Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice
Qualitative and Quantitative Comparison of PET/CT and PET/MR Imaging in Clinical Practice
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DOI：
10.2967/jnumed.113.123547
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发表时间：
2014-01-01
影响因子：
9.3
通讯作者：
Bomanji, Jamshed
中科院分区：
文献类型：
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作者：
Al-Nabhani, Khalsa Z.;Syed, Rizwan;Bomanji, Jamshed
本研究的目的是前瞻性地比较肿瘤患者的全身PET/MR成像和PET/CT，定性和定量，并评估解剖学病变定位的观察者间和观察者内一致性的置信度和程度。研究方法：50名已知癌症分期的患者接受了PET/CT和低剂量CT进行衰减校正，随后立即进行PET/MR成像和2点狄克逊衰减校正。根据标准方案（注射平均367 MBq的F-18-FDG、150 MBq的Ga-68-DOTATATE或333.8MBq的F-18-氟-乙基-胆碱后56 +/-20分钟; 2.5分钟/床位置）获得PET/CT扫描。PET/MR以5 min/床位进行。三名双重认证的核医学医生/放射科医生确定了病变，并将每个病变分配到确切的解剖位置。PET/CT和PET/MR成像的图像质量、对准和病变解剖定位的置信度按1-3分进行评分。通过比较标准化摄取值进行定量分析。使用组内相关系数和Wilcoxon符号秩检验评估观察者内和观察者间在图像质量、对线和2种模式病变定位置信度方面的一致性。结果：在50名患者中发现了227个示踪剂-avid病变。其中，225例在PET/CT上被所有3名观察者正确识别，227例在PET/MR成像上被所有3名观察者正确识别。与PET/CT相比，使用PET/MR成像时解剖定位的置信度提高了5.1%。PET/CT和PET/MR成像的观察者间平均一致率分别为96%和99%，两种模式的病变定位观察者内一致率为93%。与PET/CT相比，PET/MR成像的局部分期改善了10%（5/50例患者）。结论：在第一项研究中，我们显示了全身PET/MR成像在肿瘤学中的有效性。PET/MR成像和PET/CT在解剖学病变定位的置信度和观察者间和观察者内一致性方面没有统计学显著差异。两种模式的PET数据相似;然而，MR成像在头颈部、骨盆和结直肠癌中观察到的上级软组织分辨率以及CT在肺和纵隔淋巴结疾病中的观察到的高级软组织分辨率表明，未来可在这些部位进行量身定制。
The aim of this study was to prospectively compare whole-body PET/MR imaging and PET/CT, qualitatively and quantitatively, in oncologic patients and assess the confidence and degree of inter-and intraobserver agreement in anatomic lesion localization. Methods: Fifty patients referred for staging with known cancers underwent PET/CT with low-dose CT for attenuation correction immediately followed by PET/MR imaging with 2-point Dixon attenuation correction. PET/CT scans were obtained according to standard protocols (56 +/- 20 min after injection of an average 367 MBq of F-18-FDG, 150 MBq of Ga-68-DOTATATE, or 333.8 MBq of F-18-fluoro-ethyl-choline; 2.5 min/bed position). PET/MR was performed with 5 min/bed position. Three dual-accredited nuclear medicine physicians/radiologists identified the lesions and assigned each to an exact anatomic location. The image quality, alignment, and confidence in anatomic localization of lesions were scored on a scale of 1-3 for PET/CT and PET/MR imaging. Quantitative analysis was performed by comparing the standardized uptake values. Intraclass correlation coefficients and the Wilcoxon signed-rank test were used to assess intra-and interobserver agreement in image quality, alignment, and confidence in lesion localization for the 2 modalities. Results: Two hundred twenty-seven tracer-avid lesions were identified in 50 patients. Of these, 225 were correctly identified on PET/CT and 227 on PET/MR imaging by all 3 observers. The confidence in anatomic localization improved by 5.1% when using PET/MR imaging, compared with PET/CT. The mean percentage interobserver agreement was 96% for PET/CT and 99% for PET/MR imaging, and intraobserver agreement in lesion localization across the 2 modalities was 93%. There was 10% (5/50 patients) improvement in local staging with PET/MR imaging, compared with PET/CT. Conclusion: In this first study, we show the effectiveness of whole-body PET/MR imaging in oncology. There is no statistically significant difference between PET/MR imaging and PET/CT in respect of confidence and degree of inter-and intraobserver agreement in anatomic lesion localization. The PET data on both modalities were similar; however, the observed superior soft-tissue resolution of MR imaging in head and neck, pelvis, and colorectal cancers and of CT in lung and mediastinal nodal disease points to future tailored use in these locations.