已知患有或疑似患有肺癌患者的FDG PET/CT检查中的肾上腺结节：一种高效诊断算法的建议
Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer: a proposal for an efficient diagnostic algorithm.
作者信息
Brady Matthew J, Thomas John, Wong Terence Z, Franklin Kendra M, Ho Lisa M, Paulson Erik K
机构信息
Department of Radiology, Duke University Medical Center, Erwin Rd, Durham, NC 27710. the 2007 RSNA Annual Meeting.
出版信息
Radiology. 2009 Feb;250(2):523-30. doi: 10.1148/radiol.2502080219.
PURPOSE
To develop an algorithm to maximize the diagnostic yield of positron emission tomography (PET)/computed tomography (CT) by using defined attenuation and standardized uptake value (SUV) criteria.
MATERIALS AND METHODS
An IRB-approved, HIPAA-compliant retrospective review with waiver of informed consent of data in 1388 consecutive patients who underwent PET/CT for known or suspected lung cancer was completed, and 187 adrenal nodules were identified in 147 patients. Nodules were defined histologically or by size change (malignant, n = 37) or stability for more than 1 year (benign, n = 58). Nodules not sampled for biopsy and with less than 1 year of follow-up were considered indeterminate (n = 92). Diameter, mean attenuation, SUV(max), and SUV ratio (nodule SUV(max)/liver SUV(avg)) were compared with t test and receiver operating characteristic analyses. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for diameter > 3 cm, mean attenuation > 10 HU, nodule SUV(max) > 3.1, and SUV ratio > 1.0. These were also calculated for higher SUV(max) and SUV ratio thresholds that were found to exclude all false-positives. Diagnostic accuracy was compared by using the McNemar test (P < .05).
RESULTS
In the study group of 147 patients (aged 42-88 years; mean, 65.5 years; 59 women), combined PET/CT with mean attenuation > 10 HU and SUV(max) > 3.1 had 97.3% sensitivity and 86.2% specificity. Combined PET/CT with mean attenuation > 10 HU and SUV ratio > 1.0 had 97.3% sensitivity and 74.1% specificity. The accuracies of these threshold combinations (90.5% and 83.2%, respectively) were significantly different (P = .008). Applying a further cutoff of SUV ratio > 2.5 enabled identification of 22 of 37 metastatic lesions and exclusion of all fluorodeoxyglucose-avid benign nodules.
CONCLUSION
Definitive identification of many metastases can be accomplished by applying an SUV ratio cutoff of greater than 2.5, allowing pragmatic management of adrenal nodules that initially test positive with the combined PET/CT criteria SUV(max) > 3.1 and mean attenuation > 10 HU.
SUPPLEMENTAL MATERIAL
http://radiology.rsnajnls.org/cgi/content/full/250/2/523/DC1.
目的
开发一种算法，通过使用规定的衰减和标准化摄取值（SUV）标准来最大化正电子发射断层扫描（PET）/计算机断层扫描（CT）的诊断率。
材料与方法
完成一项经机构审查委员会批准、符合健康保险流通与责任法案且豁免知情同意的回顾性研究，纳入1388例因已知或疑似肺癌接受PET/CT检查的连续患者的数据，在147例患者中发现了187个肾上腺结节。结节通过组织学定义或根据大小变化（恶性，n = 37）或超过1年的稳定性（良性，n = 58）来定义。未进行活检采样且随访时间少于1年的结节被视为不确定（n = 92）。通过t检验和受试者操作特征分析比较直径、平均衰减、SUV（最大值）和SUV比值（结节SUV（最大值）/肝脏SUV（平均值））。计算直径> 3 cm、平均衰减> 10 HU、结节SUV（最大值）> 3.1和SUV比值> 1.0时的敏感性、特异性、阳性预测值和阴性预测值。还针对发现可排除所有假阳性的更高SUV（最大值）和SUV比值阈值计算了这些指标。使用McNemar检验比较诊断准确性（P <.05）。
结果
在147例患者（年龄42 - 88岁；平均65.5岁；59例女性）的研究组中，平均衰减> 10 HU且SUV（最大值）> 3.1的PET/CT联合检查敏感性为97.3%，特异性为86.2%。平均衰减> 10 HU且SUV比值> 1.0的PET/CT联合检查敏感性为97.3%，特异性为74.1%。这些阈值组合的准确性（分别为90.5%和83.2%）有显著差异（P =.008）。应用SUV比值> 2.5的进一步截断值能够识别出37个转移病灶中的22个，并排除所有氟脱氧葡萄糖摄取阳性的良性结节。
结论
通过应用大于2.5的SUV比值截断值可以明确识别许多转移灶，从而对最初根据PET/CT联合标准SUV（最大值）> 3.1且平均衰减> 10 HU检测为阳性的肾上腺结节进行务实管理。
补充材料
http://radiology.rsnajnls.org/cgi/content/full/250/2/523/DC1
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