Department of Clinical Radiology, University Hospitals Munich-Grosshadern, LMU, Marchioninistr. 15, 81377 München, Germany.
Eur J Radiol. 2012 Mar;81(3):e269-76. doi: 10.1016/j.ejrad.2011.02.018. Epub 2011 Mar 12.
The purpose was to evaluate the potential of FDG-PET-CT and whole-body MRI (WB-MRI) as diagnostic triage methods for patients planned for radioembolisation of metastatic liver disease.
135 patients with multifocal liver metastases were evaluated for potential palliative therapy with radioembolisation using 90-Yttrium microspheres. All patients were examined consecutively with FDG-PET-CT and WB-MRI for exclusion of relevant extra-hepatic tumor manifestations. All patients underwent 99mTc-albumine angiography followed by scintigraphy to exclude significant hepato-pulmonary shunting.
Out of the 135 patients included into the pre-therapeutic diagnostic algorithm, 56% were eligible and received radioembolisation, while 44% could not be treated. In 91% the exclusion criteria was diagnosis of significant extra-hepatic metastatic disease. In 85% exclusion diagnosis was made concordantly by both FDG-PET-CT and WB-MRI, in 9% diagnosis was provided by PET-CT, in 6% by WB-MRI alone. Patient-based sensitivity for detection of extra-hepatic disease was 94% for PET-CT and 91% for WB-MRI. False-positive diagnosis of extrahepatic disease leading to exclusion for radioembolisation therapy was made in 2% of patients, in one patient by PET-CT and in one patient by WB-MRI alone. Overall, specificity for inclusion of radioembolisation therapy by combining both modalities was 99%. In 9% of patients angiographic diagnosis made radioembolisation impossible, in 7% solely the angiographic findings were decisive.
Both FDG-PET-CT and WB-MRI are efficient diagnostic triage methods for patients planned for radioembolisation of liver metastases. Overall, FDG-PET-CT shows a trend to higher diagnostic accuracy compared to WB-MRI and may be used as imaging method of choice as a standalone examination. In combination, both modalities exhibited high sensitivity for the diagnosis of extra-hepatic tumor manifestations and result in high specificity.
评估 FDG-PET-CT 和全身 MRI（WB-MRI）作为计划接受放射性栓塞治疗转移性肝疾病患者的诊断分流方法的潜力。
对 135 例接受 90 钇微球放射性栓塞姑息性治疗的多灶性肝转移患者进行评估。所有患者均连续接受 FDG-PET-CT 和 WB-MRI 检查，以排除相关的肝外肿瘤表现。所有患者均行 99mTc-白蛋白血管造影，继以闪烁扫描，以排除明显的肝肺分流。
在纳入治疗前诊断算法的 135 例患者中，56%符合条件并接受了放射性栓塞治疗，而 44%的患者不能接受治疗。91%的排除标准是诊断为明显的肝外转移性疾病。85%的患者通过 FDG-PET-CT 和 WB-MRI 联合诊断，9%的患者通过 PET-CT 诊断，6%的患者通过 WB-MRI 诊断。FDG-PET-CT 检测肝外疾病的患者敏感性为 94%，WB-MRI 为 91%。有 2%的患者因假阳性肝外疾病诊断而被排除放射性栓塞治疗，1 例为 PET-CT 诊断，1 例为 WB-MRI 诊断。总的来说，联合两种方法进行放射性栓塞治疗纳入的特异性为 99%。9%的患者血管造影诊断使放射性栓塞治疗成为不可能，7%的患者仅血管造影结果具有决定性。
FDG-PET-CT 和 WB-MRI 都是计划接受肝转移放射性栓塞治疗患者的有效诊断分流方法。总的来说，与 WB-MRI 相比，FDG-PET-CT 显示出更高的诊断准确性趋势，可作为单独检查的首选影像学方法。联合使用这两种方法对肝外肿瘤表现的诊断具有较高的敏感性，特异性较高。
