18F—FLT和18F—FDG對孤立性肺結節診斷效能分析

李天然??譚業穎??霍天龍??盧光明??杜湘珂??趙周社

[摘要] 目的 探討18F-FLT與18F-FDG聯合顯像對孤立性肺結節的診斷價值。 方法 A549細胞與兩種示蹤劑分別進行結合實驗，分析兩者結合率差異，結合率與Ki-67的相關性。55例肺部SPN患者18F-FLT、18F-FDGPET/CT聯合顯像資料，以術后病理為“金標準”，分析兩種示蹤劑對SPN的診斷效能，觀察病灶SUV與病理組織Ki-67的相關性。 結果 A549細胞對FDG的平均攝取率高于對FLT的平均攝取率（P<0.05），肺癌A549細胞的增殖指數Ki-67與FDG的攝取率無明顯的相關性（P>0.05），而與FLT的攝取率有明顯的正相關性（r=0.824，P<0.01）。18F-FDG診斷肺癌的靈敏度為89%，特異度67%，準確性73%。18F-FLT診斷肺癌的靈敏度為71%、特異度79%、準確性76%。FDG在肺臟孤立性肺結節對示蹤劑的攝取優于FLT，FLT對原發性肺癌的顯示優于對其他病變的顯示，FDG對原發性肺癌和結核的顯示優于對感染和良性病變的顯示。肺癌組織的增殖指數Ki-67與FDG的攝取率呈明顯的正相關性（r=0.658，P<0.05），且與FLT的攝取率有明顯的正相關性（r=0.724，P<0.01）。 結論 A549細胞和SPN對18F-FDG攝取率高于18F-FLT，18F-FLT對肺癌特異性高于18F-FDG，兩種示蹤劑的聯合使用可以提高肺癌診斷的特異性和準確性。

[關鍵詞] 肺癌；18F-FLT；18F-FDG；SUV；孤立性肺結節

[中圖分類號] R445 [文獻標識碼] A [文章編號] 2095-0616（2015）17-09-07

Diagnostic performance of 18F-FLT and 18F-FDG in the solitary pulmonary nodules

LI Tianran1 TAN Yeying2 HUO Tianlong3 LU Guangming4 DU Xiangke3 ZHAO Zhoushe5

1. Department of Radiology， the First Affiliated Hospital， Fuzhou General Hospital of FuJian Medical College， Putian 351100， China； 2.Department of Radiology， Xuzhou Center Hospital， Xuzhou 221009， China； 3.Department of Radiology， Peking University Peoples Hospital， Beijing 100048， China； 4.Department of Radiology， the NanJing General Hospital of PLA， Nanjing 210002， China； 5.Molecular Imaging Department of GE（China） Health Company， Beijing 100048，China

[Abstract] Objective To explore the diagnostic value of 18F-FLT and 18F-FDGin the diagnosis of solitary pulmonary nodules （SPN）. Methods A549 cells banded with two tracers experiment respectively in vitro， and cells-tracers binding ratios difference is analyzed， and the correlation of tracers binding ratios with Ki-67is analyzed. Imaging data of 55 patients with SPN who were examined by 18F-FLT and 18F-FDGPET/CT were collected， with pathological results as the gold standard. We explored the diagnostic value of 18F-FLT and 18F-FDG in the diagnosis of solitary pulmonary nodules and the correlation of SUV with Ki-67. Results 18F-FDG uptake rate of A549 cells is higher than 18F-FLT uptake rate （P<0.05）. There was no correlation between 18F-FDG uptake ratio and proliferation index Ki-67 of A549 cells （P>0.05）， but the proliferation index Ki-67 had significant positive correlation with 18F-FLT uptake rate （r=0.824， P<0.824）.Diagnostic sensitivity of 18F-FDGfor lung cancer was 89%， and the specificity was 67%， and accuracy was73%.Diagnostic sensitivity of 18F-FLT for lung cancer was 89%， and the specificity was 67%， and accuracy was 73%.18F-FDG uptake ratio of SPN is higher than that 18F-FLT ratio， and 18F-FLT for primary lung cancer display was superior to for other lesions. 18F-FDG for primary lung cancer and tuberculosis display was superior to for infection and benign lesions. There was obviously positive correlation between lung cancer proliferation index of Ki-67 and 18F-FDG uptake ratio（r=0.658， P<0.05）， and 18F-FLT uptake ratio（r=0.724， P<0.01）. Conclusion 18F-FDG uptake rateofA549 cells and SPN are higher than 18F-FLT uptake rate. Diagnostic specificity of 18F-FLT for lung cancer is higher than 18F-FDG.A combination of two tracers can improve the diagnostic specificity and accuracy of lung cancer