Department of Radiology, Division of Functional and Diagnostic Imaging Research, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
AJR Am J Roentgenol. 2013 Jun;200(6):W593-602. doi: 10.2214/AJR.12.9197.
The objective of our study was to prospectively compare the capability of dynamic area-detector CT analyzed with different mathematic methods and PET/CT in the management of pulmonary nodules.
Fifty-two consecutive patients with 96 pulmonary nodules underwent dynamic area-detector CT, PET/CT, and microbacterial or pathologic examinations. All nodules were classified into the following groups: malignant nodules (n = 57), benign nodules with low biologic activity (n = 15), and benign nodules with high biologic activity (n = 24). On dynamic area-detector CT, the total, pulmonary arterial, and systemic arterial perfusions were calculated using the dual-input maximum slope method; perfusion was calculated using the single-input maximum slope method; and extraction fraction and blood volume (BV) were calculated using the Patlak plot method. All indexes were statistically compared among the three nodule groups. Then, receiver operating characteristic analyses were used to compare the diagnostic capabilities of the maximum standardized uptake value (SUVmax) and each perfusion parameter having a significant difference between malignant and benign nodules. Finally, the diagnostic performances of the indexes were compared by means of the McNemar test.
No adverse effects were observed in this study. All indexes except extraction fraction and BV, both of which were calculated using the Patlak plot method, showed significant differences among the three groups (p < 0.05). Areas under the curve of total perfusion calculated using the dual-input method, pulmonary arterial perfusion calculated using the dual-input method, and perfusion calculated using the single-input method were significantly larger than that of SUVmax (p < 0.05). The accuracy of total perfusion (83.3%) was significantly greater than the accuracy of the other indexes: pulmonary arterial perfusion (72.9%, p < 0.05), systemic arterial perfusion calculated using the dual-input method (69.8%, p < 0.05), perfusion (66.7%, p < 0.05), and SUVmax (60.4%, p < 0.05).
Dynamic area-detector CT analyzed using the dual-input maximum slope method has better potential for the diagnosis of pulmonary nodules than dynamic area-detector CT analyzed using other methods and than PET/CT.
本研究旨在前瞻性比较不同数学方法分析的动态容积 CT 与 PET/CT 在肺结节管理中的应用。
52 例 96 个肺结节连续患者行动态容积 CT、PET/CT 及微生物或病理检查。所有结节分为以下组：恶性结节（n=57）、低生物活性良性结节（n=15）和高生物活性良性结节（n=24）。在动态容积 CT 上，采用双输入最大斜率法计算总、肺动脉和体动脉灌注；采用单输入最大斜率法计算灌注；采用 Patlak 图法计算提取分数和血容量（BV）。统计比较三组结节的所有指标。然后，使用接收者操作特征分析比较恶性和良性结节之间有显著差异的最大标准化摄取值（SUVmax）和每个灌注参数的诊断能力。最后，采用 McNemar 检验比较各指标的诊断性能。
本研究未观察到不良反应。除 Patlak 图法计算的提取分数和 BV 外，三组之间所有指标均有显著差异（p＜0.05）。双输入法计算的总灌注、双输入法计算的肺动脉灌注、单输入法计算的灌注曲线下面积均显著大于 SUVmax（p＜0.05）。总灌注的准确性（83.3%）明显大于其他指标：肺动脉灌注（72.9%，p＜0.05）、双输入法计算的体动脉灌注（69.8%，p＜0.05）、灌注（66.7%，p＜0.05）和 SUVmax（60.4%，p＜0.05）。
与其他方法和 PET/CT 相比，采用双输入最大斜率法分析的动态容积 CT 对肺结节的诊断具有更好的潜力。
