Medical Faculty, Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, Dusseldorf, Germany.
Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ Duisburg-Essen, Essen, Germany.
Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2093-2102. doi: 10.1007/s00259-018-4061-9. Epub 2018 Jun 6.
PURPOSE: To compare the sensitivity and specificity of 18F-fluordesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), 18F-FDG PET/magnetic resonance (18F-FDG PET/MR) and 18F-FDG PET/MR including diffusion weighted imaging (DWI) in the detection of sentinel lymph node metastases in patients suffering from malignant melanoma. MATERIAL & METHODS: Fifty-two patients with malignant melanoma (female: n = 30, male: n = 22, mean age 50.5 ± 16.0 years, mean tumor thickness 2.28 ± 1.97 mm) who underwent 18F-FDG PET/CT and subsequent PET/MR & DWI for distant metastasis staging were included in this retrospective study. After hybrid imaging, lymphoscintigraphy including single photon emission computed tomography/CT (SPECT/CT) was performed to identify the sentinel lymph node prior to sentinel lymph node biopsy (SLNB). In a total of 87 sentinel lymph nodes in 64 lymph node basins visible on SPECT/CT, 17 lymph node metastases were detected by histopathology. In separate sessions PET/CT, PET/MR, and PET/MR & DWI were assessed for sentinel lymph node metastases by two independent readers. Discrepant results were resolved in a consensus reading. Sensitivities, specificities, positive predictive values and negative predictive values were calculated with histopathology following SPECT/CT guided SLNB as a reference standard. RESULTS: Compared with histopathology, lymph nodes were true positive in three cases, true negative in 65 cases, false positive in three cases and false negative in 14 cases in PET/CT. PET/MR was true positive in four cases, true negative in 63 cases, false positive in two cases and false negative in 13 cases. Hence, we observed a sensitivity, specificity, positive predictive value and negative predictive value of 17.7, 95.6, 50.0 and 82.3% for PET/CT and 23.5, 96.9, 66.7 and 82.3% for PET/MR. In DWI, 56 sentinel lymph node basins could be analyzed. Here, the additional analysis of DWI led to two additional false positive findings, while the number of true positive findings could not be increased. CONCLUSION: In conclusion, integrated 18F-FDG PET/MR does not reliably differentiate N-positive from N-negative melanoma patients. Additional DWI does not increase the sensitivity of 18F-FDG PET/MR. Hence, sentinel lymph node biopsy cannot be replaced by 18F-FDG-PE/MR or 18F-FDG-PET/CT.
目的：比较 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）、18F-FDG 正电子发射断层扫描/磁共振（18F-FDG PET/MR）和包括弥散加权成像（DWI）的 18F-FDG PET/MR 在检测恶性黑色素瘤患者前哨淋巴结转移中的敏感性和特异性。 材料与方法：本回顾性研究纳入了 52 例接受 18F-FDG PET/CT 检查和随后的 PET/MR 和 DWI 以进行远处转移分期的恶性黑色素瘤患者（女性：n=30，男性：n=22，平均年龄 50.5±16.0 岁，平均肿瘤厚度 2.28±1.97mm）。在混合成像后，通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）进行淋巴闪烁显像，以在进行前哨淋巴结活检（SLNB）之前识别前哨淋巴结。在 SPECT/CT 上可见的 64 个淋巴结中共有 87 个前哨淋巴结，通过组织病理学检查发现 17 个淋巴结转移。在单独的检查中，两位独立的读者评估了 PET/CT、PET/MR 和 PET/MR&DWI 对前哨淋巴结转移的情况。在共识阅读中解决了不一致的结果。以 SPECT/CT 引导的 SLNB 后的组织病理学检查为参考标准，计算了敏感性、特异性、阳性预测值和阴性预测值。 结果：与组织病理学检查相比，PET/CT 中淋巴结在三种情况下为真阳性，65 种情况下为真阴性，三种情况下为假阳性，14 种情况下为假阴性。在 PET/MR 中，有四种情况为真阳性，63 种情况为真阴性，两种情况为假阳性，13 种情况为假阴性。因此，我们观察到 PET/CT 的敏感性、特异性、阳性预测值和阴性预测值分别为 17.7%、95.6%、50.0%和 82.3%，而 PET/MR 的敏感性、特异性、阳性预测值和阴性预测值分别为 23.5%、96.9%、66.7%和 82.3%。在 DWI 中，可分析 56 个前哨淋巴结区。在这里，DWI 的额外分析导致了两个额外的假阳性发现，而真阳性发现的数量无法增加。 结论：综上所述，整合的 18F-FDG PET/MR 不能可靠地区分 N 阳性和 N 阴性黑色素瘤患者。额外的 DWI 并不能提高 18F-FDG PET/MR 的敏感性。因此，前哨淋巴结活检不能被 18F-FDG-PET/MR 或 18F-FDG-PET/CT 取代。
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