采用代谢体积和 SUVmax 的逐步方法，对 18F-FDG PET/CT 上的良性结直肠摄取物进行良恶性和异型增生的鉴别。
A stepwise approach using metabolic volume and SUVmax to differentiate malignancy and dysplasia from benign colonic uptakes on 18F-FDG PET/CT.
机构信息
Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
出版信息
Clin Nucl Med. 2012 Jun;37(6):e134-40. doi: 10.1097/RLU.0b013e318239245d.
PURPOSE
The purpose of this study was to suggest a new diagnostic strategy using metabolic volume (MV) and maximum standardized uptake value (SUVmax) to differentiate malignancy and dysplasia from benign colonic 2-deoxy-2-18F-fluoro-D-glucose (FDG) uptakes.
MATERIALS AND METHODS
From records of 21,317 consecutive FDG positron emission tomography/computed tomography (PET/CT) scans at 2 centers, 102 focal colonic lesions in 99 patients investigated by colonoscopy and histopathologic examination were eligible for this retrospective study. SUVmax and MV were compared according to colonoscopic and histopathologic results. Firstly, dysplasia was separated from malignancy and benign lesions. Secondly, malignancy and benign lesions were separated from each other. The better parameters of each step were determined, and a diagnostic strategy was developed from their combination.
RESULTS
A total of 102 incidental colonic FDG uptakes were revealed as 32 malignancies, 43 dysplasias, and 27 benign lesions. MV better differentiated dysplasia from malignancy and benign lesions (cutoff value, ≤3.14 cm3; area under the receiver-operating characteristic curve [AUC] = 0.947), and SUVmax better differentiated malignancy from benign lesions (cutoff value, >9.1; AUC = 0.934). Overall, the stepwise algorithm using MV and SUVmax (AUC = 0.886) was superior to single measurements of SUVmax (AUC = 0.750) and MV (AUC = 0.714) for differentiating malignancy and dysplasia from benign lesions; sensitivity: 92%, specificity: 85%, accuracy: 90%, positive predictive value: 94%, negative predictive value: 79%.
CONCLUSIONS
The stepwise approach using MV and SUVmax was able to differentiate malignancy and dysplasia from benign colonic FDG uptakes on PET/CT. Colonic FDG uptake with MV ≤3.14 cm3 had a high probability of dysplasia. MV >3.14 cm3 and SUVmax >9.1 indicated malignancy, whereas MV >3.14 cm3 and SUVmax ≤9.1 indicated benign lesions.
目的
本研究旨在提出一种新的诊断策略，利用代谢体积（MV）和最大标准化摄取值（SUVmax）来区分良恶性和异型增生的结肠 2-脱氧-2-[18F]氟-D-葡萄糖（FDG）摄取。
材料与方法
从两个中心的 21317 例连续 FDG 正电子发射断层扫描/计算机断层扫描（PET/CT）扫描记录中，对 99 例患者的 102 个结肠局灶性病变进行了结肠镜检查和组织病理学检查，这些病变符合本回顾性研究的标准。根据结肠镜和组织病理学结果比较了 SUVmax 和 MV。首先，将异型增生与恶性和良性病变分开。其次，将恶性和良性病变分开。确定了每个步骤的最佳参数，并从它们的组合中开发了一种诊断策略。
结果
共发现 102 例偶然的结肠 FDG 摄取，其中 32 例为恶性肿瘤，43 例为异型增生，27 例为良性病变。MV 能更好地区分异型增生与恶性和良性病变（截断值，≤3.14cm3；受试者工作特征曲线下面积[AUC]为 0.947），而 SUVmax 能更好地区分恶性肿瘤与良性病变（截断值，>9.1；AUC=0.934）。总体而言，使用 MV 和 SUVmax 的逐步算法（AUC=0.886）优于单独测量 SUVmax（AUC=0.750）和 MV（AUC=0.714），用于区分恶性和异型增生与良性病变；敏感性：92%，特异性：85%，准确性：90%，阳性预测值：94%，阴性预测值：79%。
结论
MV 和 SUVmax 相结合的逐步方法能够在 PET/CT 上区分恶性和异型增生的结肠 FDG 摄取。MV 为≤3.14cm3 的结肠 FDG 摄取极有可能为异型增生。MV 为>3.14cm3 和 SUVmax 为>9.1 提示为恶性肿瘤，而 MV 为>3.14cm3 和 SUVmax 为≤9.1 提示为良性病变。
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