Saboury Babak, Salavati Ali, Brothers Alex, Basu Sandip, Kwee Thomas C, Lam Marnix G E H, Hustinx Roland, Louis Edouard, Torigian Drew A, Alavi Abass
Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Eur J Nucl Med Mol Imaging. 2014 Apr;41(4):605-14. doi: 10.1007/s00259-013-2625-2. Epub 2013 Nov 20.
The aim of this study was to determine the feasibility and potential clinical utility of assessment of Crohn's disease (CD) activity by (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT employing a new quantitative approach.
A total of 22 subjects (mean age 37) with CD who had undergone FDG PET/CT followed by ileocolonoscopy within 1 week were included in this analysis. The CD endoscopy index of severity (CDEIS) for various bowel segments was calculated. The CD activity index (CDAI) was evaluated, and fecal calprotectin was measured. On PET, regions with increased FDG uptake in large bowel were segmented with an adaptive contrast-oriented thresholding algorithm, and metabolically active volume (MAV), uncorrected mean standardized uptake value (SUV(mean)), partial volume-corrected SUV(mean) (PVC-SUV(mean)), SUV(max), uncorrected total lesion glycolysis (TLG = MAV × SUV(mean)), and PVC total lesion glycolysis (PVC-TLG = MAV × PVC-SUV(mean)) were measured. Global CD activity score (GCDAS) was calculated as the sum of PVC-TLG over all clinically significant FDG-avid regions in each subject. Correlations between regional PET quantification measures (SUVs, TLGs) and CDEIS were calculated. Correlations between the global PET quantification measure (GCDAS, global SUVs) with CDAI, fecal calprotectin, CDEIS, and CRP level were also calculated.
SUV(max), PVC-SUV(mean), and PVC-TLG significantly correlated with segment CDEIS subscores (r = 0.50, r = 0.69, and r = 0.31, respectively; p < 0.05). GCDAS significantly correlated with CDAI and fecal calprotectin (r = 0.64 and r = 0.51, respectively; p < 0.05).
By employing this new quantitative approach, we were able to calculate indices of regional and global CD activity, which correlated well with both clinical and pathological disease activity surrogate markers. This approach may be of clinical importance in measuring both global disease activity and treatment response in patients with CD.
本研究的目的是通过采用一种新的定量方法的¹⁸F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT来确定评估克罗恩病（CD）活动的可行性和潜在临床效用。
本分析纳入了22名患有CD的受试者（平均年龄37岁），这些受试者在1周内接受了FDG PET/CT检查，随后进行了回结肠镜检查。计算了各个肠段的CD内镜严重程度指数（CDEIS）。评估了CD活动指数（CDAI），并测量了粪便钙卫蛋白。在PET上，使用自适应对比度导向阈值算法对大肠中FDG摄取增加的区域进行分割，并测量代谢活性体积（MAV）、未校正的平均标准化摄取值（SUV(mean)）、部分容积校正的SUV(mean)（PVC-SUV(mean)）、SUV(max)、未校正的总病变糖酵解（TLG = MAV × SUV(mean)）以及PVC总病变糖酵解（PVC-TLG = MAV × PVC-SUV(mean)）。计算每个受试者所有具有临床意义的FDG摄取区域的PVC-TLG总和作为全局CD活动评分（GCDAS）。计算区域PET定量测量值（SUV值、TLG值）与CDEIS之间的相关性。还计算了全局PET定量测量值（GCDAS、全局SUV值）与CDAI、粪便钙卫蛋白、CDEIS和CRP水平之间的相关性。
SUV(max)、PVC-SUV(mean)和PVC-TLG与各段CDEIS子评分显著相关（分别为r = 0.50、r = 0.69和r = 0.31；p < 0.05）。GCDAS与CDAI和粪便钙卫蛋白显著相关（分别为r = 0.64和r = 0.51；p < 0.05）。
通过采用这种新的定量方法，我们能够计算区域和全局CD活动指数，这些指数与临床和病理疾病活动替代标志物密切相关。这种方法在测量CD患者的全局疾病活动和治疗反应方面可能具有临床重要性。
