18F-FDG PET/CT代谢采集参数在老年孤立性肺腺癌和肺结核的诊断价值

Diagnostic value of 18F-FDG PET/CT metabolic parameters in solitary lung adenocarcinoma and solitary pulmonary tubercu-losis in elderly patients

中文关键词: 老年  孤立性肺腺癌  孤立性肺结核  18F-FDG PET/CT代谢采集参数  诊断价值

英文关键词: elderly  solitary lung adenocarcinoma  solitary pulmonary tuberculosis  18F-FDG PET/CT metabolic pa-rameter  diagnostic value

中文摘要:

      目的 探讨18 F-FDG PETCT代谢采集参数在老年孤立性肺腺癌和肺结核的诊断价值.方法 回顾性分析2023 年6 月—2024 年1 月在首都医科大学附属北京胸科医院行18F-FDG PET/CT检查随后经组织学病理等检查确诊的640 例患者的临床资料,其中老年孤立性肺腺癌326 例(设为孤立性肺腺癌组),老年孤立性肺结核314 例(设为孤立性肺结核组).比较2 组18F-FDG PET/CT代谢采集参数、CT形态学特征观察值、凝血指标(凝血活酶时间、凝血酶原时间、纤维蛋白原水平、凝血酶时间、D-二聚体、)值、肿瘤标志物(糖类抗原 153、神经元特异性烯醇化酶)值;采用Kappa一致性分析18F-FDG PET/CT对老年孤立性肺腺癌和肺结核的诊断价值,并绘制受试者工作特征(ROC)曲线,评估各参数对老年孤立性肺腺癌和肺结核鉴别价值.结果 640 例患者均顺利完成检查,图像清晰,显像效果良好.2 组CT形态学特征在形态、边界、毛刺征、卫星灶、空洞、空泡、空气支气管征、淋巴结肿大观察值差异均无统计学意义(P＞0.05);2 组患者CT形态学特征在分叶征、血管集束征、树芽征观察值差异均有统计学意义(P＜0.05).2 组患者肿瘤代谢体积(MTV)、凝血活酶时间、凝血酶时间差异均无统计学意义(P＞0.05);孤立性肺腺癌组患者标准化摄取值(SUV)max、SUVmin、SUVmean、SUVpeak均高于孤立性肺结核组;孤立性肺腺癌组患者凝血酶原时间、纤维蛋白原水平、D-二聚体水平均少/低于孤立性肺结核组(P＜0.05);孤立性肺腺癌组患者糖类抗原 153、神经元特异性烯醇化酶水平均高于孤立性肺结核组(P＜0.05).以患者SUVmax≥2.5 作为判断标准,所有肺腺癌患者SUVmax值均≥2.5,89 例肺结核患者的SUVmax值＜2.5.18F-FDG PET/CT鉴别诊断老年孤立性肺腺癌、肺结核的敏感度、特异度、准确率分别为 100.00%、28.34%、64.84%.ROC曲线分析显示,SUVmax、SUVmin、SUVmean、SUVpeak鉴别诊断老年孤立性肺腺癌和肺结核的曲线下面积(AUC)值分别为0.723、0.734、0.966、0.851,血清指标凝血酶原时间、纤维蛋白原水平、D-二聚体、糖类抗原153、神经元特异性烯醇化酶鉴别诊断老年孤立性肺腺癌和肺结核的AUC值分别为 0.721、0.668、0.793、0.998、0.992.结论 18F-FDG PET/CT代谢采集参数在老年孤立性肺腺癌和肺结核的鉴别诊断中具有一定诊断价值,单独以SUVmax≥2.5 作为判断标准具有较大局限性,临床上应同时参考多个参数进行辅助鉴别诊断.

英文摘要:

      Objective To explore the diagnostic value of 18F-FDG PET/CT metabolic parameters in solitary lung ade-nocarcinoma(SLA)and solitary pulmonary tuberculosis(SPT)in elderly patients.Methods The clinical data of 640 elderly patients who underwent 18F-FDG PET/CT examination and were subsequently confirmed by histopathological examinations in Beijing Chest Hospital Affiliated to Capital Medical University from June 2023 to January 2024 were retrospectively analyzed,including 326 cases with SLA(SLA group)and 314 ones with SPT(SPT group).The metabolic parameters of 18F-FDG PET/CT,CT morphological characteristics,coagulation indexes(thromboplastin time,prothrombin time,fibrinogen content,thrombin time,D-dimer,)and tumor markers(carbohydrate antigen 153,neuron-specific enolase)were compared between the two groups.The diagnostic value of 18F-FDG PET/CT in SLA and SPT was analyzed by Kappa consistency analysis.The re-ceiver operating characteristic(ROC)curve was drawn to evaluate the value of each parameter in the differentiation of SLA and SLA in elderly patients.Results All 640 patients completed the examination successfully with clear images and good imaging effect.There was no significant difference in some CT morphological characteristics(morphology,boundary,spicule sign,satellite lesion,cavity,vacuole,air bronchogram,lymph node enlargement)between the two groups(P＞0.05),but there were significant differences in other CT morphological characteristics(lobulation sign,vessel convergence sign,tree-in-bud)between the two groups(P＜0.05).There was no significant difference in metabolic tumor volume(MTV),thromboplastin time or thrombin time between the two groups(P＞0.05).The standardized uptake maximal value(SUVmax),minimal value(SUVmin),mean value(SUVmean)and peak value(SUVpeak)of the SLA group were higher than those of the SPT group,and the prothrombin time,fibrinogen and D-dimer were shorter/lower than those of the SPT group(P＜0.05),the levels of carbohydrate antigen 153 and neuron-specific enolase were higher than those of the SPT group(P＜0.05).Taking SUVmax≥2.5 as the judgement standard,all patients with lung adenocarcinoma had SUVmax values≥2.5,and 89 patients with pulmo-nary tuberculosis had SUVmax values＜2.5.The sensitivity,specificity and accuracy of 18F-FDG PET/CT in the differential diagnosis of SLA and SPT were 100.00%,28.34%and 64.84%,respectively.ROC curves analysis showed that the area un-der the curve(AUC)of SUVmax,SUVmin,SUVmean and SUVpeak in the differential diagnosis of SLA and SPT were 0.723,0.734,0.966 and 0.851,respectively,and AUC of prothrombin time,fibrinogen,D-dimer,carbohydrate antigen 153 and neuron-specific enolase in the differential diagnosis of SLA and SPT were 0.721,0.668,0.793,0.998 and 0.992,re-spectively.Conclusion 18F-FDG PET/CT metabolic parameters have a certain value in the differential diagnosis of SLA and SPT in elderly patients.Taking SUVmax≥2.5 as the judgement standard alone has great limitations,and multiple parameters should be simultaneously used for auxiliary differential diagnosis.