复发性卵巢癌：使用对比增强 CT 和 PET/CT 准确定位肿瘤复发并预测患者的生存。
Recurrent ovarian cancer: use of contrast-enhanced CT and PET/CT to accurately localize tumor recurrence and to predict patients' survival.
机构信息
Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, England.
出版信息
Radiology. 2010 Oct;257(1):125-34. doi: 10.1148/radiol.10092279. Epub 2010 Aug 9.
PURPOSE
To compare accuracy and interobserver variability in the detection and localization of recurrent ovarian cancer with contrast material-enhanced (CE) computed tomography (CT) and positron emission tomography (PET)/CT and determine whether imaging findings can be used to predict survival.
MATERIALS AND METHODS
Waiving informed consent, the institutional review board approved this HIPAA-compliant, retrospective study of 35 women (median age, 54.4 years) with histopathologically proven recurrent ovarian carcinoma who underwent CE CT and PET/CT before exploratory surgery. All CE CT and PET/CT scans were independently analyzed. Tumor presence, number of lesions, and the size and maximum standardized uptake value (SUV(max)) of the largest lesion were recorded for patient and region. Surgical histopathologic findings constituted the reference standard. Areas under the receiver operating characteristic curves (AUCs), κ statistics, and hazard ratios were calculated.
RESULTS
Readers' AUCs in detection of recurrence for region were 0.85 (95% confidence interval [CI]: 0.81, 0.90) and 0.78 (95% CI: 0.72, 0.83) for CE CT and 0.84 (95% CI: 0.79, 0.89) and 0.74 (95% CI: 0.67, 0.81) for PET/CT (P = .76); 12 patients died. At PET/CT, size, number, and SUV(max) of peritoneal deposits were significantly associated with poor survival for readers 1 and 2 (P ≤ .01and ≤ .05, respectively), as were long- and short-axis diameters, number, and SUV(max) of distant lymph nodes for reader 1 (P ≤ .001). With CE CT, size (reader 1) and number (readers 1 and 3) of peritoneal deposits were significantly associated with poor survival (P ≤ .01), as were long- and short-axis diameters and number of distant lymph nodes for reader 1 (P ≤ .01). Interobserver agreement ranged from fair (patient, κ = 0.30) to moderate (region, κ = 0.55) for CE CT and fair (patient, κ = 0.24) to substantial (region, κ = 0.63) for PET/CT.
CONCLUSION
Preliminary data suggest that CE CT and PET/CT may have similar accuracy in detection of recurrent ovarian cancer. Tumor size, number, and SUV(max) may have potential as prognostic biomarkers for patients with recurrent ovarian cancer.
目的
比较对比增强（CE）计算机断层扫描（CT）和正电子发射断层扫描（PET）/CT 在检测和定位复发性卵巢癌中的准确性和观察者间变异性，并确定影像学结果是否可用于预测生存。
材料与方法
本 HIPAA 合规、回顾性研究纳入了 35 名经组织病理学证实患有复发性卵巢癌的女性患者（中位年龄 54.4 岁），这些患者在探查性手术前均进行了 CE CT 和 PET/CT 检查。所有的 CE CT 和 PET/CT 扫描均由独立的观察者进行分析。记录患者和区域的肿瘤存在、病变数量、最大标准摄取值（SUV(max)）和最大病变的大小。手术病理结果为参考标准。计算受试者工作特征曲线（ROC）下面积（AUCs）、κ 统计量和危险比。
结果
在检测区域复发方面，读者的 AUC 为 0.85（95%置信区间[CI]：0.81，0.90）和 0.78（95%CI：0.72，0.83）CE CT 和 0.84（95%CI：0.79，0.89）和 0.74（95%CI：0.67，0.81）（P =.76）；12 名患者死亡。在 PET/CT 中，读者 1 和 2 观察到腹膜沉积物的大小、数量和 SUV(max)与较差的生存显著相关（P ≤.01 和 ≤.05），读者 1 观察到远处淋巴结的长径和短径、数量和 SUV(max)与较差的生存显著相关（P ≤.001）。在 CE CT 中，读者 1 观察到腹膜沉积物的大小和数量，以及读者 1 和 3 观察到腹膜沉积物的数量与较差的生存显著相关（P ≤.01），读者 1 观察到远处淋巴结的长径和短径、数量与较差的生存显著相关（P ≤.01）。观察者间一致性范围从差（患者，κ = 0.30）到中等（区域，κ = 0.55），用于 CE CT，从差（患者，κ = 0.24）到好（区域，κ = 0.63）用于 PET/CT。
结论
初步数据表明，CE CT 和 PET/CT 在检测复发性卵巢癌方面可能具有相似的准确性。肿瘤大小、数量和 SUV(max)可能是复发性卵巢癌患者的潜在预后生物标志物。
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