Palmedo Holger, Bucerius Jan, Joe Alexius, Strunk Holger, Hortling Niclas, Meyka Susanne, Roedel Roland, Wolff Martin, Wardelmann Eva, Biersack Hans-Juergen, Jaeger Ursula
Department of Nuclear Medicine, University Hospital of Bonn, 53127 Bonn, Germany.
J Nucl Med. 2006 Apr;47(4):616-24.
The aim of this study was to investigate the diagnostic accuracy and impact on patient management of the new integrated PET/CT modality in patients with suspected iodine-negative, differentiated thyroid carcinoma (DTC).
Forty patients with DTC and a suggestion of iodine-negative tumor tissue underwent PET/CT examination (370 MBq (18)F-FDG, coregistered PET/CT whole-body images). As the first step of analysis, PET and CT images were scored blindly and independently by 2 nuclear medicine physicians and 2 radiologists. A 5-point scale was used. The second step consisted of a consensus reading, during which a virtual side-by-side fusion of PET and CT images was initially evaluated and afterward the "real" fusion (i.e., coregistered) PET/CT images were also scored with the same 5-point scale. The imaging results were compared with histopathologic findings and the course of disease during further follow-up examinations.
One hundred twenty-seven lesions in 40 patients were evaluated. Diagnostic accuracy was 93% and 78% for PET/CT and PET, respectively (P = 0.049, per-patient analysis). In 17 (74%) of 23 patients with suspicious (18)F-FDG foci, integrated PET/CT added relevant information to the side-by-side interpretation of PET and CT images by precisely localizing the lesion(s). In tumor-positive PET patients, PET/CT fusion by coregistration led to a change of therapy in 10 (48%) patients. Futile surgery was prevented in an additional 3 patients.
Integrated PET/CT is able to improve diagnostic accuracy in a therapeutically relevant way in patients with iodine-negative DTC. By precisely localizing tumor tissue, image fusion by integrated PET/CT is clearly superior to side-by-side interpretation of PET and CT images.
本研究旨在调查新型一体化PET/CT模式对疑似碘阴性分化型甲状腺癌（DTC）患者的诊断准确性及其对患者管理的影响。
40例DTC患者且怀疑有碘阴性肿瘤组织接受了PET/CT检查（370 MBq (18)F-FDG，PET/CT全身图像配准）。作为分析的第一步，2名核医学医师和2名放射科医生对PET和CT图像进行独立的盲法评分。采用5分制。第二步是进行一致性读片，在此过程中，首先对PET和CT图像的虚拟并排融合进行评估，然后对“真实”融合（即配准）的PET/CT图像也采用相同的5分制进行评分。将影像学结果与组织病理学发现以及进一步随访检查期间的疾病进程进行比较。
对40例患者的127个病灶进行了评估。PET/CT和PET的诊断准确性分别为93%和78%（患者个体分析，P = 0.049）。在23例(18)F-FDG病灶可疑的患者中，有17例（74%）通过一体化PET/CT精确地定位病灶，为PET和CT图像的并排解读增添了相关信息。在PET显示肿瘤阳性的患者中，通过配准实现的PET/CT融合使10例（48%）患者的治疗方案发生了改变。另外还有3例患者避免了无效手术。
一体化PET/CT能够以与治疗相关的方式提高碘阴性DTC患者的诊断准确性。通过精确地定位肿瘤组织，一体化PET/CT的图像融合明显优于PET和CT图像的并排解读。
