Comparation on the value of PET/CT, head-enhanced CT and head-enhanced MRI in the detection of brain metastases from lung cancer
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摘要:
目的 分析与探讨18F-FDG PET/CT+头部增强CT、18F-FDG PET/CT+头部增强MRI几种检查方法对肺癌脑转移瘤的诊断价值与差异。 方法 回顾分析327例肺癌患者的临床资料，对比其18F-FDG PET/CT、头部增强CT及头部增强MRI影像资料，分析18F-FDG PET/CT联合头部增强CT、18F-FDG PET/CT联合头部增强MRI对肺癌分期的影响；比较18F-FDG PET/CT、头部增强CT、头部增强MRI 3种检查方法对肺癌脑转移瘤检出价值；比较18F-FDG PET/CT与头部增强MRI，肺癌脑转移瘤漏诊组与未漏诊组囊变、水肿表现的差异。 结果 18F-FDG PET/CT+头部增强CT、18F-FDG PET/CT+头部增强MRI这两种组合检查方法在检出肺癌脑转移瘤方面，对肺癌分期的影响差异有统计学意义（χ2=305.58，P < 0.01）；18F-FDG PET/CT、头部增强CT、头部增强MRI三种检查方法对肺癌脑转移瘤检出率分别为7.34%、12.23%、19.88%；3种检查方法对肺癌脑转移瘤检出情况比较差异具有统计学意义（χ2=22.867，P < 0.01）；肺癌脑转移瘤18F-FDG PET/CT与MRI比较漏诊组与未漏诊组发生囊变、水肿情况的差异无统计学意义（χ2=0.657，P > 0.05；χ2=0.023，P > 0.05）；漏诊组、未漏诊组出现囊变率为31.70%（13/41）、41.67%（10/24）；漏诊组、未漏诊组出现水肿率为56.09%（23/41）、54.17%（13/24）。 结论 18F-FDG PET/CT+头部增强CT、18F-FDG PET/CT+头部增强MRI检查均能够提高肺癌脑转移瘤的检出率，对精确判断肺癌分期，掌握脑转移瘤详细情况，降低脑转移瘤的漏诊率有重要作用，检出价值最高的是18F-FDG PET/CT+头部增强MRI联合。 -
关键词:
- 肺癌 /
- 脑转移瘤 /
- 18F-FDG PET/CT /
- 增强CT /
- 增强MRI
Abstract:Objective To analyze and discuss the diagnostic value and differences of 18F-FDG PET/CT+head enhanced CT and 18F-FDG PET/CT + head enhanced MRI for brain metastasis of lung cancer. Methods Clinical data of 327 patients with lung cancer were randomly selected to compare the imaging data of 18F-FDG PET/CT, head-enhanced CT and head-enhanced MRI to analyze the effects of 18F-FDG PET/CT combined with head enhanced CT and 18F-FDG PET/CT combined with head-enhanced MRI on the staging of lung cancer. Comparison of the value of 18F-FDG PET/CT, head-enhanced CT and head-enhanced MRI in the detection of brain metastases from lung cancer; Comparison between 18F-FDG PET/CT with head-enhanced MRI, and the difference in the presentation of cystic lesions and oedema between the group with and without missed brain metastases from lung cancer. Results The combined examination methods of 18F-FDG PET/CT+head enhanced CT and 18F-FDG PET/CT + head enhanced MRI had a statistically significant difference in the detection of lung cancer brain metastasis (χ2=305.58, P < 0.01). The detection rates of brain metastases from lung cancer by PET/CT, head enhanced CT and head enhanced MRI were 7.34%, 12.23% and 19.88%, respectively. The difference in the detection of brain metastases from lung cancer among the three methods was significant(χ2=22.867, P < 0.01). There was no significant difference in cystic degeneration and edema between the missed group and the unmissed group (χ2=0.657, P > 0.05;χ2=0.023, P > 0.05). The rate of cystic degeneration was 31.70% (13/41) in the missed diagnosis group and 41.67% (10/24) in the unmissed diagnosis group, and the rates of edema was 56.09% (23/41) in the missed diagnosis group and 54.17% (13/24) in the unmissed diagnosis group. Conclusion Both 18F-FDG PET/CT + head enhanced CT and 18F-FDG PET/CT + head enhanced MRI can improve the detection rate of lung cancer brain metastasis, which is important for accurately determining the stage of lung cancer, grasping the details of brain metastasis, and reducing the missed diagnosis rate of brain metastasis. The highest value has been found in the combination of 18F-FDG PET/CT+head MRI. -
Key words:
- lung cancer /
- brain metastases /
- 18F-FDG PET/CT /
- head enhanced CT /
- head enhanced MRI
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图 1 肺癌患者脑转移瘤头部平扫CT图像（A）、头部PET/CT图像（B~C）及头部增强MRI（D）图像
A: 头部平扫CT图像，右侧枕叶片状低密度影, 无法清楚显示脑转移瘤; B~C: PET/CT图像，右侧枕叶片状低密度影, 放射性分布略减低, 无法显示脑转移瘤; D: 增强MRI图像清晰显示右侧枕叶脑转移瘤, 边缘强化, 低密度影为周围水肿带.
Figure 1. The plain CT imaging of the head, PET/CT imaging and enhanced MRI imaging of a patient.
表 1 肺癌患者性别与具体病理类型资料
Table 1. Data of gender and specific pathological types of lung cancer patients (n)
性别 鳞癌 腺癌 腺鳞癌 淋巴上皮瘤样癌 神经内分泌癌 分化差的癌 男(n=216) 58 153 3 0 2 0 女(n=111) 10 93 2 4 1 1 
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表 2 肺癌患者分期及病理类型
Table 2. Data of lung cancer patients stage and pathological type (n)
分期 非小细胞癌 小细胞癌 Ⅰ期(n=51) 51 0 Ⅱ期(n=30) 30 0 Ⅲ期(n=85) 82 3 Ⅳ期(n=161) 160 1 总计(n=327) 323 4
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表 3 肺癌患者分期及具体病理情况
Table 3. Data of lung cancer patients stage and specific pathological (n)
分期 鳞癌 腺癌 腺鳞癌 淋巴上皮瘤样癌 神经内分泌癌 分化差的癌 Ⅰ期(n=51) 5 46 0 0 0 0 Ⅱ期(n=30) 12 17 0 1 0 0 Ⅲ期(n=85) 36 43 2 1 3 0 Ⅳ期(n=161) 15 140 3 2 0 1 总计(n=327) 68 246 5 4 3 1
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表 4 PET/CT+头部增强CT及PET/CT+头部增强MRI联合组两组肺癌分期改变情况
Table 4. Changes of lung cancer stage in PET/CT+head enhanced CT and PET/CT+head enhanced MRI combined groups (n)
检查方法比较 临床分期 改变 不改变 总计 PET/CT+头部增强CT联合 1 326 327 PET/CT+与头部增强MRI联合 7 320 327 χ2 305.58 P < 0.01
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表 5 三种检查方法肺癌脑转移瘤检出率比较
Table 5. Comparison of the detection rates of lung cancer brain metastases by the three methods (n=327)
检查方法 检出有脑转移病瘤(n) 检出率(%) PET/CT 24 7.34 头部增强CT 40 12.23 头颅增强MRI 65 19.88
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表 6 三种检查方法对肺癌脑转移瘤检出情况比较
Table 6. Comparison of three examination methods in the detection of lung cancer brain metastasis (n, n=327)
检查方法 检出脑转移病瘤 (+) (-) PET/CT 24 303 头部增强CT 40 287 头部增强MRI 65 262 χ2 22.867 P < 0.01
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表 7 肺癌脑转移瘤PET/CT与MRI比较漏诊组与未漏诊组囊变情况
Table 7. Comparison between PET/CT and MRI of brain metastases of lung cancer and missed diagnosis group (n)
组别 囊变 无囊变 漏诊组(n=41) 13 28 未漏诊组(n=24) 10 14 χ2 0.657 P > 0.05
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表 8 肺癌脑转移瘤PET/CT与MRI比较漏诊组与未漏诊组水肿情况
Table 8. Comparison between PET/CT and MRI of brain metastases of lung cancer and missed diagnosis group (n)
组别 水肿 无水肿 漏诊组(n=41) 23 18 未漏诊组(n=24) 13 11 χ2 0.023 P > 0.05
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