| SUV小于2.5的孤立性肺结节18F-FDG PET/CT诊断价值初探 |
| 投稿时间：2011-05-17 修订日期：2011-08-24 点此下载全文 |
| 引用本文：李文婵,姚稚明,屈婉莹,陈聪霞,刘甫庚,刘秀芹.SUV小于2.5的孤立性肺结节18F-FDG PET/CT诊断价值初探[J].医学研究杂志,2011,40(9):47-51 |
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| 中文摘要:目的正电子断层显像（PET）通常以标准摄取值（SUV）≥2.5为肺癌诊断标准，但仍有部分SUV<2.5的孤立性肺结节（SPN<2.5）为肺癌。本研究旨在分析SPN<2.5氟代脱氧葡萄糖（18F-FDG）PET/CT表现及其诊断价值。方法51例18F-FDG PET/CT 早期显像SUV平均值（SUVavg）<2.5 的孤立性肺结节病人纳入研究。对SPN放射性摄取测量采用两种方法：视觉分析及半定量分析。测量SPN的早期及延迟显像的SUVavg、SUVmax及其早期-延迟变化率（△SUVavg、△SUVmax）。37例以病理诊断及14例以2年以上临床随诊结果为最终诊断标准。统计学分析采用SPSS 16.0软件。结果51例SPN<2.5患者中，良性11例，恶性40例。虽然良恶性SPN<2.5患者各项SUV值间均无统计学差异（P>0.05），但恶性SPN<2.5患者各项SUV值均有高于良性的趋势，特别是△SUVavg、△SUVmax。以△SUVmax>0为诊断阈值，18F-FDG PET/CT诊断恶性SPN的敏感性684%、特异性60.0%、准确性66.7%、阳性预测值86.7%及阴性预测值33.3%。视觉分析：无FDG摄取的SPN<2.5 9例中，5例为良性，4例为恶性；有FDG摄取的SPN<2.5 42例中，6例良性，36例恶性，两组之间有显著的统计学差异，P=0.02。良恶性SPN<2.5的CT密度及大小之间均无统计学差异（P>0.05）。综合PET和CT信息分析SPN<2.5，18F-FDG PET/CT诊断恶性SPN<2.5的敏感性97.5%、特异性54.5%、准确性88.2%、阳性预测值88.6%、阴性预测值85.7%。结论单纯以SUV≥2.5为标准鉴别诊断SPN会导致肺癌的漏诊。对于此类结节，△SUV有较高的肺癌阳性预测值；FDG摄取视觉分析能提高结节的良恶性鉴别准确率；综合FDG PET和CT分析的PET/CT能显著提高诊断肺癌的敏感性和准确性，但特异性较低。 |
| 中文关键词:体层摄影术，发射型计算机 体层摄影术，X线计算机 脱氧葡萄糖 孤立性肺结节 |
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| 18F-FDG PET/CT Characterization of Solitary Pulmonary Nodules with an Initial Average Standard Uptake Value Less Than 2.5 |
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| Abstract:ObjectiveTraditionly，a FDG standardized uptake value (SUV) of 2.5 is used as a cutoff of pulmonary malignancies.However,the frequency of malignancies with an SUV of <2.5 is significant,and this study aimed to evaluate the value of 18F-FDG PET/CT for diagnosis of solitary pulmonary nodules(SPNs) with 18F-FDG uptake below the initial average standardized uptake value (SUVavg) of 2.5.MethodsWe retrospectively analyzed 51 patients who had SPNs with an initial SUVavg of <2.5.The uptake of 18F-FDG was graded by semiquantitative methods (SUVavg,SUVmax,△SUVavg,△SUVmax) and a visual method.Besides above,we analyzed the density and size of SPNs.Final classification was based on histopathologic findings or at least 24 months of clinical follow-up.ResultsWe found 40 malignant and 11 benign lesions.Though there were no significant differences between SUV(including all the SUVs and △SUV) of benign and malignant SPNs，there was a tendency that SUV of malignant SPNs was higher than that of benign ones(especially △SUV).When a cutoff of △SUVmax above 0 was used,the sensitivity,specificity,accuracy,positive and negative predictive values of 18F FDG PET/CT in diagnosis SPN were 68.4%，60.0%， 66.7%，86.7%，33.3%，respectively.There were 5 benign SPNs and 4 malignant SPNs in total 9 absent FDG uptake SPNs.There were 6 benign SPNs and 36 malignant SPNs in total 42 visually evident FDG uptake SPNs (P=002).There was no significant difference between benign and malignant SPNs in CT density and diameter (P=0.71，024).The sensitivity,specificity,accuracy,the positive and negative predictive values of 18F-FDG PET/CT in diagnosis SPNs were 975%，54.5%，88.2%，88.6%，85.7%,rospectively.ConclusionThese results suggested that SPNs with low 18F-FDG uptake,SUVavg and SUVmax did not improve the accuracy of 18F-FDG PET /CT.△SUV might be helpful in differential diagnosis.Visual analysis was more valuable than semiquantitative analysis.18F-FDG PET/CT demonstrates an excellent performance in classifying SPNs with an SUVavg of <2.5 as benign or malignant with a highly sensitivity and accuracy,though the specificity was low. |
| keywords:PET CT 18F-FDG Solitary pulmonary nodules |
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