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目的探讨18氟-脱氧葡萄糖(18F-FDG)正电子发射计算机体层摄影(PET)-CT对肺癌诊断、分期、治疗及疗效监测的临床应用价值。方法80例肺癌患者,其中66例为术前诊断分期,14例为治疗后复查患者。均行18F-FDG PET-CT检查,23例行胸部检查,57例行全身检查。所有病例均在PET-CT检查前后加做薄层螺旋CT扫描。最后诊断均经手术病理、纤维支气管镜或穿刺活检病理证实。分析不同病理类型肺癌的18F-FDG摄取能力与病理诊断的符合率。按照美国癌症联合委员会(AJCC)肺癌的TNM分期标准对病变分别行CT、PET-CT分期,并将组织病理结果作为参照标准。结果(1)所有原发性肺癌均示异常放射性高摄取。不同组织学类型的肺癌对18F-FDG的摄取能力差异较大,以腺鳞癌和低分化鳞癌的摄取能力最强。(2)66例术前诊断分期的患者中,与病理符合的肺癌N分期,PET-CT61例,CT48例。PET-CT对肺癌的N分期与CT相比差异有统计学意义(χ2=8·89,P<0·01)。对肺癌N分期的敏感性、特异性、阳性预测值、阴性预测值,PET-CT分别为80·09%、97·14%、96·11%、84·70%;CT分别为56·48%、71·02%、63·21%、64·93%。CT发现了11例患者的17处转移,PET-CT发现了16例患者的39处转移。PET-CT与CT相比,改变了18例患者的治疗计划。(3)对14例治疗后复查的患者PET-CT能显示其在早期评价治疗疗效、区别手术瘢痕与复发提供了指导临床治疗等方面的信息。结论18F-FDG PET-CT对肺癌的诊断、分期有较高的诊断效能,对治疗及预后监测具有积极的意义。
Objective To investigate the clinical value of 18F-FDG positron emission computed tomography (CT) -CT in the diagnosis, staging, treatment and monitoring of lung cancer. Methods Eighty patients with lung cancer, of which 66 cases were diagnosed preoperatively and 14 cases were reviewed after treatment. All patients underwent 18F-FDG PET-CT examination, 23 patients underwent chest examination and 57 patients underwent general examination. All cases were made thin-slice spiral CT scan before and after PET-CT examination. The final diagnosis by surgical pathology, fibrobronchoscopy or biopsy biopsy confirmed. Analysis of different pathological types of lung cancer 18F-FDG uptake capacity and pathological diagnosis of coincidence rate. According to the American Joint Committee on Cancer (AJCC) TNM staging criteria for lung cancer were performed CT, PET-CT staging, and histopathological findings as a reference standard. Results (1) All primary lung cancer showed abnormal radioactive uptake. Different histological types of lung cancer uptake capacity of 18F-FDG vary greatly to adenosquamous carcinoma and poorly differentiated squamous cell carcinoma uptake capacity. (2) Among the 66 patients with preoperative staging, N staging, PET-CT, and CT48 were all consistent with the pathological findings. PET-CT of lung cancer N staging compared with CT was statistically significant (χ2 = 8 · 89, P <0.01). The sensitivity, specificity, positive predictive value, negative predictive value and PET-CT of N stage of lung cancer were 80.09%, 97.14%, 96.11% and 84.7%, respectively; the CT values were 56.48 %, 71.02%, 63.21%, 64.93%. Seventeen metastases from 11 patients were found by CT, and 39 from 16 patients were detected by PET-CT. PET-CT compared with CT, changed the treatment plan of 18 patients. (3) The PET-CT of 14 patients who were reviewed after treatment showed that they could evaluate the curative effect in early stage, and provide information to guide the clinical treatment of surgical scar and recurrence. Conclusion 18F-FDG PET-CT has a high diagnostic value for the diagnosis and staging of lung cancer, and has positive significance for the treatment and prognosis monitoring.