18F-氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT）与静脉注射对比增强CT在可切除早期食管癌患者区域转移性淋巴结评估中的比较
Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer.
作者信息
Okada Masahiro, Murakami Takamichi, Kumano Seishi, Kuwabara Masatomo, Shimono Taro, Hosono Makoto, Shiozaki Hitoshi
机构信息
Department of Radiology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
出版信息
Ann Nucl Med. 2009 Jan;23(1):73-80. doi: 10.1007/s12149-008-0209-1. Epub 2009 Feb 11.
OBJECTIVE
To assess whether integrated fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can improve the diagnostic accuracy of metastatic regional lymph nodes (LNs) in esophageal cancer compared with contrast enhanced CT (CECT).
METHODS
We examined 180 consecutive patients with esophageal cancer by integrated PET/CT between April 2006 and March 2007. Eighteen patients (M:F 14:4) underwent radical esophagectomy after evaluations by PET/CT and CECT of 5-7-mm-thick slices 70-80 s after injection. Regional LNs of esophageal cancer were retrospectively reviewed on CECT images by two blinded evaluators on the basis of the following cutoff sizes: 7 mm for all regional LNs (Protocol A), 10 mm for paratracheal LNs (Protocol B), and 7 mm for others. In addition, the maximum standardized uptake value (SUVmax) on PET/CT was evaluated for positive uptake by LNs.
RESULTS
Of 210 LNs excised at surgery, 25 were positive and 185 were negative for metastasis at pathology. The PET/CT images identified 15 true-positive and 184 true-negative LNs, whereas CECT identified 15 true positives and 176 true negatives in Protocol A, and 14 true positives and 180 true negative in Protocol B. The sensitivity, specificity, accuracy, positive, and negative predictive values of PET/CT were respectively 60.0%, 99.5%, 94.8%, 93.8%, and 94.8%, whereas those of CECT were 60.0%, 95.1%, 91.0%, 62.5%, and 94.6% (Protocol A) and 56.0%, 97.3%, 92.4%, 73.7%, and 94.2% (Protocol B). A comparison of the two CECT protocols revealed fewer false-positive LNs in Protocol B, but slightly lower sensitivity in Protocol B than in Protocol A. Substantial numbers of false-positive LNs were determined by CECT in the paratracheal regions (6 of 9, 66.7%) and CECT revealed central necrosis in 4 of 15 (26.7%) true-positive LNs > 1.8 cm. The mean SUVmax on PET/CT was 2.9 (range 1.7-5.5) in true-positive LNs. The smallest LN metastasis detectable by PET/CT was 6 mm.
CONCLUSIONS
Integrated PET/CT improves the PPV of regional LNs when compared with CECT.
目的
评估与对比增强CT（CECT）相比，氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）能否提高食管癌区域转移淋巴结（LN）的诊断准确性。
方法
2006年4月至2007年3月期间，我们对180例连续性食管癌患者进行了PET/CT检查。18例患者（男∶女为14∶4）在注射后70-80秒接受了5-7毫米厚层的PET/CT和CECT检查，之后接受了根治性食管切除术。两名盲法评估者在CECT图像上根据以下截断大小对食管癌区域LN进行回顾性评估：所有区域LN为7毫米（方案A），气管旁LN为10毫米（方案B），其他为7毫米。此外，评估PET/CT上LN阳性摄取的最大标准化摄取值（SUVmax）。
结果
手术切除的210个LN中，病理检查发现25个转移阳性，185个转移阴性。PET/CT图像识别出15个真阳性和184个真阴性LN，而CECT在方案A中识别出15个真阳性和176个真阴性，在方案B中识别出14个真阳性和180个真阴性。PET/CT的敏感性、特异性、准确性、阳性和阴性预测值分别为60.0%、99.5%、94.8%、93.8%和94.8%，而CECT的敏感性、特异性、准确性、阳性和阴性预测值在方案A中分别为60.0%、95.1%、91.0%、62.5%和94.6%，在方案B中分别为56.0%、97.3%、92.4%、73.7%和94.2%。两种CECT方案比较显示，方案B中的假阳性LN较少，但方案B中的敏感性略低于方案A。CECT在气管旁区域确定了大量假阳性LN（9个中的6个，66.7%），并且CECT显示15个真阳性LN中>1.8厘米的有4个（26.7%）出现中央坏死。PET/CT上真阳性LN的平均SUVmax为2.9（范围1.7-5.5）。PET/CT可检测到的最小LN转移为6毫米。
结论
与CECT相比，PET/CT可提高区域LN的阳性预测值。
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