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目的探讨~(11)C-胆碱 PET-CT 双时相显像技术在纵隔疾病诊断中的应用价值。方法对经普通影像学检查难以确诊的35例中纵隔病灶患者4周内进行 CT、PET-CT 及电视纵隔镜检查。应用~(11)C-胆碱作为 PET 示踪剂,应用标准摄取值(SUV 值)及两次显像的变化(ASUV)作为 PET 检测指标,并与电视纵隔镜活检病理结果对照。注射~(11)C-胆碱5～10 min 后初次采集发射图像,25～30 min再次采集发射图像。结果35例纵隔病灶经电视纵隔镜活检,诊断为结节病的患者11例,结核6例,淋巴瘤5例,纵隔原发或转移癌11例(肺癌伴有纵隔淋巴结转移的患者8例,另3例无原发灶证据),肺癌纵隔淋巴结肿大病理为反应性增生2例。根据良、恶性分类,19例良性病灶早期显像的 SUV 值为5.11(2.9～8.3),延迟显像后为4.99(2.2～9.3),ASUV 为-0.12(-0.9～1.0)。16例恶性病灶早期显像的 SUV 值为6.17(3.2～9.8),延迟显像后为6.48(3.0～11.2),ASUV 为0.31(-0.4～1.4)。良恶性病灶早期显像的 SUV 值差异无统计学意义(F=0.505,P=0.09);两者的ASUV 差异有统计学意义(F=1.939,P=0.04),ΔSUV 为负值倾向于良性疾病,正值倾向于恶性疾病。CT、初次 PET-CT、双时相 PET 显像及电视纵隔镜对纵隔肿物良恶性的诊断正确率分别为54.3%(19/35)、74.3%(26/35)、82.9%(29/35)及100%(35/35)。纵隔镜检查优于双时相 PET 显像(x~2=6.563,P=0.010);双时相 PET 显像优于 CT(x~2=6.629,P=0.010)。结论对纵隔良、恶性疾病的鉴别诊断,电视纵隔镜准确可靠,单纯 CT 及单次 PET(SUV 值)显像有较高误诊率,PET-CT 两次显像可提高诊断的正确性,对良、恶性病灶的鉴别上有一定价值。
Objective To investigate the value of ~ (11) C-choline PET-CT dual-phase imaging in the diagnosis of mediastinal diseases. Methods CT, PET-CT and mediastinoscopy were performed in 35 cases of mediastinum lesions, which were difficult to diagnose by ordinary imaging examination within 4 weeks. Using 11 C-choline as a PET tracer, the standard uptake value (SUV) and the change of two visualization (ASUV) were used as PET detection indexes and compared with the results of mediastinoscopy biopsy. After ~ (11) C-choline injection, the images were collected for the first time after 5 ~ 10 min and again after 25 ~ 30 min. Results 35 cases of mediastinal lesions by mediastinoscopy biopsy, diagnosis of sarcoidosis in 11 patients, 6 cases of tuberculosis, 5 cases of lymphoma, primary or metastatic mediastinal cancer in 11 cases (lung cancer with mediastinal lymph node metastasis in 8 patients, The other 3 cases no evidence of primary lesions), lung cancer, mediastinal lymph node enlargement pathology of reactive hyperplasia in 2 cases. According to the benign and malignant classification, the SUV value of early imaging in 19 cases of benign lesions was 5.11 (2.9 ~ 8.3), 4.99 (2.2 ~ 9.3) after delayed imaging and -0.12 (-0.9 ~ 1.0) in ASUV. The SUV values of 16 cases of early malignant lesions were 6.17 (3.2 ~ 9.8), 6.48 (3.0 ~ 11.2) and 0.31 (-0.4 ~ 1.4) after delayed imaging. There was no significant difference in SUV between early stage imaging of benign and malignant lesions (F = 0.505, P = 0.09). The difference of ASUV between the two groups was statistically significant (F = 1.939, P = 0.04) Diseases, positive in favor of malignant diseases. The accuracy rates of CT, primary PET-CT, double-phase PET imaging and mediastinoscopy in the diagnosis of mediastinal masses were 54.3% (19/35), 74.3% (26/35), 82.9% (29/35) 35) and 100% (35/35). Mediastinoscopy was superior to bi-phase PET imaging (x ~ 2 = 6.563, P = 0.010); bi-phase PET imaging was superior to CT (x ~ 2 = 6.629, P = 0.010). Conclusions The differential diagnosis of benign and malignant mediastinal mediastinoscopy is accurate and reliable, with high misdiagnosis rate of single CT and single-slice PET (SUV) imaging. PET-CT double imaging can improve the accuracy of diagnosis. Good and malignant lesions on the identification of a certain value.