Department of Radiology/Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Nucl Med. 2010 Dec;51(12):1833-40. doi: 10.2967/jnumed.110.076778. Epub 2010 Nov 15.
The utility of (18)F-FDG PET/CT for response assessment in malignant lung tumors treated with radiofrequency ablation (RFA) and for the detection and prediction of local recurrence was investigated.
Between December 17, 2003, and April 9, 2008, 68 consecutive patients (mean age, 68 y) with 94 pulmonary lesions, including metastases (n = 38) and primary lung cancers (n = 44), underwent RFA. Because of inadequate imaging follow-up in 12 patients, only 82 lesions were analyzed (CT scans, n = 82; (18)F-FDG PET/CT scans, n = 62). The median follow-up was 25 mo (range, 12-66 mo). A baseline study was defined as (18)F-FDG PET/CT performed no more than 3 mo before RFA. The first postablation scan was defined as PET/CT performed between 1 and 4 mo after RFA; additional follow-up studies were obtained in some cases between 6 and 12 mo after RFA. The unidimensional maximum diameter of the lesion was recorded on a pretherapy diagnostic CT scan or on the CT component of a pretherapy (18)F-FDG PET/CT scan, whichever was obtained most recently, using lung windows. Maximum standardized uptake values (SUVs) were recorded for all lesions imaged by (18)F-FDG PET/CT. (18)F-FDG uptake patterns on post-RFA scans were classified as favorable or unfavorable. Survival and recurrence probabilities were estimated using the Kaplan-Meier method. Uni- and multivariate analyses were also performed.
Before RFA, factors predicting greater local recurrence-free survival included initial lesion size less than 3 cm (P = 0.01) and SUV less than 8 (P = 0.02), although the latter was not an independent predictor in multivariate analysis. Treated metastases recurred less often than treated primary lung cancers (P = 0.03). Important post-RFA factors that related to reduced recurrence-free survival included an unfavorable uptake pattern (P < 0.01), post-RFA SUV (P < 0.01), and an increase in SUV over time after ablation (P = 0.05).
(18)F-FDG PET/CT parameters on both preablation and postablation scans may predict local recurrence in patients treated with RFA for lung metastases and primary lung cancers.
探讨（18）F-FDG PET/CT 用于评估射频消融（RFA）治疗恶性肺肿瘤的疗效、检测和预测局部复发的作用。
2003 年 12 月 17 日至 2008 年 4 月 9 日，对 68 例（平均年龄 68 岁）94 个肺部病变患者（包括转移瘤 38 例，原发性肺癌 44 例）进行 RFA 治疗。由于 12 例患者的影像学随访不充分，仅对 82 个病变进行了分析（CT 扫描 82 例；（18）F-FDG PET/CT 扫描 62 例）。中位随访时间为 25 个月（范围：12-66 个月）。基线研究定义为 RFA 前不超过 3 个月的（18）F-FDG PET/CT 检查。第一次消融后扫描定义为 RFA 后 1-4 个月进行的 PET/CT 检查；在某些情况下，RFA 后 6-12 个月还会进行进一步的随访研究。在术前诊断性 CT 扫描或术前（18）F-FDG PET/CT 扫描的 CT 成分上记录病变的最大径（如果最近获得了 CT 扫描，则使用肺窗记录）。记录所有（18）F-FDG PET/CT 扫描的病变的最大标准化摄取值（SUV）。根据 RFA 后扫描的（18）F-FDG 摄取模式，将其分为有利或不利。使用 Kaplan-Meier 法估计生存和复发概率。还进行了单因素和多因素分析。
在 RFA 前，预测局部无复发生存率更高的因素包括初始病变大小<3cm（P=0.01）和 SUV<8（P=0.02），但后者在多因素分析中不是独立的预测因素。治疗后的转移瘤复发率低于治疗后的原发性肺癌（P=0.03）。与无复发生存率降低相关的重要 RFA 后因素包括摄取模式不良（P<0.01）、RFA 后 SUV（P<0.01）和消融后 SUV 随时间增加（P=0.05）。
（18）F-FDG PET/CT 的基线和消融后参数可能有助于预测接受 RFA 治疗的肺转移瘤和原发性肺癌患者的局部复发。
