不同影像学方法在评估非小细胞肺癌患者肿瘤远处转移和局部复发中的诊断性能。
Diagnostic performance of different imaging modalities in the assessment of distant metastasis and local recurrence of tumor in patients with non-small cell lung cancer.
机构信息
Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan.
出版信息
J Magn Reson Imaging. 2017 Dec;46(6):1707-1717. doi: 10.1002/jmri.25726. Epub 2017 Apr 17.
PURPOSE
To compare the diagnostic performance of positron emission tomography with [18F] fluoro-2-deoxy-glucose (FDG-PET) coregistered with magnetic resonance imaging (FDG-PET/MRI), MRI with and without diffusion-weighted imaging (DWI), FDG-PET fused with computed tomography (FDG-PET/CT) with brain contrast-enhanced (CE-) MRI, and routine radiological examination for assessment of postoperative recurrence in nonsmall-cell lung cancer (NSCLC) patients.
MATERIALS AND METHODS
96 consecutive postoperative NSCLC patients (52 men, 44 women; mean age 72 years) prospectively underwent whole-body 3T MRI with and without DWI; PET/CTs and routine radiological examinations consisted of CE-brain MRI, whole-body CE-CT, and bone scintigraphy. The patients were divided into a recurrence (n = 17) and a nonrecurrence (n = 79) group based on pathological and follow-up examinations. All coregistered PET/MRIs were generated by proprietary software. The probability of recurrence was visually assessed on a per-patient basis. Receiver operating characteristic analyses were used to compare the diagnostic performance of all methods. Finally, diagnostic capabilities were compared by means of McNemar's test.
RESULTS
Areas under the curves (Azs) were significantly larger for PET/MRI and whole-body MRI with DWI (Az = 0.99) than for PET/CT (Az = 0.92, P < 0.05) and conventional radiological examination (Az = 0.91, P < 0.05). Specificity and accuracy of PET/MRI and MRI with and without DWI were significantly higher than those of PET/CT (P < 0.05) and routine radiological examination (P < 0.05).
CONCLUSION
Whole-body FDG-PET/MRI and MRI with DWI were found to be more specific and accurate than FDG-PET/CT and routine radiological examinations for assessment of recurrence in NSCLC patients, although MRI with and without DWI demonstrated slightly lower sensitivity than PET/CT.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1707-1717.
目的
比较正电子发射断层扫描与 [18F] 氟-2-脱氧葡萄糖（FDG-PET）与磁共振成像（FDG-PET/MRI）融合、MRI 联合或不联合弥散加权成像（DWI）、FDG-PET 与计算机断层扫描（FDG-PET/CT）融合与脑对比增强（CE-）磁共振成像（MRI）、常规影像学检查在评估非小细胞肺癌（NSCLC）患者术后复发中的诊断性能。
材料与方法
96 例连续的术后 NSCLC 患者（52 例男性，44 例女性；平均年龄 72 岁）前瞻性地接受了全身 3T MRI 联合或不联合 DWI；FDG-PET/CT 和常规影像学检查包括 CE 脑 MRI、全身 CE-CT 和骨闪烁扫描。根据病理和随访检查，将患者分为复发（n=17）和非复发（n=79）组。所有的融合 PET/MRI 均由专有的软件生成。通过对每个患者的视觉评估来判断复发的概率。通过受试者工作特征（ROC）分析比较所有方法的诊断性能。最后，通过 McNemar 检验比较诊断能力。
结果
PET/MRI 和全身 MRI 联合 DWI 的曲线下面积（Az）明显大于 FDG-PET/CT（Az=0.92，P<0.05）和常规影像学检查（Az=0.91，P<0.05）（Az=0.99）。PET/MRI 和全身 MRI 联合 DWI 的特异性和准确性明显高于 FDG-PET/CT（P<0.05）和常规影像学检查（P<0.05）。
结论
全身 FDG-PET/MRI 和 MRI 联合 DWI 比 FDG-PET/CT 和常规影像学检查更能准确评估 NSCLC 患者的复发，尽管 MRI 联合或不联合 DWI 的敏感性略低于 FDG-PET/CT。
证据水平
2 级技术疗效：2 级 J. Magn. Reson. Imaging 2017；46：1707-1717。
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