Schaarschmidt Benedikt M, Grueneisen Johannes, Heusch Philipp, Gomez Benedikt, Umutlu Lale, Ruhlmann Verena, Rosenbaum-Krumme Sandra, Antoch Gerald, Buchbender Christian
aDepartment of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, Dusseldorf bDepartment of Diagnostic and Interventional Radiology and Neuroradiology cDepartment of Nuclear Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
Nucl Med Commun. 2015 Jun;36(6):588-95. doi: 10.1097/MNM.0000000000000298.
Incidental masses of abdominal organs are a relevant problem in radiological examinations. The aim of this study was to evaluate whether simultaneous (18)F-fluorodeoxyglucose ((18)F-FDG) PET/MRI, because of its higher soft-tissue contrast and the diversity of available pulse sequences, can reduce the number of indeterminate abdominal incidentalomas compared with (18)F-FDG PET/computed tomography (CT).
In this retrospective study, we enrolled 173 patients (91 women and 82 men, mean age 55.8±14.6 years) who underwent contrast-enhanced (18)F-FDG PET/CT on the same day for oncological indications. Data sets were examined in a random order by two readers noting incidentalomas and incidental tracer uptake of the liver, kidneys, spleen, pancreas, adrenal glands, and gallbladder. Findings were categorized into three categories: most likely malignant, indeterminate, and most likely benign. In addition, the most relevant MR sequence for the final decision was recorded for each incidentaloma. The numbers of benign, indeterminate, and malignant findings on (18)F-FDG PET/CT and (18)F-FDG PET/MRI were compared. A subgroup analysis was carried out to detect potential differences with respect to lesion location (organwise) and lesion consistency (solid vs. cystic).
A total of 649 upper abdominal incidentalomas were found. (18)F-FDG PET/MRI detected more incidentalomas (n=635) than contrast-enhanced (18)F-FDG PET/CT (n=407, P<0.001). Using (18)F-FDG PET/MRI, significantly fewer incidentalomas were categorized as indeterminate compared with (18)F-FDG PET/CT (n=27 vs. 91, P<0.001). This was true for cystic (P<0.001) as well as solid masses (P<0.001). Seventy incidentalomas categorized as indeterminate on contrast-enhanced (18)F-FDG PET/CT could be clarified as most likely benign by (18)F-FDG PET/MRI, whereas only six lesions rated as benign by (18)F-FDG PET/CT were classified as indeterminate in (18)F-FDG PET/MRI. (18)F-FDG PET/MRI compared with contrast-enhanced (18)F-FDG PET/CT had significantly fewer indeterminate findings in the liver (P<0.001), kidneys (P=0.012), and adrenal glands (P=0.002); differences for the spleen (P=0.5) were not significant.
(18)F-FDG PET/MRI identifies more incidentalomas than (18)F-FDG PET/CT, but significantly reduces the number of indeterminate incidental findings of abdominal organs.
腹部器官的偶然发现肿物是放射学检查中的一个相关问题。本研究的目的是评估同时进行的（18）F-氟脱氧葡萄糖（（18）F-FDG）PET/MRI，因其更高的软组织对比度和可用脉冲序列的多样性，与（18）F-FDG PET/计算机断层扫描（CT）相比，是否能减少腹部偶然发现的不确定肿物的数量。
在这项回顾性研究中，我们纳入了173例患者（91例女性和82例男性，平均年龄55.8±14.6岁），他们因肿瘤适应证于同一天接受了对比增强（18）F-FDG PET/CT检查。数据集由两位阅片者以随机顺序进行检查，记录肝脏、肾脏、脾脏、胰腺、肾上腺和胆囊的偶然发现肿物及偶然的示踪剂摄取情况。结果分为三类：最可能为恶性、不确定和最可能为良性。此外，记录每个偶然发现肿物最终决策中最相关的MR序列。比较（18）F-FDG PET/CT和（18）F-FDG PET/MRI上良性、不确定和恶性发现的数量。进行亚组分析以检测病变位置（按器官）和病变一致性（实性与囊性）方面的潜在差异。
共发现649例上腹部偶然发现肿物。（18）F-FDG PET/MRI检测到的偶然发现肿物（n = 635）比对比增强（18）F-FDG PET/CT（n = 407，P < 0.001）更多。与（18）F-FDG PET/CT相比，使用（18）F-FDG PET/MRI分类为不确定的偶然发现肿物明显更少（n = 27对91，P < 0.001）。囊性肿物（P < 0.001）和实性肿物（P < 0.001）均如此。在对比增强（18）F-FDG PET/CT上分类为不确定的70例偶然发现肿物通过（18）F-FDG PET/MRI可明确为最可能为良性，而在（18）F-FDG PET/CT上评为良性的仅6个病变在（18）F-FDG PET/MRI中被分类为不确定。与对比增强（18）F-FDG PET/CT相比，（18）F-FDG PET/MRI在肝脏（P < 0.001）、肾脏（P = 0.012）和肾上腺（P = 0.002）中的不确定发现明显更少；脾脏的差异（P = 0.5）不显著。
（18）F-FDG PET/MRI比（18）F-FDG PET/CT识别出更多的偶然发现肿物，但显著减少了腹部器官不确定偶然发现的数量。
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