Martini Katharina, Meier Andreas, Opitz Isabelle, Weder Walter, Veit-Haibach Patrick, Stahel Rolf A, Frauenfelder Thomas
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.
Division of Thoracic Surgery, University Hospital Zurich,University of Zurich, Switzerland.
Lung Cancer. 2016 Apr;94:40-5. doi: 10.1016/j.lungcan.2016.01.017. Epub 2016 Jan 28.
To investigate the diagnostic accuracy of sequential co-registered PET+MR (PET+MR) for local staging of malignant pleural mesothelioma (MPM) compared to PET/CT.
In a prospective clinical trial 34 consecutive patients (median age 66 years; range 40-79 years; 1 female, 33 male) with known MPM, who underwent PET/CT and PET+MR exams for either staging or re-staging/follow-up were evaluated. Imaging was conducted using a tri-modality PET/CT-MR set-up (Discovery PET/CT 690, 3T Discovery MR 750w, both GE Healthcare, Waukesha, WI, USA). In 26 cases histopathology served as standard of reference. Two independent readers evaluated images for T and N stage, confidence level (sure to unsure; 1-3) and subjective overall image quality (very good to non-diagnostic; 1-4). Inter-observer agreement of T and N stages (Cohen's kappa) and interclass correlation coefficient (ICC) between PET/CT vs. PET+MR was calculated.
Inter observer agreement for evaluation of T and N Stage in PET/CT images was excellent (k=0.844 and k=0.824, respectively), whereas PET+MR imaging showed substantial agreement in T and N stage (k=0.729 and k=0.691, respectively). The ICC of PET/CT vs. PET+MR for evaluation of both, T and N Stage, was excellent (ICC=0.951 and ICC=0.93, respectively). Diagnostic confidence was scored significantly higher in PET+MR compared to PET/CT (mean score=1.66 and 1.93, respectively; p=0.004). Image quality was diagnostic for all image series. Comparing pT and pN stage vs cT and cN stage (n=26 cases), both imaging modalities showed excellent agreement for T stage (ICCPET+MR=0.888 vs. ICCPET/CT=0.853, respectively) and substantial to moderate agreement for N stage (ICCPET+MR=0.683 vs. ICC=0.595PET/CT, respectively).
Our findings suggest that diagnostic accuracy of PET+MR is comparable to PET/CT for local staging of MPM, whereas radiologists felt significantly more confident staging PET+MR compared to PET/CT images (p=0003), using dedicated sequences.
与PET/CT相比，研究序贯联合配准PET+MR（PET+MR）对恶性胸膜间皮瘤（MPM）进行局部分期的诊断准确性。
在一项前瞻性临床试验中，对34例连续的已知MPM患者（中位年龄66岁；范围40-79岁；1例女性，33例男性）进行了评估，这些患者因分期或重新分期/随访接受了PET/CT和PET+MR检查。成像使用三模态PET/CT-MR设备（Discovery PET/CT 690，3T Discovery MR 750w，均为美国威斯康星州沃基沙市通用电气医疗集团产品）。26例病例中组织病理学作为参考标准。两名独立阅片者评估T和N分期、置信水平（确定到不确定；1-3）以及主观整体图像质量（非常好到无法诊断；1-4）。计算PET/CT与PET+MR之间T和N分期的观察者间一致性（Cohen卡方）和组内相关系数（ICC）。
PET/CT图像中T和N分期评估的观察者间一致性极佳（分别为k=0.844和k=0.824），而PET+MR成像在T和N分期方面显示出实质性一致性（分别为k=0.729和k=0.691）。PET/CT与PET+MR评估T和N分期的ICC均极佳（分别为ICC=0.951和ICC=0.93）。PET+MR的诊断置信度评分显著高于PET/CT（平均评分分别为1.66和1.93；p=0.004）。所有图像系列的图像质量均具有诊断性。比较pT和pN分期与cT和cN分期（n=26例），两种成像方式在T分期方面均显示出极佳的一致性（PET+MR的ICCPET+MR=0.888与PET/CT的ICCPET/CT=0.853），在N分期方面显示出实质性到中等程度的一致性（PET+MR的ICCPET+MR=0.683与PET/CT的ICC=0.595）。
我们的研究结果表明，PET+MR对MPM进行局部分期的诊断准确性与PET/CT相当，而放射科医生对PET+MR图像进行分期的信心明显高于PET/CT图像（p=0.003），采用了专用序列。
