定量（18）F-FDG PET研究在鉴别恶性和良性骨病变中的作用。

The role of quantitative (18)F-FDG PET studies for the differentiation of malignant and benign bone lesions.

作者信息

Dimitrakopoulou-Strauss Antonia, Strauss Ludwig G, Heichel Thomas, Wu Hua, Burger Cyrill, Bernd Ludger, Ewerbeck Volker

机构信息

Division of Oncological Diagnostics and Therapy, German Cancer Research Center, E0105 Medical PET Group, Im Neuenheimer Feld 280, Heidelberg, D-69120 Germany.

出版信息

J Nucl Med. 2002 Apr;43(4):510-8.

PMID:11937595

Abstract

UNLABELLED

The role of quantitative (18)F-FDG PET studies for the differentiation of benign and malignant bone lesions is still an open question.

METHODS

Our evaluation included 83 patients with 37 histologically proven malignancies and 46 benign lesions. Thirty-five of the 46 benign lesions were histologically confirmed. The (18)F-FDG studies were accomplished as a dynamic series for 60 min. Evaluation of the (18)F-FDG kinetics was performed using the following parameters: standardized uptake value (SUV), global influx (Ki), computation of the transport constants K1-k4 with consideration of the distribution volume (VB) according to a 2-tissue-compartment model, fractal dimension based on the box-counting procedure (parameter for the inhomogeneity of the tumors).

RESULTS

The mean SUV, the vascular fraction VB, K1, and k3 were higher in malignant tumors compared with benign lesions (t test; P < 0.05). Although the (18)F-FDG SUV was helpful to differentiate benign and malignant tumors, there was some overlap, which limited the diagnostic accuracy. On the basis of the discriminant analysis, the SUV alone showed a sensitivity of only 54.05%, a specificity of 91.30%, and a diagnostic accuracy of 74.70%. The fractal dimension was superior and showed a sensitivity of 71.88%, a specificity of 81.58%, and an accuracy of 77.14%. The combination of SUV, fractal dimension, VB, K1-k4, and Ki revealed the best results with a sensitivity of 75.86%, a specificity of 97.22%, and an accuracy of 87.69%. Bayesian analysis showed true-positive results at the level of 0.8 for a low prevalence of disease (0.235) if the full kinetic data were used in the evaluation.

CONCLUSION

(18)F-FDG PET has a high specificity for the exclusion of a malignant bone tumor. Evaluation of the full (18)F-FDG kinetics and the application of discriminant analysis are required and can be used prospectively to classify a bone lesion as malignant or benign.

摘要

未标记

定量（18）F-FDG PET研究在鉴别骨良性和恶性病变中的作用仍是一个悬而未决的问题。

方法

我们的评估纳入了83例患者，其中37例经组织学证实为恶性肿瘤，46例为良性病变。46例良性病变中有35例经组织学确认。（18）F-FDG研究作为一个60分钟的动态系列完成。使用以下参数对（18）F-FDG动力学进行评估：标准化摄取值（SUV）、整体流入率（Ki）、根据双组织室模型考虑分布容积（VB）计算转运常数K1-k4、基于盒计数法的分形维数（肿瘤不均匀性参数）。

结果

与良性病变相比，恶性肿瘤的平均SUV、血管分数VB、K1和k3更高（t检验；P<0.05）。虽然（18）F-FDG SUV有助于鉴别良性和恶性肿瘤，但存在一些重叠，这限制了诊断准确性。基于判别分析，单独的SUV敏感性仅为54.05%，特异性为91.30%，诊断准确性为74.70%。分形维数更优，敏感性为71.88%，特异性为81.58%，准确性为77.14%。SUV、分形维数、VB、K1-k4和Ki的组合显示出最佳结果，敏感性为75.86%，特异性为97.22%，准确性为87.69%。贝叶斯分析表明，如果在评估中使用完整的动力学数据，对于低疾病患病率（0.235），真阳性结果在疾病水平为0.8时出现。