Picchio M, Sironi S, Messa C, Mangili G, Landoni C, Gianolli L, Zangheri B, Viganò R, Aletti G, De Marzi P, De Cobelli F, Del Maschio A, Ferrari A, Fazio F
IBFM-CNR, University of Milano-Bicocca, University of Vita-Salute, Institute H. San Raffaele, Milan, Italy.
Q J Nucl Med. 2003 Jun;47(2):77-84.
To determine the additional value of [(18)F]FDG-PET in combination with computed tomography (CT) over CT used alone, for evaluating ovarian cancer patients after primary treatment.
Twenty-five women (mean age: 53.6 years) had primary debulking surgery followed by chemotherapy for histologically proven ovarian carcinoma. At initial diagnosis, the tumor types were papillary serous adenocarcinoma (n=20), endometroid carcinoma (n=3), mixed mullerian tumor (n=1), and granulosa cell tumor (n=1). All patients underwent [(18)F]FDG-PET and contrast enhanced CT examinations, within 30 days of the completion of chemotherapic treatment. [(18)F]FDG-PET images were interpreted with the knowledge of CT findings (PET+CT); conversely, CT images were evaluated with no knowledge of the [(18)F]FDG-PET results. Within 7 day of imaging studies, 2(nd)-look laparoscopy (n=7) or laparotomy (n=18) was performed for histological confirmation. In all cases, imaging findings were then correlated with results of histopathologic examination.
Of the 23 neoplastic viable lesions, all histologically confirmed, 16 could be detected by CT alone and 19 by PET+CT. An inflammatory lymph-node was misdiagnosed as viable tumor with both PET+CT and CT alone; an area of scar tissue in the presacral region was also misinterpreted as malignant tissue with CT alone. Overall lesion-based sensitivity, specificity and accuracy in assessing focal areas of residual tumor were as follows: 69.56%, 83.33%, 74.28% for CT, and 82.60%, 91.67%, 85.71% for PET+CT. The negative predictive value of PET+CT was markedly higher (73.33%), compared to that of CT alone (58.82%).
PET used in combination with CT allows to accurately assess tumor response. A major advantage of PET+CT over CT alone is in excluding the presence of residual viable lesions after treatment.
确定[（18）F]氟代脱氧葡萄糖正电子发射断层扫描（PET）联合计算机断层扫描（CT）相较于单独使用CT，在评估卵巢癌患者初始治疗后的附加价值。
25名女性（平均年龄：53.6岁）因组织学确诊的卵巢癌接受了初次肿瘤细胞减灭术，随后进行化疗。初诊时，肿瘤类型为乳头状浆液性腺癌（n = 20）、子宫内膜样癌（n = 3）、混合性苗勒管肿瘤（n = 1）和颗粒细胞瘤（n = 1）。所有患者在化疗结束后30天内接受了[（18）F]FDG - PET和增强CT检查。[（18）F]FDG - PET图像在知晓CT检查结果的情况下进行解读（PET + CT）；相反，CT图像在不知晓[（18）F]FDG - PET结果的情况下进行评估。在影像学检查后7天内，进行了二次腹腔镜检查（n = 7）或剖腹手术（n = 18）以进行组织学确认。在所有病例中，将影像学检查结果与组织病理学检查结果进行了关联。
在23个经组织学确认的肿瘤存活病灶中，仅CT能检测出16个，PET + CT能检测出19个。一个炎性淋巴结在PET + CT和单独CT检查中均被误诊为存活肿瘤；骶前区域的一处瘢痕组织在单独CT检查中也被误判为恶性组织。基于病灶的总体敏感性、特异性和评估残余肿瘤局部区域的准确性如下：CT分别为69.56%、83.33%、74.28%，PET + CT分别为82.60%、91.67%、85.71%。PET + CT的阴性预测值（73.33%）明显高于单独CT（58.82%）。
PET联合CT能够准确评估肿瘤反应。PET + CT相较于单独CT的一个主要优势在于排除治疗后残余存活病灶的存在。
