基于 F-FDG PET/CT 的多参数分析在胰腺囊性肿瘤鉴别诊断中的应用。
Multiparameter Analysis Using F-FDG PET/CT in the Differential Diagnosis of Pancreatic Cystic Neoplasms.
机构信息
Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Fuxing Road 28, Beijing 100853, China.
Medical School of Chinese PLA, Fuxing Road 28, Beijing 100853, China.
出版信息
Contrast Media Mol Imaging. 2021 Apr 7;2021:6658644. doi: 10.1155/2021/6658644. eCollection 2021.
PURPOSE
To evaluate multiparametric analysis in differential diagnosis between pancreatic serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) as well as the differentiation of the benign and malignant MCNs with F-FDG (18-fluorodeoxyglucose) PET/CT (positron emission tomography).
METHODS
Forty patients with total of 41 lesions (SCNs: 27/41; MCNs: 14/41), who were preoperatively examined with F-FDG PET/CT, were retrospectively analyzed. Multiple quantitative parameters using conventional and texture features were included. The combined model was established with complementary PET/MR parameters. The differential diagnostic efficacy of each independent parameter and the combined model were evaluated with receiver operating characteristic (ROC) analysis. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI) were used to evaluate improvement of diagnostic efficacy by using combination of multiple parameters.
RESULTS
Among all independent parameters, the percentile 5th (0.88 ± 0.38 vs 0.47 ± 0.23, < 0.001) showed the highest discriminative diagnostic value. The combination of multiple parameters can improve the differential diagnostic efficacy of SCNs and MCNs (sensitivity = 71.4%, specificity = 77.8%, and AUC = 0.788), and the addition of texture parameters to the conventional parameters allowed a significant reclassification with IDI = 0.236 (95% CI: 0.095-0.377) and categorical NRI = 0.434 (95% CI: 0.030-0.838). SURmax (tumor to normal pancreas ratio, T/P) and SURmax (tumor to aorta ratio, T/A) both showed the highest discriminative diagnostic value (sensitivity = 100.0%, specificity = 70.0%, AUC = 0.900, and Youden index = 0.700) in the differential diagnosis of benign and malignant MCNs, with the cutoff values of 0.84 and 0.90, respectively.
CONCLUSION
Combination of multiple parameters using F-FDG PET/CT could further improve differentiation between pancreatic SCNs and MCNs. SURmax (T/P) and SURmax (T/A) could improve differential diagnosis of benign and malignant MCNs.
目的
评估 F-FDG（18-氟脱氧葡萄糖）PET/CT（正电子发射断层扫描）在胰腺浆液性囊腺瘤（SCNs）和黏液性囊腺瘤（MCNs）鉴别诊断中的作用，并对良恶性 MCNs 的 F-FDG 摄取进行分析。
方法
回顾性分析 40 例（SCNs：27/41；MCNs：14/41）共 41 个病灶的患者，术前均接受 F-FDG PET/CT 检查。纳入了常规和纹理特征的多个定量参数。使用互补的 PET/MR 参数建立联合模型。采用受试者工作特征（ROC）分析评估每个独立参数和联合模型的鉴别诊断效果。整合判别改善（IDI）和净重新分类改善（NRI）用于评估多个参数联合使用对诊断效果的改善。
结果
在所有独立参数中，第 5 个百分位数（0.88±0.38 比 0.47±0.23，<0.001）显示出最高的鉴别诊断价值。多个参数的组合可以提高 SCNs 和 MCNs 的鉴别诊断效果（敏感性=71.4%，特异性=77.8%，AUC=0.788），将纹理参数添加到常规参数中可以显著重新分类，IDI=0.236（95%CI：0.095-0.377）和分类 NRI=0.434（95%CI：0.030-0.838）。肿瘤与正常胰腺的比值（T/P）和肿瘤与主动脉的比值（T/A）在良恶性 MCNs 的鉴别诊断中均显示出最高的鉴别诊断价值（敏感性=100.0%，特异性=70.0%，AUC=0.900，约登指数=0.700），截断值分别为 0.84 和 0.90。
结论
F-FDG PET/CT 联合使用多个参数可以进一步提高胰腺 SCNs 和 MCNs 的鉴别诊断能力。T/P 和 T/A 比值可以提高良恶性 MCNs 的鉴别诊断能力。
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