Pinilla I, Gómez-León N, Del Campo-Del Val L, Hernandez-Maraver D, Rodríguez-Vigil B, Jover-Díaz R, Coya J
Department of Radiology and Nuclear Medicine, Hospital Universitario La Paz Madrid, Spain.
Q J Nucl Med Mol Imaging. 2011 Oct;55(5):567-75. Epub 2010 Dec 9.
The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma.
One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard.
For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients.
PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.
本文旨在比较对比增强计算机断层扫描（CT）、正电子发射断层扫描（PET）、非增强低剂量PET/CT（LD-PET/CT）和全剂量增强PET/CT（FD-PET/CT）在淋巴瘤初始分期中的准确性。
101例淋巴瘤患者接受了[18F]FDG-PET/CT检查，包括非增强低剂量CT和增强全剂量CT。PET/CT的每种模式由一名核医学医师和一名不了解另一种模式的放射科医生进行评估，而CT和PET图像分别由另一名独立的放射科医生和核医学医师解读。将每种技术检测到的淋巴结和结外病变与参考标准进行比较。
对于淋巴结评估，LD-PET/CT的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）和阴性似然比（LR-）分别为97%、96%、98%、95%、26和0.02，FD-PET/CT的分别为97%、97%、98%、95%、36和0.02。这些结果显著优于PET（敏感性82%，特异性81%，PPV 88%，NPV 72%，LR+ 4.3，LR- 0.21）。同样，两种PET/CT模式的敏感性、NPV和LR-均高于CT（分别为91%、84%、0.1）。对于器官评估，两种PET/CT模式的敏感性和NPV也显著优于PET（LD-PET/CT：敏感性92%，NPV 90%；FD-PET/CT敏感性94%，NPV 92%；PET：敏感性70%，NPV 69%）。PET检测骨髓受累的敏感性、特异性、PPV和NPV分别为29%、84%、45%和72%，LD-PET/CT和FD-PET/CT两者的分别为29%、90%、56%和74%。LD-PET/CT和FD-PET/CT之间未发现显著差异，但FD-PET/CT在5.9%的患者中检测到重要的偶然发现。
PET/CT是淋巴瘤初始分期的准确技术，LD-PET/CT和FD-PET/CT之间无显著差异。FD-PET/CT能检测到LD-PET/CT遗漏的相关偶然发现。
