Qin Chunxia, Shao Fuqiang, Hu Fan, Song Wenyu, Song Yangmeihui, Guo Jinxia, Lan Xiaoli
Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
Eur J Nucl Med Mol Imaging. 2020 May;47(5):1083-1093. doi: 10.1007/s00259-019-04632-w. Epub 2019 Dec 5.
Correct diagnosis and prognostic assessment of cardiac masses are crucial before therapy. We evaluated the diagnostic and prognostic value of F-FDG PET/CT in patients with cardiac masses.
F-FDG PET/CT images of 64 patients with 65 cardiac masses were retrospectively analysed (34 men, 30 women; average age, 51.2 ± 17.5 years). Comparisons of CT features and F-FDG metabolic indices between benign and malignant entities, as well as among primary and secondary malignancies and lymphoma, were performed. The diagnostic values of PET/CT for distinguishing benign versus malignant masses were calculated. PET/CT data were further assessed for the predictive value for overall survival (OS) using the Cox proportional hazards model to assess potential independent predictors. Kaplan-Meier curves were generated to assess the value of PET/CT for prognostication.
Statistically significant differences in various morphological features and metabolic indices between benign and malignant masses were found. An SUV of 6.75 was the optimal cutoff value to differentiate between benign and malignant masses, and the diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 92.11%, 88.89%, 90.77%, 92.11%, and 88.89%, respectively. Taking CT features and SUV ≥ 6.75 as a criterion, the values were 76.32%, 100.00%, 86.15%, 100.00%, and 75.00%, respectively; taking ≥ 3 CT features or SUV ≥ 6.75 as a criterion, the values were 94.74%, 88.89%, 92.31%, 92.31%, and 92.31%, respectively, indicating optimal diagnostic performance when paired with the anatomic information provided by the CT component. A univariate analysis of OS determined that surrounding tissue infiltration, epicardial infiltration, necrosis, multiple chambers or vessel involvement, distant metastasis, SUV, SUV, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were significant predictors of survival. In the multivariate analysis, only SUV ≥ 6.715 was significant (P < 0.01). Median OS was 1460 days for SUV < 6.715 and 342 days for SUV ≥ 6.715 (P < 0.01).
F-FDG PET/CT is helpful in the diagnosis of cardiac masses before treatment and has value in detecting extracardiac primary or secondary tumours. F-FDG PET/CT could also be a promising tool to provide prognostic information for these patients, especially SUV displaying independent prognostic value.
在治疗前对心脏肿块进行正确诊断和预后评估至关重要。我们评估了F-FDG PET/CT在心脏肿块患者中的诊断和预后价值。
回顾性分析了64例患有65个心脏肿块患者的F-FDG PET/CT图像（34例男性，30例女性；平均年龄51.2±17.5岁）。对良性和恶性实体之间以及原发性和继发性恶性肿瘤与淋巴瘤之间的CT特征和F-FDG代谢指标进行了比较。计算了PET/CT区分良性与恶性肿块的诊断价值。使用Cox比例风险模型进一步评估PET/CT数据对总生存期（OS）的预测价值，以评估潜在的独立预测因素。生成Kaplan-Meier曲线以评估PET/CT的预后价值。
发现良性和恶性肿块在各种形态特征和代谢指标上存在统计学显著差异。SUV为6.75是区分良性和恶性肿块的最佳临界值，诊断敏感性、特异性、准确性、阳性预测值和阴性预测值分别为92.11%、88.89%、90.77%、92.11%和88.89%。以CT特征和SUV≥6.75为标准，相应的值分别为76.32%、100.00%、86.15%、100.00%和75.00%；以≥3个CT特征或SUV≥6.75为标准，相应的值分别为94.74%、88.89%、92.31%、92.31%和92.31%，表明与CT组件提供的解剖信息配对时具有最佳诊断性能。OS的单因素分析确定周围组织浸润、心外膜浸润、坏死、多腔或血管受累、远处转移、SUV、SUV、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）是生存的显著预测因素。在多因素分析中，只有SUV≥6.715具有显著性（P<0.01）。SUV<6.715时的中位OS为1460天，SUV≥6.715时为342天（P<0.01）。
F-FDG PET/CT有助于治疗前心脏肿块的诊断，在检测心脏外原发性或继发性肿瘤方面具有价值。F-FDG PET/CT也可能是为这些患者提供预后信息的有前景的工具，尤其是SUV显示出独立的预后价值。
