Morikawa Miwa, Demura Yoshiki, Ishizaki Takeshi, Ameshima Shingo, Miyamori Isamu, Sasaki Masato, Tsuchida Tatsuro, Kimura Hirohiko, Fujibayashi Yasuhisa, Okazawa Hidehiko
Department of Respiratory Medicine, University of Fukui, Fukui, Japan.
J Nucl Med. 2009 Jan;50(1):81-7. doi: 10.2967/jnumed.108.056408. Epub 2008 Dec 17.
The purpose of this study was to compare the efficacy of short-tau inversion-recovery (STIR) MRI and 18F-FDG PET/CT for the detection of metastasis in mediastinal and hilar lymph nodes in patients with lung cancer.
Ninety-three patients with known or suspected lung cancer with mediastinal and hilar lymph node swelling underwent STIR MRI and 18F-FDG PET/CT examinations. STIR MRI scans were obtained with a 2% copper sulfate phantom placed along the back of each patient, with the lymph node-to-phantom ratio calculated for quantitative analysis. For qualitative analysis, the results of all STIR MRI scans were evaluated using a 5-point visual scoring system. To evaluate the diagnostic capabilities of STIR MRI and 18F-FDG PET/CT, we used receiver-operating-characteristic curve analysis to determine the optimal thresholds for the lymph node-to-phantom ratio, visual score, and maximal standardized uptake value. Further, the capability of each to determine N-stage was compared in each patient using the McNemar test.
A total of 137 lymph nodes (82 malignant lesions, 55 benign lesions) were analyzed. When optimal threshold values were adopted, the quantitative and qualitative sensitivity, specificity, and accuracy of STIR MRI were not significantly different from those of 18F-FDG PET/CT. However, 18F-FDG PET/CT in combination with qualitative STIR MRI analysis had a significantly higher capability to detect nodal involvement on an individual-patient basis (96.9% specificity, 90.3% accuracy) than did 18F-FDG PET/CT alone (65.6% specificity, 81.7% accuracy).
We found that the diagnostic capability of STIR MRI was not significantly different from that of 18F-FDG PET/CT. However, when those methods were combined, the diagnostic capability for N-staging was significantly improved.
本研究的目的是比较短tau反转恢复（STIR）磁共振成像（MRI）和18F-氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（18F-FDG PET/CT）在检测肺癌患者纵隔和肺门淋巴结转移方面的疗效。
93例已知或疑似肺癌且伴有纵隔和肺门淋巴结肿大的患者接受了STIR MRI和18F-FDG PET/CT检查。在每位患者背部放置2%硫酸铜模型进行STIR MRI扫描，计算淋巴结与模型的比值用于定量分析。对于定性分析，所有STIR MRI扫描结果采用5分视觉评分系统进行评估。为评估STIR MRI和18F-FDG PET/CT的诊断能力，我们使用受试者操作特征曲线分析来确定淋巴结与模型比值、视觉评分和最大标准化摄取值的最佳阈值。此外，使用McNemar检验比较每位患者中各方法确定N分期的能力。
共分析了137个淋巴结（82个恶性病变，55个良性病变）。采用最佳阈值时，STIR MRI的定量和定性敏感性、特异性及准确性与18F-FDG PET/CT无显著差异。然而，18F-FDG PET/CT联合定性STIR MRI分析在个体患者基础上检测淋巴结受累的能力（特异性96.9%，准确性90.3%）明显高于单独使用18F-FDG PET/CT（特异性65.6%，准确性81.7%）。
我们发现STIR MRI的诊断能力与18F-FDG PET/CT无显著差异。然而，当将这些方法联合使用时，N分期的诊断能力显著提高。
