Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 60 Staniford St, Boston, MA, USA.
Eur J Nucl Med Mol Imaging. 2021 Jun;48(6):1976-1986. doi: 10.1007/s00259-020-05113-1. Epub 2021 Jan 7.
To evaluate PET/MR lung nodule detection compared to PET/CT or CT, to determine growth of nodules missed by PET/MR, and to investigate the impact of missed nodules on clinical management in primary abdominal malignancies.
This retrospective IRB-approved study included [18F]-FDG PET/MR in 126 patients. All had standard of care chest imaging (SCI) with diagnostic chest CT or PET/CT within 6 weeks of PET/MR that served as standard of reference. Two radiologists assessed lung nodules (size, location, consistency, position, and [18F]-FDG avidity) on SCI and PET/MR. A side-by-side analysis of nodules on SCI and PET/MR was performed. The nodules missed on PET/MR were assessed on follow-up SCI to ascertain their growth (≥ 2 mm); their impact on management was also investigated.
A total of 505 nodules (mean 4 mm, range 1-23 mm) were detected by SCI in 89/126 patients (66M:60F, mean age 60 years). PET/MR detected 61 nodules for a sensitivity of 28.1% for patient and 12.1% for nodule, with higher sensitivity for > 7 mm nodules (< 30% and > 70% respectively, p < 0.05). 75/337 (22.3%) of the nodules missed on PET/MR (follow-up mean 736 days) demonstrated growth. In patients positive for nodules at SCI and negative at PET/MR, missed nodules did not influence patients' management.
Sensitivity of lung nodule detection on PET/MR is affected by nodule size and is lower than SCI. 22.3% of missed nodules increased on follow-up likely representing metastases. Although this did not impact clinical management in study group with primary abdominal malignancy, largely composed of extra-thoracic advanced stage cancers, with possible different implications in patients without extra-thoracic spread.
评估 PET/MR 对肺结节的检出率，并与 PET/CT 或 CT 进行比较，以确定 PET/MR 漏诊的结节的生长情况，并探讨这些漏诊结节对原发性腹部恶性肿瘤临床管理的影响。
本回顾性 IRB 批准的研究纳入了 126 例接受[18F]-FDG PET/MR 的患者。所有患者在 PET/MR 检查前 6 周内均接受了标准的胸部影像学检查（SCI），包括诊断性胸部 CT 或 PET/CT，作为参考标准。两名放射科医生评估了 SCI 和 PET/MR 上的肺结节（大小、位置、一致性、位置和[18F]-FDG 摄取情况）。对 SCI 和 PET/MR 上的结节进行了并排分析。对 PET/MR 漏诊的结节进行了随访 SCI 检查，以确定其生长情况（≥2mm）；还研究了它们对管理的影响。
在 89/126 例患者（66 例男性：60 例女性，平均年龄 60 岁）的 SCI 上共检测到 505 个结节（平均大小为 4mm，范围为 1-23mm）。PET/MR 共检测到 61 个结节，患者的敏感性为 28.1%，结节的敏感性为 12.1%，>7mm 的结节敏感性更高（分别为<30%和>70%，p<0.05）。在 PET/MR 上漏诊的 337 个结节中的 75 个（75/337，22.3%）在随访时（平均随访时间为 736 天）显示生长。在 SCI 阳性而 PET/MR 阴性的患者中，漏诊的结节未影响患者的管理。
PET/MR 对肺结节的检出率受结节大小的影响，且低于 SCI。22.3%的漏诊结节在随访时增大，可能代表转移灶。尽管在主要为胸部外晚期癌症的原发性腹部恶性肿瘤研究组中，这并未影响临床管理，但在无胸部外扩散的患者中，可能有不同的影响。
