韦 枫,黄晓琪,覃丽兰,陆邓露,邓燕云

背景：随着低剂量计算机断层扫描（LDCT）的广泛应用，孤立性肺结节（solitary pulmonary nodules，SPN）的检出率显著提高。然而，准确评估SPN的良恶性仍是临床面临的挑战。18F-脱氧葡萄糖正电子发射计算机断层显像/计算机断层扫描（18F-fluorodeoxyglucose positron emission tomography/computed tomography，18F-FDG PET/CT）通过评估肿瘤葡萄糖代谢提供信息，但其准确性因肿瘤类型而异。18F-脱氧胸腺嘧啶核苷（18F-fluoro-3'-deoxy-3'-L：-fluorothymidine，18F-FLT）PET/CT通过评估细胞增殖活性，可能在早期恶性结节检测中具有优势。目的：通过比较标准化摄取值（standardized uptake value，SUV），比较18F-FDG与18F-FLT PET/CT对SPN良恶性的诊断效能并确立最佳的SUV诊断阈值。材料与方法：这项回顾性研究纳入2021年至2024年在柳州市工人医院同时接受18F-FDG和18F-FLT PET/CT检查的84例SPN患者。以病理结果和临床随访作为比较两种显像剂判断SPN良恶性效能的金标准。结果：84例患者中，39例为恶性病变，45例为良性病变。18F-FLT的SUVmax、SUVmean和SUVpeak在良恶性病变间差异具有统计学意义（P<0.05），而18F-FDG的各项SUV值差异无统计学意义（P>0.05）。18F-FLT SUVmean与恶性病变呈中度正相关（r=0.442，P=0.000）。ROC分析显示，18F-FLT SUVmean>1.88诊断恶性的特异性为68.9%（AUC=0.756）。Logistic回归分析确定18F-FLT SUVmean是判断SPN为恶性的独立预测因子（OR=2.69）。结论：在SPN良恶性评估中，18F-FLT PET/CT的诊断效能优于18F-FDG PET/CT，尤其体现在SUVmean参数上。标准化18F-FLT检查方案及结合多模态成像有望提高SPN的早期诊断水平，减少不必要的侵入性操作。

18F-FDG；18F-FLT；PET/CT；孤立性肺结节

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