Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer.
Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer.
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DOI：
10.1186/s40644-016-0096-y
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发表时间：
2016-11-03
期刊：
影响因子：
--
通讯作者：
Miederer M
中科院分区：
文献类型：
--
作者：
Hempel JM;Kloeckner R;Krick S;Pinto Dos Santos D;Schadmand-Fischer S;Boeßert P;Bisdas S;Weber MM;Fottner C;Musholt TJ;Schreckenberger M;Miederer M
当放射性碘全身扫描和超声检查结果均为阴性时，怀疑甲状腺癌复发是一个诊断挑战。PET/CT和MRI已被证明可用于检测复发性疾病。然而，放射科医师和核医学医师的共识阅读的附加值（已被认为在临床常规中有帮助）尚未被研究。本研究旨在研究联合FDG-PET/ldCT和MRI对高危患者局部复发性TC和淋巴结转移检测的影响，特别关注多学科共识阅读的价值。回顾性分析了46例甲状腺切除术和放射性碘治疗后怀疑局部复发或淋巴结转移的甲状腺癌患者。入选标准包括甲状腺球蛋白血液水平升高、超声检查阴性、碘全身扫描阴性以及FDG-PET/ldCT和MRI联合检查。由两名设盲的观察者独立分析FDG-PET/ldCT和MRI检查中的颈部隔室，以确定甲状腺癌的局部复发和淋巴结转移。因此，扫描结果是一致的。为了探索可能的协同效应，将FDG-PET/ldCT和MRI结果结合起来。组织学或长期随访作为金标准。为了进行方法比较，计算灵敏度、特异性、阳性和阴性预测值以及诊断准确性。FDG-PET/ldCT在检测局部复发和淋巴结转移方面明显比MRI更敏感和更特异。FDG-PET/ldCT中局部复发（κ = 0.71）和淋巴结转移（κ = 0.63）检测的观察者间一致性很高。对于MRI，观察者间的一致性对于局部复发（κ = 0.69）和淋巴结转移（κ = 0.55）检测是显著的。相比之下，FDG-PET/ldCT和MRI仅显示轻微一致性（κ = 0.21）。然而，这两种成像模式识别不同的真阳性结果。因此，该组合产生了协同效应。多学科共识阅读进一步提高了敏感性、特异性和诊断准确性。FDG-PET/ldCT和MRI是互补的成像方式，应结合使用，以提高对高危患者甲状腺癌局部复发和淋巴结转移的检测。多学科共识阅读是诊断方法的关键要素。本文的在线版本（doi：10.1186/s40644-016-0096-y）包含补充材料，可供授权用户使用。
Suspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading. Forty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations. Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard. For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. FDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy. FDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach. The online version of this article (doi:10.1186/s40644-016-0096-y) contains supplementary material, which is available to authorized users.
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DOI：
10.1007/s00259-012-2248-z
发表时间：
2013-01
影响因子：
9.1
作者：
Platzek, Ivan;Beuthien-Baumann, Bettina;Schneider, Matthias;Gudziol, Volker;Langner, Jens;Schramm, Georg;Laniado, Michael;Kotzerke, Joerg;van den Hoff, Joerg
通讯作者：
van den Hoff, Joerg
DOI：
10.1007/s00259-014-2707-9
发表时间：
2014-06-01
影响因子：
9.1
作者：
Queiroz, Marcelo A.;Huellner, Martin;Veit-Haibach, Patrick
通讯作者：
Veit-Haibach, Patrick
影响因子：
2.6
作者：
ANTTINEN, I;PAMILO, M;ROIHA, M
通讯作者：
ROIHA, M
影响因子：
2.6
作者：
Gross, ND;Weissman, JL;Cohen, JI
通讯作者：
Cohen, JI
影响因子：
3.3
作者：
Kim, Seong-Jang;Lee, Tae Hong;Kim, Yong-Ki
通讯作者：
Kim, Yong-Ki