使用 320 层螺旋 CT 定量首过灌注成像与 FDG PET/CT 鉴别肺良恶性结节。

Differentiation of malignant and benign pulmonary nodules with quantitative first-pass 320-detector row perfusion CT versus FDG PET/CT.

机构信息

Department of Radiology, Division of Thoracic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.

出版信息

Radiology. 2011 Feb;258(2):599-609. doi: 10.1148/radiol.10100245.

DOI:10.1148/radiol.10100245

PMID:21273522

Abstract

PURPOSE

To prospectively compare the capability of quantitative first-pass perfusion 320-detector row computed tomography (CT) (ie, area-detector CT) with that of combined positron emission tomography and CT (PET/CT) for differentiation between malignant and benign pulmonary nodules.

MATERIALS AND METHODS

This prospective study was approved by the institutional review board, and written informed consent was obtained from 50 consecutive patients with 76 pulmonary nodules. All patients underwent dynamic area-detector CT, PET/CT, and microbacterial and/or histopathologic examinations. All pulmonary nodules were divided into three groups: malignant nodules (n = 43), benign nodules with low biologic activity (n = 6), and benign nodules with high biologic activity (n = 27). For each dynamic area-detector CT data set, the perfusion derived by using the maximum slope model (PF(MS)), extraction fraction derived by using the Patlak plot model (EF(PP)), and blood volume derived by using the Patlak plot model (BV(PP)) were calculated. These parameters were statistically compared among the three nodule groups. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability of the CT and PET/CT indexes. Finally, the sensitivity, specificity, and accuracy of each index were compared by using the McNemar test.

RESULTS

All indexes in the malignant nodule group were significantly different from those in the low-biologic-activity benign nodule group (P < .05). Areas under the ROC curve for PF(MS) and EF(PP) were significantly larger than those for BV(PP) (P < .05) and maximal standard uptake value (SUV(max)) (P < .05). The specificity and accuracy of PF(MS) and EF(PP) were significantly higher than those of BV(PP) and SUV(max) (P < .05).

CONCLUSION

Dynamic first-pass area-detector perfusion CT has the potential to be more specific and accurate than PET/CT for differentiating malignant from benign pulmonary nodules.

SUPPLEMENTAL MATERIAL

http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100245/-/DC1.

摘要

目的

前瞻性比较定量首过灌注 320 排 CT（面积探测器 CT）与正电子发射断层扫描和 CT（PET/CT）联合应用对良恶性肺结节的鉴别能力。

材料与方法

本前瞻性研究经机构审查委员会批准，并获得 50 例 76 个肺结节连续患者的书面知情同意书。所有患者均行动态面积探测器 CT、PET/CT、微生物和/或组织病理学检查。所有肺结节分为三组：恶性结节（n = 43）、低生物活性的良性结节（n = 6）和高生物活性的良性结节（n = 27）。对每个动态面积探测器 CT 数据集，通过最大斜率模型（PF（MS））计算灌注，通过 Patlak 图模型（EF（PP））计算提取分数，通过 Patlak 图模型（BV（PP））计算血容量。比较三组结节间各参数的统计学差异。采用受试者工作特征（ROC）曲线分析比较 CT 和 PET/CT 指标的诊断效能。最后，采用 McNemar 检验比较各指标的灵敏度、特异度和准确性。

结果

恶性结节组各指标均明显不同于低生物活性良性结节组（P <.05）。PF（MS）和 EF（PP）的 ROC 曲线下面积明显大于 BV（PP）（P <.05）和最大标准摄取值（SUV（max））（P <.05）。PF（MS）和 EF（PP）的特异度和准确性明显高于 BV（PP）和 SUV（max）（P <.05）。