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Dual Time Point FDG-PET/CT for the Differentiation of Adrenal Lesions in Patients with Cancer

雙相氟化葡萄糖正子/電腦斷層應用於鑑別癌症病人的腎上腺病灶

摘要


Background: The adrenal gland is a common site of metastatic disease in oncology patients. The accurate characterization of adrenal lesions in images is important in avoiding unnecessarily invasive biopsies or surgeries. The aim of this study is to assess the value of dual time point F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for differentiating malignant from benign adrenal lesions in patients with cancer. Methods: Patients with adrenal nodules (size > 1 cm) evidenced through dual time point (1 and 3 hours after injection) FDG-PET/CT were enrolled in this retrospective study. The 1 hour and 3 hour maximum standardized uptake values (SUV_(max)) of adrenal lesions were measured. The 1 hour and 3 hour adrenal SUV_(max) to liver SUV_(mean) ratios (A/L SUR) were calculated. The additional parameters of ΔSUV_(max), retention index of SUV_(max) (RI-SUV max), Δ A/L SUR, and RI-A/L SUR were also calculated. Results: A total of 36 patients were enrolled in this study. There were 41 adrenal lesions identified among 36 patients, including 15 malignant and 26 benign adrenal lesions. There were significant differences between malignant and benign lesions within the parameters of 1 hour SUV_(max), 3 h SUV_(max), ΔSUV_(max), 1 h A/L SUR, 3 h A/L SUR, ΔA/L SUR, and RI-A/L SUR. In the receiver operating characteristic curve analysis, the parameters of 1 hour SUV_(max), 3 h SUV_(max), 1 h A/L SUR, 3 h A/L SUR, and ΔA/ L SUR yielded excellent or good diagnostic performance results. In applying cutoff values of 1 hour SUV_(max) > 2.7, 3 h SUV_(max) > 2.8, 1 hour A/L SUR > 1.0, 3 hour A/L SUR > 1.15, and ΔA/L SUR > 0.18, the diagnostic accuracies were 82.9%, 82.9%, 85.4%, 85.4%, and 80.5% respectively. To maximize diagnostic accuracy, we developed a diagnostic algorithm using 1 hour SUV_(max) and ΔA/L SUR. Eleven adrenal lesions with 1 hour SUV_(max) less than 2.3 were all benign and 10 adrenal lesions with 1 hour SUV_(max) greater than 3.3 were all malignant. In the subgroup of 1 hour SUV_(max) 2.3 to 3.3, 12 adrenal lesions with ΔA/L SUR less than 0.18 were all benign and 5 of 8 adrenal lesions with ΔA/L SUR greater than 0.18 were malignant. The diagnostic accuracy was improved to 92.7%. Conclusion: Parameters of 1 hour SUV_(max), 3 h SUV_(max), 1 h A/L SUR, 3 h A/L SUR, and ΔA/L SUR in dual time point FDG-PET yield excellent or good diagnostic performance results in differentiating malignant from benign adrenal lesions. A diagnostic algorithm using 1 hour SUV_(max) and ΔA/L SUR can be helpful in improving diagnostic accuracy.

並列摘要


背景:腎上腺是惡性腫瘤好發的轉移部位,正確地鑑別癌症病人腎上腺病灶的良惡性可避免侵入性切片或手術。本研究的目的是評估雙相氟化葡萄糖正子/電腦斷層應用於鑑別癌症病人腎上腺病灶的價值。方法:本研究回溯性收集在雙相氟化葡萄糖正子/電腦斷層中發現大於1公分腎上腺病灶的癌症病人。雙相氟化葡萄糖正子造影參數包括1小時及3小時的最大標準攝取值(1 h, 3 h SUV_(max))、腎上腺/肝臟標準攝取值比率(1 h, 3 h A/L SUR)、最大標準攝取值與腎上腺/肝臟標準攝取值比率的差與滯留參數(ΔSUV_(max)、RI-SUV_(max)、ΔA/L SUR和RI-A/L SUR)。結果:本研究收集36個病人共41個腎上腺病灶,15個為惡性病灶,26個為良性病灶。結果顯示雙相氟化葡萄糖正子造影的1 h SUV_(max)、3 h SUV_(max)、ΔSUV_(max)、1 h A/L SUR、3 h A/L SUR、ΔA/L SUR和RI-A/L SUR等參數在惡性和良性病灶間有顯著性差異。藉由ROC曲線分析,1 h SUV_(max)、3 h SUV_(max)、1 h A/L SUR、3 h A/L SUR 和ΔA/L SUR等參數具有優良或良好的鑑別力。若以1 h SUV_(max) > 2.7;3 h SUV_(max) > 2.8;1 h A/L SUR > 1.0;3 h A/L SUR > 1.15和ΔA/L SUR > 0.18為分界點,準確度分別為82.9%;82.9%;85.4%;85.4% 和80.5%。為了臨床使用與最大化診斷準確度,我們使用1 h SUV_(max)合併ΔA/L SUR的診斷流程,11個1 h SUV_(max)小於2.3的病灶均為良性,10個1 h SUV_(max)大於3.3的病灶均為惡性,介於2.3到3.3之間的病灶,12個ΔA/L SUR小於0.18的病灶均為良性,8個ΔA/L SUR大於0.18的病灶有5個是惡性,使用診斷流程整體的準確度提高到92.7%。結論:雙相氟化葡萄糖正子造影中的1 h SUV_(max)、3 h SUV_(max)、1 h A/L SUR、3 h A/L SUR和ΔA/L SUR等參數對於腎上腺病灶的良惡性具有優良或良好的鑑別力。使用1 h SUV_(max)合併ΔA/L SUR的診斷流程有助於提高準確度。

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