鉴别复发性肿瘤与放射性坏死：是时候重新评估正电子发射断层扫描了吗？
Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography?
作者信息
Ricci P E, Karis J P, Heiserman J E, Fram E K, Bice A N, Drayer B P
机构信息
Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ 85001, USA.
出版信息
AJNR Am J Neuroradiol. 1998 Mar;19(3):407-13.
UNLABELLED
Our purpose was to evaluate the ability of FDG PET to differentiate recurrent tumor from posttherapy radiation necrosis.
METHODS
MR images, PET scans, and medical records of 84 consecutive patients with a history of a treated intracranial neoplasm were evaluated retrospectively. In all patients, recurrent tumor or radiation necrosis was suggested by clinical or MR findings. Metabolic activity of the PET abnormality was compared qualitatively with normal contralateral gray and white matter.
RESULTS
PET findings were confirmed histologically in 31 patients. With contralateral white matter as the standard of comparison, the PET scan sensitivity and specificity were found to be 86% and 22%, respectively. With contralateral gray matter as the reference standard, the sensitivity and specificity became 73% and 56%, respectively. Overall, nearly one third of the patients would have been treated inappropriately in either scheme had the PET scan been the sole determinant of therapy.
CONCLUSION
Our data suggest that the ability of FDG PET to differentiate recurrent tumor from radiation necrosis is limited. Both false-positive and false-negative PET scan results contributed to unacceptably low sensitivity and specificity values.
未加标注
我们的目的是评估氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）区分复发性肿瘤与治疗后放射性坏死的能力。
方法
回顾性评估84例有颅内肿瘤治疗史的连续患者的磁共振成像（MR）图像、PET扫描及病历资料。所有患者均根据临床或MR表现提示有复发性肿瘤或放射性坏死。将PET异常的代谢活性与对侧正常灰质和白质进行定性比较。
结果
31例患者的PET检查结果经组织学证实。以对侧白质作为对照标准，PET扫描的敏感性和特异性分别为86%和22%。以对侧灰质作为对照标准，敏感性和特异性分别变为73%和56%。总体而言，如果仅以PET扫描作为治疗的唯一决定因素，近三分之一的患者在任何一种方案中都可能接受不适当的治疗。
结论
我们的数据表明，FDG PET区分复发性肿瘤与放射性坏死的能力有限。PET扫描的假阳性和假阴性结果均导致敏感性和特异性值低得令人无法接受。
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