Park Soo Bin, Choi Joon Young, Lee Eun Jeong, Yoo Jang, Cheon Miju, Cho Suk Kyong, Choe Yearn Seong, Lee Kyung-Han, Kim Byung-Tae
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Republic of Korea.
Nucl Med Mol Imaging. 2012 Jun;46(2):95-101. doi: 10.1007/s13139-012-0135-y. Epub 2012 Apr 21.
We investigated PET/CT diagnostic criteria for differentiating benign from malignant parotid lesions with focal (18)F-FDG uptake.
The subjects of the study were 272 patients who exhibited focal (18)F-FDG uptake of the parotid gland. Sixty-eight pathologically confirmed parotid lesions from 67 patients were included. The maximum SUV (SUVmax), uptake patterns (homogeneous vs. heterogeneous), size measured by CT, maximum Hounsfield units (HUmax) and margins on CT (well vs. ill defined) of each parotid lesion on PET/CT images were compared with final diagnoses.
Thirty-two parotid lesions were histologically proven to be malignant. There were significant differences in uptake patterns (cancer incidence, heterogeneous:homogeneous = 79.2%:29.5%, p < 0.0001) and margins on CT (cancer incidence, ill:well defined = 84.4%:13.3%, p < 0.0001) between benign and malignant lesions. The cancer risks of parotid lesions were 89.5% with heterogeneous uptake and ill-defined margins, 70.6% with heterogeneous uptake or ill-defined margins (no overlap in subjects) and 9.3% with homogeneous uptake and well-defined margins (p < 0.0001). When any lesion with heterogeneous uptake or ill-defined margins was regarded as malignant, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.6% (29/32), 80.6% (29/36), 80.6% (29/36), 90.6% (29/32) and 85.6% (58/68), respectively. For predicting malignancy, combined PET/CT criteria showed better sensitivity, NPV and accuracy than PET-only criteria, and had a tendency to have more accurate results than CT-only criteria. There were no significant differences in SUVmax, size or HUmax between benign and malignant lesions.
Uptake patterns and margins on CT are useful PET/CT diagnostic criteria for differentiating benign from malignant lesions.
我们研究了PET/CT用于鉴别腮腺局灶性（18）F-FDG摄取的良性和恶性病变的诊断标准。
研究对象为272例腮腺表现出局灶性（18）F-FDG摄取的患者。纳入了来自67例患者的68例经病理证实的腮腺病变。将PET/CT图像上每个腮腺病变的最大SUV（SUVmax）、摄取模式（均匀性与不均匀性）、CT测量的大小、最大亨氏单位（HUmax）以及CT上的边界（清晰与不清晰）与最终诊断结果进行比较。
32例腮腺病变经组织学证实为恶性。良性和恶性病变在摄取模式（癌症发生率，不均匀性：均匀性 = 79.2%：29.5%，p < 0.0001）和CT上的边界（癌症发生率，不清晰：清晰 = 84.4%：13.3%，p < 0.0001）方面存在显著差异。腮腺病变的癌症风险在摄取不均匀且边界不清晰时为89.5%，在摄取不均匀或边界不清晰时（受试者无重叠）为70.6%，在摄取均匀且边界清晰时为9.3%（p < 0.0001）。当任何摄取不均匀或边界不清晰的病变被视为恶性时，敏感性、特异性、阳性预测值、阴性预测值和准确性分别为90.6%（29/32）、80.6%（29/36）、80.6%（29/36）、90.6%（29/32）和85.6%（58/68）。对于预测恶性肿瘤，PET/CT联合标准在敏感性、阴性预测值和准确性方面优于仅PET标准，并且比仅CT标准有获得更准确结果的趋势。良性和恶性病变在SUVmax、大小或HUmax方面无显著差异。
摄取模式和CT上的边界是用于鉴别腮腺良性和恶性病变的有用的PET/CT诊断标准。
