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目的探索如何将病灶SUV_(max)与薄层CT相结合,提高18F-FDG PET/CT对肺孤立性结节的定性诊断准确性。方法回顾性分析267例经手术病理检查或临床随访证实的SPN患者的~(18)F-FDG PET/CT及薄层CT显像结果,依据薄层CT将SPN分为实性结节与非实性结节。分别采用标准1(SUV_(max)≥2.5)和标准2(SUV_(max)结合薄层CT综合分析)诊断肺癌,以病理和临床随访为金标准,分析两种标准对肺孤立性结节的诊断效能。结果采用两种标准诊断肺癌的灵敏度和准确性分别为80.4%、76.4%(标准1)和91.0%、87.2%(标准2)(均P<0.05)。在非实性结节中,良、恶性病灶的SUV_(max)无明显显著性差异(P>0.05),而病灶大小和分叶征、含气支气管征或空泡征以及病灶内有无粗大血管等CT征象对鉴别诊断有意义(均P<0.05)。40例PET表现为低代谢的肺癌患者,均被误诊为良性病变,结合薄层CT图像,纠正了其中50%(20/40)的诊断。采用标准1诊断肺癌,灵敏度为40.0%,而采用标准2诊断肺癌,灵敏度为90%,标准2对非实性结节诊断的灵敏度明显高于标准1(P=0.000),但特异性无显著性差异(75.2%vs 58.3%,P=0.667)。然而,对实性结节,薄层CT对于诊断结果无明显影响(均P>0.05)。结论对于肺孤立性结节,仅依据SUV_(max)≥2.5诊断肺癌,诊断效能并不理想。对非实性结节,须依据SUV_(max)和薄层CT所见进行综合分析。
Objective To explore how to combine the SUV max of lesion with thin-section CT and improve the diagnostic accuracy of 18F-FDG PET / CT for the diagnosis of solitary pulmonary nodules. Methods We retrospectively analyzed the results of ~ (18) F-FDG PET / CT and thin-section CT imaging in 267 SPN patients confirmed by pathological examination or clinical follow-up. SPN was divided into solid nodules and non- Solid nodules. Lung cancer was diagnosed by using standard 1 (SUV max ≥2.5) and standard 2 (SUV max) combined with thin layer CT comprehensive analysis. The pathological and clinical follow-up were taken as the gold standard. Diagnostic efficiency. Results The sensitivity and accuracy of the two methods for the diagnosis of lung cancer were 80.4%, 76.4% (standard 1) and 91.0%, 87.2% (standard 2) respectively (all P <0.05). In non-solid nodules, there was no significant difference in SUV max between benign and malignant lesions (P> 0.05), and the size of lesion and lobulation, air bronchus sign or vacuole sign, CT signs of blood vessels and other signs of differential diagnosis (all P <0.05). Forty patients with low-grade PET showed low-grade lung cancer, which were all misdiagnosed as benign lesions. Correcting 50% (20/40) of them with thin-section CT images. The standard 1 diagnostic lung cancer with a sensitivity of 40.0%, while the standard 2 diagnostic lung cancer, the sensitivity was 90%, the sensitivity of standard 2 in the diagnosis of non-solid nodules was significantly higher than the standard 1 (P = 0.000), but the specificity was not significant Sex differences (75.2% vs 58.3%, P = 0.667). However, for solid nodules, TLC showed no significant effect on the diagnosis (all P> 0.05). Conclusions For solitary pulmonary nodules, diagnosis of lung cancer based solely on SUV_ (max) ≥2.5 is not satisfactory. For non-solid nodules, a comprehensive analysis based on SUV max and thin-layer CT findings is required.