2-[F]FDG-PET/CT 最大标准摄取值与 CT 衰减值用于指导骨活检的效用。

The utility of 2-[F]FDG-PET/CT maximum SUV versus CT attenuation for directing bone biopsies.

机构信息

Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.

Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.

出版信息

Eur Radiol. 2021 Sep;31(9):6780-6792. doi: 10.1007/s00330-021-07770-8. Epub 2021 Mar 8.

DOI:10.1007/s00330-021-07770-8

PMID:33686475

Abstract

OBJECTIVES

This study aimed to compare the accuracy of PET/CT parameters with CT parameters for directing bone biopsies.

METHODS

The study was an IRB-approved retrospective study of 388 patients who underwent both 2-[F] FDG PET/CT and CT within 6 weeks before a bone biopsy. Age, sex, cancer type, lesion length, SUV, tumor to liver (T/L) ratio, CT attenuation, difference in CT attenuation between the lesion and normal bone (delta CT attenuation), and the absolute delta CT attenuation were used as predictors. T tests and chi-squared tests were used to compare variables. DeLong's test was used to compare receiver operator characteristic (ROC) curves.

RESULTS

We reviewed the data from 388 patients. Of these, 295 patients had bone lesion biopsies, and 93 patients had bone marrow aspirations/biopsies. Biopsies of larger bone lesions (p = 0.033) and bone lesions with higher SUV (p = 0.005) were more likely to show malignancy. For bone lesions, the ROC curve for the SUV (AUC = 0.6827) was better than the ROC curves for delta CT attenuation (AUC = 0.5766, p = 0.032) and absolute delta CT attenuation (AUC = 0.5491, p = 0.006), but not significantly better than the ROC curves for CT attenuation (AUC = 0.5894, p = 0.061) and T/L ratio (AUC = 0.6778, p = 0.774). A threshold SUV of 5.25 had an accuracy of 0.713, sensitivity of 0.766, and specificity of 0.549 to predict malignancy in bone lesion biopsies. None of these variables predicted malignancy in bone marrow biopsies (p > 0.05 for all).

CONCLUSIONS

Metabolic 2-[F]FDG PET/CT parameters have more clinical impact for planning bone biopsies as compared to CT parameters.

KEY POINTS

• The 2-[F]FDG PET/CT measurement (SUVmax) has more clinical impact for planning bone biopsies as compared to CT measurements. • Neither the change in CT attenuation of the lesion relative to normal bone nor the absolute value of this change was a significant predictor of malignancy. • 2-[F]FDG PET/CT may have clinical benefit and an additional role in directing bone biopsies.

摘要

目的

本研究旨在比较 PET/CT 参数与 CT 参数在引导骨活检中的准确性。

方法

这是一项经过机构审查委员会批准的回顾性研究，共纳入 388 例患者，这些患者均在骨活检前 6 周内同时接受了 2-[F] FDG PET/CT 和 CT 检查。年龄、性别、癌症类型、病灶长度、SUV、肿瘤与肝脏（T/L）比值、CT 衰减值、病灶与正常骨 CT 衰减差值（delta CT attenuation）以及绝对 delta CT 衰减值被用作预测指标。采用 t 检验和卡方检验比较变量，DeLong 检验比较受试者工作特征（ROC）曲线。

结果

我们回顾了 388 例患者的数据。其中 295 例患者进行了骨病灶活检，93 例患者进行了骨髓抽吸/活检。较大的骨病灶（p=0.033）和 SUV 较高的骨病灶（p=0.005）更有可能显示恶性肿瘤。对于骨病灶，SUV 的 ROC 曲线（AUC=0.6827）优于 delta CT 衰减值（AUC=0.5766，p=0.032）和绝对 delta CT 衰减值（AUC=0.5491，p=0.006）的 ROC 曲线，但与 CT 衰减值（AUC=0.5894，p=0.061）和 T/L 比值（AUC=0.6778，p=0.774）的 ROC 曲线相比并无显著差异。SUV 阈值为 5.25 时，预测骨病灶活检恶性肿瘤的准确率为 0.713，灵敏度为 0.766，特异性为 0.549。这些变量均不能预测骨髓活检的恶性肿瘤（p>0.05）。