Respiratory Medicine, Lister Hospital, Stevenage, UK.
Radiology Department, Papworth Hospital, Papworth Everard, Cambridge, UK.
Eur J Nucl Med Mol Imaging. 2018 May;45(5):806-815. doi: 10.1007/s00259-017-3917-8. Epub 2018 Jan 16.
There is a lack of prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) patients. The objective of this study is to investigate the potential of F-FDG-PET/ CT to predict mortality in IPF.
A total of 113 IPF patients (93 males, 20 females, mean age ± SD: 70 ± 9 years) were prospectively recruited for F-FDG-PET/CT. The overall maximum pulmonary uptake of F-FDG (SUV), the minimum pulmonary uptake or background lung activity (SUV), and target-to-background (SUV/ SUV) ratio (TBR) were quantified using routine region-of-interest analysis. Kaplan-Meier analysis was used to identify associations of PET measurements with mortality. We also compared PET associations with IPF mortality with the established GAP (gender age and physiology) scoring system. Cox analysis assessed the independence of the significant PET measurement(s) from GAP score. We investigated synergisms between pulmonary F-FDG-PET measurements and GAP score for risk stratification in IPF patients.
During a mean follow-up of 29 months, there were 54 deaths. The mean TBR ± SD was 5.6 ± 2.7. Mortality was associated with high pulmonary TBR (p = 0.009), low forced vital capacity (FVC; p = 0.001), low transfer factor (TLCO; p < 0.001), high GAP index (p = 0.003), and high GAP stage (p = 0.003). Stepwise forward-Wald-Cox analysis revealed that the pulmonary TBR was independent of GAP classification (p = 0.010). The median survival in IPF patients with a TBR < 4.9 was 71 months, whilst in those with TBR > 4.9 was 24 months. Combining PET data with GAP data ("PET modified GAP score") refined the ability to predict mortality.
A high pulmonary TBR is independently associated with increased risk of mortality in IPF patients.
特发性肺纤维化（IPF）患者缺乏预后生物标志物。本研究旨在探讨 F-FDG-PET/CT 预测 IPF 死亡率的潜力。
前瞻性招募了 113 名 IPF 患者（93 名男性，20 名女性，平均年龄±标准差：70±9 岁）进行 F-FDG-PET/CT。使用常规感兴趣区域分析量化 F-FDG 的总最大肺摄取量（SUV）、最小肺摄取量或背景肺活性（SUV）和目标与背景的比值（SUV/SUV）（TBR）。Kaplan-Meier 分析用于确定 PET 测量值与死亡率的关联。我们还比较了 PET 与 IPF 死亡率的关联与既定的 GAP（性别年龄和生理学）评分系统。Cox 分析评估了显著的 PET 测量值从 GAP 评分的独立性。我们研究了肺 F-FDG-PET 测量值与 GAP 评分之间的协同作用，以对 IPF 患者进行风险分层。
在平均 29 个月的随访期间，有 54 例死亡。平均 TBR±标准差为 5.6±2.7。高肺 TBR（p=0.009）、用力肺活量（FVC）低（p=0.001）、转移因子（TLCO）低（p<0.001）、GAP 指数高（p=0.003）和 GAP 阶段高（p=0.003）与死亡率相关。逐步向前 Wald-Cox 分析显示，肺 TBR 与 GAP 分类独立（p=0.010）。TBR<4.9 的 IPF 患者的中位生存时间为 71 个月，而 TBR>4.9 的患者为 24 个月。将 PET 数据与 GAP 数据结合（“PET 改良 GAP 评分”）可改善预测死亡率的能力。
肺 TBR 高与 IPF 患者死亡风险增加独立相关。
