【作者】 常林凤；

【导师】 卢光明；

【作者基本信息】 南方医科大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 肺癌是危害人类健康的主要肿瘤之一，肺癌预后与其是否能早期诊断、早期治疗密切相关。影像学检查对肺癌的早期诊断、治疗方案的选择、疗效的观察及预后的评估至关重要。PET与X线、CT、MR等解剖学影像检查的差异在于其是功能学影像，能够无创性、定性、定量显示机体功能和代谢状况，因而具有一定的优势。¹⁸F-FDG PET及PET／CT在肺部肿瘤中的应用较广，常以SUVmax值≥2．5作为判断良、恶性病变的标准，但存在较多假阳性和假阴性，如何应用¹⁸F-FDG PET／CT显像判断肺良、恶性病变一直是研究的重点问题。¹¹C-胆碱作为一种新型PET显像剂，在临床肿瘤研究中也受到高度重视。第一部分¹⁸F-脱氧葡萄糖PET／CT显像在肺部肿块病变诊断中的价值目的：探讨¹⁸F-FDG PET／CT显像对肺部良、恶性病变的诊断价值，并探讨¹⁸F-FDG PET／CT显像SUVmax值与肺部肿块病变大小及肺癌的病理类型有无相关性。材料与方法：122例肺部肿块病变患者静脉注射¹⁸F-FDG 8-10mCi 60分钟后行全身PET／CT显像，将¹⁸F-FDG PET及PET／CT显像结果与病理结果进行对照分析：（1）从灵敏度、特异性、准确性、阳性预测值、阴性预测值方面评价¹⁸F-FDGPET及PET／CT显像对肺部良、恶性病变的诊断价值；（2）评价肺良、恶性病变¹⁸F-FDG PET／CT显像SUVmax的差异；（3）分析¹⁸F-FDG PET／CT显像SUVmax值与肺部病变大小有无相关性；（4）分析肺癌不同病理类型SUVmax值的差异。结果：（1）¹⁸F-FDG PET显像结果：正确诊断肺癌82例，良性病变18例；假阴性8例，假阳性14例。灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为：91．1％、56．3％、81．97％、85．4％、69．2％。¹⁸F-FDG PET／CT显像结果：正确诊断肺癌84例，良性病变27例；假阴性6例，假阳性5例。灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为：93．3％、84．4％、91％、94．4％、81．8％。¹⁸F-FDG PET／CT显像诊断准确性高于¹⁸F-FDG PET显像（X²=4．24），P<0．05。（2）肺癌SUV_max值（9．51±4．80）明显高于肺良性病变SUV_max值（2．77±1．73），两者之间的差异有统计学意义；（3）¹⁸F-FDG PET／CT显像SUV_max与肺部病灶大小有正相关关系；腺癌与鳞癌之间SUV_max差异没有统计学意义，肺泡细胞癌SUV_max低于腺癌与鳞癌。结论：（1）¹⁸F-FDG PET／CT显像是一种无创伤性的诊断肺部良、恶性病变的有效方法，诊断效能优于单纯PET检查。（2）病灶越大，¹⁸F-FDG PET／CT显像SUV值越高。腺癌与鳞癌SUV值无差别，肺泡细胞癌SUV值明显低于腺癌与鳞癌。第二部分¹¹C-胆碱与¹⁸F-脱氧葡萄糖PET／CT显像在原发性肺癌中的对比研究目的：通过¹¹C-胆碱与¹⁸F-FDG PET／CT显像在原发性肺癌中的对比研究，探讨原发性肺癌中¹¹C-胆碱与¹⁸F-FDG PET／CT显像的相关性。材料与方法：对20例经病理学证实的原发性肺癌患者包括腺癌10例，鳞癌6例，小细胞癌2例，肺泡细胞癌2例行¹¹C-胆碱及¹⁸F-FDG PET／CT显像，分别分析¹¹C-胆碱及¹⁸F-FDG PET／CT图像，进行半定量分析，计算SUV，并利用统计学方法分析：（1）¹¹C-胆碱与¹⁸F-FDG PET／CT显像结果的差异；（2）¹¹C-choline及¹⁸F-FDG PET／CT显像SUV值的差异，分析两种显像剂SUV值间的相关性；（3）¹¹C-胆碱PET／CT显像SUV值与病变大小的相关性。结果：（1）20例原发性肺癌17例¹¹C-胆碱及¹⁸F-FDG代谢增高，3例¹¹C-胆碱及¹⁸F-FDG代谢未见明显增高；（2）¹¹C-胆碱的SUV明显低于¹⁸F-FDG的SUV，¹¹C-胆碱SUV与¹⁸F-FDG的SUV有正相关关系；（3）¹¹C-胆碱的SUV与肺癌病灶大小有正相关关系。结论：原发性肺癌¹¹C-胆碱PET／CT显像灵敏度与¹⁸F-FDG PET／CT显像相似。病灶越大，¹¹C-胆碱PET／CT显像SUV值越高。¹¹C-胆碱PET／CT显像在原发性肺癌的诊断中具有一定价值。更多还原

【Abstract】 Pulmonary carcinoma is one of the major malignant tumors which harm human health. The prognosis of pulmonary carcinoma has a close relationship with earlier diagnosis and earlier treatment. Medical imaging played an important role in diagnosis, treatment planning, therapeutic effectiveness and prognosis evaluation. Compared with morphologic imaging modalities such as X-ray plain film, CT and MRI, PET with the merits of functional and anatomical imaging could display function and metabolism noninvasively, quantitively and qualitively. F-FDG PET and PET/CT imaging had wide application in diagnosis of pulmonary tumors. The SUVmax more than or equal to 2.5 was regarded as positive, but this PET diagnostic criteria of pulmonary malignancies had false positive and false negative results. How to use ¹⁸F-FDG PET to characterize pulmonary masses is the hot topic. ¹¹C-choline acting as a novel PET tracing agent is emphasized in clinical research of the tumors nowadays. PartⅠApplication of ¹⁸F-FDG PET/CT imaging in the diagnosis ofpulmonary massesObjective: To investigate the value of ¹⁸F-FDG PET/CT imaging in the diagnosis of benign and malignant pulmonary lesions,to explore the correlation between the F-FDG PET maximum standardized uptake value （SUVmax） and the size of pulmonary lesions and to study the difference of SUVmax between different pathological types.Materials and methods: 122 cases with pulmonary masses were underwent ¹⁸F-FDG PET/CT imaging.Images were obtained 60min after the injection of 296-370MBq ¹⁸F-FDG. PET and PET/CT images were analyzed. The results were compared with pathological results. Statistical analysis was done, including the following issues.（1）Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were computed to evaluate the diagnosis value of ¹⁸F-FDG PET and PET/CT in pulmonary benign and malignant lesions.（2）The difference of SUVmax for ¹⁸F-FDG PET/CT imaging between benign and malignant lesions.（3）The correlation between SUV of ¹⁸F-FDG PET/CT imaging and the size of pulmonary lesions and the difference of SUVmax between different pathological types.Results: （1）82 cases with pulmonary carcinoma and 18 cases with benign pulmonary lesions were correctly diagnosed with 8 false negative results and 14 false positive results for ¹⁸F-FDG PET imaging in 122 cases with pulmonary lesions. The Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET imaging were 91.1%, 56.3%, 81.97%, 85.4% and 69.2 % respectively. 84 cases with pulmonary carcinoma and 27 cases with pulmonary benign lesions were correctly diagnosed with 6 false negative results and 5 false positive results for PET/CT imaging. The Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT imaging were 93.3%, 84.4%, 91%, 94.4% and 81.8 % respectively. The accuracy of ¹⁸F-FDG PET/CT imaging was higher than that of ¹⁸F-FDG PET imaging （X²=4. 24, P<0. 05 ） . （2）SUVmax of pulmonary carcinoma （9.51±4.80） was significantly higher than the values of benign pulmonary lesions （2.77±1.73） for ¹⁸F-FDG PET/CT imaging.（3）There was a positive correlation between SUVmax of ¹⁸F-FDG PET/CT imaging and the size of pulmonary lesions, and there was no statistical significance for SUVs between adencarcinoma and squamous carcinoma. SUV of bronchioalveolar carcinoma was significantly lower than adencarcinoma and squamous carcinoma.Conclusions: （1） ¹⁸F-FDG PET/CT imaging is an effective and noninvasive method in the diagnosis of benign and malignant pulmonary lesions. The diagnosis efficiency is superior to that of PET imaging.（2）SUVmax of ¹⁸F-FDG PET imaging increases with the enlargement of the lesion.There is no difference for SUVs between adencarcinoma and squamous carcinoma and SUV of bronchioalveolar carcinoma is significantly lower than adencarcinoma and squamous carcinoma. PartⅡComparison of ¹¹C-Choline and ¹⁸F-FDG PET/CT imaging in thediagnosis of primary pulmonary carcinomaObjective: To compare the diagnostic value of ¹¹C-choline and ¹⁸F-FDG PET/CT imaging in the detection of primary pulmonary carcinoma, to explore the relationship of ¹¹C-choline PET/CT imaging and ¹⁸F-FDG PET/CT imaging in primary pulmonary carcinoma.Materials and methods: 20 cases with histologically proven primary pulmonary carcinoma （10 cases with adencarcinoma, 6 cases with squamous carcinoma, 2 cases with small cell carcinoma, 2 case with bronchioalveolar carcinoma） were done with ¹¹C-choline PET/CT imaging and ¹⁸F-FDG PET/CT imaging. Images were analyzed semi-quantitively and SUV of the lesions with the differential imaging agent were calculated. Finally statistical analyses were done, including the following issues. （1） The difference of results for ¹¹C-Choline and ¹⁸F-FDG PET/CT imaging.（2） The difference of SUVs between ¹¹C-choline and ¹⁸F-FDG PET/CT imaging, the relationship of SUVs between ¹¹C-choline and ¹⁸F-FDG PET/CT imaging.（3） The relationship between SUVs of ¹¹C-choline PET/CT imaging and the size of lesions.Results: （1）Both ¹¹C-choline and ¹⁸F-FDG PET/CT imaging showed an increase in tracer uptake in 17 of 20 patients with primary pulmonary carcinoma. However neither ¹¹C-choline nor ¹⁸F-FDG PET/CT imaging showed an increase in tracer uptake in the other three patients.（2）SUVs of the lesions using the ¹¹C-choline PET/CT imaging were lower significantly than the values of ¹⁸F-FDG PET/CT imaging. There was a positive correlation between SUVs of ¹⁸F-FDG and ¹¹C-choline PET/CT imaging in pulmonary carcinoma. （3） SUVs of ¹¹C-choline PET/CT imaging had a positive correlation with the size of the lesions. Conclusions: The sensitivity of ¹¹C-choline PET/CT imaging is similar to that of ¹⁸F-FDG PET/CT imaging in primary pulmonary carcinoma. SUVmax of ¹¹C-choline PET/CT imaging increases with the enlargement of the lesion.¹¹C-choline PET/CT imaging is valuable in differentiating primary pulmonary carcinoma.更多还原