Utility of PET/CT in Differentiating Benign from Malignant Adrenal Nodules in Patients with Cancer
Utility of PET/CT in Differentiating Benign from Malignant Adrenal Nodules in Patients with Cancer
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DOI：
10.2214/ajr.07.3447
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发表时间：
2008-11-01
影响因子：
5
通讯作者：
Iyer, Revathy B.
中科院分区：
文献类型：
--
作者：
Vikram, Raghunandan;Yeung, Henry D. W.;Iyer, Revathy B.
OBJECTIVE.本回顾性研究的目的是确定联合PET/CT在鉴别肿瘤患者直径至少1 cm的肾上腺结节良恶性方面的敏感性和特异性。我们回顾了患有已知恶性疾病的患者的放射学报告和图像，这些患者接受了PET/CT进行癌症分期或监测，并且肾上腺结节直径至少为1 cm。我们在96例患者中发现了112个肾上腺结节。在给予F-18-FDG后1小时进行二维PET。进行非增强CT以进行衰减校正，确定病变大小，并与PET数据配准。如果平均标准化摄取值大于肝脏的摄取值，则认为肾上腺结节具有阳性PET结果。随访资料和活检报告被用来确定肾上腺结节的病理状态。肾上腺恶性病变30例。30个恶性结节中有25个PET结果阳性。82个良性结节中12个阳性，敏感性83.3%，特异性85.4%。PET结果阴性的5个恶性结节中有4个患者接受过既往治疗。恶性病变检出的阳性预测值为67%，阴性预测值为93%。非FDG阳性的肾上腺肿块很可能是良性的，阴性预测值很高。然而，特别是在接受治疗的患者中，有一个小但统计学显著的假阴性率。相当一部分良性结节的FDG活性增加。
OBJECTIVE. The purpose of this retrospective study was to determine the sensitivity and specificity of combined PET/CT in differentiating benign from malignant adrenal nodules measuring at least 1 cm in diameter in patients with cancer.MATERIALS AND METHODS. We reviewed the radiology reports and images of patients with known malignant disease who had undergone PET/CT for cancer staging or surveillance and who had adrenal nodules at least 1 cm in diameter. We identified 112 adrenal nodules in 96 patients. Two-dimensional PET had been performed 1 hour after administration of F-18-FDG. Unenhanced CT was performed for attenuation correction, to determine lesion size, and for coregistration with PET data. Adrenal nodules were considered to have a positive PET result if the average standardized uptake value was greater than that of the liver. Follow-up data and biopsy reports were used to determine the pathologic status of the adrenal nodules.RESULTS. Thirty adrenal lesions were malignant. Twenty-five of the 30 malignant nodules had positive PET results. Twelve of 82 benign nodules were PET positive with a sensitivity of 83.3% and specificity of 85.4%. Patients with four of five malignant nodules with negative PET results had received previous therapy. The positive predictive value for detection of malignant lesions was 67%, and the negative predictive value was 93%.CONCLUSION. Adrenal masses that are not FDG avid are likely to be benign with a high negative predictive value. Especially in patients undergoing therapy, however, there is a small but statistically significant false-negative rate. A considerable proportion of benign nodules have increased FDG activity.