全身磁共振成像在儿科患者恶性肿瘤分期中的应用：美国放射学会影像学网络 6660 试验的结果。
Whole-body MR imaging for staging of malignant tumors in pediatric patients: results of the American College of Radiology Imaging Network 6660 Trial.
机构信息
Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110, USA.
出版信息
Radiology. 2013 Feb;266(2):599-609. doi: 10.1148/radiol.12112531. Epub 2012 Dec 21.
PURPOSE
To compare whole-body magnetic resonance (MR) imaging with conventional imaging for detection of distant metastases in pediatric patients with common malignant tumors.
MATERIALS AND METHODS
This institutional review board-approved, HIPAA-compliant, multicenter prospective cohort study included 188 patients (109 male, 79 female; mean age, 10.2 years; range, < 1 to 21 years) with newly diagnosed lymphoma, neuroblastoma, or soft-tissue sarcoma. Informed consent was obtained and all patients underwent noncontrast material-enhanced whole-body MR imaging and standard-practice conventional imaging. All images were reviewed centrally by 10 pairs of readers. An independent panel verified the presence or absence of distant metastases. Detection of metastasis with whole-body MR and conventional imaging was quantified by using the area under the receiver operating characteristic curve (AUC). The effects of tumor subtype, patient age, and distant skeletal and pulmonary disease on diagnostic accuracy were also analyzed.
RESULTS
Of the 134 eligible patients, 66 (33 positive and 33 negative for metastasis) were selected for image review and analysis. Whole-body MR imaging did not meet the noninferiority criterion for accuracy when compared with conventional imaging for detection of metastasis (difference between average AUCs was -0.03 [95% confidence interval: -0.10, 0.04]); however, the average AUC for solid tumors was significantly higher than that for lymphomas (P = .006). More skeletal metastases were detected by using whole-body MR imaging than by using conventional imaging (P = .03), but fewer lung metastases were detected (P < .001). Patient age did not affect accuracy.
CONCLUSION
The noninferior accuracy for diagnosis of distant metastasis in patients with common pediatric tumors was not established for the use of whole-body MR imaging compared with conventional methods. However, improved accuracy was seen with whole-body MR imaging in patients with nonlymphomatous tumors.
目的
比较全身磁共振成像（MR）与常规成像在检测儿童常见恶性肿瘤远处转移中的作用。
材料与方法
本研究经机构审查委员会批准，符合 HIPAA 规定，为多中心前瞻性队列研究，纳入 188 例新诊断为淋巴瘤、神经母细胞瘤或软组织肉瘤的患者（男 109 例，女 79 例；平均年龄 10.2 岁；范围 1 岁至 21 岁）。所有患者均获得知情同意，并接受非增强对比剂全身 MR 成像和标准常规成像检查。所有图像均由 10 对阅读者进行中心阅片。独立专家组验证是否存在远处转移。采用受试者工作特征曲线（ROC）下面积（AUC）定量评估全身 MR 和常规成像对转移灶的检出效能。还分析了肿瘤亚型、患者年龄以及远处骨骼和肺部疾病对诊断准确性的影响。
结果
在 134 例符合条件的患者中，有 66 例（33 例转移阳性，33 例转移阴性）被选入进行图像回顾和分析。与常规成像相比，全身 MR 成像在检测转移方面未达到准确性非劣效性标准（平均 AUC 差值为 -0.03 [95%置信区间：-0.10，0.04]）；然而，实体瘤的平均 AUC 显著高于淋巴瘤（P =.006）。全身 MR 成像比常规成像检测到更多的骨骼转移（P =.03），但检测到的肺部转移较少（P <.001）。患者年龄未影响准确性。
结论
与常规方法相比，全身 MR 成像在诊断儿童常见肿瘤患者远处转移方面的准确性未达到非劣效性标准。然而，全身 MR 成像在非淋巴瘤肿瘤患者中显示出更好的准确性。
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