Fraioli Francesco, Lyasheva Maria, Porter Joanna C, Bomanji Jamshed, Shortman Robert I, Endozo Raymond, Wan Simon, Bertoletti Linda, Machado Maria, Ganeshan Balaji, Win Thida, Groves Ashley M
Institute of Nuclear Medicine, UCL(H) and University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK.
Department of Oncology, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Eur J Nucl Med Mol Imaging. 2019 Sep;46(10):2023-2031. doi: 10.1007/s00259-019-04386-5. Epub 2019 Jul 8.
To investigate the combined performance of quantitative CT (qCT) following a computer algorithm analysis (IMBIO) and F-FDG PET/CT to assess survival in patients with idiopathic pulmonary fibrosis (IPF).
A total of 113 IPF patients (age 70 ± 9 years) prospectively and consecutively underwent F-FDG PET/CT and high-resolution CT (HRCT) at our institution. During a mean follow-up of 29.6 ± 26 months, 44 (48%) patients died. As part of the qCT analysis, pattern evaluation of HRCT (using IMBIO software) included the total extent (percentage) of the following features: normal-appearing lung, hyperlucent lung, parenchymal damage (comprising ground-glass opacification, reticular pattern and honeycombing), and the pulmonary vessels. The maximum (SUV) and minimum (SUV) standardized uptake value (SUV) for F-FDG uptake in the lungs, and the target-to-background (SUV/SUV) ratio (TBR) were quantified using routine region-of-interest (ROI) analysis. Pulmonary functional tests (PFTs) were acquired within 14 days of the PET/CT/HRCT scan. Kaplan-Meier (KM) survival analysis was used to identify associations with mortality.
Data from 91 patients were available for comparative analysis. The average ± SD GAP [gender, age, physiology] score was 4.2 ± 1.7 (range 0-8). The average ± SD SUV, SUV, and TBR were 3.4 ± 1.4, 0.7 ± 0.2, and 5.6 ± 2.8, respectively. In all patients, qCT analysis demonstrated a predominantly reticular lung pattern (14.9 ± 12.4%). KM analysis showed that TBR (p = 0.018) and parenchymal damage assessed by qCT (p = 0.0002) were the best predictors of survival. Adding TBR and qCT to the GAP score significantly increased the ability to differentiate between high and low risk (p < 0.0001).
F-FDG PET and qCT are independent and synergistic in predicting mortality in patients with IPF.
研究定量CT（qCT）结合计算机算法分析（IMBIO）和F-FDG PET/CT评估特发性肺纤维化（IPF）患者生存率的联合性能。
共有113例IPF患者（年龄70±9岁）在我院前瞻性、连续地接受了F-FDG PET/CT和高分辨率CT（HRCT）检查。在平均29.6±26个月的随访期间，44例（48%）患者死亡。作为qCT分析的一部分，HRCT的模式评估（使用IMBIO软件）包括以下特征的总范围（百分比）：外观正常的肺、肺透亮度增加、实质损害（包括磨玻璃影、网状影和蜂窝状影）以及肺血管。使用常规感兴趣区（ROI）分析对肺内F-FDG摄取的最大（SUV）和最小（SUV）标准化摄取值（SUV）以及靶本比（SUV/SUV）（TBR）进行量化。在PET/CT/HRCT扫描后14天内进行肺功能测试（PFT）。采用Kaplan-Meier（KM）生存分析来确定与死亡率的关联。
91例患者的数据可用于比较分析。平均±标准差GAP[性别、年龄、生理学]评分为4.2±1.7（范围0-8）。平均±标准差SUV、SUV和TBR分别为3.4±1.4、0.7±0.2和5.6±2.8。在所有患者中，qCT分析显示主要为网状肺模式（14.9±12.4%）。KM分析表明，TBR（p=0.018）和qCT评估的实质损害（p=0.0002）是生存的最佳预测指标。将TBR和qCT添加到GAP评分中显著提高了区分高风险和低风险的能力（p<0.0001）。
F-FDG PET和qCT在预测IPF患者死亡率方面具有独立性和协同性。
