A predictive tool for an effective use of (18)F-FDG PET in assessing activity of sarcoidosis.
A predictive tool for an effective use of (18)F-FDG PET in assessing activity of sarcoidosis.
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DOI：
10.1186/1471-2466-12-57
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发表时间：
2012-09-14
影响因子：
3.1
通讯作者：
Drent M
中科院分区：
文献类型：
--
作者：
Mostard RL;Van Kuijk SM;Verschakelen JA;van Kroonenburgh MJ;Nelemans PJ;Wijnen PA;Drent M
18F-FDG PET/CT(PET)有助于评价结节病的炎症活动性。然而，没有适当的适应症可用。这项研究的目的是开发一种预测规则，可用于识别PET阳性概率较高的症状性结节病患者。我们回顾分析了一组具有非器官特异性持续性致残症状的结节病患者(n = 95)。预定义模型包括可溶性白介素2受体(sIL-2R)检测结果和高分辨率计算机断层扫描(HRCT)结果。HRCT扫描使用半定量评分系统进行分类，PET检查结果分别为阳性或阴性。建立了基于Logistic回归分析的预测模型。我们使用区分和校准措施来量化模型的性能。最后，我们构建了一个易于在临床实践中应用的预测规则。预测规则显示良好的校正和良好的整体性能(拟合优度检验，p = 为0.78，Brier评分为20.1%)，并区分阳性和阴性患者(受试者-操作特征曲线下面积为0.83)。如果90%的≥炎症活动度的阳性预测值在临床决策中被认为是可以接受的，而不转诊到正电子发射计算机断层扫描，那么只有29.5%的患者被认为是正电子发射计算机断层扫描。使用98%的阳性预测值，大约一半的患者(46.3%)需要转诊到PET。根据sIL-2R水平和HRCT评分结果得出的和内部验证的临床预测规则，似乎有助于识别具有高概率炎症活动的结节病患者。使用这一规则可以更有效地使用正电子发射计算机断层扫描来评估结节病的炎症活动。
18F-FDG PET/CT (PET) is useful in assessing inflammatory activity in sarcoidosis. However, no appropriate indications are available. The aim of this study was to develop a prediction rule that can be used to identify symptomatic sarcoidosis patients who have a high probability of PET-positivity. We retrospectively analyzed a cohort of sarcoidosis patients with non organ specific persistent disabling symptoms (n = 95). Results of soluble interleukin-2 receptor (sIL-2R) assessment and high-resolution computed tomography (HRCT) were included in the predefined model. HRCT scans were classified using a semi-quantitative scoring system and PET findings as positive or negative, respectively. A prediction model was derived based on logistic regression analysis. We quantified the model’s performance using measures of discrimination and calibration. Finally, we constructed a prediction rule that should be easily applicable in clinical practice. The prediction rule showed good calibration and good overall performance (goodness-of-fit test, p = 0.78, Brier score 20.1%) and discriminated between patients with positive and negative PET findings (area under the receiver-operating characteristic curve, 0.83). If a positive predictive value for the presence of inflammatory activity of ≥90% is considered acceptable for clinical decision-making without referral to PET, PET would be indicated in only 29.5% of the patients. Using a positive predictive value of 98%, about half of the patients (46.3%) would require referral to PET. The derived and internally validated clinical prediction rule, based on sIL-2R levels and HRCT scoring results, appeared to be useful to identify sarcoidosis patients with a high probability of inflammatory activity. Using this rule may enable a more effective use of PET scan for assessment of inflammatory activity in sarcoidosis.