18F—FLT和18F—FDG对孤立性肺结节诊断效能分析

李天然??谭业颖??霍天龙??卢光明??杜湘珂??赵周社

[摘要] 目的 探讨18F-FLT与18F-FDG联合显像对孤立性肺结节的诊断价值。 方法 A549细胞与两种示踪剂分别进行结合实验，分析两者结合率差异，结合率与Ki-67的相关性。55例肺部SPN患者18F-FLT、18F-FDGPET/CT联合显像资料，以术后病理为“金标准”，分析两种示踪剂对SPN的诊断效能，观察病灶SUV与病理组织Ki-67的相关性。 结果 A549细胞对FDG的平均摄取率高于对FLT的平均摄取率（P<0.05），肺癌A549细胞的增殖指数Ki-67与FDG的摄取率无明显的相关性（P>0.05），而与FLT的摄取率有明显的正相关性（r=0.824，P<0.01）。18F-FDG诊断肺癌的灵敏度为89%，特异度67%，准确性73%。18F-FLT诊断肺癌的灵敏度为71%、特异度79%、准确性76%。FDG在肺脏孤立性肺结节对示踪剂的摄取优于FLT，FLT对原发性肺癌的显示优于对其他病变的显示，FDG对原发性肺癌和结核的显示优于对感染和良性病变的显示。肺癌组织的增殖指数Ki-67与FDG的摄取率呈明显的正相关性（r=0.658，P<0.05），且与FLT的摄取率有明显的正相关性（r=0.724，P<0.01）。 结论 A549细胞和SPN对18F-FDG摄取率高于18F-FLT，18F-FLT对肺癌特异性高于18F-FDG，两种示踪剂的联合使用可以提高肺癌诊断的特异性和准确性。

[关键词] 肺癌；18F-FLT；18F-FDG；SUV；孤立性肺结节

[中图分类号] R445 [文献标识码] A [文章编号] 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