【摘要】 目的:探讨正电子发射体层扫描及电视纵隔镜在中纵隔肿物(包括肿瘤及淋巴结)的诊断价值。方法:35例患者在4周内进行CT、11C-胆碱PET-CT及电视纵隔镜检查。应用11C-胆碱作为PET示踪剂,应用标准摄取值(SUV)作为PET检测指标,并与病理结果对照。结果:单纯纵隔病灶中,诊断为结节病的患者12例,结核5例,淋巴瘤7例,无典型“结节”的非干酪性肉芽肿3例。非小细胞肺癌或高度怀疑肺癌的患者8例中,有7例证实为纵隔淋巴结转移(N2或N3),1例纵隔淋巴结病理为反应性增生。根据良恶性分类,CT、11C-胆碱PET-CT及电视纵隔镜对纵隔肿物的诊断准确性分别为51.4%(18/35)、74.3%(26/35)及100%(35/35),电视纵隔镜优于11C-胆碱PET-CT(χ2=22.453,P=0.000)。恶性病灶的SUV值6.9(3.2～9.8,n=14)略高于良性病灶4.9(2.9～8.3,n=21),但差异无统计学意义,P=0.051。结论:电视纵隔镜对中纵隔疾病的诊断仍然是金标准,具有较高的准确性。11C-胆碱PET-CT对良恶性病灶的鉴别上有一定价值,单纯CT及单纯PET(SUV值)在一定程度上导致误诊。更多还原

【Abstract】 OBJECTIVE:To explore the value of positron emission tomography（PET）and videomediastinoscopy in the diagnosis of middle mediastinal masses which comprise a wide variety of tumors or lymphadenopathy.METHODS:Thirty-five patients were subjected to CT,PET-CT and videomediastionoscopy within four weeks.11C-choline,as PET tracers,was used to visualize various masses.PET data were evaluated by using the standardized uptake value（SUV）and were analyzed in accordance with the pathologic data.RESULTS:There were 15 men and 20 women aged from 21 to 74（mean 45.6）.Among the patients with mediastinal diseases,sarcoidosis was diagnosed in 12 patients,tuberculosis in 5 patients,lymphoma in 7 patients,and noncaseating granulomata without classical “sarcoid” in 3 patients.N₂ or N₃ nodal metastasis was revealed in 7 of 8 patients who had non-small cell lung cancer or suspected lung cancer,one was negative（the pathological diagnosis was reactive hyperplasia）.The accuracy of CT,PET-CT and videomediastinoscopy,if the diagnosis classified as benign or malignancy,was 51.4%（18/35）,74.3%（26/35）,100%（35/35）,respectively.The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT,χ2=22.453,P=0.000.The SUV of malignancy lesion（6.9,3.2-9.8;n=14）was higher than that of benign lesion（4.9,2.9-8.3;n=21）,however,the difference was not statistically significant,P=0.051.CONCLUSION:To diagnose lesions located in the middle mediastinumn,we confirm that videomediastinoscopy with a high diagnostic yield remains the gold standard.PET-CT is available for diagnosis of benign or malignancy lesion,however,CT alone or PET alone（SUV）may provide misdignosis in a certain proportion.更多还原