Inoue Akihiro, Nagao Michinobu, Kaneko Koichiro, Yamamoto Atsushi, Shirai Yurie, Toshihiro Ohno, Sakai Akiko, Imakado Risa, Sakai Shuji
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Eur Radiol. 2025 Feb;35(2):1012-1021. doi: 10.1007/s00330-024-11022-w. Epub 2024 Aug 16.
On F-Fludeoxyglucose (FDG) PET/CT, active sarcoid lesions are often difficult to differentiate from malignant lesions. We investigated the potential of the glucose metabolic rate (MR, mg/min/100 mL), a new quantification of glucose metabolic kinetics derived from direct reconstruction based on linear Patlak analysis, to distinguish between sarcoidosis and malignant lesions.
A total of 100 patients with cardiac sarcoidosis (CS) and 67 patients with cancer who underwent four-dimensional FDG PET/CT were enrolled. The lesions with a standardized uptake value (SUV) ≥ 2.7 on the standard scan were included as active lesions in the analysis. SUV and MR were derived using data acquired between 30 min and 50 min on four-dimensional FDG PET/CT. The mean value in the volume of interest (size 1.5 cm) was measured. The diagnostic performance of sarcoidosis using MR and SUV was evaluated using receiver-operating-characteristic (ROC) analysis.
A total of 90 sarcoidosis lesions from 44 CS patients (18 males, 63.4 ± 12.2 years) and 87 malignant lesions from 57 cancer-bearing patients (32 males, 65 ± 14 years) were analyzed. SUV and MR for sarcoid lesions were significantly lower than those for malignant lesions (SUV, 4.98 ± 2.00 vs 6.21 ± 2.14; MR, 2.52 ± 1.39 vs 3.68 ± 1.61; p < 0.01). ROC analysis indicated that the ability to discriminate sarcoid patients from those with malignancy yielded areas under the curves of 0.703 and 0.754, with sensitivities of 64% and 77% and specificities of 75% and 72% for SUV 5.025 and MR 2.855, respectively.
MR was significantly lower in sarcoid lesions than malignant lesions, and improved sarcoid lesions identification over SUV alone.
MR improves sarcoid lymph node identification over SUV alone and is expected to shorten the examination time by eliminating delayed scans.
Active sarcoid lesions are sometimes associated with FDG accumulation and should be differentiated from malignant lesions. SUV and metabolic rate of glucose (MRglc) strongly positively correlated, and MRglc could differentiate sarcoid and malignant lesions. MRglc allows for accurate evaluation and staging of malignant lesions.
在氟脱氧葡萄糖（FDG）PET/CT检查中，活跃的结节病病变常难以与恶性病变区分开来。我们研究了葡萄糖代谢率（MR，mg/min/100 mL）这一基于线性Patlak分析直接重建得出的葡萄糖代谢动力学新定量指标，用于区分结节病和恶性病变的潜力。
共纳入100例心脏结节病（CS）患者和67例癌症患者，这些患者均接受了四维FDG PET/CT检查。标准扫描中标准化摄取值（SUV）≥2.7的病变被纳入分析作为活跃病变。SUV和MR通过四维FDG PET/CT在30分钟至50分钟之间采集的数据得出。测量感兴趣区（大小为1.5 cm）内的平均值。使用受试者操作特征（ROC）分析评估MR和SUV对结节病的诊断性能。
共分析了44例CS患者（18例男性，63.4±12.2岁）的90个结节病病变和57例癌症患者（32例男性，65±14岁）的87个恶性病变。结节病病变的SUV和MR显著低于恶性病变（SUV，4.98±2.00对6.21±2.14；MR，2.52±1.39对3.68±1.61；p<0.01）。ROC分析表明，区分结节病患者和恶性肿瘤患者的能力在曲线下面积分别为0.703和0.754，对于SUV 5.025和MR 2.855，敏感性分别为64%和77%，特异性分别为75%和72%。
结节病病变的MR显著低于恶性病变，与单独使用SUV相比，能更好地识别结节病病变。
与单独使用SUV相比，MR能更好地识别结节病淋巴结，预计通过消除延迟扫描可缩短检查时间。
活跃的结节病病变有时与FDG摄取有关，应与恶性病变区分开来。SUV与葡萄糖代谢率（MRglc）呈强正相关，MRglc可区分结节病和恶性病变。MRglc可准确评估恶性病变并进行分期。
