~(18)F-FDG PET/CT半定量参数在肾上腺病灶鉴别诊断中的价值
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摘要
[目的]探讨~(18)F-FDG PET/CT半定量参数在鉴别肾上腺病灶中的价值。[方法]对90例疑有肾上腺疾病患者的~(18)F-FDG PET/CT检查结果进行分析。利用半定量分析法,测量所有病灶的T/L SUV_(max)、SUV_(max)、肿瘤直径和平均CT值,与最终病理结果比较。[结果]共检出110个病灶,其中恶性肾上腺病灶51例、良性肾上腺病灶39例。恶性肾上腺病灶的平均T/L SUV_(max)(2.9±1.6)、SUV_(max)(8.3±5.1)、肿瘤直径(3.1cm±1.6cm)和平均CT值(31.9±7.0Hu)较良性病灶的平均T/L SUV_(max)(0.9±0.5)、SUV_(max)(2.7±1.4)、肿瘤直径(2.1cm±1.7cm)和平均CT值(12.1±17.5Hu)显著升高(P均<0.001)。假阳性3例、假阴性2例。ROC曲线分析显示,T/L SUV_(max)>1.15、SUV_(max)>3.86、CT值>23.5Hu和肿瘤直径>2.35cm可作为鉴别良恶性肾上腺病灶的最佳截断值。此最佳截断值的ROC曲线下的面积分别为0.95、0.95、0.84和0.76。多变量Logistic回归分析表明T/L SUV_(max)、SUV_(max)可作为恶性肾上腺病灶的独立诊断因素(P<0.001)。[结论]当T/L SUV_(max)>1.15、SUV_(max)>3.86时,~(18)F-FDG PET/CT在鉴别肾上腺病灶性质中具有较高价值。T/L SUV_(max)、SUV_(max)均可作为预测恶性病灶的独立因素,且T/L SUV_(max)更为客观。
[Objective] To evaluate the value of semi-quantitative parameters of ~(18)F-FDG PET/CT for the differentiation of malignant from benign adrenal lesions. [Methods] Included 90 patients(58 men and 32 women,age 60.1±11.6 year) who had undergone ~(18)F-FDG PET/CT for evaluation of110 adrenal lesions. For semi-quantitative analysis,adrenal to liver(T/L) SUV_(max)ratio,the maximum standardized uptake value(SUV_(max)),tumor diameter and mean CT attenuation value were measured in all lesions and compared with the pathological findings. [Results] A total of 110 lesions were detected,including 51 malignant and 39 benign. Malignant adrenal masses had a significantly higher T/L SUV_(max)ratio(2.9±1.6 vs. 0.9±0.5),a higher mean SUV_(max)(8.3±5.1 vs. 2.7±1.4),a greater tumor diameter(3.1±1.6 cm vs. 2.1±1.7 cm) and a higher mean CT attenuation value(31.9±7.0 Hu vs. 12.1 ±17.5 Hu) than benign lesions(P<0.001). There were three false positives and two false negatives. Based on ROC curve analysis,a T/L SUV_(max)ratio >1.15,an adrenal SUV_(max)>3.86,an attenuation value >23.5 Hu and a tumor diameter >2.35 cm were chosen as the optimal cut-off values for differentiating malignant from benign adrenal masses. The areas under the ROC curves for the selected cut-off values were 0.95,0.95,0.84 and 0.76,respectively. A multivariate logistic regression model revealed that the T/L SUV_(max)and SUV_(max)were an independent prognostic factor for malignancy(P<0.001);a CT attenuation value of >23.5 Hu and a tumor diameter >2.35 cm had no additional individual importance in the diagnosis of malignancy. [Conclusion] Using a T/L SUV_(max) ratio >1.15 and an adrenal SUV_(max)>3.86 in ~(18)F-FDG PET/CT led to high diagnostic sensitivity,accuracy and positive predictive value for characterizing adrenal lesions. T/L SUV_(max)and SUV_(max)could be used as independent predictors of malignancy,however,the T/L SUV_(max)is more objective.
[Objective] To evaluate the value of semi-quantitative parameters of ~(18)F-FDG PET/CT for the differentiation of malignant from benign adrenal lesions. [Methods] Included 90 patients(58 men and 32 women,age 60.1±11.6 year) who had undergone ~(18)F-FDG PET/CT for evaluation of110 adrenal lesions. For semi-quantitative analysis,adrenal to liver(T/L) SUV_(max)ratio,the maximum standardized uptake value(SUV_(max)),tumor diameter and mean CT attenuation value were measured in all lesions and compared with the pathological findings. [Results] A total of 110 lesions were detected,including 51 malignant and 39 benign. Malignant adrenal masses had a significantly higher T/L SUV_(max)ratio(2.9±1.6 vs. 0.9±0.5),a higher mean SUV_(max)(8.3±5.1 vs. 2.7±1.4),a greater tumor diameter(3.1±1.6 cm vs. 2.1±1.7 cm) and a higher mean CT attenuation value(31.9±7.0 Hu vs. 12.1 ±17.5 Hu) than benign lesions(P<0.001). There were three false positives and two false negatives. Based on ROC curve analysis,a T/L SUV_(max)ratio >1.15,an adrenal SUV_(max)>3.86,an attenuation value >23.5 Hu and a tumor diameter >2.35 cm were chosen as the optimal cut-off values for differentiating malignant from benign adrenal masses. The areas under the ROC curves for the selected cut-off values were 0.95,0.95,0.84 and 0.76,respectively. A multivariate logistic regression model revealed that the T/L SUV_(max)and SUV_(max)were an independent prognostic factor for malignancy(P<0.001);a CT attenuation value of >23.5 Hu and a tumor diameter >2.35 cm had no additional individual importance in the diagnosis of malignancy. [Conclusion] Using a T/L SUV_(max) ratio >1.15 and an adrenal SUV_(max)>3.86 in ~(18)F-FDG PET/CT led to high diagnostic sensitivity,accuracy and positive predictive value for characterizing adrenal lesions. T/L SUV_(max)and SUV_(max)could be used as independent predictors of malignancy,however,the T/L SUV_(max)is more objective.
引文
[1]Guerin C,Pattou F,Brunaud L,et al.Performance of18F-FDG PET/CT in the characterization of adrenal masses in noncancer patients:a prospective study[J].J Clin Endocrinol Metab,2017,102(7):2465-2472.
[2]Liu H,Huang KX,Bai YH,et al.Malignant adrenal tumors:CT and MRI findings with corresponding pathological basis[J].J Pract Radiol,2016,32(7):1077-1080.[刘衡,黄可忻,柏永华,等.肾上腺恶性肿瘤的CT、MRI表现及其病理基础[J].实用放射学杂志,2016,32(7):1077-1080.]
[3]Kim SJ,Lee SW,Pak K,et al.Diagnostic accuracy of18F-FDG PET or PET/CT for the characterization of adrenal masses:a systematic review and meta-analysis[J].Br JRadiol,2018,91(1086):20170520.
[4]Kim BS,Lee JD,Kang WJ.Differentiation of an adrenal mass in patients with non-small cell lung cancer by means of a normal range of adrenal standardized uptake values on FDG PET/CT[J].Ann Nucl Med,2015,29(3):276-283.
[5]Dong A,Cui Y,Wang Y,et al.18F-FDG PET/CT of adrenal lesions[J].AJR Am J Roentgenol,2014,203(2):245-252.
[6]Groussin L,Bonardel G,Silvéra S,et al.18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors:a prospective study in 77 operated patients[J].J Clin Endocrinol Metab,2009,94(5):1713-1722.
[7]Altinmakas E,Hobbs BP,Ye H,et al.Diagnostic performance of18F-FDG PET-CT in adrenal lesions using histopathology as reference standard[J].Abdom Radiol,2017,42(2):577-584.
[8]Evans PD,Miller CM,Marin D,et al.FDG PET/CT characterization of adrenal nodules:diagnostic accuracy and interreader agreement using quantitative and qualitative methods[J].Acad Radiol,2013,20(8):923-929.
[9]Watanabe H,Kanematsu M,Goshima S,et al.Adrenal-toliver SUV ratio is the best parameter for differentiation of adrenal metastases from adenomas using18F-FDG PET/CT[J].Ann Nucl Med,2013,27(7):648-653.
[10]Gratz S,Kemke B,Kaiser W,et al.Incidental non-secreting adrenal masses in cancer patients:intra-individual comparison of18F-fluorodeoxyglucose positron emission tomography/computed tomography with computed tomography and shift magnetic resonance imaging[J].J Int Med Res,2010,38(2):633-644.
[11]Delivanis DA,Bancos I,Atwell TD,et al.Diagnostic performance of unenhanced computed tomography and18F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours[J].Clin Endocrinol,2018,88(1):30-36.
[12]Ciftci E,Turgut B,Cakmakcilar A,et al.Diagnostic importance of18F-FDG PET/CT parameters and total lesion glycolysis in differentiating between benign and malignant adrenal lesions[J].Nucl Med Commun,2017,38(9):788-794.
[13]Nakajo M,Jinguji M,Nakajo M,et al.Texture analysis of FDG PET/CT for differentiating between FDG-avid benign and metastatic adrenal tumors:efficacy of combining SUVand texture parameters[J].Abdom Radiol,2017,42(12):2882-2889.
[14]Xi Y,Zhang M,Guo R,et al.Correlation between the degree of malignancy of pheochromocytoma and the maximum standardized uptake value measured by18F-FDGPET/CT[J].Chin J Nucl Med and Mol Imaging,2012,32(4):259-264.[席云,张敏,郭睿,等.18F-FDG PET/CT显像SUVmax与嗜铬细胞瘤恶性程度的相关性探讨[J].中华核医学与分子影像杂志,2012,32(4):259-264.]
[15]Wu Q,Luo W,Zhao Y,et al.The utility of18F-FDG PET/CT for the diagnosis of adrenal metastasis in lung cancer:a prisma-compliant meta-analysis[J].Nucl Med Commun,2017,38(12):1117-1124.
[16]Stone WZ,Wymer DC,Canales BK.Fluorodeoxyglucosepositron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer:review and diagnostic algorithm[J].J Endourol,2014,28(1):104-111.
[17]Brady MJ,Thomas J,Wong TZ,et al.Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer:a proposal for an efficient diagnostic algorithm[J].Radiology,2009,250(2):523-530.
[18]Lang BH,Cowling BJ,Li JY,et al.High false positivity in positron emission tomography is a potential diagnostic pitfall in patients with suspected adrenal metastasis[J].World J Surg,2015,39(8):1902-1908.
[19]Park SY,Park BK,Kim CK.The value of adding18F-FDG PET/CT to adrenal protocol CT for characterizing adrenal metastasis(≥10mm)in oncologic patients[J].AJRAm J Roentgenol,2014,202(2):W153-W160.
[2]Liu H,Huang KX,Bai YH,et al.Malignant adrenal tumors:CT and MRI findings with corresponding pathological basis[J].J Pract Radiol,2016,32(7):1077-1080.[刘衡,黄可忻,柏永华,等.肾上腺恶性肿瘤的CT、MRI表现及其病理基础[J].实用放射学杂志,2016,32(7):1077-1080.]
[3]Kim SJ,Lee SW,Pak K,et al.Diagnostic accuracy of18F-FDG PET or PET/CT for the characterization of adrenal masses:a systematic review and meta-analysis[J].Br JRadiol,2018,91(1086):20170520.
[4]Kim BS,Lee JD,Kang WJ.Differentiation of an adrenal mass in patients with non-small cell lung cancer by means of a normal range of adrenal standardized uptake values on FDG PET/CT[J].Ann Nucl Med,2015,29(3):276-283.
[5]Dong A,Cui Y,Wang Y,et al.18F-FDG PET/CT of adrenal lesions[J].AJR Am J Roentgenol,2014,203(2):245-252.
[6]Groussin L,Bonardel G,Silvéra S,et al.18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors:a prospective study in 77 operated patients[J].J Clin Endocrinol Metab,2009,94(5):1713-1722.
[7]Altinmakas E,Hobbs BP,Ye H,et al.Diagnostic performance of18F-FDG PET-CT in adrenal lesions using histopathology as reference standard[J].Abdom Radiol,2017,42(2):577-584.
[8]Evans PD,Miller CM,Marin D,et al.FDG PET/CT characterization of adrenal nodules:diagnostic accuracy and interreader agreement using quantitative and qualitative methods[J].Acad Radiol,2013,20(8):923-929.
[9]Watanabe H,Kanematsu M,Goshima S,et al.Adrenal-toliver SUV ratio is the best parameter for differentiation of adrenal metastases from adenomas using18F-FDG PET/CT[J].Ann Nucl Med,2013,27(7):648-653.
[10]Gratz S,Kemke B,Kaiser W,et al.Incidental non-secreting adrenal masses in cancer patients:intra-individual comparison of18F-fluorodeoxyglucose positron emission tomography/computed tomography with computed tomography and shift magnetic resonance imaging[J].J Int Med Res,2010,38(2):633-644.
[11]Delivanis DA,Bancos I,Atwell TD,et al.Diagnostic performance of unenhanced computed tomography and18F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours[J].Clin Endocrinol,2018,88(1):30-36.
[12]Ciftci E,Turgut B,Cakmakcilar A,et al.Diagnostic importance of18F-FDG PET/CT parameters and total lesion glycolysis in differentiating between benign and malignant adrenal lesions[J].Nucl Med Commun,2017,38(9):788-794.
[13]Nakajo M,Jinguji M,Nakajo M,et al.Texture analysis of FDG PET/CT for differentiating between FDG-avid benign and metastatic adrenal tumors:efficacy of combining SUVand texture parameters[J].Abdom Radiol,2017,42(12):2882-2889.
[14]Xi Y,Zhang M,Guo R,et al.Correlation between the degree of malignancy of pheochromocytoma and the maximum standardized uptake value measured by18F-FDGPET/CT[J].Chin J Nucl Med and Mol Imaging,2012,32(4):259-264.[席云,张敏,郭睿,等.18F-FDG PET/CT显像SUVmax与嗜铬细胞瘤恶性程度的相关性探讨[J].中华核医学与分子影像杂志,2012,32(4):259-264.]
[15]Wu Q,Luo W,Zhao Y,et al.The utility of18F-FDG PET/CT for the diagnosis of adrenal metastasis in lung cancer:a prisma-compliant meta-analysis[J].Nucl Med Commun,2017,38(12):1117-1124.
[16]Stone WZ,Wymer DC,Canales BK.Fluorodeoxyglucosepositron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer:review and diagnostic algorithm[J].J Endourol,2014,28(1):104-111.
[17]Brady MJ,Thomas J,Wong TZ,et al.Adrenal nodules at FDG PET/CT in patients known to have or suspected of having lung cancer:a proposal for an efficient diagnostic algorithm[J].Radiology,2009,250(2):523-530.
[18]Lang BH,Cowling BJ,Li JY,et al.High false positivity in positron emission tomography is a potential diagnostic pitfall in patients with suspected adrenal metastasis[J].World J Surg,2015,39(8):1902-1908.
[19]Park SY,Park BK,Kim CK.The value of adding18F-FDG PET/CT to adrenal protocol CT for characterizing adrenal metastasis(≥10mm)in oncologic patients[J].AJRAm J Roentgenol,2014,202(2):W153-W160.