Ma Guangyu, Zhang Xiaojun, Wang Minshu, Xu Xiaodan, Xu Baixuan, Guan Zhiwei
Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China.
Quant Imaging Med Surg. 2021 May;11(5):2013-2018. doi: 10.21037/qims-20-875.
This retrospective study was performed to estimate the clinical role of whole-body positron emission tomography/computed tomography (PET/CT) using 2-[F] fluoro-2-deoxy-D-glucose (FDG) in the differential diagnosis of primary benign and malignant unilateral adrenal tumors.
A total of 64 patients (31 male, 33 female; age range: 3-76 years, mean: 48.5) with a confirmed unilateral adrenal tumor underwent F-FDG PET/CT examination for diagnosis and staging. The whole-body F-FDG PET/CT examination excluded metastasis, and all patients were confirmed by operation and biopsy pathology. Their clinical data and pathological results were collected. On visual analysis of PET/CT imaging, adrenal uptake was based on a three-scale grading system. The region of interest (ROI) was delineated in the liver and the renal lesion site. Standardized uptake value (SUV) measurements were determined on a standardized reconstruction, and the maximum values (SUV) of the lesion and liver were measured. The ratio of tumor to the liver was defined as T/L. Visual interpretation, SUV-receiver operating characteristics (ROC) method, and T/L-ROC method were used to analyze the diagnostic accuracy.
A total of 64 lesions (48 benign, 16 malignant lesions) were detected. The visual analysis found that 100% of Grade I cases were benign, 90.9% of Grade II cases were benign, and 65.1% of Grade III cases were benign. The SUV of malignant lesions (10.0±5.8) was higher than that of benign lesions (5.4±5.3, P<0.05). The T/L was 3.39±1.79 for malignant lesions and 1.99±2.09 for benign lesions (P<0.05). In the differentiation of primary benign and malignant unilateral adrenal tumors, the sensitivity, specificity, and accuracy of the SUV-ROC method (cut-off value =5.65) were 81.25%, 72.91%, 75.00%, and the positive and negative predictive values were 50.00% and 92.11%, respectively. The sensitivity, specificity, and accuracy of the T/L-ROC method (cut-off value =1.52) were 93.73%, 62.50%, 70.31%, and the positive and negative predictive values were 46.88% and 96.77%, respectively.
F-FDG PET/CT improved diagnostic accuracy in differentiating primary benign and malignant unilateral adrenal tumors. There was a high negative predictive value, and for positive prediction, other tracer imaging is needed for differential diagnosis.
本回顾性研究旨在评估使用2-[F]氟-2-脱氧-D-葡萄糖（FDG）的全身正电子发射断层扫描/计算机断层扫描（PET/CT）在原发性单侧肾上腺良恶性肿瘤鉴别诊断中的临床作用。
共有64例确诊为单侧肾上腺肿瘤的患者（男性31例，女性33例；年龄范围：3 - 76岁，平均48.5岁）接受了F-FDG PET/CT检查以进行诊断和分期。全身F-FDG PET/CT检查排除了转移情况，所有患者均经手术及活检病理证实。收集他们的临床资料和病理结果。在PET/CT影像的视觉分析中，肾上腺摄取基于三级分级系统。在肝脏和肾脏病变部位划定感兴趣区（ROI）。在标准化重建上测定标准化摄取值（SUV），并测量病变和肝脏的最大值（SUV）。肿瘤与肝脏的比值定义为T/L。采用视觉解读、SUV-受试者操作特征（ROC）法和T/L-ROC法分析诊断准确性。
共检测到64个病变（48个良性病变，16个恶性病变）。视觉分析发现，I级病例100%为良性，II级病例90.9%为良性，III级病例65.1%为良性。恶性病变的SUV（10.0±5.8）高于良性病变（5.4±5.3，P<0.05）。恶性病变的T/L为3.39±1.79，良性病变的T/L为1.99±2.09（P<0.05）。在原发性单侧肾上腺良恶性肿瘤的鉴别诊断中，SUV-ROC法（临界值=5.65）的敏感性、特异性和准确性分别为81.25%、72.91%、75.00%，阳性和阴性预测值分别为50.00%和92.11%。T/L-ROC法（临界值=1.52）的敏感性、特异性和准确性分别为93.73%、62.50%、70.31%，阳性和阴性预测值分别为46.88%和96.77%。
F-FDG PET/CT提高了原发性单侧肾上腺良恶性肿瘤鉴别诊断的准确性。有较高的阴性预测值，对于阳性预测，需要其他示踪剂成像进行鉴别诊断。
