CAJ | 학술논문

目的探讨PET/CT联合高分辨超声(US)对甲状腺偶发病灶良、恶性的鉴别诊断价值.方法对73个PET/CT检出的甲状腺偶发病灶病理确诊前PET/CT和US诊断意见按3分法(0分,良性可能；1分,无明确定性；2分,恶性可疑)分类,并测定病灶长径和SUVmax.以病理诊断为“金标准”,评价SUVmax、PET/CT、US、PET/CT联合US( PET/CT+US)对恶性病灶的检出效能.统计学检验包括t检验、Z检验、x2检验和Kappa一致性检验.结果 73个甲状腺偶发病灶病理确诊恶性病灶占59％(43/73),良性病灶占41％(30/73).恶性病灶SUVmax (7.0±8.1)高于良性病灶(4.1±3.8；t=2.062,P=0.043),长径小于良性病灶[(2.0±1.1) cm比(2.7±1.4) cm；t=2.628,P=0.011].SUVmax、PET/CT、US及PET/CT+ US诊断恶性病灶的ROC AUC(95％CI)分别为0.580(0.448-0.713)、0.763 (0.647～0.878)、0.905(0.826～0.983)和0.909(0.840～0.979),PET/CT AUC明显大于SUVmax(Z=2.033,P=0.042),US、PET/CT+US也明显大于PET/CT(Z值分别为1.992和2.112,P均＜0.05)和SUVmax(Z值分别为4.120和4.276,P均＜0.001).最佳阈值下,SUVmax、PET/CT、US、PET/CT+US诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为42％(18/43)、83％(25/30)、59％(43/73)、78％(18/23)、50％(25/50),79％(34/43)、80％(24/30)、79％(58/73)、85％(34/40)、73％(24/33),84％(36/43)、90％(27/30)、86％(63/73)、92％(36/39)、79％(27/34)和98％(42/43)、67％(20/30)、85％(62/73)、81％(42/52)、95％(20/21).与病理诊断比较,SUV.诊断的一致性较差(Kappa=0.229,P=0.023),PET/CT的一致性中等(Kappa=0.582,P＜0.001),US和PET/CT+US的一致性好(Kappa值分别为0.668和0.674,P均＜0.001).PET/CT+US与PET/CT比较,灵敏度从79％(34/43)提高到98％(42/43),差异有统计学意义(x2=6.125,P=0.008),而特异性差异无统计学意义(从80％降低到67％;x2=2.250,P＞0.05).结论联合高分辨US能明显提高18F-FDG PET/CT对甲状腺偶发病灶良、恶性的鉴别诊断效能. 目的探討PET/CT聯閤高分辨超聲(US)對甲狀腺偶髮病竈良、噁性的鑒彆診斷價值.方法對73箇PET/CT檢齣的甲狀腺偶髮病竈病理確診前PET/CT和US診斷意見按3分法(0分,良性可能；1分,無明確定性；2分,噁性可疑)分類,併測定病竈長徑和SUVmax.以病理診斷為“金標準”,評價SUVmax、PET/CT、US、PET/CT聯閤US( PET/CT+US)對噁性病竈的檢齣效能.統計學檢驗包括t檢驗、Z檢驗、x2檢驗和Kappa一緻性檢驗.結果 73箇甲狀腺偶髮病竈病理確診噁性病竈佔59％(43/73),良性病竈佔41％(30/73).噁性病竈SUVmax (7.0±8.1)高于良性病竈(4.1±3.8；t=2.062,P=0.043),長徑小于良性病竈[(2.0±1.1) cm比(2.7±1.4) cm；t=2.628,P=0.011].SUVmax、PET/CT、US及PET/CT+ US診斷噁性病竈的ROC AUC(95％CI)分彆為0.580(0.448-0.713)、0.763 (0.647～0.878)、0.905(0.826～0.983)和0.909(0.840～0.979),PET/CT AUC明顯大于SUVmax(Z=2.033,P=0.042),US、PET/CT+US也明顯大于PET/CT(Z值分彆為1.992和2.112,P均＜0.05)和SUVmax(Z值分彆為4.120和4.276,P均＜0.001).最佳閾值下,SUVmax、PET/CT、US、PET/CT+US診斷的靈敏度、特異性、準確性、暘性預測值、陰性預測值分彆為42％(18/43)、83％(25/30)、59％(43/73)、78％(18/23)、50％(25/50),79％(34/43)、80％(24/30)、79％(58/73)、85％(34/40)、73％(24/33),84％(36/43)、90％(27/30)、86％(63/73)、92％(36/39)、79％(27/34)和98％(42/43)、67％(20/30)、85％(62/73)、81％(42/52)、95％(20/21).與病理診斷比較,SUV.診斷的一緻性較差(Kappa=0.229,P=0.023),PET/CT的一緻性中等(Kappa=0.582,P＜0.001),US和PET/CT+US的一緻性好(Kappa值分彆為0.668和0.674,P均＜0.001).PET/CT+US與PET/CT比較,靈敏度從79％(34/43)提高到98％(42/43),差異有統計學意義(x2=6.125,P=0.008),而特異性差異無統計學意義(從80％降低到67％;x2=2.250,P＞0.05).結論聯閤高分辨US能明顯提高18F-FDG PET/CT對甲狀腺偶髮病竈良、噁性的鑒彆診斷效能.
목적 탐토PET/CT연합고분변초성(US)대갑상선우발병조량、악성적감별진단개치.방법 대73개PET/CT검출적갑상선우발병조병리학진전PET/CT화US진단의견안3분법(0분,량성가능；1분,무명학정성；2분,악성가의)분류,병측정병조장경화SUVmax.이병리진단위“금표준”,평개SUVmax、PET/CT、US、PET/CT연합US( PET/CT+US)대악성병조적검출효능.통계학검험포괄t검험、Z검험、x2검험화Kappa일치성검험.결과 73개갑상선우발병조병리학진악성병조점59％(43/73),량성병조점41％(30/73).악성병조SUVmax (7.0±8.1)고우량성병조(4.1±3.8；t=2.062,P=0.043),장경소우량성병조[(2.0±1.1) cm비(2.7±1.4) cm；t=2.628,P=0.011].SUVmax、PET/CT、US급PET/CT+ US진단악성병조적ROC AUC(95％CI)분별위0.580(0.448-0.713)、0.763 (0.647～0.878)、0.905(0.826～0.983)화0.909(0.840～0.979),PET/CT AUC명현대우SUVmax(Z=2.033,P=0.042),US、PET/CT+US야명현대우PET/CT(Z치분별위1.992화2.112,P균＜0.05)화SUVmax(Z치분별위4.120화4.276,P균＜0.001).최가역치하,SUVmax、PET/CT、US、PET/CT+US진단적령민도、특이성、준학성、양성예측치、음성예측치분별위42％(18/43)、83％(25/30)、59％(43/73)、78％(18/23)、50％(25/50),79％(34/43)、80％(24/30)、79％(58/73)、85％(34/40)、73％(24/33),84％(36/43)、90％(27/30)、86％(63/73)、92％(36/39)、79％(27/34)화98％(42/43)、67％(20/30)、85％(62/73)、81％(42/52)、95％(20/21).여병리진단비교,SUV.진단적일치성교차(Kappa=0.229,P=0.023),PET/CT적일치성중등(Kappa=0.582,P＜0.001),US화PET/CT+US적일치성호(Kappa치분별위0.668화0.674,P균＜0.001).PET/CT+US여PET/CT비교,령민도종79％(34/43)제고도98％(42/43),차이유통계학의의(x2=6.125,P=0.008),이특이성차이무통계학의의(종80％강저도67％;x2=2.250,P＞0.05).결론 연합고분변US능명현제고18F-FDG PET/CT대갑상선우발병조량、악성적감별진단효능.
Objective To investigate the value of 18F-FDG PET/CT combined with ultrasound (US) imaging for differentiating malignant from benign thyroid lesions.Methods Seventy-three thyroid lesions incidentally found by 18F-FDG PET/CT imaging were enrolled.Final diagnosis was confirmed by histopathology or cytology.Interpretations of PET/CT and US included a subjective classification on a 3-point scale (0:probably benign,1:uncertain,2:probably malignant),along with the longest diameter measure and SUVmax of the thyroid lesions.The accuracies of PET/CT,US and PET/CT + US for differentiating malignant from benign thyroid lesions were compared by ROC curve analysis,with a Z test to compare the AUC.The Kappa test,t-test and x2 test were also used.Results Of the 73 thyroid lesions,there were 43 (59％)malignant and 30 (41％) benign lesions.The SUVmmax of malignant lesions was significantly higher than that of benign lesions (7.0±8.1 vs 4.1±3.8; t=2.062,P=0.043),and the longest diameter of malignant lesions was smaller than that of benign lesions ( 2.0 ± 1.1 vs 2.7 ± 1.4 ; t=2.628,P=0.011 ).To differentiate malignant from benign thvroid lesions,the AUC of SUVmax was 0.580 (95％ CI:0.448-0.713).After analyzing the features of PET and CT images,the AUC of PET/CT was significantly improved to 0.763(95％ CI:0.647-0.878; Z=2.033,P=0.042).The AUC of US (0.905,95％ CI:0.826-0.983)and PET/CT + US (0.909,95 ％ CI:0.840-0.979 ) were significantly higher than that of PET/CT ( Z =1.992 and 2.112,both P＜0.05 ) or SUV max ( Z=4.120 and 4.276,both P＜0.001 ).The optimal sensitivity,specificity,accuracy,positive predictive value,negative predictive value were 42％(18/43),83(25/30),59％(43/73),78％(18/23),50％(25/50) for SUVmax,79％(34/43),80％(24/30),79％(58/73),85％(34/40),73％(24/33) for PET/CT,84％(36/43),90％(27/30),86％(63/73),92％(36/39),79％(27/34) for US,and 98％(42/43),67％(20/30),85％(62/73),81％(42/52),95％(20/21) for PET/CT + US,respectively.Agreement was poor for SUVmax ( Kappa =0.229,P =0.023 ),fair for PET/CT ( Kappa =0.582,P ＜0.001 ),and good for US ( Kappa =0.668,P ＜ 0.001 )and PET/CT+US (Kappa =0.674,P＜0.001).Compared with PET/CT,the sensitivity of PET/CT + US was significantly higher (x2 =6.125,P =0.008 ),while the specificity had no statistical difference (x2 =2.250,P ＞ 0.05 ).Conclusion By combining PET/CT with US,the diagnostic efficacy is significantly improved in differentiating malignant from benign thyroid lesions found by 18F-FDG PET/CT.