Dewan N A, Gupta N C, Redepenning L S, Phalen J J, Frick M P
Department of Medicine, Creighton University, Omaha.
Chest. 1993 Oct;104(4):997-1002. doi: 10.1378/chest.104.4.997.
Positron emission tomography (PET), a new noninvasive imaging modality, utilizing 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG), has demonstrated increased FDG uptake in lung tumors.
To determine the diagnostic efficacy of PET-FDG imaging in differentiating benign from malignant solitary pulmonary nodules.
A prospective study of 30 patients who presented with indeterminate solitary pulmonary nodules less than 3 cm in size based on chest radiograph and computed tomographic (CT) scan.
Two tertiary care medical centers in Omaha, Neb: Creighton University Medical Center and the Omaha Veterans Administration Medical Center.
Positron emission tomographic imaging of the lung was performed 1 h after intravenous injection of 10 mCi of F-18-FDG. Qualitative analysis of the images was performed independently by two observers by visual identification of the areas of increased FDG uptake in the lung nodules. Semiquantitative analysis was performed using computation of differential uptake ratio (DUR). Histologic specimens were obtained in 29 patients (thoracotomy 20, transthoracic needle aspiration biopsy 8, bronchoscopy 1).
Positron emission tomographic imaging correctly identified 27 of 30 pulmonary nodules. Diagnostic accuracy was high with sensitivity of 95 percent and specificity of 80 percent. The positive and negative predictive value of PET imaging for solitary pulmonary nodules was 90 percent and 89 percent, respectively. The DUR values were significantly higher for malignant nodules (mean +/- SD, 5.55 +/- 2.79) than benign nodules (mean +/- SD, 0.95 +/- 0.99) (p < 0.001). There was one false-negative result in a patient with a 1-cm nodule identified as a scar adenocarcinoma. There were two false-positive cases and both had caseating granulomas with active inflammation and Histoplasma organisms.
PET-FDG imaging of the lung, a new noninvasive diagnostic test, has a high degree of accuracy in differentiating benign from malignant pulmonary nodules. PET-FDG imaging could complement CT scanning in the evaluation and treatment of patients with solitary pulmonary nodules.
正电子发射断层扫描（PET）是一种新型非侵入性成像方式，利用2-[F-18]-氟-2-脱氧-D-葡萄糖（FDG），已证实在肺肿瘤中FDG摄取增加。
确定PET-FDG成像在鉴别良性与恶性孤立性肺结节方面的诊断效能。
一项对30例患者的前瞻性研究，这些患者根据胸部X线片和计算机断层扫描（CT）显示有大小小于3 cm的不确定孤立性肺结节。
内布拉斯加州奥马哈市的两家三级医疗中心：克里顿大学医学中心和奥马哈退伍军人管理局医疗中心。
静脉注射10 mCi的F-18-FDG 1小时后进行肺部正电子发射断层成像。两名观察者独立对图像进行定性分析，通过视觉识别肺结节中FDG摄取增加的区域。使用差异摄取率（DUR）计算进行半定量分析。29例患者获得了组织学标本（开胸手术20例，经胸针吸活检8例，支气管镜检查1例）。
正电子发射断层成像正确识别了30个肺结节中的27个。诊断准确性高，敏感性为95%，特异性为80%。PET成像对孤立性肺结节的阳性和阴性预测值分别为90%和89%。恶性结节的DUR值（均值±标准差，5.55±2.79）显著高于良性结节（均值±标准差，0.95±0.99）（p<0.001）。1例1 cm结节被诊断为瘢痕腺癌的患者出现1例假阴性结果。有2例假阳性病例，两者均有干酪样肉芽肿伴活动性炎症和荚膜组织胞浆菌。
肺部PET-FDG成像作为一种新型非侵入性诊断测试，在鉴别良性与恶性肺结节方面具有高度准确性。PET-FDG成像可在孤立性肺结节患者的评估和治疗中补充CT扫描。
