PET和CT在PET/CT研究中对骨与软组织肉瘤进行分期及评估治疗反应的影响。

Impact of PET and CT in PET/CT studies for staging and evaluating treatment response in bone and soft tissue sarcomas.

作者信息

Piperkova Elena, Mikhaeil Mounir, Mousavi Ali, Libes Richard, Viejo-Rullan Francisco, Lin Henry, Rosen Gerald, Abdel-Dayem Hussein

机构信息

Department of Nuclear Medicine, St Vincent's Hospital and Comprehensive Cancer Center Manhattan and New York Medical College, Valhalla, NY, USA.

出版信息

Clin Nucl Med. 2009 Mar;34(3):146-50. doi: 10.1097/RLU.0b013e3181966f9d.

DOI:10.1097/RLU.0b013e3181966f9d

PMID:19352275

Abstract

PURPOSE

Study impact of F-18 FDG PET/CT on initial staging, restaging, and evaluating treatment response (ETR) in bone and soft tissue sarcomas (BSTS), focusing on discrepancy between CT and PET portions.

PATIENTS AND METHODS

Ninety-three BSTS patients having 204 F-18 FDG PET/CT studies were retrospectively reviewed. They were divided into 4 groups. Group I for initial staging included 16 patient studies. The other 3 groups were divided according to the time interval from last treatment received. Group II for ETR up to 2 months included 83 studies. Group III was for early restaging after 2 to 6 months included 45 studies. Group IV was for long-term follow-up after 6 months included 60 studies. All results were confirmed either by pathology, or by clinical follow-up.

RESULTS

Sixteen studies for initial staging were concordant in 14 and discordant in 2 patients (48 lesions, 46 concordant, and 2 discordant). PET showed 97.2% sensitivity and 100% specificity versus 100% and 91.6% on CT. Regarding the other 3 groups, 498 lesions were detected; PET and CT were concordant in 436/498 (88%) and discordant in 62/498 (12%). In group II for ETR, PET and CT were concordant in 64/83 (77%) and discordant in 19/83(23%) studies-13 showed excellent to complete response on PET with partial response (PR) or stable disease (SD) on CT; 6 studies in PET showed PR versus SD or progression of disease (PD) on CT. In group III, for early restaging of disease 36/45 (80%) concordant and 9/45 (20%) discordant (3 showed excellent to complete response and 2 PR on PET versus CT SD, 3 PET PR versus CT PD, and 1 PET study showed PD while CT showed SD). In group IV, for long-term restaging, 49/60 (82%) were concordant and 11/60 (18%) were discordant; 9 PET studies were negative for active disease versus CT positive and 2 PET studies showed PD, CT was negative. PET alone showed 94.1% sensitivity and 94.6% specificity versus 97.2% and 63.5% for CT, 100% and 95.9% for PET/CT.

CONCLUSIONS

In BSTS for the purpose of initial staging, ETR, short-term, or long-term restaging, FDG-PET is more accurate than CT. Combined PET/CT has higher accuracy than either alone.

摘要

目的

研究F-18 FDG PET/CT对骨与软组织肉瘤（BSTS）的初始分期、再分期及评估治疗反应（ETR）的影响，重点关注CT与PET部分之间的差异。

患者与方法

回顾性分析93例接受204次F-18 FDG PET/CT检查的BSTS患者。他们被分为4组。初始分期的I组包括16例患者的研究。其他3组根据上次接受治疗后的时间间隔划分。ETR至2个月的II组包括83项研究。2至6个月后的早期再分期的III组包括45项研究。6个月后的长期随访的IV组包括60项研究。所有结果均通过病理或临床随访得到证实。

结果

16例初始分期的研究中，14例结果一致，2例不一致（48个病灶，46例一致，2例不一致）。PET显示敏感性为97.2%，特异性为100%，而CT分别为100%和91.6%。对于其他3组，共检测到498个病灶；PET与CT一致的有436/498（88%），不一致的有62/498（12%）。在ETR的II组中，PET与CT一致的有64/83（77%），不一致的有19/83（23%）——13例PET显示极佳至完全缓解，而CT显示部分缓解（PR）或疾病稳定（SD）；PET的6项研究显示PR，而CT显示SD或疾病进展（PD）。在III组中，疾病早期再分期时，36/45（80%）一致，9/45（20%）不一致（3例PET显示极佳至完全缓解，2例PR，而CT显示SD，3例PET显示PR，而CT显示PD，1例PET显示PD，而CT显示SD）。在IV组中，长期再分期时，49/60（82%）一致，11/60（18%）不一致；9项PET研究显示无活动性疾病，而CT为阳性，2项PET研究显示PD，CT为阴性。单独PET显示敏感性为94.1%，特异性为94.6%，而CT分别为97.2%和63.5%，PET/CT分别为100%和95.9%。