【作者】 张敬勉； 赵新明； 王建方； 李德志； 戴春暖； 孙莉； 王颖晨； 张召奇； 江志华；

【Author】 Zhang Jing-Mian Zhao Xin-Ming Wang Jian-Fang Li De-Zhi Dai Chun-Nuan Sun Li Wang Ying-Chen Zhang Zhao-Qi Jiang Zhi-Hua Department of nuclear medicine, the fourth hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院核医学科；

【摘要】 目的:评价18F—FDG符合线路显像与异机螺旋CT 融合诊断非小细胞肺癌术后或放化疗后复发转移的临床价值。方法:非小细胞肺癌术后或放化疗后疑复发转移者20例,其中男18例,女2例。年龄46～76岁,平均61．20±10．03岁。单纯手术治疗5例,术后给予化疗及放疗4例,单纯放疗4例, 单纯化疗3例;同时行放化疗4例。所有患者均行18F—FDG 显像,并于显像前后2周内行CT扫描。显像仪为Siemens e． cam duet型双探头1英寸晶体pET／SPECT仪。将以DICOM 格式保存的螺旋CT容积数据用syngo软件通过医院网络传输到PET／SPECT仪的数据处理工作站,应用3D图像融合软件进行图像融合。以病理结果及临床随访为最终诊断结果,随访内容包括:症状、体格检查、各种影像学检查(B超、CT 及MRI等)、肿瘤标志物检查(CEA等)及临床治疗措施等, 随访时间为6-15月。其中任何两项检查同时为异常考虑为阳性。将融合图像和单纯CT图像的诊断结果分别与最终诊断结果进行比较,并行对比分析。结果:在18F—FDG显像与CT 扫描相同的范围内,20例患者共检出病灶58处,其中恶性52 处,良性6处。52处恶性病灶中有49处18F—FDG与CT融合图像诊为术后或放化疗后复发转移。表现为肺内和(或)远处可见异常葡萄糖高代谢灶。假阳性1处,为对侧肺内炎性病变。假阴性3处,1处肺癌术后纵隔淋巴结转移;1处为肺内小转移灶(转移灶直径为0．7cm),另外1处为腹腔淋巴结转移。此外18F—FDG显像检出了2处CT扫描范围以外的身体其他部位的转移。52处恶性病灶中44处CT诊为复发转移。假阳性3处,假阴性10处。18F—FDG符合线路显像与CT融合诊断非小细胞肺癌复发转移的灵敏度为94．23％(49／52)、特异性为83．33％(5／6)、准确度为93．10％(54／58)、阳性预测值为98．00%(49／50)、阴性预测值为62．50%(5／8)、阳性似然比为5．65、阴性似然比为0．07。而单纯CT的灵敏度、特异性、准确度、阳性预测值、阴性预测值、阳性似然比及阴性似然比分别为81．48%(44／54)、25．00%(1／4)、77．59％(45／ 58)、93．62％(44／47)、9．09％(1／11)、1．09及0．74。在灵敏度、准确度、阴性预测值方面18F—FDG符合线路显像与CT 融合明显高于CT(P<0．05)。结论:1．在诊断非小细胞肺癌术后或放化疗后复发转移方面,18F—FDG符合线路显像与CT 融合同单纯CT相比,具有较高的灵敏度、准确度、阴性预测值、阳性似然比以及较低的阴性似然比,值得推广应用。2． 18F-FDG一次显像可同时检出局部复发和远处转移,具有较高临床应用价值。更多还原

【Abstract】 Objective: The aim of the study was to evaluate the clinical value of fusion of 18F-FDG coincidence image and CT in the diagnosis of non-small cell lung cancer recurrence and distant metastases, as compared with CT imaging. Methods: 20 patients with non-small cell lung cancer with clinically suspected recurrence and metastases (18 men, 2 women, average age 61.20 ± 10.03 years )underwent 18F-FDG coincidence image using a coincidence image device, meanwhile, all patients received a Computed Tomography (CT) scan using the spiral technique two weeks before or after the 18F-FDG coincidence image examination. The functional anatomic imaging fusion of 18F-FDG coincidence image and CT was done automatically by 3D image fusion software (syngo,siemens). The final diagnosis of recurrence and metastases was confirmed by pathology or clinical follow-up. The follow-up included symptom, medical examination, all kinds of imaging examinations (Ultrasound, Computed Tomography, Magnetic Resonance Imaging), tumor mark examination (CEA) and clinical treated management etc. It was considered recurrence and metastases when any two items of examination results was abnormal. The results of fusion imaging and CT imaging were compared with the final results. Results: In the same region of 18F-FDG coincidence image examination and CT scan, 52 malignant lesions and 6 benign lesions were found in 20 patients in the study. The fusion imaging of 18F-FDG coincidence image and CT showed markly uptake of 18F-FDG in 49 of 52 malignant lesions, three lesions false negative, one lesion false positive. Meanwhile, 18F-FDG imaging had detected two malignant lesions beyond CT scan region. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of fusion of 18F-FDG coincidence image and CT in defining non-small cell lung cancer recurrence and metastases were 94.23% (49/52), 83.33% (5/ 6), 93.10%(54/58), 98.00%(49/50), 62.50%(5/8), 5.65 and 0.07, respectively. those of CT scan were 81.48% (44/54), 25.00%(1/4), 77.59%(45/58), 93.62%(44/47) 9.09%(1/11), 1.09 and 0.74, respectively. The difference is significant between the fusion imaging and CT alone in sensitivity, accuracy and negative predictive value (P<0.05). Conclusion: As compared with CT, the fusion of 18F-FDG coincidence and CT has a higher sensitivity, accuracy, negative predictive value, positive likelihood ratio and a lower negative likelihood ratio in detecting recurrence and metastases in non-small cell lung cancer, and it is a quite valuable method to detect recurrence and metastases.更多还原