F-FDG PET/CT对特发性肺纤维化患者孤立性肺结节的鉴别诊断是否有用？

Is F-FDG PET/CT useful for the differential diagnosis of solitary pulmonary nodules in patients with idiopathic pulmonary fibrosis?

作者信息

Lee Suk Hyun, Sung Changhwan, Lee Hyo Sang, Yoon Hee-Young, Kim Soo-Jong, Oh Jungsu S, Song Jin Woo, Kim Mi Young, Ryu Jin-Sook

机构信息

Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

出版信息

Ann Nucl Med. 2018 Aug;32(7):492-498. doi: 10.1007/s12149-018-1273-9. Epub 2018 Jul 4.

DOI:10.1007/s12149-018-1273-9

PMID:29974372

Abstract

OBJECTIVE

Idiopathic pulmonary fibrosis (IPF) is associated with an increased incidence of lung cancer, but patients with IPF often have poor pulmonary function and are vulnerable to pneumothorax and so using an invasive procedure to diagnose a single nodule detected on chest CT risks a critical adverse outcome. F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) is recognized to be useful for differentiating between benign and malignant solitary pulmonary nodules (SPN) in patients without IPF, but its diagnostic accuracy has not been investigated in patients with IPF. In this study, therefore, we investigated whether F-FDG PET/CT is useful for the differential diagnosis of SPNs in patients with IPF.

METHODS

From the IPF patient cohort of our institution, we retrospectively reviewed 55 patients (54 men, 1 woman; age 67.8 ± 7.6 years) with an SPN sized 8-30 mm (mean 18.5 ± 5.7 mm) who underwent chest CT followed by F-FDG PET/CT between April 2004 and March 2016. The F-FDG uptake of the SPN was analyzed visually and semiquantitatively, and these determinations were compared with the final diagnosis obtained by pathology (n = 52) or imaging follow-up (n = 3).

RESULTS

The final diagnoses showed that 41 (75%) of the SPNs were malignant (21 squamous cell carcinomas, 9 adenocarcinomas, 5 small-cell carcinomas, 4 mixed-type carcinomas, 1 large-cell neuroendocrine carcinoma, and 1 sarcoid carcinoma) and 14 (25%) were benign. The determination of malignant SPNs by visual analysis of the PET/CT images had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 98, 86, 95, and 92%, respectively. The semiquantitative analysis using a maximum standardized uptake value of 2.0 as the cut-off had a sensitivity, specificity, PPV, and NPV of 95, 93, 98, and 87%, respectively.

CONCLUSIONS

F-FDG PET/CT is useful for differentiating benign and malignant SPNs in patients with IPF, as it is for patients without IPF.

摘要

目的

特发性肺纤维化（IPF）与肺癌发病率增加相关，但IPF患者通常肺功能较差，且易发生气胸，因此使用侵入性检查来诊断胸部CT发现的单个结节有导致严重不良后果的风险。氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）被认为有助于鉴别无IPF患者的良性和恶性孤立性肺结节（SPN），但其在IPF患者中的诊断准确性尚未得到研究。因此，在本研究中，我们调查了F-FDG PET/CT对IPF患者SPN的鉴别诊断是否有用。

方法

从我们机构的IPF患者队列中，我们回顾性分析了2004年4月至2016年3月期间接受胸部CT及随后F-FDG PET/CT检查的55例SPN大小为8-30mm（平均18.5±5.7mm）的患者（54例男性，1例女性；年龄67.8±7.6岁）。对SPN的F-FDG摄取进行视觉和半定量分析，并将这些结果与通过病理（n=52）或影像随访（n=3）获得的最终诊断进行比较。

结果

最终诊断显示，41个（75%）SPN为恶性（21例鳞状细胞癌、9例腺癌、5例小细胞癌、4例混合型癌、1例大细胞神经内分泌癌和1例类癌），14个（25%）为良性。通过PET/CT图像视觉分析诊断恶性SPN的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为98%、86%、95%和92%。以最大标准化摄取值2.0为临界值的半定量分析的敏感性、特异性、PPV和NPV分别为95%、93%、98%和87%。