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  • 原文摘要
  • 目的:探讨18 F-FDG PET/CT显像对结直肠癌患者孤立性肺结节的临床诊断价值。方法:回顾性分析经病理诊断为结直肠癌(CRC)且PET/CT显像发现孤立性肺结节的59例患者的病例资料,其中男36例,女23例,年龄33~91岁,中位年龄(58.4±13.3)岁。分析SPN的部位、直径、最大标准摄取值(SUVmax),依据病灶的SUVmax值及CT形态特征综合判定病灶的性质,并与最终诊断结果(组织病理学诊断或长期临床随访结果)进行对照分析。结果:59例中32例最终诊断为恶性SPN,其中27例PET/CT显示为阳性;良性SPN27例,24例PET/CT 显示为阴性。PET/CT 对于结直肠癌患者SPN的诊断敏感度、特异度、符合率及阳性和阴性预测值分别为84.38%、88.89%、86.44%、90.00%及82.76%。恶性SPN的平均直径为(13.00±6.46)mm,良性 SPN 为(5.48±6.48)mm,两组间差异有统计学意义(t=-4.448,P<0.001)直径为5.5mm 时具有最大诊断效能。恶性 SPN 的 SUVmax 为3.30±2.17,良性 SPN 为1.19±1.30,两组间差异有统计学意义(t=-4.609,P<0.001),以SUVmax值1.15作为诊断良恶性结节的阈值时诊断效能最大。患者的年龄和病灶的发生部位对SPN良恶性的判断无统计学意义。结论:18 F-FDG PET/CT显像对于结直肠癌患者孤立性肺结节的检出及良恶性判断具有很高的敏感性和特异性,当结节直径大于5.5 mm或SUVmax大于1.15时提示病灶为恶性可能性较大。 Objective:To determine the utility of 18 F-FDG PET/CT imaging in indentifying solitary pulmonary nodules with colorectal cancer (CRC).Methods:A total of 706 patients with colorectal carcinoma underwent 18 F-FDG PET/CT for the detection of tumor recurrence from June 2011 to September 2014 at our PET center.This retrospective study in-cluded 59 patients for evaluation of SPN with CRC,36 men and 23 women,middle age 58.4±13.3 (ranged from 33 to 91). We analysed the location,diameter and SUVmax of the SPNs.The diagnosis relied on the SUVmax of PET and the mor-phology of CT.Proof of metastases was based on histopathology or clinical/imaging follow-up,demonstrating disease pro-gression or response.Results:There were 32 cases of confirmed malignant SPN from 59 cases,the PET/CT results were positive in 27 of 32 cases;there were 29 cases of confirmed benign SPN and the PET/CT nedules were mgative in 24 of 27 cases.For the group as a whole (n= 59),the sensitivity,specificity,accuracy,positive predict value (PPV)and negative pre-dict value (NPV)were 84.38%,88.89%,86.44%,90.00% and 82.76% respectively.The diameter of malignant SPNs were (13.00±6.46)mm,and that of the benign SPNs were (5.48±6.48)mm (t= -4.448,P<0.001).The SUVmax of malignant SPNs were 3.30±2.17 and the benign SPNs were 1.19±1.30 (t= -4.609,P<0.001).We could use the diam-eter of 5.5mm and the SUVmax of 1.15 or more as an indication of malignancy.But the location of the SPNs and the age of the patients had no statistic difference to evaluate the SPNs.Conclusion:FDG-PET/CT has high sensitivity and specificity in the evaluation of solitary pulmonary nodules in patients with colorectal cancer.We could use the diameter of 5 .5mm or more and the SUVmax of 1 .1 5 or more as an indication of malignant.
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