多参数 FDG-PET/MRI 对肝细胞癌的诊断：初步经验。
Multiparametric FDG-PET/MRI of Hepatocellular Carcinoma: Initial Experience.
机构信息
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029, USA.
Sorbonne Universités, UPMC, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
出版信息
Contrast Media Mol Imaging. 2018 Oct 3;2018:5638283. doi: 10.1155/2018/5638283. eCollection 2018.
PURPOSE
To compare multiparametric (mp)FDG-PET/MRI metrics between hepatocellular carcinoma (HCC) and liver parenchyma and to assess the correlation between mpMRI and FDG-PET standard uptake values (SUVs) in liver parenchyma and HCC.
METHODS
This prospective, institutional review board-approved study enrolled 15 patients (M/F 12/3; mean age 61 y) with HCC. mpMRI including blood-oxygen-level-dependent (BOLD) MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and dynamic contrast-enhanced-(DCE-) MRI was performed simultaneously with F-FDG-PET on a 3T PET/MRI hybrid system. Quantitative BOLD, IVIM and DCE-MRI parameters (Tofts model (TM) and shutter-speed model (SSM)), and PET parameters (SUV and SUV) were quantified and compared between HCC lesions and liver parenchyma using Wilcoxon signed-rank tests. SUV ratios between HCCs and liver were also calculated (SUV T/L and SUV T/L). Diagnostic performance of (combined) mp-PET/MRI parameters for characterization of HCC was assessed using ROC analysis. Spearman correlations between PET and mpMRI parameters in HCC tumors and liver parenchyma were evaluated.
RESULTS
21 HCC lesions (mean size 4.0 ± 2.4 cm; range 2-13 cm) were analyzed. HCCs exhibited significantly higher arterial fraction (from DCE-MRI) and lower pre-O and post-O (from BOLD-MRI) versus liver parenchyma ( < 0.032). The highest diagnostic performance for differentiation between HCC and liver parenchyma was achieved for combined ART SSM and post-O (AUC = 0.91). SUV showed reasonable performance for differentiation of HCC versus liver (AUC = 0.75). In HCC, DCE-MRI parameters (TM and SSM) and TM exhibited significant negative correlations with SUV T/L ( ranges from -0.624 to -0.566; FDR-adjusted < 0.050).
CONCLUSIONS
Despite the observed reasonable diagnostic performance of FDG-PET SUV for HCC detection and several significant correlations between FDG-PET SUV and DCE-MRI parameters, FDG-PET did not provide clear additional value for HCC characterization compared to mpMRI in this pilot study.
目的
比较肝细胞癌（HCC）与肝实质的多参数（mp）FDG-PET/MRI 指标，并评估肝实质和 HCC 的 mpMRI 与 FDG-PET 标准摄取值（SUV）之间的相关性。
方法
本前瞻性、机构审查委员会批准的研究纳入了 15 例 HCC 患者（M/F12/3；平均年龄 61 岁）。在 3T PET/MRI 混合动力系统上同时进行了包括血氧水平依赖（BOLD）MRI、体素内不相干运动扩散加权成像（IVIM-DWI）和动态对比增强（DCE）MRI 的 mpMRI。使用 Wilcoxon 符号秩检验比较 HCC 病变与肝实质之间的定量 BOLD、IVIM 和 DCE-MRI 参数（Tofts 模型（TM）和快门速度模型（SSM））以及 PET 参数（SUV 和 SUV）。还计算了 HCC 与肝之间的 SUV 比值（SUV T/L 和 SUV T/L）。使用 ROC 分析评估（联合）mp-PET/MRI 参数对 HCC 特征的诊断性能。评估 HCC 肿瘤和肝实质中 PET 和 mpMRI 参数之间的 Spearman 相关性。
结果
分析了 21 个 HCC 病变（平均大小 4.0±2.4cm；范围 2-13cm）。与肝实质相比，HCC 的动脉分数（来自 DCE-MRI）显著升高，而 pre-O 和 post-O（来自 BOLD-MRI）显著降低（ < 0.032）。在区分 HCC 和肝实质方面，联合 ART SSM 和 post-O 的诊断性能最高（AUC=0.91）。SUV 对 HCC 与肝的区分具有良好的性能（AUC=0.75）。在 HCC 中，DCE-MRI 参数（TM 和 SSM）和 TM 与 SUV T/L 呈显著负相关（范围从-0.624 到-0.566；FDR 调整 < 0.050）。
结论
尽管 FDG-PET SUV 对 HCC 检测具有合理的诊断性能，并且 FDG-PET SUV 与 DCE-MRI 参数之间存在几个显著相关性，但与 mpMRI 相比，FDG-PET 在本研究中并未为 HCC 特征提供明确的附加价值。
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