Lee Dong Yun, Kim Yong-Il, Ryu Jin-Sook
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2025 Jan;35(1):479-486. doi: 10.1007/s00330-024-10961-8. Epub 2024 Jul 18.
[F]Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a non-invasive imaging modality used in the differential diagnosis of splenic lesions, although ideal parameters and thresholds remain unclear. The present study evaluated the ability of [F]FDG PET/CT, including its visual and quantitative parameters, to differentiate between benign and malignant splenic lesions.
Patients who underwent [F]FDG PET/CT following the detection of splenic lesions on contrast-enhanced CT were retrospectively analysed. Visual parameters assessed on [F]FDG PET/CT included whole spleen uptake intensity, lesion multiplicity, and lesion uptake, and quantitative parameters included maximum standardised uptake value (SUVmax), lesion-to-background ratio (LBR), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and lesion size. Parameters differentiating between benign and malignant lesions were evaluated by Pearson's chi-square test, Mann-Whitney U-test, and receiver operating characteristics (ROC) curve analysis.
Splenic lesion uptake (p = 0.001) was the only visual parameter significantly distinguishing between benign and malignant lesions. ROC curve analysis demonstrated that SUVmax had the largest area under the ROC, 0.91 (p < 0.001), with an optimal cut-off > 5.3 having a sensitivity of 90.3% and a specificity of 80.6%. Subgroup analysis of malignant lesions showed that SUVmax (p = 0.013), LBR (p = 0.012), and TLG (p = 0.034) were significantly higher in splenic lymphomas than in splenic metastases.
Of the [F]FDG PET/CT parameters investigated, SUVmax had the highest accuracy in diagnosing malignant splenic lesions and was significantly higher in splenic lymphomas than in splenic metastases. Visual determination of [F]FDG uptake by splenic lesions may be an easily evaluated parameter.
SUVmax and visual grade of [F]FDG PET/CT help to differentiate spleen lesions. [F]FDG PET/CT is useful for discriminating between benign and malignant spleen lesions.
Many splenic lesions are difficult to diagnose on anatomical imaging, with histopathologic analyses are required. SUVmax of PET/CT provided the diagnostic ability to differentiate between benign and malignant splenic lesions. More than normal spleen uptake can be a convenient parameter to diagnose malignant spleen lesions.
氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）是一种用于脾病变鉴别诊断的非侵入性成像方式，尽管理想参数和阈值仍不明确。本研究评估了FDG PET/CT区分良性和恶性脾病变的能力，包括其视觉和定量参数。
对在增强CT上检测到脾病变后接受FDG PET/CT检查的患者进行回顾性分析。FDG PET/CT评估的视觉参数包括全脾摄取强度、病变数量和病变摄取，定量参数包括最大标准化摄取值（SUVmax）、病变与背景比值（LBR）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）和病变大小。通过Pearson卡方检验、Mann-Whitney U检验和受试者工作特征（ROC）曲线分析评估区分良性和恶性病变的参数。
脾病变摄取（p = 0.001）是唯一能显著区分良性和恶性病变的视觉参数。ROC曲线分析表明，SUVmax在ROC曲线下面积最大，为0.91（p < 0.001），最佳截断值> 5.3时，灵敏度为90.3%，特异性为80.6%。恶性病变亚组分析显示，脾淋巴瘤的SUVmax（p = 0.013）、LBR（p = 0.012）和TLG（p = 0.034）显著高于脾转移瘤。
在所研究的FDG PET/CT参数中，SUVmax在诊断恶性脾病变方面准确性最高，且在脾淋巴瘤中显著高于脾转移瘤。脾病变FDG摄取的视觉判断可能是一个易于评估的参数。
SUVmax和FDG PET/CT的视觉分级有助于鉴别脾病变。FDG PET/CT有助于区分良性和恶性脾病变。
许多脾病变在解剖成像上难以诊断，需要进行组织病理学分析。PET/CT的SUVmax提供了区分良性和恶性脾病变的诊断能力。超过正常脾摄取可作为诊断恶性脾病变的一个便捷参数。
