Indeterminate Findings on Oncologic PET/CT: What Difference Does PET/MRI Make?
Indeterminate Findings on Oncologic PET/CT: What Difference Does PET/MRI Make?
复制标题
肿瘤 PET/CT 的不确定结果：PET/MRI 有何不同？
DOI：
10.1007/s13139-016-0405-1
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发表时间：
2016
影响因子：
1.3
通讯作者：
Dehdashti,Farrokh
中科院分区：
文献类型：
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作者：
Fraum,TylerJ;Fowler,KathrynJ;McConathy,Jonathan;Dehdashti,Farrokh
背景2-脱氧-2-[18 F]氟代-D-葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）已成为许多不同恶性肿瘤的初始分期和后续治疗反应评估的标准护理。尽管取得了这一成功，PET/CT通常辅以MRI，以改善局部肿瘤浸润的评估，并有助于检测具有高背景FDG摄取的器官中的病变。因此，PET/MRI有可能通过增加读片者的确定性和减少后续成像的需要来扩大PET检查的临床价值。本研究评估FDG-PET/MRI的能力，以澄清最初被认为是不确定的临床FDG-PET/CT study.MethodsA共190肿瘤患者进行全身PET/CT，紧接着PET/MRI利用相同的FDG管理的结果。每个PET/CT都由我们机构的核医学服务解释为标准护理临床检查。对这些PET/CT报告进行审查，发现31例患者（16%）的结果不确定。两名阅片人评价了所有31项PET/CT研究，随后评价了相应的PET/MRI研究。对每例病例达成共识，并记录PET/MRI审查直接导致的解释变化。结果在PET/CT检查结果不确定的31例患者中，PET/MRI检查有助于区分感染/炎症与恶性肿瘤（15/18），能准确定位FDG阳性病灶（2/18），以及偶发的非FDG亲合性实体器官病变的特征（1/18）。PET/MRI提高阅片者确定性的说明包括MRI的上级软组织对比度和通过弥散加权成像评估细胞密度的能力。大多数（12/18）此类病例有适当的参考标准;在所有12例病例中，明确的PET/MRI解释被证明是正确的。这12名患者接受了6项额外的诊断研究，以澄清最初不确定的PET/CT结果。在其余13例PET/CT和PET/MRI结果不确定的31例中，不确定性的常见原因包括无法区分反应性恶性淋巴结病（4/13）和局部复发治疗effects.ConclusionsIndeterminate PET/CT结果可能导致模棱两可的读数和额外的诊断研究。PET/MRI可通过促进更好的肿瘤分期、FDG活性定位和病变表征来降低不确定结果的发生率。在我们的研究中，PET/MRI导致更明确的成像解释，具有高准确性。PET/MRI还显示出减少PET/CT结果提示的额外诊断研究数量的潜力。我们的研究结果表明，全身PET/MRI提供了一定的诊断优势，PET/CT，促进更明确的成像解释，并可能提高PET的整体临床效用。
BackgroundPositron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) has become the standard of care for the initial staging and subsequent treatment response assessment of many different malignancies. Despite this success, PET/CT is often supplemented by MRI to improve assessment of local tumor invasion and to facilitate detection of lesions in organs with high background FDG uptake. Consequently, PET/MRI has the potential to expand the clinical value of PET examinations by increasing reader certainty and reducing the need for subsequent imaging. This study evaluates the ability of FDG-PET/MRI to clarify findings initially deemed indeterminate on clinical FDG-PET/CT studies.MethodsA total of 190 oncology patients underwent whole-body PET/CT, immediately followed by PET/MRI utilizing the same FDG administration. Each PET/CT was interpreted by our institution's nuclear medicine service as a standard-of-care clinical examination. Review of these PET/CT reports identified 31 patients (16 %) with indeterminate findings. Two readers evaluated all 31 PET/CT studies, followed by the corresponding PET/MRI studies. A consensus was reached for each case, and changes in interpretation directly resulting from PET/MRI review were recorded. Interpretations were then correlated with follow-up imaging, pathology results, and other diagnostic studies.ResultsIn 18 of 31 cases with indeterminate findings on PET/CT, PET/MRI resulted in a more definitive interpretation by facilitating the differentiation of infection/inflammation from malignancy (15/18), the accurate localization of FDG-avid lesions (2/18), and the characterization of incidental non-FDG-avid solid organ lesions (1/18). Explanations for improved reader certainty with PET/MRI included the superior soft tissue contrast of MRI and the ability to assess cellular density with diffusion-weighted imaging. The majority (12/18) of such cases had an appropriate standard of reference; in all 12 cases, the definitive PET/MRI interpretation proved correct. These 12 patients underwent six additional diagnostic studies to clarify the initial indeterminate PET/CT findings. In the remaining 13 of 31 cases with indeterminate findings on both PET/CT and PET/MRI, common reasons for uncertainty included the inability to distinguish reactive from malignant lymphadenopathy (4/13) and local recurrence from treatment effect (2/13).ConclusionsIndeterminate PET/CT findings can result in equivocal reads and additional diagnostic studies. PET/MRI may reduce the rate of indeterminate findings by facilitating better tumor staging, FDG activity localization, and lesion characterization. In our study, PET/MRI resulted in more definitive imaging interpretations with high accuracy. PET/MRI also showed potential in reducing the number of additional diagnostic studies prompted by PET/CT findings. Our results suggest that whole-body PET/MRI provides certain diagnostic advantages over PET/CT, promotes more definitive imaging interpretations, and may improve the overall clinical utility of PET.