【摘要】 目的探讨18氟-脱氧葡萄糖(18F-FDG)正电子发射计算机体层摄影(PET)-CT对肺癌诊断、分期、治疗及疗效监测的临床应用价值。方法80例肺癌患者,其中66例为术前诊断分期,14例为治疗后复查患者。均行18F-FDG PET-CT检查,23例行胸部检查,57例行全身检查。所有病例均在PET-CT检查前后加做薄层螺旋CT扫描。最后诊断均经手术病理、纤维支气管镜或穿刺活检病理证实。分析不同病理类型肺癌的18F-FDG摄取能力与病理诊断的符合率。按照美国癌症联合委员会(AJCC)肺癌的TNM分期标准对病变分别行CT、PET-CT分期,并将组织病理结果作为参照标准。结果(1)所有原发性肺癌均示异常放射性高摄取。不同组织学类型的肺癌对18F-FDG的摄取能力差异较大,以腺鳞癌和低分化鳞癌的摄取能力最强。(2)66例术前诊断分期的患者中,与病理符合的肺癌N分期,PET-CT61例,CT48例。PET-CT对肺癌的N分期与CT相比差异有统计学意义(χ2=8·89,P<0·01)。对肺癌N分期的敏感性、特异性、阳性预测值、阴性预测值,PET-CT分别为80·09%、97·14%、96·11%、84·70%;CT分别为56·48%、71·02%、63·21%、64·93%。CT发现了11例患者的17处转移,PET-CT发现了16例患者的39处转移。PET-CT与CT相比,改变了18例患者的治疗计划。(3)对14例治疗后复查的患者PET-CT能显示其在早期评价治疗疗效、区别手术瘢痕与复发提供了指导临床治疗等方面的信息。结论18F-FDG PET-CT对肺癌的诊断、分期有较高的诊断效能,对治疗及预后监测具有积极的意义。更多还原

【Abstract】 Objective To evaluate the c li nical value of [~18F]fluoro-2-deoxy-glucose(~18F-FDG) positron e mission tomographic (PET)-CT in the diagnosis, staging, therapy, and monitoring of lung cancer. Methods PET-CT was performed in 80 pat ients with lung cancer. The uptake of ~18F-FDG was analyzed and cancer st aging was determined by using TNM and American Joint Committee on Cancer staging systems. Histopathologic results served as the reference standard. The statis tical significance of differences among CT and PET-CT was determined by using t he SPSS 10.0 χ~2 test. Results (1)All lesions of lu ng cancer showed intense uptake of ~18F-FDG. The most intense uptake was showed in adenosquamous carcinoma and poorly differentiated squamous carcinoma. (2)Overall tumor staging was correctly classified as N stage with CT in 48 pat ients and with PET-CT in 61 patients. Differences in the accuracy of overall t umor staging between PET-CT and CT (P<0.01) were significant. Primary tu mor staging was correctly determined in more patients with PET-CT than with CT alone. Sensitivity, specificity, positive predictive value, and negative predic tive value were 80.09%, 97.14%, 96.11%, and 84.70%, respectively with PET-C T;56.48%, 71.02%, 63.21%, and 64.93%, respectively with CT. 17 distant met astases were detected in 11 patients with CT, 39 distant metastases were detecte d in 16 patients with PET-CT. PET-CT findings when compared with CT findings led to a treatment change for 18 patients. Conclusions ~18F-FDG PET-CT is an excellent modality in the diagnosis and staging of lung cancer. It has a positive effect on the treatment and prognostic monitorin g.更多还原