雙時相18F-FDG PET鑒別肺部良惡性病變準確性的Meta分析_《中國循證醫學雜志》

作者：

王海軍 , 李彥彥 , 王慧春 , 翟亞楠 , 莊貴學 ,  王玉斌

甘肅省人民醫院核醫學科（蘭州　730000）;

關鍵詞：

雙時相掃描 18F-FDG PET 肺部病變鑒別診斷 Meta分析診斷性試驗

DOI：

10.7507/1672-2531.20130228

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目的　對18F-FDG PET雙時相掃描方法鑒別肺部良惡性病變的準確性進行系統評價，明確雙時相掃描的必要性和臨床價值。
方法　計算機檢索PubMed、EMbase、The Cochrane Library、WanFang Data、CNKI和CBM數據庫，檢索時限從1990年1月至2011年11月，納入18F-FDG PET雙時相掃描與金標準（手術式穿刺活檢結果）比較鑒別肺部良惡性病變的診斷性試驗。由2位研究者按納入與排除標準進行文獻篩選、資料提取與納入研究的方法學質量評價后，計算其敏感度與特異度合并效應量以及受試者工作特征曲線下面積（AUC），并進行敏感性分析和亞組分析。
結果　共納入19篇文獻，包括1 225個病灶。Meta分析結果顯示：雙時相18F-FDG PET鑒別肺部良惡性病變的敏感度為0.82［95%CI（0.79，0.85）］，特異度為0.74［95%CI（0.71，0.78）］，AUC為0.837 5。敏感性分析結果顯示：① 剔除結核病變占良性病變比例 gt;50%的研究，合并敏感度為0.81［95%CI（0.77，0.84）］，特異度為0.76［95%CI（0.72，0.80）］，AUC為0.850 3；② 剔除樣本量 lt;50例的研究，合并敏感度為0.78［95%CI（0.74，0.82）］，特異度為0.78［95%CI（0.74，0.82）］，AUC為0.814 1；③ 剔除iSUV（首次標準攝取值） gt;2.5的研究，合并敏感度為0.67［95%CI（0.55，0.78）］，特異度為0.66［95%CI（0.54，0.77）］，AUC為0.779 8。
結論　18F-FDG PET雙時相掃描具有中等診斷價值，跟單時相掃描相比不具有優勢，雙時相掃描不必作為常規檢查應用于臨床。

引用本文： 王海軍,李彥彥,王慧春,翟亞楠,莊貴學,王玉斌. 雙時相18F-FDG PET鑒別肺部良惡性病變準確性的Meta分析. 中國循證醫學雜志, 2013, 13(11): 1326-1332. doi: 10.7507/1672-2531.20130228 復制

1.	Whiting PF, Weswood ME, Rutjes AW, et al. QUADAS評價:一種用于診斷性研究的質量評價工具(修訂版). 中國循證醫學雜志, 2007, 7(7): 531-536.
2.	Alkhawaldeh K, Bural G, Kumar R, et al. Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging, 2008, 35(2): 246-252.
3.	Chen CJ, Lee BF, Yao WJ, et al. Dual-phase 18F-FDG PET in the diagnosis of pulmonary nodules with an initial standard uptake value less than 2.5. AJR Am J Roentgenol, 2008, 191(2): 475-479.
4.	Cloran FJ, Banks KP, Song WS, et al. Limitations of dual time point PET in the assessment of lung nodules with low FDG avidity. Lung Cancer, 2010, 68(1): 66-71.
5.	Demura Y, Tsuchida T, Ishizaki T, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med, 2003, 44(4): 540-548.
6.	Kaplan GH, Yildiz A, Ozbudak O, et al. Comparative value of SUVmax, dual time point imaging and non-attenuation corrected images in PET/CT in the evaluation of solitary pulmonary nodule. Eur J Nucl Med Mol Imaging, 2011, 38S361.
7.	Laffon E, de Clermont H, Begueret H, et al. Assessment of dual-time-point 18F-FDG-PET imaging for pulmonary lesions. Nucl Med Commun, 2009, 30(6): 455-461.
8.	Lan XL, Zhang YX, Wu ZJ, et al. The value of dual time point (18)F-FDG PET imaging for the differentiation between malignant and benign lesions. Clin Radiol, 2008, 63(7): 756-764.
9.	Macdonald K, Searle J, Lyburn I. The role of dual time point FDG PET imaging in the evaluation of solitary pulmonary nodules with an initial standard uptake value less than 2.5. Clin Radiol, 2011, 66(3): 244-250.
10.	Matthies A, Hickeson M, Cuchiara A, et al. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med, 2002, 43(7): 871-875.
11.	Nunez R, Kalapparambath A, Varela J. Improvement in sensitivity with delayed imaging of pulmonary lesions with FDG-PET. Rev Esp Med Nucl, 2007, 26(4): 196-207.
12.	Sathekge MM, Maes A, Pottel H, et al. Dual time-point FDG PET/CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. South African Medical Journal, 2010, 100(9): 598-601.
13.	Schillaci O, Travascio L, Bolacchi F, et al. Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients. Radiol Med, 2009, 114(6): 890-906.
14.	Suga K, Kawakami Y, Hiyama A, et al. Dual-time point 18F-FDG PET/CT scan for differentiation between 18F-FDG-avid non-small cell lung cancer and benign lesions. Ann Nucl Med, 2009, 23(5): 427-435.
15.	王躍濤, 劉德峰, 錢作賓, 等. F18-FDG PET/CT雙時相顯像對肺部病灶的定性診斷價值. 中華核醫學雜志, 2009, 29(5): 293-296.
16.	姚稚明, 屈婉瑩, 劉甫庚, 等. 18F-FDG PET/CT雙時相顯像對孤立性肺結節的診斷價值. 中華核醫學雜志, 2007, 27(1): 5-7.
17.	Xiu Y, Bhutani C, Dhurairaj T, et al. Dual-time point FDG PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity. Clin Nucl Med, 2007, 32(2): 101-105.
18.	楊鵬, 龔靜山, 陳立光, 等. 雙時相～(18)F-FDG PET鑒別診斷肺內良惡性病變的價值. 中國醫學影像技術, 2011, 27(10): 2017-2020.
19.	趙秀娟, 趙新明, 王建方, 等. 18F-FDG PET/CT雙時相顯像鑒別診斷肺良惡性病變的臨床研究. 腫瘤學雜志, 2011, 17(10): 736-740.
20.	周克, 吳平, 陳治明, 等. F18-FDG雙時相顯影在肺結節病灶中的應用. 西南國防醫藥, 2011, 21(10): 1079-1081.
21.	Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA, 2001, 285(7): 914-924.

1. Whiting PF, Weswood ME, Rutjes AW, et al. QUADAS評價:一種用于診斷性研究的質量評價工具(修訂版). 中國循證醫學雜志, 2007, 7(7): 531-536.
2. Alkhawaldeh K, Bural G, Kumar R, et al. Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging, 2008, 35(2): 246-252.
3. Chen CJ, Lee BF, Yao WJ, et al. Dual-phase 18F-FDG PET in the diagnosis of pulmonary nodules with an initial standard uptake value less than 2.5. AJR Am J Roentgenol, 2008, 191(2): 475-479.
4. Cloran FJ, Banks KP, Song WS, et al. Limitations of dual time point PET in the assessment of lung nodules with low FDG avidity. Lung Cancer, 2010, 68(1): 66-71.
5. Demura Y, Tsuchida T, Ishizaki T, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med, 2003, 44(4): 540-548.
6. Kaplan GH, Yildiz A, Ozbudak O, et al. Comparative value of SUVmax, dual time point imaging and non-attenuation corrected images in PET/CT in the evaluation of solitary pulmonary nodule. Eur J Nucl Med Mol Imaging, 2011, 38S361.
7. Laffon E, de Clermont H, Begueret H, et al. Assessment of dual-time-point 18F-FDG-PET imaging for pulmonary lesions. Nucl Med Commun, 2009, 30(6): 455-461.
8. Lan XL, Zhang YX, Wu ZJ, et al. The value of dual time point (18)F-FDG PET imaging for the differentiation between malignant and benign lesions. Clin Radiol, 2008, 63(7): 756-764.
9. Macdonald K, Searle J, Lyburn I. The role of dual time point FDG PET imaging in the evaluation of solitary pulmonary nodules with an initial standard uptake value less than 2.5. Clin Radiol, 2011, 66(3): 244-250.
10. Matthies A, Hickeson M, Cuchiara A, et al. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med, 2002, 43(7): 871-875.
11. Nunez R, Kalapparambath A, Varela J. Improvement in sensitivity with delayed imaging of pulmonary lesions with FDG-PET. Rev Esp Med Nucl, 2007, 26(4): 196-207.
12. Sathekge MM, Maes A, Pottel H, et al. Dual time-point FDG PET/CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. South African Medical Journal, 2010, 100(9): 598-601.
13. Schillaci O, Travascio L, Bolacchi F, et al. Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients. Radiol Med, 2009, 114(6): 890-906.
14. Suga K, Kawakami Y, Hiyama A, et al. Dual-time point 18F-FDG PET/CT scan for differentiation between 18F-FDG-avid non-small cell lung cancer and benign lesions. Ann Nucl Med, 2009, 23(5): 427-435.
15. 王躍濤, 劉德峰, 錢作賓, 等. F18-FDG PET/CT雙時相顯像對肺部病灶的定性診斷價值. 中華核醫學雜志, 2009, 29(5): 293-296.
16. 姚稚明, 屈婉瑩, 劉甫庚, 等. 18F-FDG PET/CT雙時相顯像對孤立性肺結節的診斷價值. 中華核醫學雜志, 2007, 27(1): 5-7.
17. Xiu Y, Bhutani C, Dhurairaj T, et al. Dual-time point FDG PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity. Clin Nucl Med, 2007, 32(2): 101-105.
18. 楊鵬, 龔靜山, 陳立光, 等. 雙時相～(18)F-FDG PET鑒別診斷肺內良惡性病變的價值. 中國醫學影像技術, 2011, 27(10): 2017-2020.
19. 趙秀娟, 趙新明, 王建方, 等. 18F-FDG PET/CT雙時相顯像鑒別診斷肺良惡性病變的臨床研究. 腫瘤學雜志, 2011, 17(10): 736-740.
20. 周克, 吳平, 陳治明, 等. F18-FDG雙時相顯影在肺結節病灶中的應用. 西南國防醫藥, 2011, 21(10): 1079-1081.
21. Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA, 2001, 285(7): 914-924.

《中國循證醫學雜志》

雙時相18F-FDG PET鑒別肺部良惡性病變準確性的Meta分析

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《中國循證醫學雜志》

雙時相18F-FDG PET鑒別肺部良惡性病變準確性的Meta分析

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