Park Taegyu, Lee Sinae, Park Soyeon, Lee Eunsub, Pahk Kisoo, Rhee Seunghong, Cho Jaehyuk, Kim Chulhan, Eo Jae Seon, Choe Jae Gol, Kim Sungeun
Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, South Korea.
Department of Nuclear Medicine, Korea University Anam Hospital, #73, Inchon-ro, Seoungbuk-gu, Seoul, 136-705 South Korea.
Nucl Med Mol Imaging. 2015 Mar;49(1):42-51. doi: 10.1007/s13139-014-0303-3. Epub 2014 Oct 28.
Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment.
A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by (18)F-FDG PET/CT, and an additional 2-h delayed (18)F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial (18)F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters.
In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h (18)F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions.
Although further study with a larger patient population is needed, the visual assessment of (18)F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.
卵巢癌是妇科恶性肿瘤的主要病因。由于卵巢癌症状不具特异性，只有20%的卵巢癌在仍局限于卵巢时被诊断出来。因此，早期准确检测疾病对于改善预后很重要。为了在氟代脱氧葡萄糖（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）上准确有效地诊断卵巢恶性肿瘤，我们分析了包括视觉评估在内的几个参数。
纳入19例显示卵巢肿块伴弥漫性腹膜浸润患者的51个腹膜病变。经病理检查，12例患者确诊为卵巢恶性肿瘤，7例为良性疾病。所有患者均接受18F-FDG PET/CT检查，另外15例有42个腹膜病变的患者还进行了2小时延迟18F-FDG PET/CT检查。我们在1小时初始18F-FDG PET/CT图像（参数1）和2小时延迟图像（参数2）上测量了半定量参数，包括最大和平均标准化摄取值（SUVmax、SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。此外，计算每个参数的保留指数，并通过Mann-Whitney U检验比较恶性和良性病变中的每个参数。我们还评估了每个腹膜病变的视觉特征，包括代谢范围、强度、形状、异质性和总视觉评分。使用线性关联方法分析视觉分级与恶性肿瘤之间的关联。此外，分析了受试者工作特征（ROC）曲线以比较重要参数的有效性。
在对51个腹膜病变的分析中，恶性和良性组之间的比较显示，SUVmax1、SUVmean1和TLG1存在显著差异。同样，在对42个腹膜病变进行额外2小时18F-FDG PET/CT检查的分析中，SUVmax1,2、SUVmean1,2、TLG2和TLG的保留指数在恶性和良性组之间存在显著差异。MTV在对51个腹膜病变或42个病变的分析中均未显示出显著差异。关于视觉评估，代谢强度、形状、异质性和总视觉评分与恶性肿瘤相关。在ROC分析中，在对51个腹膜病变和42个病变的分析中，视觉评分的AUC均大于其他参数的AUC。
尽管需要对更多患者进行进一步研究，但在其他半定量参数的辅助下，18F-FDG PET/CT成像的视觉评估在卵巢癌患者恶性肿瘤检测中起主要作用。
