析结果显示,当SUVmax=1.625时,AUC为0.699,约登指数为0.363,鉴别诊断低危组与高危组的灵敏度为57.7%(15/26)、特异度为78.6%(92/117)、准确率为74.8%(107/143);当SUVmean=0.845时,AUC为0.698,约登指数为0.244,鉴别诊断低危组与高危组的灵敏度为80.8%(21/26)、特异度为43.6%(51/117)、准确率为50.3%(72/143);当病灶径线=13.765 mm时,AUC为0.716,约登指数为0.355,鉴别诊断低危组与高危组的灵敏度为80.8%(21/26)、特异度为54.7%(64/117)、准确率为59.4%(85/143)。
分析因素 B值 标准误 Wald χ2值 P值 OR值 95%CI 病灶径线 0.184 0.083 4.887 0.027 1.202 1.021~1.416 SUVmax 0.234 0.267 0.766 0.381 1.263 0.748~2.133 SUVmean 0.627 0.285 4.844 0.028 1.872 1.071~3.271 分叶征 1.628 1.145 2.021 0.155 5.093 0.540~48.045 胸膜尾征 1.350 0.522 6.681 0.010 3.857 1.386~10.735 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;CI为置信区间 表 2 143例浸润性肺腺癌磨玻璃结节低危组与高危组患者病灶的多因素非条件Logistic回归分析结果
Table 2. Multivariate unconditional Logistic regression analysis for the diagnosis of 143 cases of pulmonary invasive adenocarcinoma appearing as ground-glass nodules in the low-risk group and high-risk groups
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50例行18F-FDG PET/CT双时相显像的患者中,高危组10例、低危组40例。18F-FDG PET/CT双时相显像结果显示,高危组病灶RI及延迟显像的SUVmax、SUVmean、T/N均高于低危组,2组之间的差异均有统计学意义(均P<0.05);2组ΔT/Nmax之间的差异无统计学意义(P>0.05,表3)。在此基础上行多因素非条件Logistic回归分析,结果显示双时相显像RI及延迟显像的SUVmax、SUVmean、T/N均不是鉴别诊断低危组与高危组的独立影响因素。
组别 延迟显像SUVmax 延迟显像SUVmean 延迟显像T/N 双时相显像RI ΔT/Nmax 高危组(n=10) 2.85±1.82 2.72±1.69 5.84±3.83 0.20±0.07 0.23±0.18 低危组(n=40) 1.18±0.63 0.92±0.43 2.55±1.33 0.01±0.36 0.06±0.28 t值 −2.867 −3.359 −2.678 −3.042 −1.759 P值 0.018 0.008 0.024 0.004 0.085 注:FDG为氟脱氧葡萄糖;PET/CT为正电子发射断层显像计算机体层摄影术;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;T/N为肿瘤与对侧正常肺本底SUVmax的比值;RI为滞留指数;ΔT/Nmax为基于SUVmax的肿瘤与对侧正常肺本底的比值变化率 表 3 50例浸润性肺腺癌磨玻璃结节低危组与高危组患者病灶18F-FDG PET/CT双时相显像的代谢参数(
±s)$\bar x $ Table 3. 18F-FDG PET/CT dual-phase imaging metabolism of 50 cases of pulmonary invasive adenocarcinoma appearing as ground-glass nodules in the low-risk and high-risk groups (
±s)$\bar x $ -
由表4可知,不同因素的联合诊断对鉴别浸润性GGN危险程度的差异均有统计学意义(均P<0.05),其中,SUVmax+SUVmean+病灶径线+胸膜尾征+分叶征联合诊断的AUC(0.774)最高。由图3可见,SUVmax+SUVmean+病灶径线+胸膜尾征+分叶征联合诊断的诊断效能均高于独立影响因素SUVmean、病灶径线、胸膜尾征的单独诊断效能。
分析因素 AUC 95%CI P值 灵敏度 特异度 准确率 约登
指数阳性预测值 阴性预测值 SUVmax 0.699 0.572~0.827 0.004 0.577(15/26) 0.786(92/117) 0.748(107/143) 0.363 0.375(15/40) 0.893(92/103) SUVmean 0.698 0.573~0.823 0.004 0.808(21/26) 0.436(51/117) 0.503(72/143) 0.244 0.241(21/87) 0.911(51/56) 病灶径线 0.716 0.599~0.833 0.002 0.808(21/26) 0.547(64/117) 0.594(85/143) 0.355 0.284(21/74) 0.928(64/69) 胸膜尾征 0.654 0.527~0.781 0.025 0.692(18/26) 0.607(71/117) 0.622(89/143) 0.299 0.281(18/64) 0.899(71/79) 分叶征 0.605 0.484~0.726 0.129 0.923(24/26) 0.239(28/117) 0.364(52/143) 0.162 0.212(24/113) 0.933(28/30) SUVmax+病灶径线 0.727 0.612~0.842 0.001 0.538(14/26) 0.786(92/117) 0.741(106/143) 0.324 0.359(14/39) 0.885(92/104) SUVmax+胸膜尾征 0.738 0.626~0.849 0.001 0.423(11/26) 0.863(101/117) 0.783(112/143) 0.286 0.407(11/27) 0.871(101/116) SUVmax+SUVmean 0.701 0.580~0.823 0.004 0.577(15/26) 0.786(92/117) 0.748(107/143) 0.363 0.375(15/40) 0.893(92/103) SUVmax+分叶征 0.728 0.610~0.845 0.001 0.577(15/26) 0.803(94/117) 0.762(109/143) 0.380 0.395(15/38) 0.895(94/105) SUVmax+SUVmean+ 病灶径线 0.738 0.629~0.847 0.001 0.538(14/26) 0.786(92/117) 0.741(106/143) 0.324 0.359(14/39) 0.885(92/104) SUVmax+SUVmean+ 胸膜尾征 0.724 0.609~0.839 0.001 0.423(11/26) 0.863(101/117) 0.783(112/143) 0.286 0.407(11/27) 0.871(101/116) SUVmax+SUVmean+ 分叶征 0.718 0.605~0.830 0.002 0.577(15/26) 0.803(94/117) 0.762(109/143) 0.380 0.395(15/38) 0.895(94/105) SUVmax+SUVmean+ 病灶径线+胸膜 尾征 0.755 0.648~0.861 <0.01 0.385(10/26) 0.863(101/117) 0.776(111/143) 0.248 0.385(10/26) 0.863(101/117) SUVmax+SUVmean+ 病灶径线+胸膜 尾征+分叶征 0.774 0.672~0.876 <0.01 0.385(10/26) 0.863(101/117) 0.776(111/143) 0.248 0.385(10/26) 0.863(101/117) 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;AUC为曲线下面积;CI为置信区间 表 4 不同因素及其联合鉴别浸润性肺腺癌磨玻璃结节危险程度的诊断效能
Table 4. Efficacy of different factors and their combined diagnosis in differentiating the risk levels of ground-glass nodules in pulmonary invasive adenocarcinoma
图 3 独立影响因素SUVmean、病灶径线、胸膜尾征单独诊断与SUVmax+SUVmean+病灶径线+胸膜尾征+分叶征联合诊断鉴别浸润性肺腺癌磨玻璃结节危险程度的受试者工作特征曲线病灶径线为横断面最大层面长径和垂直短径的平均值;SUVmean为平均标准化摄取值;SUVmax为最大标准化摄取值
Figure 3. Receiver operating characteristic curves of independent influencing factors mean standardized uptake value, lesion size and pleural indentation sign, and maximum standardized uptake value combined with mean standardized uptake value, lesion size, pleural indentation and lobulation sign to diagnose the risk level of ground-glass nodules in pulmonary invasive adenocarcinoma
18F-FDG PET/CT对浸润性肺腺癌磨玻璃结节危险程度的诊断价值
Value of 18F-FDG PET/CT in the diagnosis of risk level of pulmonary invasive adenocarcinoma appearing as ground-glass nodules
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摘要:
目的 探讨18F-氟脱氧葡萄糖(FDG) PET/CT对浸润性肺腺癌磨玻璃结节(GGN)危险程度的诊断价值。 方法 回顾性分析2015年6月至2019年6月于青岛市中心医院经组织病理学检查或随访证实为浸润性肺腺癌的143例患者的临床资料,其中男性54例、女性89例,年龄30~79(60.2±8.9)岁。所有患者均行18F-FDG PET/CT全身显像(其中50例行18F-FDG PET/CT双时相显像)后经手术切除肺孤立性GGN,按腺癌生长模式分为2组:含有贴壁为主型腺癌(LPA)和(或)腺泡为主型腺癌(APA)和(或)乳头为主型腺癌(PPA)病灶的患者归入低危组;含有实体为主型腺癌(SPA)和(或)微乳头为主型腺癌(MPA)病灶的患者归入高危组。分别测量或记录患者以下信息:性别、年龄、病灶位置、径线、密度、最大标准化摄取值(SUVmax)、平均标准化摄取值(SUVmean)、双时相显像滞留指数(RI)、肿瘤与对侧正常肺本底SUVmax的比值(T/N)、基于SUVmax的肿瘤与对侧正常肺本底的比值变化率(ΔT/Nmax)及多层螺旋CT征象。计量资料的组间比较采用独立样本t检验,计数资料的组间比较采用χ2检验;采用多因素非条件Logistic回归分析组间差异有统计学意义的因素,根据其结果进行受试者工作特征(ROC)曲线分析。 结果 143例患者中,低危组(117例)与高危组(26例)的病灶径线[(14.33±4.18) mm对(17.61±4.48) mm]、SUVmax(1.32±1.07对2.00±1.25)、SUVmean(1.07±0.85对1.66±1.11)、双时相显像RI(0.01±0.36对0.20±0.07)、分叶征[76.1%(89/117)对92.3%(24/27)]、胸膜尾征[39.3%(46/117)对69.2%(18/26)]的差异均有统计学意义(t=−3.242~−2.392,χ2=4.773、6.766,均P<0.05)。行18F-FDG PET/CT双时相显像的50例患者中,低危组(40例)与高危组(10例)的延迟显像SUVmax(1.18±0.63对2.85±1.82)、延迟显像SUVmean(0.92±0.43对2.72±1.69)、延迟显像T/N(2.55±1.33对5.84±3.83)的差异均有统计学意义(t=−2.867、−3.359、−2.678,均P<0.05);SUVmean、病灶径线和胸膜尾征为鉴别诊断低危组和高危组的独立影响因素。ROC曲线分析结果显示,当SUVmax=1.625时,ROC曲线的曲线下面积(AUC)为0.699,鉴别诊断低危组与高危组的灵敏度为57.7%(15/26)、特异度为78.6%(92/117)、准确率为74.8%(107/143);当SUVmean=0.845时,AUC为0.698,鉴别诊断二者的灵敏度为80.8%(21/26)、特异度为43.6%(51/117)、准确率为50.3%(72/143);当病灶径线=13.765 mm时,AUC为0.716,鉴别诊断二者的灵敏度为80.8%(21/26)、特异度为54.7%(64/117)、准确率为59.4%(85/143);与单独诊断比较,SUVmax+SUVmean+病灶径线+胸膜尾征+分叶征联合诊断鉴别二者的效能最高。 结论 18F-FDG PET/CT有助于对浸润性肺腺癌GGN危险程度的诊断。 -
关键词:
- 肺腺癌 /
- 孤立性肺结节 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 磨玻璃结节
Abstract:Objective To comparatively analyze the 18F-fluorodeoxyglucose (FDG) PET metabolic characteristics and multislice spiral CT imaging features of pulmonary invasive adenocarcinoma appearing as ground-glass nodules (GGN) with different risk levels and to evaluate the value of 18F-FDG PET/CT in the diagnosis of risk levels of GGN. Methods Retrospective analysis was performed on 143 patients (54 males, 89 females, 30−79(60.2±8.9) years old) with pulmonary invasive adenocarcinoma confirmed by histopathological examination or follow-up. All patients underwent 18F-FDG PET/CT whole body imaging (including 50 cases of 18F-FDG PET/CT dual-phase imaging) and surgical resection of solitary GGN of the lung. In accordance with the adenocarcinoma growth pattern, the patients were further divided into two groups. Patients with lesions with lepidic predominant adenocarcinoma and/or acinar predominant adenocarcinoma and/or papillary predominant adenocarcinoma were assigned to the low-risk group, and those with lesions with solid predominant adenocarcinoma and/or micropapillary predominant adenocarcinoma were classified into the high-risk group. The recorded data included gender, age, lesion location, size, density, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), retention index (RI) in dual phase imaging, the SUVmax ratio of tumor to contralateral normal lung background (T/N), the rate of change in the ratio of tumor to contralateral normal lung background based on the SUVmax (ΔT/Nmax), lobulation sign, spiculation sign, vocule sign, air bronchgram, pleural indentation, and vascular convergence sign. Qualitative factors were analyzed by using independent-sample t test, whereas quantitative variables were analyzed by using χ2 test. Multivariate unconditional Logistic regression analysis was utilized to test the correlation factors with statistical differences before treatment. Receiver operating characteristic (ROC) curve analysis was performed in accordance with the Logistic regression analysis results. Results In 143 patients, lesion size ((14.33±4.18) mm vs. (17.61±4.48) mm), SUVmax (1.32±1.07 vs. 2.00±1.25), SUVmean (1.07±0.85 vs. 1.66±1.11), RI (0.01±0.36 vs. 0.20±0.07), lobulation (76.1%(89/117) vs. 92.3%(24/27)), and pleural indentation (39.3%(46/117) vs. 69.2%(18/26)) showed statistically significant differences between low-risk group (117 cases) and high-risk group (26 cases) (t=−3.242 to −2.392; χ2=4.773, 6.766; all P<0.05). In 50 patients underwent 18F-FDG PET/CT dual-phase imaging, delayed imaging SUVmax (1.18±0.63 vs. 2.85±1.82), delayed imaging SUVmean (0.92±0.43 vs. 2.72±1.69), delayed imaging T/N (2.55±1.33 vs. 5.84±3.83) showed statistically significant differences between low-risk group (40 cases) and high-risk group (10 cases) (t=−2.867, −3.359, −2.678; all P<0.05). Among these factors, SUVmean, lesion size, and pleural indentation were the independent influencing factors for differentiating the two groups. When the value of SUVmax was 1.625, the area under the ROC curve was 0.699. The sensitivity, specificity, and accuracy of differentiating the two groups were 57.7%(15/26), 78.6%(92/117), and 74.8%(107/143), respectively. When the value of SUVmean was 0.845, the area under the ROC curve was 0.698. The sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 43.6%(51/117), and 50.3%(72/143), respectively. When the lesion size was 13.765 mm, the area under the ROC curve was 0.716, and the sensitivity, specificity, and accuracy of differentiating the two groups were 80.8%(21/26), 54.7%(64/117), and 59.4%(85/143), respectively. The combined diagnosis with SUVmax+SUVmean+lesion size+pleural indentation+lobulation sign has the highest efficiency in differentiating the two groups compared with single diagnosis. Conclusion In the diagnosis of pulmonary invasive adenocarcinoma appearing as GGN, 18F-FDG PET/CT contributes to risk levels. -
图 3 独立影响因素SUVmean、病灶径线、胸膜尾征单独诊断与SUVmax+SUVmean+病灶径线+胸膜尾征+分叶征联合诊断鉴别浸润性肺腺癌磨玻璃结节危险程度的受试者工作特征曲线病灶径线为横断面最大层面长径和垂直短径的平均值;SUVmean为平均标准化摄取值;SUVmax为最大标准化摄取值
Figure 3. Receiver operating characteristic curves of independent influencing factors mean standardized uptake value, lesion size and pleural indentation sign, and maximum standardized uptake value combined with mean standardized uptake value, lesion size, pleural indentation and lobulation sign to diagnose the risk level of ground-glass nodules in pulmonary invasive adenocarcinoma
表 1 浸润性肺腺癌磨玻璃结节低危组与高危组患者的临床资料和影像学特征的比较
Table 1. Analysis of the clinical data and imaging features of the low-risk and high-risk groups with pulmonary invasive adenocarcinoma appearing as ground-glass nodules
参数 高危组(n=26) 低危组(n=117) 检验值 P值 性别(男/女,例) 15/11 39/78 χ2=3.071 0.084 年龄( ±s,岁)$\bar x $ 60.81±7.78 60.13±9.20 t=0.814 0.420 病灶位置(例) χ2=3.713 0.449 左肺上叶 5 26 左肺下叶 8 17 右肺上叶 9 44 右肺中叶 0 5 右肺下叶 4 25 病灶径线( ±s,mm)$ \bar x $ 17.61±4.48 14.33±4.18 t=−3.242 0.002 病灶密度( ±s,HU)$ \bar x $ −308.37±221.37 −352.45±187.79 t=−0.944 0.353 SUVmax( ±s)$\bar x $ 2.00±1.25 1.32±1.07 t=−2.568 0.012 SUVmean( ±s)$\bar x $ 1.66±1.11 1.07±0.85 t=−2.392 0.023 T/N( ±s)$\bar x $ 3.37±1.80 2.56±2.59 t=−1.391 0.168 MSCT征象[例(%)] 分叶征 24(92.3) 89(76.1) χ2=4.773 0.030 毛刺征 7 (26.9) 13(11.1) χ2=1.878 0.171 空泡征 9 (34.6) 43(36.8) χ2=0.000 0.993 支气管气相 9 (34.6) 46(39.3) χ2=0.112 0.744 胸膜尾征 18(69.2) 46(39.3) χ2=6.766 0.010 血管集束征 25(96.2) 92(78.6) χ2=3.542 0.063 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;T/N为肿瘤与对侧正常肺本底SUVmax的比值;MSCT为多层螺旋计算机体层摄影术 表 2 143例浸润性肺腺癌磨玻璃结节低危组与高危组患者病灶的多因素非条件Logistic回归分析结果
Table 2. Multivariate unconditional Logistic regression analysis for the diagnosis of 143 cases of pulmonary invasive adenocarcinoma appearing as ground-glass nodules in the low-risk group and high-risk groups
分析因素 B值 标准误 Wald χ2值 P值 OR值 95%CI 病灶径线 0.184 0.083 4.887 0.027 1.202 1.021~1.416 SUVmax 0.234 0.267 0.766 0.381 1.263 0.748~2.133 SUVmean 0.627 0.285 4.844 0.028 1.872 1.071~3.271 分叶征 1.628 1.145 2.021 0.155 5.093 0.540~48.045 胸膜尾征 1.350 0.522 6.681 0.010 3.857 1.386~10.735 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;CI为置信区间 表 3 50例浸润性肺腺癌磨玻璃结节低危组与高危组患者病灶18F-FDG PET/CT双时相显像的代谢参数(
±s)$\bar x $ Table 3. 18F-FDG PET/CT dual-phase imaging metabolism of 50 cases of pulmonary invasive adenocarcinoma appearing as ground-glass nodules in the low-risk and high-risk groups (
±s)$\bar x $ 组别 延迟显像SUVmax 延迟显像SUVmean 延迟显像T/N 双时相显像RI ΔT/Nmax 高危组(n=10) 2.85±1.82 2.72±1.69 5.84±3.83 0.20±0.07 0.23±0.18 低危组(n=40) 1.18±0.63 0.92±0.43 2.55±1.33 0.01±0.36 0.06±0.28 t值 −2.867 −3.359 −2.678 −3.042 −1.759 P值 0.018 0.008 0.024 0.004 0.085 注:FDG为氟脱氧葡萄糖;PET/CT为正电子发射断层显像计算机体层摄影术;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;T/N为肿瘤与对侧正常肺本底SUVmax的比值;RI为滞留指数;ΔT/Nmax为基于SUVmax的肿瘤与对侧正常肺本底的比值变化率 表 4 不同因素及其联合鉴别浸润性肺腺癌磨玻璃结节危险程度的诊断效能
Table 4. Efficacy of different factors and their combined diagnosis in differentiating the risk levels of ground-glass nodules in pulmonary invasive adenocarcinoma
分析因素 AUC 95%CI P值 灵敏度 特异度 准确率 约登
指数阳性预测值 阴性预测值 SUVmax 0.699 0.572~0.827 0.004 0.577(15/26) 0.786(92/117) 0.748(107/143) 0.363 0.375(15/40) 0.893(92/103) SUVmean 0.698 0.573~0.823 0.004 0.808(21/26) 0.436(51/117) 0.503(72/143) 0.244 0.241(21/87) 0.911(51/56) 病灶径线 0.716 0.599~0.833 0.002 0.808(21/26) 0.547(64/117) 0.594(85/143) 0.355 0.284(21/74) 0.928(64/69) 胸膜尾征 0.654 0.527~0.781 0.025 0.692(18/26) 0.607(71/117) 0.622(89/143) 0.299 0.281(18/64) 0.899(71/79) 分叶征 0.605 0.484~0.726 0.129 0.923(24/26) 0.239(28/117) 0.364(52/143) 0.162 0.212(24/113) 0.933(28/30) SUVmax+病灶径线 0.727 0.612~0.842 0.001 0.538(14/26) 0.786(92/117) 0.741(106/143) 0.324 0.359(14/39) 0.885(92/104) SUVmax+胸膜尾征 0.738 0.626~0.849 0.001 0.423(11/26) 0.863(101/117) 0.783(112/143) 0.286 0.407(11/27) 0.871(101/116) SUVmax+SUVmean 0.701 0.580~0.823 0.004 0.577(15/26) 0.786(92/117) 0.748(107/143) 0.363 0.375(15/40) 0.893(92/103) SUVmax+分叶征 0.728 0.610~0.845 0.001 0.577(15/26) 0.803(94/117) 0.762(109/143) 0.380 0.395(15/38) 0.895(94/105) SUVmax+SUVmean+ 病灶径线 0.738 0.629~0.847 0.001 0.538(14/26) 0.786(92/117) 0.741(106/143) 0.324 0.359(14/39) 0.885(92/104) SUVmax+SUVmean+ 胸膜尾征 0.724 0.609~0.839 0.001 0.423(11/26) 0.863(101/117) 0.783(112/143) 0.286 0.407(11/27) 0.871(101/116) SUVmax+SUVmean+ 分叶征 0.718 0.605~0.830 0.002 0.577(15/26) 0.803(94/117) 0.762(109/143) 0.380 0.395(15/38) 0.895(94/105) SUVmax+SUVmean+ 病灶径线+胸膜 尾征 0.755 0.648~0.861 <0.01 0.385(10/26) 0.863(101/117) 0.776(111/143) 0.248 0.385(10/26) 0.863(101/117) SUVmax+SUVmean+ 病灶径线+胸膜 尾征+分叶征 0.774 0.672~0.876 <0.01 0.385(10/26) 0.863(101/117) 0.776(111/143) 0.248 0.385(10/26) 0.863(101/117) 注:病灶经线为横断面最大层面长径和垂直短径的平均值;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;AUC为曲线下面积;CI为置信区间 -
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