总病变糖酵解作为鉴别中高危肾上腺偶发瘤的最佳18F-FDG PET/CT参数。
Total lesion glycolysis as the best 18F-FDG PET/CT parameter in differentiating intermediate-high risk adrenal incidentaloma.
作者信息
Kim Yong-il, Cheon Gi Jeong, Paeng Jin Chul, Cho Jeong Yeon, Kang Keon Wook, Chung June-Key, Kim Euishin Edmund, Lee Dong Soo
机构信息
aDepartment of Nuclear Medicine bCancer Research Institute cRadiological Science Research Institute, Seoul National University College of Medicine dDepartment of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University eDepartment of Radiology, Seoul National University Hospital, Seoul, Korea fDepartment of Radiological Sciences, University of California, Irvine, California, USA.
出版信息
Nucl Med Commun. 2014 Jun;35(6):606-12. doi: 10.1097/MNM.0000000000000101.
OBJECTIVE
Characterization of intermediate-high risk adrenal incidentaloma (AI) is important because biopsy or surgery should be performed to confirm the malignancy. We investigated which parameters of F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) had an additive role in distinguishing malignancies in patients with incidental adrenal masses of intermediate-high risk.
METHODS
From January 2008 to July 2013, 52 patients with a pathologically proven diagnosis of AI were retrospectively enrolled (age=56.4±12.7 years, M : F=34 : 18; benign : malignant=14 : 38). Volumetric parameters were size and volume according to combined CT, and metabolic parameters were peak standardized uptake value (SUV(peak)), maximum SUV (SUV(max)), mean SUV (SUV(mean)), and tumor-to-background ratio (SUV(max) of adrenal mass/SUV(mean) of liver). Metabolovolumetric parameters of metabolic tumor volume and total lesion glycolysis (TLG, SUV(mean)×metabolic tumor volume) were also included and compared with the diagnostic value. In addition, the highest diagnostic parameters among volumetric and metabolic parameters were combined and compared in terms of diagnostic accuracy.
RESULTS
Compared with benign adrenal adenoma, malignant lesions showed significantly higher values of all (18)F-FDG PET/CT volumetric, metabolic, and metabolovolumetric parameters. Size showed the highest area under the curve (AUC) of 0.759 among the volumetric parameters, and SUV(peak) showed the highest AUC of 0.853 among the metabolic parameters. Among all the PET/CT parameters, TLG showed the highest AUC of 0.900, with a sensitivity of 92.1% and specificity of 78.6% at a cutoff of 12.0. The combined value of size and SUV(peak) showed lower diagnostic value than TLG.
CONCLUSION
We found that TLG showed the best result in distinguishing intermediate-high risk AI among PET/CT parameters. TLG can be a useful PET/CT parameter for differential diagnosis of AI.
目的
中高风险肾上腺偶发瘤（AI）的特征描述很重要，因为需要进行活检或手术以确认是否为恶性肿瘤。我们研究了氟脱氧葡萄糖（（18）F-FDG）PET/计算机断层扫描（CT）的哪些参数在鉴别中高风险肾上腺偶发肿块患者的恶性肿瘤方面具有辅助作用。
方法
回顾性纳入2008年1月至2013年7月间52例经病理证实诊断为AI的患者（年龄=56.4±12.7岁，男∶女=34∶18；良性∶恶性=14∶38）。体积参数根据联合CT确定为大小和体积，代谢参数为峰值标准化摄取值（SUV(peak)）、最大SUV（SUV(max)）、平均SUV（SUV(mean)）以及肿瘤与本底比值（肾上腺肿块的SUV(max)/肝脏的SUV(mean)）。还纳入了代谢肿瘤体积和总病变糖酵解（TLG，SUV(mean)×代谢肿瘤体积）的代谢体积参数，并与诊断价值进行比较。此外，将体积参数和代谢参数中的最高诊断参数进行组合，并就诊断准确性进行比较。
结果
与良性肾上腺腺瘤相比，恶性病变的所有（18）F-FDG PET/CT体积、代谢和代谢体积参数值均显著更高。在体积参数中，大小的曲线下面积（AUC）最高，为0.759，在代谢参数中，SUV(peak)的AUC最高，为0.853。在所有PET/CT参数中，TLG的AUC最高，为0.900，在截断值为12.0时，敏感性为92.1%，特异性为78.6%。大小和SUV(peak)的组合值的诊断价值低于TLG。
结论
我们发现TLG在PET/CT参数中鉴别中高风险AI的结果最佳。TLG可作为AI鉴别诊断的有用PET/CT参数。
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