Pfannenberg A C, Aschoff P, Brechtel K, Müller M, Klein M, Bares R, Claussen C D, Eschmann S M
Department of Diagnostic Radiology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler- Strasse 3, 72076 Tuebingen, Germany.
Br J Radiol. 2007 Jun;80(954):437-45. doi: 10.1259/bjr/34082277. Epub 2007 Feb 28.
To evaluate the additional value of contrast-enhanced multiphase CT in comparison with low-dose non-contrast CT in combined positron emission tomography (PET)/CT protocols for oncological imaging, we retrospectively analysed 100 patients with different malignant tumours. All patients underwent a PET/CT consisting of a multiphase CT protocol including a low-dose non-enhanced attenuation scan and an arterial and portal-venous contrast-enhanced scan followed by a whole-body PET. PET/CT studies were analysed by different categories to determine the added value of contrast-enhanced CT. The additional value was defined as new information provided by diagnostic CT and not available from the low-dose CT, resulting in change of PET/CT interpretation. The results were validated either by histopathology or by clinical-radiological follow up at > or =6 months. The clinical impact was evaluated with respect to changes in patient management. Diagnostic multiphase CT was of additional value in 52 out of 100 patients with 85 suspected lesions. In 40 out of 100 patients, no additional value could be detected. Eight patients were excluded due to inconclusive diagnosis in both methods including fusion. The analysis showed the greatest benefit of diagnostic CT in the categories localization of pathological fluorodeoxyglucose (FDG) uptake and precise tumour delineation, changing PET/CT interpretation in 42% and 31% of patients, respectively. The benefit of diagnostic CT was influenced by the tumour type demonstrating the highest impact in gastrointestinal, lung and neuroendocrine tumours. Diagnostic CT changed clinical management in 21 patients (21%). Diagnostic multiphase CT as part of the combined PET/CT protocol has the potential to provide considerable additional value in specific clinical conditions with resultant change of management in a substantial proportion of patients.
为了评估在肿瘤成像的联合正电子发射断层扫描（PET）/CT方案中，对比增强多期CT相较于低剂量非增强CT的附加价值，我们回顾性分析了100例患有不同恶性肿瘤的患者。所有患者均接受了PET/CT检查，该检查包括一个多期CT方案，其中有一次低剂量非增强衰减扫描以及一次动脉期和门静脉期对比增强扫描，随后进行全身PET检查。PET/CT研究按不同类别进行分析，以确定对比增强CT的附加价值。附加价值定义为诊断性CT提供的、低剂量CT无法获得的新信息，从而导致PET/CT解读的改变。结果通过组织病理学或≥6个月的临床放射学随访进行验证。根据患者管理的变化评估临床影响。在100例有85个可疑病变的患者中，诊断性多期CT对52例具有附加价值。在100例患者中，有40例未检测到附加价值。由于两种方法（包括融合）诊断均不明确，8例患者被排除。分析显示，诊断性CT在病理性氟脱氧葡萄糖（FDG）摄取定位和精确肿瘤勾勒类别中获益最大，分别使42%和31%的患者PET/CT解读发生改变。诊断性CT的获益受肿瘤类型影响，在胃肠道、肺部和神经内分泌肿瘤中影响最大。诊断性CT使21例患者（21%）的临床管理发生改变。作为联合PET/CT方案一部分的诊断性多期CT，在特定临床情况下有可能提供相当大的附加价值，从而使相当一部分患者的管理发生改变。
