CAJ | 학술논문

目的评价18F-FLT联合18F-FDG PET/CT显像对肺部恶性肿瘤患者纵隔淋巴结良恶性的诊断价值.方法回顾性分析2009年4月至2011年10月全国11个PET/CT中心18F-FLT与18 F-FDG PET/CT显像的患者资料,选择行肺部恶性肿瘤切除和纵隔淋巴结清扫、获得病理检查结果的患者共41例,其中男28例,女13例,年龄(56.1 ±12.2)岁.对18F-FLT与18F-FDG PET/CT淋巴结的显像结果分别进行视觉分析和半定量分析,采用,检验比较各方法的诊断效能.结果 (1)41例患者手术共检出533枚淋巴结,经病理检查证实恶性192枚,良性341枚(炎性增生淋巴结或正常淋巴结)；(2)以18 F-FDG SUV≥2.5和18F-FLT SUV≥2.0为诊断恶性淋巴结的阈值,18F-FDG和18F-FLTPET/CT对纵隔淋巴结良恶性诊断的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为91.67％ (176/192)、80.94％ (276/341)、84.80％(452/533)、73.03％(176/241)、94.52％(276/292)和81.25％ (156/192)、92.96％(317/341)、88.74％ (473/533)、86.67％ (156/180)、89.80％ (317/353),两者灵敏度、特异性及阳性预测值差异均有统计学意义(x2=8.897、21.722和11.495,均P＜0.05),准确性和阴性预测值差异均无统计学意义(x2=3.604和3.712,均P＞0.05)；18F-FDG联合18 F-FLT诊断纵隔淋巴结的灵敏度、特异性、准确性、阳性预测值及阴性预测值则分别提高至93.75％(180/192)、94.43％ (322/341)、94.18％ (502/533)、90.45％ (180/199)、96.41％(322/334).结论 18F-FDG诊断纵隔淋巴结良恶性的灵敏度高于18F-FLT,但特异性及阳性预测值明显低于FLT,两者联合诊断可明显提高诊断准确性.
목적 평개18F-FLT연합18F-FDG PET/CT현상대폐부악성종류환자종격림파결량악성적진단개치.방법 회고성분석2009년4월지2011년10월전국11개PET/CT중심18F-FLT여18 F-FDG PET/CT현상적환자자료,선택행폐부악성종류절제화종격림파결청소、획득병리검사결과적환자공41례,기중남28례,녀13례,년령(56.1 ±12.2)세.대18F-FLT여18F-FDG PET/CT림파결적현상결과분별진행시각분석화반정량분석,채용,검험비교각방법적진단효능.결과 (1)41례환자수술공검출533매림파결,경병리검사증실악성192매,량성341매(염성증생림파결혹정상림파결)；(2)이18 F-FDG SUV≥2.5화18F-FLT SUV≥2.0위진단악성림파결적역치,18F-FDG화18F-FLTPET/CT대종격림파결량악성진단적령민도、특이성、준학성、양성예측치급음성예측치분별위91.67％ (176/192)、80.94％ (276/341)、84.80％(452/533)、73.03％(176/241)、94.52％(276/292)화81.25％ (156/192)、92.96％(317/341)、88.74％ (473/533)、86.67％ (156/180)、89.80％ (317/353),량자령민도、특이성급양성예측치차이균유통계학의의(x2=8.897、21.722화11.495,균P＜0.05),준학성화음성예측치차이균무통계학의의(x2=3.604화3.712,균P＞0.05)；18F-FDG연합18 F-FLT진단종격림파결적령민도、특이성、준학성、양성예측치급음성예측치칙분별제고지93.75％(180/192)、94.43％ (322/341)、94.18％ (502/533)、90.45％ (180/199)、96.41％(322/334).결론 18F-FDG진단종격림파결량악성적령민도고우18F-FLT,단특이성급양성예측치명현저우FLT,량자연합진단가명현제고진단준학성.
Objective To evaluate the diagnostic value of 18F-FDG combined with 18F-FLT PET/CT imaging for benign and malignant mediastinal lymph nodes in patients with lung malignant tumors.Methods Forty-one patients from 11 PET/CT centers with lung malignant tumors underwent 18F-FLT and 18F-FDG PET/CT imaging from April 2009 to October 2011.The patients were made up of 28 males and 13females with a mean age (56.1 ± 12.2) y.The gold standard for diagnosis was histopathology.The results of 18F-FLT and 18F-FDG PET/CT images were analyzed by visual and semi-quantitative analysis.x2 test was used to analyze diagnosis efficacy.Results (1) A total of 533 mediastinal lymph nodes were obtained and histopathologically confirmed.There were 192 malignant lymph nodes and 341 benign lymph nodes (either inflammatory hyperplasia or normal lymph nodes).(2) When 18F-FDG SUV ≥2.5 and 18F-FLT SUV ≥2.0 were used as the threshold for the malignant lesion,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 18F-FDG and 18F-FLT were 91.67％ (176/192) vs 81.25％(156/192),80.94％ (276/341) vs 92.96％ (317/341),84.80％ (452/533) vs 88.74％ (473/533),73.03％ (176/241) vs 86.67％ (156/180),94.52％ (276/292) vs 89.80％ (317/353),respectively.There were significant differences in sensitivity,specificity and positive predictive value (x2 =8.897,21.722,11.495,all P ＜ 0.05),while there were no significant differences in accuracy and negative predictive value (x2 =3.604,3.712,both P ＞0.05).The combination of dual-tracer PET/CT improved the sensitivity,specificity,accuracy,positive predictive value and negative predictive value up to 93.75％(180/192),94.43％ (322/341),94.18％ (502/533),90.45％ (180/199) and 96.41％ (322/334).Conclusions 18F-FDG PET had a higher sensitivity in diagnosis of benign and malignant mediastinal lymph nodes than 18F-FLT,but 18F-FLT had a higher specificity and positive predictive value.Dual tracer PET/CT using 18F-FDG and 18F-FLT could improve the diagnostic accuracy of mediastinal lymph nodes.