【摘要】 目的：分析¹⁸F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在恶性胸膜间皮瘤（MPM）临床诊断及术后评估中的作用。方法：回顾性分析哈尔滨医科大学附属第一医院2015年4月-2020年3月首诊收治的27例疑似MPM患者的临床资料，所有患者术前均接受¹⁸F-FDG PET/CT检查，以术后病理活检结果为金标准，评价¹⁸F-FDG PET/CT对MPM的诊断价值；术后随访2年将病理检查确诊的23例MPM患者依据是否发生肿瘤转移分为未复发组（n=12）和复发组（n=11），比较不同分组¹⁸F-FDG PET/CT病灶类型分布及显像病灶最大标准摄取值（SUVmax），使用受试者工作特征曲线（ROC）分析SUVmax对MPM预后评估的效能。结果：27例可疑MPM患者病理组织活检最终确诊MPM共23例，上皮型13例，纤维肉瘤型6例，混合细胞型4例。病灶积聚类型：环形13例，结节型6例，不规则环形4例。¹⁸F-FDG PET/CT检出MPM共21例，其他胸膜病变6例，其中21例与病检结果相符，准确率为92.59%（25/27），敏感度91.30%，特异度为100%，Kappa值为0.757；¹⁸F-FDG PET/CT诊断环型MPM 13例，其中12例与病检结果相符，准确率为91.30%（21/23），敏感度为92.31%（12/13），特异度为90.00%（9/10）；结节型病灶检出7例，其中6例与病检结果相符，准确率为95.65%（22/23），敏感度为100%（6/6），特异度为94.12%（16/17）；诊断不规则环形3例，其中3例与病检结果相符，准确率为95.65%（22/23），敏感度为75.00%（3/4），特异度为100%（19/19）；¹⁸F-FDG PET/CT诊断MPM病灶积聚类型环形、结节型和不规则环形的Kappa值分别为0.823、0.893和0.832。复发组¹⁸F-FDG PET/CT环形病灶类型占比高于未复发组，且复发组SUVmax明显高于未复发组（P<0.05）。ROC示，当SUVmax值>12.40时预测MPM术后复发的效能较高（P<0.05），其曲线下面积（AUC）为0.886，敏感度为81.82%，特异度为83.33%，约登指数为0.652。结论：¹⁸F-FDG PET/CT诊断恶性胸膜间皮瘤和区分不同病灶积聚类型的准确度较高，且环形样胸膜增厚与¹⁸F-FDG PET/CT显像中SUVmax水平升高与术后复发转移存在关联，其中SUVmax对于预测MPM术后是否复发的效能较高。更多还原

【Abstract】 Objective:To analyze the role of ¹⁸F-fluorodeoxyglucose （FDG） positron emission tomography/computed tomography （PET/CT） in the clinical diagnosis and postoperative evaluation of malignant pleural mesothelioma （MPM）.Method:The clinical data of 27 patients with suspected MPM who were first diagnosed and treated in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed from April 2015 to March 2020.All patients underwent ¹⁸F-FDG PET/CT examination before surgery,and the diagnostic value of ¹⁸F-FDG PET/CT on MPM was evaluated with the postoperative pathological biopsy results as the gold standard.At 2-year follow-up after surgery,23 patients with MPM confirmed by pathological examination were divided into non-recurrence group （n=12） and recurrence group （n=11） according to whether tumor metastasis occurred.The distribution of ¹⁸F-FDG PET/CT lesion types and the maximum standard uptake value （SUVmax） of imaging lesions were compared among different groups.Receiver operating characteristic curve （ROC） was used to analyze the efficiency of SUVmax on the prognosis of MPM.Result:Pathological biopsy of 27 patients with suspected MPM finally confirmed 23 MPM cases,including 13 cases of epithelial type,6 cases of fibrosarcoma type and 4 cases of mixed cell type.Types of lesion accumulation were shown as annular in 13 cases,nodular in 6 cases and irregular annular in 4 cases.¹⁸F-FDG PET/CT detected 21 cases of MPM,6 cases of other pleural lesions,of which 21 cases were consistent with the results of pathological examination,with the accuracy rate,sensitivity,specificity and Kappa value of 92.59% （25/27）,91.30%,100% and 0.757.¹⁸F-FDG PET/CT diagnosed 13 cases of annular MPM,of which 12 cases were consistent with pathological examination,with the accuracy rate of 91.30% （21/23）,sensitivity of 92.31% （12/13） and specificity of 90.00% （9/10）.7 cases of nodular lesions were detected,of which 6 cases were consistent with pathological examination,with the accuracy rate,sensitivity and specificity of 95.65% （22/23）,100% （6/6） and 94.12% （16/17）.3 cases of irregular annular lesions were diagnosed,of which 3 cases were consistent with the results of the pathological examination,with accuracy rate,sensitivity and specificity of 95.65% （22/23）,75.00% （3/4） and 100% （19/19）.The Kappa values of ¹⁸F-FDG PET/CT in the diagnosis of annular,nodular and irregular annular MPM lesions were 0.823,0.893 and 0.832 respectively.The proportion of annular lesions by ¹⁸F-FDG PET/CT in recurrence group was higher than that in non-recurrence group,and the SUVmax was significantly higher than that in non-recurrence group （P<0.05）.ROC showed that when the SUVmax value was greater than 12.40,the efficiency of predicting postoperative recurrence of MPM was higher （P<0.05）,and the area under the curve （AUC）,sensitivity,specificity and Youden index were 0.886,81.82%,83.33% and 0.652.Conclusion:¹⁸F-FDG PET/CT has high accuracy in diagnosing malignant pleural mesothelioma and distinguishing different types of lesion accumulation,and annular-like pleural thickening and elevated SUVmax level in ¹⁸F-FDG PET/CT imaging are associated with postoperative recurrence and metastasis,and SUVmax has a high efficiency on predicting recurrence after MPM.更多还原