目的：探讨18F-FDG PET/CT在非小细胞肺癌（NSCLC）放射治疗靶区勾画及临床分期中的价值，为临床治疗方案的制定提供依据。方法：收集2014年1月—2015年11月我院收治的经细胞学或病理学确诊为NSCLC且具有肿瘤放射治疗适应证的80例NSCLC患者，其中鳞癌51例，腺癌29例，分别行胸部增强CT及18F-FDG PET/CT检查，并通过两种影像学方法勾画肿瘤靶区（Gross tumor volume，GTV），比较两者间的差异，以P＜0．05为差异有统计学意义。结果：①80例NSCLC患者GTVPET/CT均值（（20.74±15.57） cm3）较GTVCT（（26.33±17.31） cm3）小，两者间差异有统计学意义（P＜0.05）。GTVPET/CT较GTVCT平均缩小24.16%。其中68例GTVPET/CT小于GTVCT，但有12例患者的GTVPET/CT大于GTVCT。②按肿瘤组织学类型分为鳞癌组与腺癌组，鳞癌组GTVCT （27.85±15.79） cm3，GTVPET/CT （22.35±14.06） cm3；腺癌组GTVCT （25.46±18.21） cm3，GTVPET/CT （19.83±16.44） cm3，两组均显示GTVPET/CT均值较GTVCT小，差异具有统计学意义（P＜0.05）。③通过18F-FDG PET/CT显像，本研究80例NSCLC患者中，57％（46/80）的患者临床分期发生了改变：其中分期上调35例（N分期上调22例，M分期上调13例）；分期下调者11例（7例从T3降到T2，4例从T4降到T3）。结论：18F-FDG PET/CT显像融合了功能代谢和解剖图像，能很好的分辨肿瘤组织与周围的肺不张或炎症组织，精确指导放疗靶区的勾画，并可准确的指导临床分期，为进一步制定治疗计划提供可靠依据，显著提高患者的预后及生活质量。
Abstract
Objective: To explore the application value of 18F-FDG PET/CT in delineation of radiotherapy target area and clinical stage in non-small cell lung cancer, and to provide a basis for formulation of treatment plan. Methods: Eighty patients confirmed with non-small cell lung cancer by cytology or pathology and suitable for radiotherapy from January 2014 to November 2015 in our hospital were enrolled in this study. In which, 51 cases were squamous cell carcinoma, 29 cases were adenocarcinoma. Breast enhancement CT and 18F-FDG PET/CT were performed in all patients, and GTVPET/CT and GTVCT were determined, and the difference was compared statistically. Results: ①GTVPET/CT((20.74±15.57) cm3) was 24.16% smaller than GTVCT((26.33±17.31) cm3), and the difference was statistically significant(P<0.05). ②GTVCT and GTVPET/CT were (27.85±15.79) cm3 and (22.35±14.06) cm3 respectively in squamous carcinoma group, GTVCT and GTVPET/CT were (25.46±18.21) cm3 and (19.83±16.44) cm3 respectively in adenocarcinoma group, and GTVCT were bigger than GTVPET/CT in both groups, and the difference was significant statistically(P<0.05). ③18F-FDG PET/CT changed the clinical stage in 46 patients(57%) in all patients, in which 35 cases were up regulated, 11 cases were down regulated. Conclusion: 18F-FDG PET/CT can be helping in distinguishing tumor tissue with the surrounding atelectasis or inflammation, and in delineation of radiotherapy target area, and also in accurate clinical staging.
关键词
癌 /
非小细胞肺 /
氟脱氧葡萄糖F18 /
正电子发射断层显像术
Key words
Carcinoma, non-small-cell lung /
Fluorodeoxyglucose F18 /
Positron-emission tomography
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