CAJ | 학술논문

目的：18 F-FDG PET/CT结合 HRCT 对肺微浸润性腺癌（minimally invasive adenocarcinoma ，MIA）的诊断价值。方法搜集经手术病理证实28例肺 MIA 患者的18 F-FDG PET/CT 及 HRCT 影像资料，患者均先行18 F-FDG PET/CT显像，后行HRCT扫描检查，分析其形态学表现及放射性分布，同时测量其SUVmax值，分析PET/CT、HRCT、PET/CT结合 HRCT三者的准确率。结果28例患者中，18 F-FDG PET 显像有19例出现高于肺本底的局灶性异常放射性摄取增高影，以SUVmax＞2．5为标准，诊断MIA的灵敏度为32．1％（9/28）。HRCT 病灶显示磨玻璃密度结节27例（96．4％），其中单纯磨玻璃密度结节10例，混杂磨玻璃密度结节17例，单纯实性密度结节1例；病灶出现边缘分叶征18例（64．3％），毛刺征20例（71．4％），空泡征或支气管充气征21例（75％），胸膜凹陷征12例（42．9％），血管集束征10例（35．7％），圆形结节征13例（46．4％）。PET/CT、HRCT、PET/CT结合 HRCT 三者的准确率分别为71．4％、82.1％和96．4％。结论18 F-FDG PET/CT诊断MIA易出现假阴性，PET/CT结合HRCT有利于提高诊断准确率。
목적：18 F-FDG PET/CT결합 HRCT 대폐미침윤성선암（minimally invasive adenocarcinoma ，MIA）적진단개치。방법수집경수술병리증실28례폐 MIA 환자적18 F-FDG PET/CT 급 HRCT 영상자료，환자균선행18 F-FDG PET/CT현상，후행HRCT소묘검사，분석기형태학표현급방사성분포，동시측량기SUVmax치，분석PET/CT、HRCT、PET/CT결합 HRCT삼자적준학솔。결과28례환자중，18 F-FDG PET 현상유19례출현고우폐본저적국조성이상방사성섭취증고영，이SUVmax＞2．5위표준，진단MIA적령민도위32．1％（9/28）。HRCT 병조현시마파리밀도결절27례（96．4％），기중단순마파리밀도결절10례，혼잡마파리밀도결절17례，단순실성밀도결절1례；병조출현변연분협정18례（64．3％），모자정20례（71．4％），공포정혹지기관충기정21례（75％），흉막요함정12례（42．9％），혈관집속정10례（35．7％），원형결절정13례（46．4％）。PET/CT、HRCT、PET/CT결합 HRCT 삼자적준학솔분별위71．4％、82.1％화96．4％。결론18 F-FDG PET/CT진단MIA역출현가음성，PET/CT결합HRCT유리우제고진단준학솔。
Objective To evaluate the diagnostic value of combined 18 F-FDG PET/CT and HRCT for minimally invasive adenocarcinoma(MIA) .Methods The 18F-FDG PET/CT images of 28 cases with pathologically confirmed MIA were studied .All were followed up by HRCT study .The morphological and radioactive findings of the lesions were reviewed , and the maximum standard uptake values (SUVmax) were measured .The diagnostic accuracy of PET/CT ,HRCT ,and combined PET/CT and HRCT were analyzed .The synergistic effect of combined PET/CT and HRCT were investigated . Results 18 F-FDG PET imaging showed local abnormal radioactive uptake in 19 of 28 cases .When SUVmax of 2 .5 was employed as criteria in the diagnosis of MIA ,the sensitivity of 18 F-FDG PET imaging was 32 .1% .Of the total of 28 ca-ses ,10 had ground glass opacity (GGO) changes ,17 exhibited mixed nodules with GGO changes around the lesions ,and 1 case presented with solid nodules .HRCT showed that the lesions were showing lobulation in 18 cases (64 .3% ) ,spicu-lation in 20 cases (71 .4% ) ,vacuolar changes or air bronchogram in 21 cases (75% ) ,pleural indentation in 12 cases (42.9% ) ,vascular convergence in 10 cases (35 .7% ) ,and round nodule in 13 cases (46 .4% ) .The diagnostic accuracy of PET/CT ,HRCT ,and combined PET/CT and HRCT for MIA was 71 .4% ,82 .1% and 96 .4% respectively .Conclusion The false negative rate and the misdiagnosis rate were high in the diagnosis of MIA with routine PET /CT imaging .Combi-ning 18 F-FDG PET/CT with HRCT was reasonable and practicable ,which had synergistic effect in diagnosing MIA and could greatly improve the diagnostic accuracy .