回顾性融合 PET 和 MR 图像在肝转移检测中的价值：与 18F-FDG PET/CT 和 Gd-EOB-DTPA 增强 MRI 的比较。

Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI.

机构信息

Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.

出版信息

J Nucl Med. 2010 May;51(5):692-9. doi: 10.2967/jnumed.109.068510. Epub 2010 Apr 15.

DOI:10.2967/jnumed.109.068510

PMID:20395324

Abstract

UNLABELLED

The purpose of this study was to compare the accuracy of lesion detection and diagnostic confidence between (18)F-FDG PET/CT, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, and retrospectively fused PET and MRI (PET/MRI).

METHODS

Thirty-seven patients (mean age +/- SD, 60.2 +/- 12 y) with suspected liver metastases underwent PET/CT and Gd-EOB-DTPA-enhanced MRI within 0-30 d (mean, 11.9 +/- 9 d). PET and Gd-EOB-DTPA-enhanced MR image data were retrospectively fused. Images were reviewed independently by 2 readers who identified and characterized liver lesions using PET/CT, Gd-EOB-DTPA-enhanced MRI, and PET/MRI. Each liver lesion was graded on a 5-point confidence scale ranging from definitely benign (grade of 1) to definitely malignant (grade of 5). The accuracy of each technique was determined by receiver-operating-characteristic analysis. Histopathology served as the standard of reference for all patients with malignant lesions.

RESULTS

A total of 85 liver lesions (55 liver metastases [65%] and 30 benign lesions [35%]) were present in 29 (78%) of the 37 patients. Twenty-four (65%) of the 37 patients had liver metastases. The detection rate of liver lesions was significantly lower for PET/CT than for Gd-EOB-DTPA-enhanced MRI (64% and 85%; P = 0.002). Sensitivity in the detection and characterization of liver metastases for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 was 76%, 91%, 93%, and 93%, respectively; the respective specificity values were 90%, 100%, 87%, and 97%. The difference in sensitivity between PET/CT and PET/MRI was significant (P = 0.023). The level of confidence regarding liver lesions larger than 1 cm in diameter was significantly higher in PET/MRI than in PET/CT (P = 0.046). Accuracy values (area under the receiver-operating-characteristic curve) for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 were 0.85, 0.94, 0.92, and 0.96, respectively.

CONCLUSION

The sensitivity of Gd-EOB-DTPA-enhanced MRI and PET/MRI in the detection of liver metastases is higher than that of PET/CT. Diagnostic confidence was significantly better with PET/MRI than with PET/CT regarding lesions larger than 1 cm in diameter. Compared with Gd-EOB-DTPA-enhanced MRI, PET/MRI resulted in a nonsignificant increase in sensitivity and diagnostic confidence.

摘要

目的

本研究旨在比较 18F-FDG PET/CT、钆塞酸二钠（Gd-EOB-DTPA）增强 MRI 及回顾性融合 PET 和 MRI（PET/MRI）在肝脏病变检测和诊断信心方面的准确性。

方法

37 例疑似肝转移患者在 0-30 天内（平均 11.9±9 天）接受了 PET/CT 和 Gd-EOB-DTPA 增强 MRI 检查。对 PET 和 Gd-EOB-DTPA 增强 MR 图像数据进行了回顾性融合。2 位读者独立对图像进行了检查，使用 PET/CT、Gd-EOB-DTPA 增强 MRI 和 PET/MRI 对肝脏病变进行了识别和描述。每个肝脏病变都使用 5 分置信度评分进行了分级，范围从肯定良性（1 级）到肯定恶性（5 级）。通过接受者操作特性分析确定了每种技术的准确性。所有恶性病变患者均以组织病理学为参考标准。

结果

29 例（78%）患者中共有 85 个肝脏病变（55 个肝转移灶[65%]和 30 个良性病变[35%]）。37 例患者中有 24 例（65%）存在肝转移灶。与 Gd-EOB-DTPA 增强 MRI 相比，PET/CT 对肝脏病变的检出率明显较低（分别为 64%和 85%；P=0.002）。在检测和描述肝转移灶方面，PET/CT、Gd-EOB-DTPA 增强 MRI、读者 1 的 PET/MRI 和读者 2 的 PET/MRI 的敏感性分别为 76%、91%、93%和 93%；各自的特异性值分别为 90%、100%、87%和 97%。PET/CT 和 PET/MRI 之间的敏感性差异具有统计学意义（P=0.023）。与 PET/CT 相比，直径大于 1cm 的肝脏病变的诊断信心在 PET/MRI 中显著提高（P=0.046）。PET/CT、Gd-EOB-DTPA 增强 MRI、读者 1 的 PET/MRI 和读者 2 的 PET/MRI 的准确性值（受试者工作特征曲线下面积）分别为 0.85、0.94、0.92 和 0.96。

结论

Gd-EOB-DTPA 增强 MRI 和 PET/MRI 对肝脏转移灶的检测敏感性高于 PET/CT。与 Gd-EOB-DTPA 增强 MRI 相比，PET/MRI 对直径大于 1cm 的病变的诊断信心显著提高。与 Gd-EOB-DTPA 增强 MRI 相比，PET/MRI 的敏感性和诊断信心略有提高，但无统计学意义。