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

【Author】 Zhao Xin-Ming Wang Jian-Fang Zhang Jing-Mian Li De-Zhi Sun Li Dai Chun-Nuan 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符合线路显像与诊断CT图像融合在肿瘤诊断中的临床价值。方法:55例可疑恶性肿瘤或肿瘤复发转移的住院患者,男31例,女24例。年龄28₇8岁, 平均60．02±11．85岁。其中肺癌25例,宫颈癌8例,胃癌 5例,卵巢癌、食管癌、非何杰金氏淋巴瘤及原发灶不明者各 2例,甲状腺癌、胸膜间皮瘤、胰腺囊腺癌、胰腺囊肿、癌结肠癌、直肠癌、胆囊癌、乳腺癌、鼻咽癌各1例。分别进行可疑部位的螺旋CT扫描和全身18F—FDG符合线路显像。所有患者均于18F—FDG符合线路显像前后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。在融合后的图像上观察 18F—FDG显像浓聚灶在CT图像上的位置及其放射性摄取情况。以病理结果及临床随访为最终诊断结果。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对比分析。结果:在18F—FDG符合线路显像与CT相同的扫描范围内, 55例患者共检出病灶107处,其中恶性87处,良性20处。87 处恶性病灶中有81处18F—FDG符合线路显像与CT融合图像诊断真阳性。假阳性2处,假阴性6处,其中4处为胃癌腹腔淋巴结转移,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）。20处良性病灶中融合图像诊断 18处与最终结果一致。此外18F—FDG显像还发现了2处CT 扫描部位以外的身体其他部位的转移。在CT扫描中87处恶性病灶真阳性72处。假阳性10处,假阴性15处。20良性病灶有5处CT诊断与最终结果一致。18F—FDG符合线路显像与CT融合诊断恶性肿瘤病灶的灵敏度为93．1％（81／87）、特异性为90%（18／20）、准确度为92．5％（99／107）、阳性预测值为97．6％（81／83）、阴性预测值为75％（18／24）、假阳性率10％（2／20）、假阴性率6．9％（6／87）、阳性似然比9．31、阴性似然比0．076。而单纯诊断CT的灵敏度、特异性、准确度、阳性预测值、阴性预测值、假阳性率、假阴性率、阳性似然比及阴性似然比分别为82．75%（72／82）、25％（5／20）、 71．96％（77／107）、82．75％（72／87）、25％（5／20）、75％（15／ 20）、17．24％（15／87）、1.10和0．69。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:18F—FDG符合线路显像与诊断CT 图像融合是一种经经济有效的检查手段,在诊断肿瘤及肿瘤术后放化疗后复发转移方面,优于单纯CT,具有重要的临床价值,值得推广应用。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 spiral CT in the diagnosis of tumor. Methods: 55 patients with suspected tumor or with clinically suspected recurrence and metastases after tumor operation (31 men, 24 women, age from28 to 78, average age 60.02 ±11.85 years ) underwent 18F-FDG coincidence image using a dual-head coincidence (DHC) imaging 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 fusion imaging of 18F-FDG coincidence image and CT was done automatically by 3D image fusion software (syngo, Siemens). The final diagnosis was proved by pathology or clinical folio wing-up. Results: There are 107 lesions within the same examination region of 18F-FDG coincidence image and CT. 87 malignant lesions and 20 benign lesions were found in 55 patients in the study. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false positive rate, false negative rate, positive likelihood ratio and negative likelihood ratio of the fusion image of 18F-FDG coincidence image and CT in diagnosis tumor were 93.1 %(81/87), 90% (18/20), 92.5%(99/107), 97.6%(81/83), 75%(18/24), 10%(2/ 20), 6.9% (6/87 ), 9.31 and 0.08, respectively. Those of CT scan were 82.75%(72/87), 25%(5/20), 71.96%(77/107), 82.75%(72/87) 25%(5/20), 75% (15/20 ), 17.24% (15/ 87 ), 1.10 and 0.69, respectively. The difference is significant between the fusion imaging and CT alone in sensitivity, accuracy and negative predictive value (P<0.05). Conclusion: The fusion imaging 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 tumor, and the fusion imaging has important clinical value in detecting tumor or tumor recurrence and metastases.更多还原