Ren Yun-Yan, Li You-Cai, Wu Hu-Bing, Wang Quan-Shi, Han Yan-Jiang, Zhou Wen-Lan, Li Hong-Sheng, Wang Zhen, Mohammed Shah Alam Mohammed Shah Alam
Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2017 Mar 20;37(3):283-289. doi: 10.3969/j.issn.1673-4254.2017.03.01.
To investigate whether fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) combined with thin-section CT improves the diagnostic performance for solitary pulmonary nodules (SPNs).
A total of 267 patients underwent examinations with 18F-FDG PET/CT and thin-section CT for evaluating the SPNs with undetermined nature, which was further confirmed by pathological examination or clinical follow-up. The performance of two diagnostic criteria based on findings in PET/CT alone (Criterion 1) and in PET/CT combined with thin-section CT (Criterion 2) were compared.
Thin-section CT provided greater diagnostic information for SPNs in 84.2% of the patients. Compared with Criterion 1, the diagnosis based on Criterion 2 significantly increased the diagnostic sensitivity (80.4% 91%, <0.01) and accuracy (76.4% 87.2%, <0.01) for lung cancer. The lesion size and the CT features including lobulation, air bronchogram, and feeding vessel, but not SUV, were all helpful for characterizing non-solid SPNs. Thin-section CT rectified diagnostic errors in 50% (20/40) of the cancerous lesions, which had been diagnosed as benign by PET due to their low metabolism. For non-solid SPNs, Criterion 2 showed a significantly higher diagnostic sensitivity than Criterion 1 (90.0% 40.0%, =0.000) but their diagnostic specificity were comparable (75.2% 58.3%, =0.667). For solid nodules, the use of thin-section CT resulted in no significant improvement in the diagnostic performance (>0.05).
The combination of PET/CT and thin-section CT creates a synergistic effect for the characterization of SPNs, especially non-solid nodules.
探讨氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）联合薄层CT是否能提高孤立性肺结节（SPN）的诊断效能。
共有267例患者接受了18F-FDG PET/CT和薄层CT检查，以评估性质未明的SPN，最终通过病理检查或临床随访得以进一步确诊。比较了仅基于PET/CT检查结果的两种诊断标准（标准1）和PET/CT联合薄层CT的诊断标准（标准2）的效能。
薄层CT为84.2%的患者的SPN提供了更多诊断信息。与标准1相比，基于标准2的诊断显著提高了肺癌的诊断敏感性（80.4%对91%，<0.01）和准确性（76.4%对87.2%，<0.01）。病变大小以及包括分叶、空气支气管征和供血血管在内的CT特征（而非SUV）均有助于非实性SPN的特征性诊断。薄层CT纠正了50%（20/40）癌性病变的诊断错误，这些病变因代谢低而被PET诊断为良性。对于非实性SPN，标准2显示出比标准1显著更高的诊断敏感性（90.0%对40.0%，=0.000），但其诊断特异性相当（75.2%对58.3%，=0.667）。对于实性结节，使用薄层CT并未显著提高诊断效能（>0.05）。
PET/CT与薄层CT联合应用对SPN尤其是非实性结节的特征性诊断具有协同作用。
