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因SUV受很多因素的影响, 不能作为诊断SPN的唯一依据, 应用PET-CT有助于结节定位, 主观判断分析图像, 根据结节大小适当调整SUV诊断阈值, 对于PET和CT图像配准不良导致的低估放射性活性情况作出准确判断, 还可利用PET-CT的同机CT图像分析结节解剖结构特征[11], 提高诊断SPN良恶性的准确率。
多项研究结果均证实, 18F-FDG PET-CT对SPN良恶性的诊断优于其他影像学检查。张金娥等[12]对CT、18F-FDG PET和PET-CT鉴别诊断118例SPN的良恶性进行了比较分析, 结果:CT、PET和PET-CT的灵敏度分别为86.2%、88.5%和97.7%, 特异度分别为58.1%、61.3%和74.2%, 准确率分别为78.8%、81.4%和91.5%。Ding等[13]对60例SPN患者的研究也获得类似结果, 与18F-FDG PET比较, 18F-FDG PET-CT诊断SPN的灵敏度从86.7%提高至90.0%, 特异度从89.7%提高至93.3%, 阳性预测值从89.7%提高至93.1%, 阴性预测值从87.1%提高至90.3%。Yi等[14]对119例行增强CT和PET-CT的SPN患者进行比较分析, 结果显示, 增强CT的灵敏度、特异度和准确率分别为81%、93%和85%, PET-CT分别为96%、88%和93%。
有关PET-CT鉴别诊断SPN良恶性不同研究的具体结果如表 1。
表 1 PET-CT对孤立性肺结节良恶性的鉴别诊断效能
由此表可以看出, 18F-FDG PET-CT对SPN良恶性的诊断准确率较高, 但还是存在一定的误诊率。
18F-FDG PET-CT诊断孤立性肺结节良恶性的研究进展
The development of 18F-FDG PET-CT in the diagnosis of benign and malignant solitary pulmonary nodules
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摘要: 孤立性肺结节(SPN)的良恶性诊断非常困难, 在诊断不明确而手术切除的结节中, 约30%为良性。常规影像学技术虽然可以对大部分SPN做出定性诊断, 但对一部分SPN仍然诊断困难, 且各具有一定的局限性。PET-CT作为一种新的显像技术, 能够综合提供SPN的代谢及形态信息, 在SPN的良恶性诊断与鉴别诊断中显示出更高的灵敏度及准确率。近期多种新的显像方法的应用更进一步提高了SPN的诊断准确率。
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关键词:
- 硬币病变, 肺 /
- 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
Abstract: It is very difficult to differentiate correctly between the benign and malignant solitary pulmonary nodules(SPNs). About 30% of the resected indefinite SPNs are benign. Conventional imaging techniques can identify most patients with SPN, but cannot afford a few patients with SPN which have equivocate manifestations, and each has some limitations. PET-CT is a new imaging technique that can offer metabolic and anatomical information of SPN, which results in higher diagnostic sensitivity and accuracy of SPN. Recently various new imaging method is further improved the diagnostic accuracy. -
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