Zheng Fan, Wanjun Xiao, Shuaishuai Wang, Tong Wang, Lue Zou
Department of Orthopedics, The 4th People's Hospital of Shenyang, Liaoning, 110031, P.R. China.
Department of Radiology, The 4th People's Hospital of Shenyang, Liaoning, 110031, P.R. China.
Med Int (Lond). 2021 Nov 30;1(5):23. doi: 10.3892/mi.2021.23. eCollection 2021 Nov-Dec.
The aim of the present study was to investigate the value of the use of fluorine-18 (F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) vs. magnetic resonance imaging (MRI) for the diagnosis of and differentiation between benign and malignant lesions in the spinal canal. For this purpose, a retrospective analysis was performed on the use of MRI and F-FDG PET/CT from January, 2017 to December, 2020, and the final diagnosis was obtained by performing a post-operative pathological examination or following a tissue biopsy (gold standard). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the two examination techniques were calculated and comparisons between them were made. The PET metabolic parameters, maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in the benign and malignant groups were calculated and compared, and the corresponding ROC curves were plotted. A total of 58 patients were enrolled, including 30 patients with malignant and 28 with benign lesions. The specificity of MRI was significantly higher than that of PET/CT (P<0.05). The sensitivity and negative predictive value of PET/CT were higher than those of MRI, although with no significant difference (P>0.05). The mean ± tandard deviation values of the PET metabolic parameters, SUVmax, SUVpeak, SUVmean, MTV and TLG, were 4.27±1.25, 3.49±1.07, 2.49±0.84, 6.58±5.36 and 17.12±15.50 in the benign, and 8.99±3.75, 7.35±3.26, 5.43±2.40, 12.25±12.18 and 112.41±85.98 in the malignant groups, respectively. The SUVmax, SUVpeak, SUVmean and TLG in the malignant group were higher than those in the benign group. The differences were all statistically significant (all P<0.0001). In distinguishing benign from malignant lesions, the area under the ROC curve (AUC) for SUVmax was 0.919, which was the largest, and the Youden index was 0.762, indicating 83.3% sensitivity and 92.9% specificity. The AUC for SUVpeak was 0.905 and that for SUVmean was 0.899. The aforementioned AUCs were significantly higher than those for MTV and TLG (0.609 and 0.786, respectively) (P<0.001). On the whole, the present study demonstrates that MRI is a reliable imaging technique for the diagnosis of intravertebral lesions. F-FDG PET/CT, as a noteworthy supplement to MRI, has a high sensitivity and accuracy for the qualitative diagnosis and identification of lesions. The synergistic effect of the two examination techniques may be helpful for a more accurate diagnosis.
本研究的目的是探讨氟-18（F）-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）与磁共振成像（MRI）在诊断椎管内良恶性病变及鉴别两者方面的价值。为此，对2017年1月至2020年12月期间使用MRI和F-FDG PET/CT的情况进行了回顾性分析，并通过术后病理检查或组织活检（金标准）获得最终诊断。计算了两种检查技术的敏感性、特异性、准确性、阳性预测值和阴性预测值，并进行了比较。计算并比较了良恶性组的PET代谢参数，即最大标准化摄取值（SUVmax）、峰值标准化摄取值（SUVpeak）、平均标准化摄取值（SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG），并绘制了相应的ROC曲线。共纳入58例患者，其中恶性病变患者30例，良性病变患者28例。MRI的特异性显著高于PET/CT（P<0.05）。PET/CT的敏感性和阴性预测值高于MRI，但差异无统计学意义（P>0.05）。良性组PET代谢参数SUVmax、SUVpeak、SUVmean、MTV和TLG的均值±标准差分别为4.27±1.25、3.49±1.07、2.49±0.84、6.58±5.36和17.12±15.50，恶性组分别为8.99±3.75、7.35±3.26、5.43±2.40、12.25±12.18和112.41±85.98。恶性组SUVmax、SUVpeak、SUVmean和TLG高于良性组。差异均具有统计学意义（均P<0.0001）。在鉴别良恶性病变时，SUVmax的ROC曲线下面积（AUC）为0.919，最大，约登指数为0.762，表明敏感性为83.3%，特异性为92.9%。SUVpeak的AUC为0.905，SUVmean的AUC为0.899。上述AUC显著高于MTV和TLG的AUC（分别为0.609和0.786）（P<0.001）。总体而言，本研究表明MRI是诊断椎体内病变的可靠成像技术。F-FDG PET/CT作为MRI的重要补充，在病变的定性诊断和鉴别方面具有较高的敏感性和准确性。两种检查技术的协同作用可能有助于更准确的诊断。
