PET/CT在诊断肺部占位性病变中的价值及应用
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摘要
肺癌在我国是一种发生率相对较高的恶性肿瘤。正电子发射型计算机断层显像(positron emission computed tomography,PET)作为一种功能显像可反映组织的葡萄糖代谢状况,恶性疾病葡萄糖代谢水平增高,通过PET/CT全身显像可显示肿瘤的原发灶及转移灶,从而为肺癌的早期诊断及分期提供重要依据。本研究主要探讨~(18)F-FDGPET/CT在诊断肺部占位性病变中的价值,并在测量不同体积的肿瘤放射性摄取值时,评估部分容积效应(the partial volume effect,PVE)对SUV产生的影响。在患者PET/CT显像时,应用体积阈值法诊断肺内占位性病变,提高PET/CT诊断肺部结节的准确率。对肺部难以鉴别良、恶性的结节进行延迟显像,对照病理或随访结果,评价延迟显像。最后在~(18)F-FDG PET/CT显像中可能遇到的问题及其解决方案等方面进行分析探讨。
研究目的
探讨~(18)SF-FDG PET/CT在诊断肺部占位性病变中的价值,评估PVE对SUV产生的影响,应用体积阈值法,在患者PET/CT显像时依据肺内病灶不同体积确定不同阈值,提高PET/CT诊断肺部结节的准确率。针对肺部难以鉴别良、恶性的结节进行延迟显像,对照病理或随访结果,评价延迟显像。
研究方法
整个实验共分为三部分,第一部分主要探讨~(18)F-FDG PET/CT在诊断肺部占位性病变中的价值。对100例肺部占位性病变进行回顾性分析,使用感兴趣区法(region ofinterest,ROI)针对每个病灶测定SUV,对照病理及随访结果比较PET/CT与PET及CT的诊断效度、不同大小肿瘤的SUV、不同病理类型肺癌的SUV。
第二部分则应用断层分辨率模型(Model No.76-823 IAEA提供)进行试验,评估PVE对SUV产生的影响,运用数学公式对静态受检物的SUV进行校正。收集2006年12月—2007年12月行~(18(F-FDG PET/CT检查的114例未经治疗的肺部结节患者。将经过病理确诊的恶性肿瘤按照病灶直径分为＜2cm,≥12并＜3cm,≥3并＜4cm,≥4并＜5cm,≥5cm五组,计算5组SUV平均值,并比较5组间SUV差异。将良性病灶及恶性病灶按病灶大小分组分为直径≥1并＜2cm组,直径≥2并＜3cm组,及直径≥3并＜4cm组,比较3组间SUV差异。应用体积阈值法鉴别相同体积分组中病灶良、恶性,并比较SUV2.5阈值法与体积阈值法的诊断效度。
第三部分对病例收集中遇到的形态不典型、SUV摄取增高、难以诊断的病灶进行延迟显像,将延迟显像SUV的变化情况与病理进行对照,分析所得结果及可能产生的干扰因素,评价延迟显像的临床意义。
结果
对100例经病理或随访证实的肺部良恶性病变进行回顾性分析,PET/CT诊断灵敏度为97.5%,特异度为80.0%,准确率为94.0%,鳞癌与腺癌SUV无显著差异。
对断层分辨率模型进行PET/CT显像,不同孔径内放射性计数值与孔径大小成对数相关。对114例未经治疗的肺部结节患者进行PET/CT显像,认为不同大小恶性肿瘤之间或良性病变之间,SUV均有显著差异。依据SUV≥2.5作为诊断肺部恶性肿瘤阈值,灵敏度90.57%,特异度71.15%,准确率80.95%。应用体积阈值法进行诊断,总体灵敏度92.45%,特异度86.54%,准确率89.52%。体积阈值法诊断特异度及准确率均优于SUV2.5阈值法(P＜0.05)。
对33例较难诊断的肺部结节患者进行延迟显像,总共23个经病理确诊为肺癌的病灶,18个SUV升高,3个SUV下降,2个SUV基本不变。13个良性病灶中9个SUV升高,3个SUV下降,1个SUV基本不变。13个良性病灶180分钟显像时1个炎性结节和4个结核性病灶SUV开始下降,2个肺脓肿、3个结核性病灶和1个炎性结节SUV仍然保持上升趋势,2个炎性结节SUV基本不变。
结论
PET/CT在诊断肺部占位时具有较高价值。体积阈值法的应用可以减少PVE对诊断产生的影响,提高PET/CT诊断效度。对疑难病例进行延迟显像时需注意肺脓肿及肉芽肿性病变可能出现假阳性结果。
Objective
The objective of this work was to evaluate the efficacy of whole-body ~(18)F-FDG PET/CT in diagnosing pulmonary occupying lesion,and describe PVE's consequences in SUV.Size-threshold was used to diagnose the different size lesions,which was help for increasing diagnosis accuracy of PET/CT.Patients with the lesions difficult to diagnose Undergone delay PET scans.Comparing with pathologic and follow-up findings,the value of delay scan was assessed.
Methods
This study included three parts.The value of 18F-FDG PET/CT in diagnosing pulmonary occupying lesion was evaluated in the first part.Patient studies:one hundred patients who had 18F-FDG PET/CT scans were retrospectively analyzed.SUVs in the ROI were measured.According to pathologic and follow-up findings,the efficacy of PET/CT, PET and CT;the SUVs of different size tumor;the SUVs of different pathologic tumor were compared respectively.
In the second part,Model No.76-823 was used for this part.The influence of PVE to SUV was described.Mathematics method was used for correcting SUVs.One hundred fourteen patients with pulmonary occupying lesions undergo 18F-FDG PET/CT scans. According to the size,tumors were divided to five groups:＜2cm group,≥2cm and＜3cm group,≥3cm and＜4cm group,≥4cm and＜5cm group,and＞5cm group.The mean SUV of each group was calculated and was compared among different groups.According to the size,the benign lesions were divided to three groups:≥1cm and＜2cm group,≥2cm and＜3cm group,≥2cm and＜3cm group.The SUVs of different groups were compared.Size-threshold was used to differentiate malignant from benign lesion.The diagnosis validity of SUV 2.5 threshold and size-threshold were compared.Patients with the lesions difficult to diagnose undergo delay PET scans.Comparing with pathologic and follow-up findings,the value of delay imaging was assessed.
Results
One hundred patients who had 18F-FDG PET/CT scans were retrospectively analyzed. The diagnosis sensitivity of PET/CT was 97.5%,specificity was 80.0%,accuracy was 94.0%.There was no difference between the SUV of squamous cell carcinoma and adencarcinoma.
Model No.76-823 was used to PET/CT imaging.The size of rotundum had logarithm correlation with the radioactive counting.One hundred fourteen patients with pulmonary occupying lesions undergo 18F-FDG PET/CT scans.Significant deviation of SUV was found between the different size lesions.The diagnosis specificity and accuracy of size-threshold were higher than that of SUV 2.5 threshold(P＜0.05).Thirty-three patients with the lesions difficult to diagnose undergo delay PET scans.The SUVs of the lesions in twenty-three known cancer patients increased in eighteen lesions,decreased in three lesions and were stable in two lesions.The SUVs of thirteen benign lesions increased in nigh lesions,decreased in three lesions and was stable in one lesion.The delaying 180mins SUVs of thirteen benign lesions decreased in one inflaming nodule and four tuberculosis granulomas;increased in two pulmonary abscesses,three tuberculosis granulomas and one inflaming nodule.The SUVs of two inflaming nodule were stable.
Conclusion
These preliminary data show that PET/CT imaging appears to be useful in diagnosing pulmonary occupying lesion.The using of size-threshold induced influence of PVE and enhanced diagnosis validity.Positive result of pulmonary abscess and tuberculosis granuloma should be pay attention.
研究目的
探讨~(18)SF-FDG PET/CT在诊断肺部占位性病变中的价值,评估PVE对SUV产生的影响,应用体积阈值法,在患者PET/CT显像时依据肺内病灶不同体积确定不同阈值,提高PET/CT诊断肺部结节的准确率。针对肺部难以鉴别良、恶性的结节进行延迟显像,对照病理或随访结果,评价延迟显像。
研究方法
整个实验共分为三部分,第一部分主要探讨~(18)F-FDG PET/CT在诊断肺部占位性病变中的价值。对100例肺部占位性病变进行回顾性分析,使用感兴趣区法(region ofinterest,ROI)针对每个病灶测定SUV,对照病理及随访结果比较PET/CT与PET及CT的诊断效度、不同大小肿瘤的SUV、不同病理类型肺癌的SUV。
第二部分则应用断层分辨率模型(Model No.76-823 IAEA提供)进行试验,评估PVE对SUV产生的影响,运用数学公式对静态受检物的SUV进行校正。收集2006年12月—2007年12月行~(18(F-FDG PET/CT检查的114例未经治疗的肺部结节患者。将经过病理确诊的恶性肿瘤按照病灶直径分为＜2cm,≥12并＜3cm,≥3并＜4cm,≥4并＜5cm,≥5cm五组,计算5组SUV平均值,并比较5组间SUV差异。将良性病灶及恶性病灶按病灶大小分组分为直径≥1并＜2cm组,直径≥2并＜3cm组,及直径≥3并＜4cm组,比较3组间SUV差异。应用体积阈值法鉴别相同体积分组中病灶良、恶性,并比较SUV2.5阈值法与体积阈值法的诊断效度。
第三部分对病例收集中遇到的形态不典型、SUV摄取增高、难以诊断的病灶进行延迟显像,将延迟显像SUV的变化情况与病理进行对照,分析所得结果及可能产生的干扰因素,评价延迟显像的临床意义。
结果
对100例经病理或随访证实的肺部良恶性病变进行回顾性分析,PET/CT诊断灵敏度为97.5%,特异度为80.0%,准确率为94.0%,鳞癌与腺癌SUV无显著差异。
对断层分辨率模型进行PET/CT显像,不同孔径内放射性计数值与孔径大小成对数相关。对114例未经治疗的肺部结节患者进行PET/CT显像,认为不同大小恶性肿瘤之间或良性病变之间,SUV均有显著差异。依据SUV≥2.5作为诊断肺部恶性肿瘤阈值,灵敏度90.57%,特异度71.15%,准确率80.95%。应用体积阈值法进行诊断,总体灵敏度92.45%,特异度86.54%,准确率89.52%。体积阈值法诊断特异度及准确率均优于SUV2.5阈值法(P＜0.05)。
对33例较难诊断的肺部结节患者进行延迟显像,总共23个经病理确诊为肺癌的病灶,18个SUV升高,3个SUV下降,2个SUV基本不变。13个良性病灶中9个SUV升高,3个SUV下降,1个SUV基本不变。13个良性病灶180分钟显像时1个炎性结节和4个结核性病灶SUV开始下降,2个肺脓肿、3个结核性病灶和1个炎性结节SUV仍然保持上升趋势,2个炎性结节SUV基本不变。
结论
PET/CT在诊断肺部占位时具有较高价值。体积阈值法的应用可以减少PVE对诊断产生的影响,提高PET/CT诊断效度。对疑难病例进行延迟显像时需注意肺脓肿及肉芽肿性病变可能出现假阳性结果。
Objective
The objective of this work was to evaluate the efficacy of whole-body ~(18)F-FDG PET/CT in diagnosing pulmonary occupying lesion,and describe PVE's consequences in SUV.Size-threshold was used to diagnose the different size lesions,which was help for increasing diagnosis accuracy of PET/CT.Patients with the lesions difficult to diagnose Undergone delay PET scans.Comparing with pathologic and follow-up findings,the value of delay scan was assessed.
Methods
This study included three parts.The value of 18F-FDG PET/CT in diagnosing pulmonary occupying lesion was evaluated in the first part.Patient studies:one hundred patients who had 18F-FDG PET/CT scans were retrospectively analyzed.SUVs in the ROI were measured.According to pathologic and follow-up findings,the efficacy of PET/CT, PET and CT;the SUVs of different size tumor;the SUVs of different pathologic tumor were compared respectively.
In the second part,Model No.76-823 was used for this part.The influence of PVE to SUV was described.Mathematics method was used for correcting SUVs.One hundred fourteen patients with pulmonary occupying lesions undergo 18F-FDG PET/CT scans. According to the size,tumors were divided to five groups:＜2cm group,≥2cm and＜3cm group,≥3cm and＜4cm group,≥4cm and＜5cm group,and＞5cm group.The mean SUV of each group was calculated and was compared among different groups.According to the size,the benign lesions were divided to three groups:≥1cm and＜2cm group,≥2cm and＜3cm group,≥2cm and＜3cm group.The SUVs of different groups were compared.Size-threshold was used to differentiate malignant from benign lesion.The diagnosis validity of SUV 2.5 threshold and size-threshold were compared.Patients with the lesions difficult to diagnose undergo delay PET scans.Comparing with pathologic and follow-up findings,the value of delay imaging was assessed.
Results
One hundred patients who had 18F-FDG PET/CT scans were retrospectively analyzed. The diagnosis sensitivity of PET/CT was 97.5%,specificity was 80.0%,accuracy was 94.0%.There was no difference between the SUV of squamous cell carcinoma and adencarcinoma.
Model No.76-823 was used to PET/CT imaging.The size of rotundum had logarithm correlation with the radioactive counting.One hundred fourteen patients with pulmonary occupying lesions undergo 18F-FDG PET/CT scans.Significant deviation of SUV was found between the different size lesions.The diagnosis specificity and accuracy of size-threshold were higher than that of SUV 2.5 threshold(P＜0.05).Thirty-three patients with the lesions difficult to diagnose undergo delay PET scans.The SUVs of the lesions in twenty-three known cancer patients increased in eighteen lesions,decreased in three lesions and were stable in two lesions.The SUVs of thirteen benign lesions increased in nigh lesions,decreased in three lesions and was stable in one lesion.The delaying 180mins SUVs of thirteen benign lesions decreased in one inflaming nodule and four tuberculosis granulomas;increased in two pulmonary abscesses,three tuberculosis granulomas and one inflaming nodule.The SUVs of two inflaming nodule were stable.
Conclusion
These preliminary data show that PET/CT imaging appears to be useful in diagnosing pulmonary occupying lesion.The using of size-threshold induced influence of PVE and enhanced diagnosis validity.Positive result of pulmonary abscess and tuberculosis granuloma should be pay attention.
引文
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