BioMedical Engineering and Imaging Institute, Icahn School of Medicine Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
Department of Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Abdom Radiol (NY). 2023 Dec;48(12):3634-3642. doi: 10.1007/s00261-022-03703-1. Epub 2022 Oct 29.
To assess the diagnostic performance of FDG-PET/MRI for the preoperative diagnosis and staging of peritoneal carcinomatosis (PC) using surgical Sugarbaker's PC index (PCI) as the reference in a multireader pilot study.
Fourteen adult patients (M/F: 3/11, mean age: 57 ± 12 year) with PC were prospectively included in this single-center study. Patients underwent FDG-PET/MRI prior to surgery (mean delay: 14 d, range: 1-63 d). Images were reviewed independently by 2 abdominal radiologists and 2 nuclear medicine physicians. The radiologists assessed contrast-enhanced abdominal MR images, while the nuclear medicine physicians assessed PET images fused with T2-weighted images. The abdomen was divided in 13 regions, scored from 0 to 3. A hybrid FDG-PET/MRI radiological PCI was created by combining the study data. Radiological PCI was compared to the surgical PCI on a per-patient and per-region basis. Inter-reader agreement was evaluated.
Mean surgical PCI was 10 ± 8 (range: 0-24). Inter-reader agreement was almost perfect for all sets for radiologic PCI (Kappa: 0.81-0.98). PCI scores for all reading sets significantly correlated with the surgical PCI score (r range: 0.57-0.74, p range: < 0.001-0.003). Pooled per-patient sensitivity, specificity, and accuracy were 75%/50%/71.4% for MRI, 66.7%/50%/64.3% for FDG-PET, and 91.7%/50%/85.7% for FDG-PET/MRI, without significant difference (p value range 0.13-1). FDG-PET/MRI achieved 100% sensitivity and 100% specificity for a cutoff PCI of 20. Per-region sensitivity and accuracy were lower: 37%/61.8% for MRI, 17.8%/64.3% for FDG-PET, and 52.7%/60.4% for FDG-PET/MRI, with significantly higher sensitivity for FDG-PET/MRI. Per-region specificity was higher for FDG-PET (95%) compared to MRI (78.4%) and FDG-PET/MRI (66.5%).
FDG-PET/MRI achieved an excellent diagnostic accuracy per-patient and weaker performance per-region for detection of PC. The added value of PET/MRI compared to MRI and FDG-PET remains to be determined.
使用多读者试点研究中手术 Sugarbaker 的腹膜癌（PC）指数（PCI）作为参考，评估 FDG-PET/MRI 对术前诊断和分期腹膜癌的诊断性能。
前瞻性纳入 14 例成人 PC 患者（M/F：3/11，平均年龄：57±12 岁）。患者在术前进行 FDG-PET/MRI（平均延迟时间：14d，范围：1-63d）。由 2 名腹部放射科医生和 2 名核医学医生独立对图像进行评估。放射科医生评估增强腹部 MRI 图像，核医学医生评估融合 T2 加权图像的 PET 图像。腹部被分为 13 个区域，评分从 0 到 3 分。通过组合研究数据创建了混合 FDG-PET/MRI 放射学 PCI。基于患者和区域的基础，将放射学 PCI 与手术 PCI 进行比较。评估了读者间的一致性。
手术 PCI 平均值为 10±8（范围：0-24）。所有检查组的放射学 PCI 之间的读者间一致性几乎为完美（Kappa：0.81-0.98）。所有阅读组的 PCI 评分与手术 PCI 评分显著相关（r 范围：0.57-0.74，p 范围：<0.001-0.003）。对于 MRI，基于患者的敏感性、特异性和准确性分别为 75%/50%/71.4%，对于 FDG-PET 为 66.7%/50%/64.3%，对于 FDG-PET/MRI 为 91.7%/50%/85.7%，差异无统计学意义（p 值范围 0.13-1）。对于截断 PCI 值为 20，FDG-PET/MRI 实现了 100%的敏感性和 100%的特异性。区域敏感性和准确性较低：MRI 为 37%/61.8%，FDG-PET 为 17.8%/64.3%，FDG-PET/MRI 为 52.7%/60.4%，FDG-PET/MRI 的敏感性明显更高。与 MRI（78.4%）和 FDG-PET/MRI（66.5%）相比，FDG-PET 的区域特异性更高。
FDG-PET/MRI 在检测 PC 方面，基于患者的诊断准确性较好，基于区域的检测性能较弱。与 MRI 和 FDG-PET 相比，FDG-PET/MRI 的附加价值仍有待确定。
