Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
Eur Rev Med Pharmacol Sci. 2022 Aug;26(16):5902-5910. doi: 10.26355/eurrev_202208_29529.
In the hybrid Positron Emission Tomography/Computed Tomography (PET/CT) method, the functional evaluation is integrated with the morphological information provided by co-registered CT, still performed for attenuation correction and lesion localization. However, co-registered CT images could provide additional diagnostic information that PET alone could underestimate. To optimize the diagnostic potential of this hybrid examination, we evaluated the prevalence and the clinical significance of incidental findings detected on co-registered CT images in a cohort of multiple myeloma (MM) patients.
We evaluated 112 MM patients (mean age 65.8 y), who underwent [18F]FDG-PET/CT during their regular workup. All co-registered CT images were retrospectively reviewed by two expert radiologists and each non-myelomatous incidental finding (nM-IF) was collected and clinically graded according to a nM-IF Reporting and Data System (nM-RADS). In addition, nM-IFs were classified according to anatomic localization (skull, lung, mediastinum, abdomen, breast, gastrointestinal, genitourinary and cardiovascular system and muscle/soft tissue).
163 nM-IFs were detected in 94/112 patients (83.9%) (mean value: 1.5 IFs per patient). The most interested anatomic districts were the lung (n=33; 20.2%), genitourinary (n=33; 20.2%) and gastrointestinal (n=30; 18.4%) systems. Focusing on the clinically significant findings (nM3+nM4), 92/163 (56.4%) IFs could have been required further investigations, of which 38/163 (23.3%) were potentially important and detected in 33/112 (29.5%) patients.
The high percentage of potentially clinically significant IFs detected in MM patients emphasizes that co-registered CT images hold precious information often missed. Giving more relevance to co-registered CT with tailored acquisition and reconstruction protocols and dedicated reporting could optimize the potentiality of this multimodality imaging method with impact on clinical management.
在正电子发射断层扫描/计算机断层扫描（PET/CT）混合方法中，功能评估与共配准 CT 提供的形态信息相结合，仍然用于衰减校正和病变定位。然而，共配准 CT 图像可以提供 PET 单独可能低估的额外诊断信息。为了优化这种混合检查的诊断潜力，我们评估了在一组多发性骨髓瘤（MM）患者中，共配准 CT 图像上偶然发现的发生率和临床意义。
我们评估了 112 名 MM 患者（平均年龄 65.8 岁），他们在常规检查中接受了[18F]FDG-PET/CT。两名专家放射科医生回顾性地评估了所有共配准 CT 图像，收集并根据非骨髓瘤偶然发现（nM-IF）报告和数据系统（nM-RADS）对每个非骨髓瘤偶然发现进行临床分级。此外，根据解剖学定位（颅骨、肺、纵隔、腹部、乳腺、胃肠道、泌尿生殖和心血管系统以及肌肉/软组织）对 nM-IF 进行分类。
94/112 名患者（83.9%）共发现 163 个 nM-IF（平均每位患者 1.5 个 IF）。最感兴趣的解剖区域是肺（n=33；20.2%）、泌尿生殖系统（n=33；20.2%）和胃肠道（n=30；18.4%）系统。关注具有临床意义的发现（nM3+nM4），163 个 IF 中有 92/163（56.4%）可能需要进一步检查，其中 38/163（23.3%）具有潜在重要性，在 33/112（29.5%）名患者中发现。
在 MM 患者中检测到的具有潜在临床意义的 IF 发生率较高，这强调了共配准 CT 图像包含了经常被遗漏的宝贵信息。通过使用定制的采集和重建方案以及专门的报告，更加重视共配准 CT，可以优化这种多模态成像方法的潜力，从而对临床管理产生影响。
