Sanli Yasemin, Turkmen Cuneyt, Bakir Baris, Iyibozkurt Cem, Ozel Sevda, Has Duygu, Yilmaz Ebru, Topuz Samet, Yavuz Ekrem, Unal Seher Nilgun, Mudun Ayse
Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Nucl Med Commun. 2012 May;33(5):509-15. doi: 10.1097/MNM.0b013e32834fc5bf.
The aim of this study was to evaluate the diagnostic value of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET/CT in comparison with MRI for the detection of recurrent ovarian cancer.
Forty-seven patients with suspected ovarian cancer recurrence after total ablative or cytoreductive surgery, as well as neoadjuvant or adjuvant chemotherapy, who had undergone (18)F-FDG PET/CT imaging were recruited for the present study. All patients also underwent MRI within a month of (18)F-FDG PET/CT for the same purpose. Recurrent cancer in the abdomen and pelvis was evaluated in each of the 47 patients and classified as either distant metastasis or local pelvic recurrence involving the vaginal stump, peritoneal implants, supradiaphragmatic region, and/or abdominal and pelvic lymph nodes. Special attention was paid to peritoneal implants. These were divided into five groups according to size of the implants: less than 0.5 cm (group 1), 0.5-1 cm (group 2), 1-2 cm (group 3), 2-3 cm (group 4), and larger than 3 cm (group 5). PET/CT findings were compared with abdominopelvic MR findings. Statistical analysis was carried out using the Wilcoxon signed rank test.
Thirty-nine of 47 patients were found to have recurrent ovarian cancer. Both PET/CT and MRI were negative for recurrence in six patients. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET/CT were 97.5, 100, 100, 87.5, and 97.8%, respectively, whereas those of MRI were 95, 85.7, 97.4, 75, and 93.6%, respectively. For the peritoneal implants in groups 2 and 3, the sensitivity, negative predictive value, and diagnostic accuracy values of PET/CT were significantly better than those of MRI (P<0.05).
The present study revealed that PET/CT is similar to conventional MRI for the detection of recurrent ovarian cancer. PET/CT has greater accuracy in the detection of small-to-medium-sized (<2 cm) peritoneal implants compared with MRI. This may affect surgical decision making.
本研究旨在评估2-（氟-18）-氟-2-脱氧-D-葡萄糖（（18）F-FDG）PET/CT与MRI在检测复发性卵巢癌方面的诊断价值。
本研究纳入了47例在全消融或肿瘤细胞减灭术以及新辅助或辅助化疗后疑似卵巢癌复发且接受了（18）F-FDG PET/CT成像的患者。所有患者在进行（18）F-FDG PET/CT检查后一个月内出于相同目的还接受了MRI检查。对47例患者中的每例患者的腹部和盆腔复发性癌症进行评估，并分类为远处转移或局部盆腔复发，包括阴道残端、腹膜种植灶、膈上区域和/或腹部及盆腔淋巴结。特别关注腹膜种植灶。根据种植灶大小将其分为五组：小于0.5 cm（第1组）、0.5 - 1 cm（第2组）、1 - 2 cm（第3组）、2 - 3 cm（第4组）和大于3 cm（第5组）。将PET/CT检查结果与腹部盆腔MR检查结果进行比较。采用Wilcoxon符号秩检验进行统计分析。
47例患者中有39例被发现患有复发性卵巢癌。6例患者的PET/CT和MRI检查结果均为复发阴性。PET/CT的总体敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为97.5%、100%、100%、87.5%和97.8%，而MRI的相应值分别为95%、85.7%、97.4%、75%和93.6%。对于第2组和第3组的腹膜种植灶，PET/CT的敏感性、阴性预测值和诊断准确性值显著优于MRI（P<0.05）。
本研究表明，PET/CT在检测复发性卵巢癌方面与传统MRI相似。与MRI相比，PET/CT在检测中小型（<2 cm）腹膜种植灶方面具有更高的准确性。这可能会影响手术决策。
