Hill M, Cunningham D, MacVicar D, Roldan A, Husband J, McCready R, Mansi J, Milan S, Hickish T
Cancer Research Campaign Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
J Clin Oncol. 1993 Nov;11(11):2273-8. doi: 10.1200/JCO.1993.11.11.2273.
This prospective study of patients treated at the Royal Marsden Hospital Lymphoma Unit was designed to evaluate the role of magnetic resonance imaging (MRI) in the assessment of residual masses evident on computed tomographic (CT) scanning following treatment of lymphoma.
All patients had MRI, gallium-67 single-photon emission CT (67Ga SPECT), and erythrocyte sedimentation rate (ESR) performed within 3 months of completing therapy. Patients were monitored for 1 year posttreatment and observed for signs of relapse. Investigation results were correlated with disease status, and the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) calculated. Time-to-relapse curves were derived and the log-rank test used to determine whether patients with a positive result were more likely to have a relapse within the mass than those with a negative result.
Thirty-four patients were studied, 14 of whom relapsed, 11 within the area of residual mass. Overall, MRI had a high specificity (90%), PPV (71%), and NPV (75%), but poor sensitivity (45%). The results for 67Ga SPECT were similar, apart from lower sensitivity (33%). ESR had inferior performance in predicting relapse compared with the other tests. MRI was the only investigation to show statistical significance (P = .14) in predicting relapse, and this was particularly evident in Hodgkin's lymphoma (P = .003). Combining results of 67Ga SPECT and MRI did not improve predictive power.
These data demonstrate that MRI is a valuable tool in the setting of a residual mass after treatment, giving clinically useful prognostic information. 67Ga SPECT also has a role, but is less effective in predicting relapse than MRI.
本前瞻性研究针对在皇家马斯登医院淋巴瘤科接受治疗的患者，旨在评估磁共振成像（MRI）在评估淋巴瘤治疗后计算机断层扫描（CT）上可见的残留肿块方面的作用。
所有患者在完成治疗后3个月内均接受了MRI、镓-67单光子发射计算机断层扫描（67Ga SPECT）及红细胞沉降率（ESR）检查。对患者进行了为期1年的治疗后监测，并观察复发迹象。将检查结果与疾病状态相关联，并计算敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。绘制复发时间曲线，并使用对数秩检验来确定检查结果为阳性的患者在肿块内复发的可能性是否高于检查结果为阴性的患者。
共研究了34例患者，其中14例复发，11例在残留肿块区域内复发。总体而言，MRI具有较高的特异性（90%）、PPV（71%）和NPV（75%），但敏感性较差（45%）。67Ga SPECT的结果与之相似，只是敏感性较低（33%）。与其他检查相比，ESR在预测复发方面表现较差。MRI是唯一在预测复发方面具有统计学意义（P = 0.14）的检查，在霍奇金淋巴瘤中尤为明显（P = 0.003）。将67Ga SPECT和MRI的结果相结合并不能提高预测能力。
这些数据表明，MRI是治疗后残留肿块情况下的一种有价值的工具，可提供具有临床意义的预后信息。67Ga SPECT也有一定作用，但在预测复发方面不如MRI有效。
