Ruhlmann Verena, Poeppel Thorsten Dirk, Brandt Alexander Sascha, Grüneisen Johannes, Ruhlmann Marcus, Theysohn Jens Matthias, Forsting Michael, Bockisch Andreas, Umutlu Lale
Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
Department of Urology and Paediatric Urology, HELIOS Medical Center Wuppertal, University Hospital Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany.
Eur J Nucl Med Mol Imaging. 2016 Aug;43(9):1646-52. doi: 10.1007/s00259-016-3351-3. Epub 2016 Mar 11.
The aim of this study was to evaluate integrated (18)F-FDG PET/MRI as a one-stop diagnostic procedure in the assessment of (active) idiopathic retroperitoneal fibrosis (RPF) METHODS: A total of 22 examinations comprising a PET/CT scan followed by a PET/MRI scan in 17 patients (13 men, 4 women, age 58 ± 11 years) with histopathologically confirmed RPF at diagnosis or during follow-up under steroid therapy were analysed in correlation with laboratory inflammation markers (ESR, CRP). The patient cohort was subdivided into two groups: 6 examinations in untreated and 16 in treated patients. Tissue formations in typically periaortic localization suggestive of RPF were visually and quantitatively evaluated. The PET analysis included the assessment of SUVmax and a qualitative score for FDG uptake in RPF tissue in relation to the uptake in the liver. MRI analysis included evaluation of the T2-weighted image signal intensity, contrast enhancement and diffusion restriction (ADC values). Mean values were compared using the Mann-Whitney U test. ADC, SUVmax and ESR values were correlated using Pearson's correlation.
MRI analysis revealed restricted diffusion in 100 % and 56 %, hyperintense T2 signal in 100 % and 31 %, and contrast enhancement in the periaortic tissue formation suggestive of RPF in 100 % and 62.5 % in the untreated and treated patients, respectively. In the qualitative and quantitative PET analysis, statistically significant differences were found for mean FDG uptake scores (2.5 ± 0.8 in untreated patients and 1.1 ± 0.9 in treated patients) and mean SUVmax (7.8 ± 3.5 and 4.1 ± 2.2, respectively). A strong correlation was found between the ADC values and SUVmax (Pearson r -0.65, P = 0.0019), and between ESR and CRP values and SUVmax (both r = 0.45, P = 0.061).
Integrated (18)F-FDG PET/MRI shows high diagnostic potential as a one-stop diagnostic procedure for the assessment of (active) RPF providing multiparametric supportive information.
本研究旨在评估一体化（18）F-FDG PET/MRI作为一站式诊断方法在评估（活动性）特发性腹膜后纤维化（RPF）中的应用。方法：对17例（13例男性，4例女性，年龄58±11岁）经组织病理学确诊为RPF的患者进行分析，这些患者在诊断时或接受类固醇治疗随访期间先进行了PET/CT扫描，随后进行了PET/MRI扫描，共22次检查，并与实验室炎症指标（血沉、C反应蛋白）进行相关性分析。患者队列分为两组：6例未治疗患者的检查和16例治疗患者的检查。对典型腹主动脉周围定位提示RPF的组织形成进行视觉和定量评估。PET分析包括评估SUVmax以及RPF组织中FDG摄取相对于肝脏摄取的定性评分。MRI分析包括评估T2加权图像信号强度、对比增强和扩散受限（ADC值）。采用Mann-Whitney U检验比较平均值。使用Pearson相关性分析ADC、SUVmax和血沉值之间的相关性。结果：MRI分析显示，未治疗和治疗患者中，提示RPF的腹主动脉周围组织形成的扩散受限分别为100%和56%，T2信号高分别为100%和31%，对比增强分别为100%和62.5%。在定性和定量PET分析中，发现平均FDG摄取评分（未治疗患者为2.5±0.8，治疗患者为1.1±0.9）和平均SUVmax（分别为7.8±3.5和4.1±2.2）存在统计学显著差异。发现ADC值与SUVmax之间存在强相关性（Pearson r=-0.65，P=0.0019），血沉和C反应蛋白值与SUVmax之间也存在相关性（两者r=0.45，P=0.061）。结论：一体化（18）F-FDG PET/MRI作为评估（活动性）RPF的一站式诊断方法具有很高的诊断潜力，可提供多参数支持信息。
