1 Department of Radiology, Division of Functional and Diagnostic Imaging Research, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
2 Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan.
AJR Am J Roentgenol. 2019 Feb;212(2):311-319. doi: 10.2214/AJR.18.20111. Epub 2018 Dec 4.
The purpose of this study was to compare the diagnostic accuracy of whole-body MRI, coregistered FDG PET/MRI, integrated FDG PET/CT, and conventional imaging examination including bone scintigraphy, contrast-enhanced brain MRI, and CT for malignant pleural mesothelioma (MPM) staging according to the new International Association for the Study of Lung Cancer (IASLC) system.
The study subjects were 23 consecutively registered patients with MPM (15 men, eight women; mean age, 68 years for both sexes) who had prospectively undergone whole-body FDG PET/CT, whole-body MRI, conventional radiologic examination, surgical or conventional treatments, pathologic examination, and follow-up conventional imaging examinations between January 2011 and December 2017. TNM staging was evaluated by two independent readers. Kappa statistics and chi-square tests were used for evaluation agreements on each factor and clinical stage between each method and final diagnosis. The diagnostic accuracy of each method was statistically compared by use of McNemar test.
The kappa values for each factor between each method and final diagnosis were significant (p < 0.0001) and ranged between 0.33 and 0.91. Kappa values between final diagnosis and stage evaluation were also significant (p < 0.0001) and ranged between 0.57 and 0.91. The diagnostic accuracy of N and stage assessment of whole-body MRI and FDG PET/MRI was significantly higher than that of conventional imaging examination (N factor, p < 0.05; stage, p < 0.05).
The diagnostic accuracy of whole-body MRI, FDG PET/MRI, and FDG PET/CT for TNM stage assessment based on the new IASLC MPM staging system is greater than that of conventional imaging examination.
本研究旨在比较全身 MRI、FDG PET/MRI 配准、FDG PET/CT 融合以及包括骨闪烁扫描、增强对比脑 MRI 和 CT 的常规影像学检查在新国际肺癌研究协会（IASLC）系统下用于恶性胸膜间皮瘤（MPM）分期的诊断准确性。
本研究对象为 2011 年 1 月至 2017 年 12 月期间连续登记的 23 例经前瞻性全身 FDG PET/CT、全身 MRI、常规影像学检查、手术或常规治疗、病理检查和随访常规影像学检查诊断为 MPM 的患者（男 15 例，女 8 例；平均年龄，男女均为 68 岁）。TNM 分期由两名独立的读者进行评估。使用 Kappa 统计和卡方检验评估每种方法与最终诊断之间每个因素和临床分期的一致性。使用 McNemar 检验对每种方法的诊断准确性进行统计学比较。
每种方法与最终诊断之间的每个因素的 Kappa 值均具有统计学意义（p < 0.0001），范围为 0.33 至 0.91。最终诊断与分期评估之间的 Kappa 值也具有统计学意义（p < 0.0001），范围为 0.57 至 0.91。全身 MRI 和 FDG PET/MRI 的 N 因素和分期评估的诊断准确性明显高于常规影像学检查（N 因素，p < 0.05；分期，p < 0.05）。
基于新 IASLC MPM 分期系统，全身 MRI、FDG PET/MRI 和 FDG PET/CT 对 TNM 分期的诊断准确性优于常规影像学检查。
