Department of Radiology, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China, Department of Nuclear Medicine, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China, Department of Oncology, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China and Department of Colorectal Surgery, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China.
Department of Radiology, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China, Department of Nuclear Medicine, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China, Department of Oncology, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China and Department of Colorectal Surgery, The Sixth Affiliated Hospital (The Gastrointestinal & Anal Hospital) of Sun Yat-sen University, Guangzhou, China
Gastroenterol Rep (Oxf). 2015 May;3(2):128-35. doi: 10.1093/gastro/gou078. Epub 2014 Nov 17.
The primary aim of this study was to assess the efficacy of whole-body diffusion-weighted imaging (WB-DWI) in detecting tumour recurrence and metastasis of gastrointestinal cancers by comparison with 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography or computed tomography ((18)F-FDG-PET/CT). A secondary aim was to evaluate the change of apparent diffusion coefficient (ADC) value between metastases and normal tissues.
Twenty-eight previously confirmed gastrointestinal cancer patients with suspected tumour recurrence or metastasis were recruited. WB-DWI and PET/CT images were evaluated by two radiologists and a nuclear medicine physician. Agreement between WB-DWI and PET/CT for detective efficacy was compared using kappa statistics. Additionally, diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were also statistically analysed. ADC values between metastatic and normal tissues were compared.
There was no statistically significant difference (P > 0.05) in the overall diagnostic performances of PET/CT (accuracy 98.9%; sensitivity 95.2%; specificity 99.8%; PPV 98.9%; NPV 98.9%) and WB-DWI (accuracy 95.9%; sensitivity 81.7%; specificity 99.1%; PPV 95.0%; NPV 96.1%). WB-DWI showed agreement with PET/CT (κ = 0.877) for detecting recurrence and distant metastases. A statistically significant difference in ADC value was observed between tissues of normal healthy volunteers and metastases in lymph nodes, liver and bones (P < 0.05).
WB-DWI is reliable in detecting tumour recurrence and metastasis of colorectal cancer and offers the same diagnostic performance as (18)F-PET/CT without ionizing radiation. The quantitative value of ADC provides extra information to determine cancer metastasis.
本研究的主要目的是通过与 18F-2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描或计算机断层扫描（18F-FDG-PET/CT）比较，评估全身扩散加权成像（WB-DWI）检测胃肠道癌症肿瘤复发和转移的疗效。次要目的是评估转移灶与正常组织之间表观扩散系数（ADC）值的变化。
招募了 28 名先前确诊为胃肠道癌症且疑似肿瘤复发或转移的患者。两名放射科医生和一名核医学医师评估了 WB-DWI 和 PET/CT 图像。使用 Kappa 统计比较 WB-DWI 和 PET/CT 对检测效能的一致性。此外，还对诊断准确性、敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）进行了统计学分析。比较了转移灶与正常组织之间的 ADC 值。
PET/CT 的整体诊断性能（准确性 98.9%；敏感性 95.2%；特异性 99.8%；PPV 98.9%；NPV 98.9%）和 WB-DWI（准确性 95.9%；敏感性 81.7%；特异性 99.1%；PPV 95.0%；NPV 96.1%）之间无统计学差异（P>0.05）。WB-DWI 与 PET/CT 对复发和远处转移的检测具有一致性（κ=0.877）。正常健康志愿者的组织与淋巴结、肝脏和骨骼中的转移灶之间的 ADC 值存在统计学显著差异（P<0.05）。
WB-DWI 可可靠地检测结直肠癌的肿瘤复发和转移，且与无电离辐射的 18F-PET/CT 具有相同的诊断性能。ADC 值的定量值提供了确定癌症转移的额外信息。
