ROC曲線比較全身PET/CT和全身CT平掃對血清腫瘤標志物升高患者惡性腫瘤的檢出效能

[摘要]目的 比較全身18F-FDG PET/CT和全身CT平掃對血清腫瘤標志物升高患者惡性腫瘤的檢出效能。 方法 收集筆者所在醫(yī)院2009年12月～2011年3月行全身PET/CT檢查并伴有檢查前2周內血清腫瘤標志物異常升高的患者30例。全身PET/CT顯像和全身CT平掃均按5分法進行評分，并將血清腫瘤標志物測量值除以正常上限值以實現(xiàn)歸一化處理。以病理診斷或臨床隨訪為“金標準”，繪制全身PET/CT和全身CT顯像評分的ROC曲線，計算二者曲線下面積，并比較其差異是否具有統(tǒng)計學意義。將顯像評分合并成兩類：陰性（0、1、2分）和陽性（3、4分），分別計算全身PET/CT和全身CT相對于金標準的靈敏度、特異性、準確性、陽性預測值和陰性預測值。 結果 全身PET/CT及全身CT顯像評分相對于金標準的ROC曲線下面積AUC（95%可信區(qū)間）分別為0.962（0.821～0.995）和0.917（0.757～0.985），二者差異無統(tǒng)計學意義（P=0.599）。二者的靈敏度均為80.00%（8/10），特異性均為100.00%（20/20），準確性均為93.33%（28/30），陽性預測值100.00%（8/8），陰性預測值均為90.90%（20/22）。 結論 全身PET/CT和全身CT平掃在預測腫瘤標志物升高患者是否存在惡性腫瘤病變方面無明顯差異。

[關鍵詞] 血清腫瘤標志物；受試者工作曲線；PET/CT；CT

[中圖分類號] R445.3 [文獻標識碼] B [文章編號] 2095-0616（2012）21-101-03

Compare the efficacy of whole body PET/CT with whole body CT scan for detecting malignant tumor in patients with elevated serum tumor markers by ROC curve

JIANG Rifeng1 DONG Ximin2 JI Zhongyou1 CHEN Weimin1

1.Department of Nuclear Medicine，F(xiàn)ujian Union Hospital，F(xiàn)uzhou 350001， China；2.Department of Nursing， Fujian Union Hospital， Fuzhou 350001， China

[Abstract] Objective To compare the whole body 18F-FDG PET/CT with whole body CT scan for detecting malignant tumor in patients with elevated serum tumor markers. Methods 30 cases undergoing whole-body PET/CT and with elevated serum tumor markers were included. All PET/CT and CT images were scored according to the following criteria. And the normalization of serum tumor markers was performed. Using the pathology or clinical follow-up as the gold standard， the ROC curve of whole body PET/CT and whole body CT scan were drawn， the area under the curve （AUC） were calculated， and the difference between both AUC were compared. Imaging scores were then combined into two categories： negative （0，1，2） and positive （3，4）. The sensitivity， specificity， accuracy， positive predictive value and negative predictive value of PET/CT and CT relative to the gold standard were calculated. Results The AUC（95% confidence interval） of the whole body PET/CT and whole body CT scan were 0.962（0.821-0.995） and 0.917（0.757-0.985） respectively， and the difference between them was not statistically significant （P=0.599）. Both sensitivity were 80.00% （8/10）， specificity were 100.00% （20/20）， accuracy were 93.33% （28/30）， positive predictive value were 100.00% （8/8）， negative predictive value were 90.90% （20/22）. Conclusion There was no significant difference between whole body PET/CT and whole body CT scan for detecting malignant tumor in patients with elevated serum tumor markers.

[Key words] Serum tumor markers； Receiver operating characteristic curve； PET/CT； CT

血清腫瘤標志物檢測是一種廣泛應用于篩查腫瘤性病變的有效手段，其靈敏度高，但特異性差，且無法定位病灶[1]。因此，腫瘤標志物升高時，受檢者應積極地排查腫瘤，以達到早期發(fā)現(xiàn)、診斷和治療，這對腫瘤的預后至關重要。隨著PET/CT檢查的日益普及，已有不少血清腫瘤標志物升高的患者直接被推薦做PET/CT檢查。雖然價格不菲，但因其能反映葡萄糖代謝情況、掃描野大且覆蓋面廣而具有重要價值[2]。……