FDG PET/CT for the detection of bone marrow involvement in diffuse large B-cell lymphoma: systematic review and meta-analysis

Purpose

To systematically review and meta-analyse published data on the diagnostic performance of ¹⁸F-FDG PET/CT in detecting bone marrow involvement in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).

Methods

PubMed/MEDLINE and Embase were systematically searched for relevant studies. The methodological quality of each study was assessed. Sensitivities and specificities of FDG PET/CT in individual studies were calculated and meta-analysed with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses-Shapiro-Littenberg method. Weighted summary proportions of discrepancies between the FDG PET/CT and (blind) bone marrow biopsy (BMB) results among all patients were calculated.

Results

Seven studies, with a total of 654 patients with newly diagnosed DLBCL, were included. Overall, the quality of the included studies was moderate. The sensitivity and specificity of FDG PET/CT for detecting bone marrow involvement ranged from 70.8 % to 95.8 % and from 99.0 % to 100 %, with pooled estimates of 88.7 % (95 % confidence interval, CI, 82.5 – 93.3 %) and 99.8 % (95 % CI 98.8 – 100 %), respectively. The area under the sROC curve was 0.9983. The weighted summary proportion of FDG PET/CT-negative patients with positive BMB findings among all patients was 3.1 % (95 % CI 1.8 – 5.0 %) and the weighted summary proportion of FDG PET/CT-positive patients with negative BMB findings among all patients was 12.5 % (95 % CI 8.4 – 17.3 %).

Conclusion

FDG PET/CT is accurate and complementary to BMB for detecting bone marrow involvement in patients with newly diagnosed DLBCL. A negative FDG PET/CT scan cannot rule out the presence of bone marrow involvement, but positive FDG PET/CT findings obviate the need for BMB for the detection of bone marrow involvement in these patients.     

Fluorine-18-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer after surgical resection: a systematic review and meta-analysis

We aimed to explore the diagnostic accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) for detection of gastric cancer recurrence after surgical resection through a systematic review and meta-analysis. “PubMed”, EMBASE, Web of Knowledge and Springer, from the beginning of 2002 to Feb 2015, were searched for studies evaluating the diagnostic performance of 18F-FDG PET in detecting recurrent gastric cancer. We calculated sensitivities, specificities, diagnostic odds ratios and likelihood ratios, and constructed summary receiver operating characteristic curves. Fourteen studies (828 patients) were included. On a per-patient basis, the forest plots showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ¹⁸F-FDG PET or PET/CT were 0.85 [95 % confidence interval (CI) 0.75–0.92], 0.78 (95 % CI 0.72–0.84), 3.9 (95 % CI 2.9–5.4), 0.19 (95 % CI 0.11–0.34), and 21 (95 % CI 9–47), respectively. On a per-lesion basis, the pooled sensitivity was 0.75 (95 % CI 0.61–0.86). The area under the SROC curve of PET/CT on the basis of per-patient was 0.86. ¹⁸F-FDG PET had great value in the detection of gastric cancer recurrence after surgical resection. The sensitivities of ¹⁸F-FDG PET were 85 and 75 %, respectively, on per-patient basis and on per-lesion basis.     

Usefulness of 18F-FDG PET/CT for the Evaluation of Bone Marrow Involvement in Patients with High-Grade Non-Hodgkin’s Lymphoma

Purpose

To assess the usefulness of ¹⁸F-fluorodeoxyglucose PET/CT in the detection of bone marrow (BM) involvement of high-grade non-Hodgkin’s lymphoma (NHL).

Methods

One hundred twenty patients with newly diagnosed diffuse large B-cell lymphoma or peripheral T-cell lymphoma between January 2007 and June 2011, who received BM trephine biopsy and ¹⁸F-FDG PET/CT before chemotherapy, were included in this retrospective study. We reviewed their ¹⁸F-FDG PET/CT images and bone marrow biopsy (BMB) results. After reviewing the images, we reviewed the medical records and radiological findings of interesting patients.

Results

There were 23 ¹⁸F-FDG PET/CT scans in which the marrow was considered to be abnormal (either positive or equivocal), and 97 ¹⁸F-FDG PET/CT scans were regarded as having negative FDG uptake. Of 120 patients, 100 (83.3 %) had a concordant result of BM interpretation between ¹⁸F-FDG PET/CT and BMB, and the remaining 20 patients had discordant results. Among 23 patients with either positive or equivocal ¹⁸F-FDG PET/CT scans, 1 of 12 patients with ‘positive’ ¹⁸F-FDG PET/CT had a lymphomatous involvement on BMB. In contrast, 10 of 11 patients with ‘equivocal’ BM hypermetabolism were reported as having positive involvement by BMB. Patients with abnormal ¹⁸F-FDG PET/CT had significantly higher mSUV_highest than those with normal FDG-PET/CT.

Conclusions

¹⁸F-FDG PET/CT and BMB are complementary techniques in assessing the presence of BM involvement in patients with high-grade NHL. The increasing availability of ¹⁸F-FDG PET/CT will raise the need for additional biopsy for FDG-avid lesions, especially in patients with negative standard BMBs. ¹⁸F-FDG PET/CT can be useful as a decision-making tool for determining whether to perform a standard BMB or targeted biopsy to the FDG-avid lesion as an initial staging procedure. A direct bone biopsy for FDGpositive bone lesions should be included in staging guidelines in future. In ¹⁸F-FDG PET/CT-negative cases, BMB is still a powerful procedure, but BMB alone is insufficient for full evaluation of BM.     

18F-FDG PET/CT bone/bone marrow findings in Hodgkin’s lymphoma may circumvent the use of bone marrow trephine biopsy at diagnosis staging

Purpose

Accurate staging of Hodgkin’s lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. ¹⁸F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant ¹⁸F-FDG PET/CT.

Methods

Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and ¹⁸F-FDG PET/CT. Results of BMB were not available at the time of ¹⁸F-FDG PET/CT imaging.

Results

Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on ¹⁸F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on ¹⁸F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy ¹⁸F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient.

Conclusion

¹⁸F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging.     

18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的系统评价

目的 系统评价18F-FDOPA与18F-FDG PET/CT显像在脑肿瘤诊断中的临床价值.方法 采用Meta分析与直接比较方法.使用计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library,从建库至2016年10月,搜索直接比较18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的诊断性试验.用Meta-Disc 1.4软件进行分析,计算两种不同显像剂的合并敏感度(sensitivity,SEN)、合并特异度(specificity,SPE)、合并阳性似然比(positive likelihood ratio,+LR)、合并阴性似然比(negative likelihood ratio,-LR)、诊断优势比(diagnostic odds ratio,DOR),并绘制综合受试者工作特征曲线计算曲线下面积(area under curve,AUC)与Q*值.结果 最终共纳入4篇文章,Meta 分析结果显示,18F-FDOPA PET/CT对脑肿瘤诊断的合并SEN为0.97(95％ CI =0.90 ～ 1.00),SPE为0.67(95％ CI =0.45 ～0.84),+LR为2.31 (95％ CI=1.40 ～3.81),-LR为0.07 (95％ CI =0.02～ 0.24),DOR为39.72(95％ CI=8.94～176.48),AUC为0.9725,Q*为0.9239.18F-FDG PET/CT对脑肿瘤诊断的合并SEN为0.51(95％CI=0.39～0.63),SPE为0.75(95％ CI=0.53 ～0.90,+LR为l.59(95％ CI=0.70 ～ 3.61),-LR为0.63(95％ CI =0.47 ～0.86),DOR为2.55(95％ CI =0.82 ～7.92),AUC为0.5848,Q*为0.5638.结论 18F-FDOPA PET/CT显像诊断脑肿瘤的敏感性比18F-FDG高,对脑肿瘤具有良好的诊断价值,可作为脑肿瘤诊断的方法之一.     

全身MRI与PET/CT在淋巴瘤骨髓浸润诊断及预后中的作用

淋巴瘤是一种血液系统恶性肿瘤。淋巴瘤骨髓浸润(BMI)使疾病分期上升至IV期, 是疾病进展、预后较差的标志。常规部位的骨髓活检(BMB)具有创伤性, 且检出率低。PET/CT与全身MRI的出现, 丰富了BMI的检测手段。PET/CT与全身MRI对于淋巴瘤, 尤其是侵袭性淋巴瘤BMI均具有较高的检出率, 二者孰高孰低, 尚未定论。对于红骨髓、良性骨髓病变(炎症等)、淋巴瘤BMI病灶以及肿瘤治疗后骨髓的变化与骨髓残留或复发病灶, 全身MRI很难区分, 而PET/CT却可以很好地鉴别这些病灶。但是, PET/CT存在电离辐射; 对于惰性淋巴瘤的BMI, 超出PET/CT分辨率的病灶, 可能出现假阴性; 某些情况会限制PET/CT的使用, 包括18F-FDG生理性摄取量可能发生改变的正常组织、18F-FDG摄取相关性炎症、高血糖或高胰岛素血症导致的18F-FDG分布的改变、肿瘤患者治疗后出现的骨髓活化等。然而, 这些情况可以使用全身MRI。因此, 全身MRI和PET/CT相辅相成, 优势互补, 但二者均不能代替BMB。对于常规BMB阴性, 但影像学提示阳性的患者, 在影像学引导下进行BMB, 可以提高BMI的检出率。另外, 全身MRI阳性的淋巴瘤BMI患者与全身MRI阴性的淋巴瘤BMI患者相比, 前者预后可能较差。     

18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: A systematic review and meta-analysis

The present study assessed the diagnostic performances of 18F-FDG PET or PET/CT in detecting pelvic and/or paraaortic lymph node metastasis in patients with endometrial cancer. METHODS: Through a search of MEDLINE (January 1998 to March 2011), an overall weighted average for sensitivity and specificity as well as pooled estimates of positive and negative likelihood ratios were calculated. A summary receiver-operating-characteristics (sROC) curve was constructed and the area under the sROC curve (AUC) was calculated. I-square was calculated to explore heterogeneity. RESULTS: The present study included 243 patients from seven studies. Results indicated a lack of significant heterogeneity for sensitivity and specificity (I(2)<50% and p>0.05). The overall pooled estimates for sensitivity and specificity of FDG-PET or PET/CT scans in the detection of pelvic and/or paraaortic metastasis were 63.0% (95% CI, 48.7-75.7%) and 94.7% (95% CI, 90.4-97.4%), respectively. The positive likelihood ratio was 10.465 (95% CI, 5.646-19.396) and the negative likelihood ratio 0.399 (95% CI, 0.284-0.560). The AUC was 0.9533. The overall diagnostic accuracy (Q* index) was 89.5%. Conclusion The high positive likelihood value confirms the reliability of a positive FDG-PET or PET/CT to detect pelvic and/or paraaortic lymph nodes metastasis in patients with untreated endometrial cancer. FDG-PET or PET/CT may prove beneficial to surgeons when selecting appropriate patients on whom to perform lymphadenectomy.     

18F-FDG PET, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: a systematic review and meta-analysis

Background and purpose

Evaluation of bone marrow infiltration is an essential step in the staging of lymphoma. The accuracy of ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET), combined ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG-PET/CT) and magnetic resonance imaging (MRI) in diagnosing bone marrow involvement of lymphoma has never been systematically assessed, and the present systematic review was aimed at this issue.

Methods

MEDLINE, EMBASE, Cochrane library and some other databases, from January 1995 to July 2010, were searched for initial studies. All the studies published in English or Chinese relating to the diagnostic value of ¹⁸F-FDG PET, PET/CT and MRI for patients with bone marrow involvement of lymphoma were collected. We extracted data to calculate sensitivity, specificity, SROC curves and AUC and to test for heterogeneity. The statistic software called “Meta-Disc 1.4” was used for data analysis.

Result

In 32 included studies, PET/CT had the highest pooled sensitivity, 91.6% (95%CI: 85.1, 95.9) and highest pooled specificity, 90.3% (95%CI: 85.9, 93.7). PET/CT also had the highest pooled DOR, 68.89 (95%CI: 15.88, 298.92). The AUC of PET, PET/CT, and MRI were 0.9430, 0.9505 and 0.8764. There was heterogeneity among studies and no evidence of publication bias.

Conclusion

PET/CT was a highly sensitive and specific modality in diagnosing patients with bone marrow involvement in lymphoma. Compared with MRI and PET alone, PET/CT can play important roles in the staging of lymphoma.     

淋巴瘤骨髓浸润的18F-FDG PET显像研究

目的 用^18F-脱氧葡萄糖（FDG）PET显像研究淋巴瘤细胞骨髓浸润。方法 恶性淋巴癌患者30例，其中非霍奇金淋巴瘤（NHL）20例、霍奇金病（HD）10例，进行全身^18F-FDG PET显像。局灶性边缘清楚的淋巴结相应区域^18F-FDG浓聚视为恶性淋巴结显影。利用灰度色标，视觉分析骨髓及肝脏内^18F-FDG浓聚情况。骨髓的^18F-FDG分布不均，摄取高于肝脏，判断为骨髓^18F-FDG摄取异常；骨髓的^18F-FDG分布均匀，摄取低于或等于肝脏，判断为骨髓^18F-FDG摄取正常。所有患者均行髂棘的骨髓活组织检查。结果 30例中18例有淋巴结摄取^18F-FDG；12例淋巴结摄取^18F-FDG阴性患者中，8例NHL，4例HD。有26例患者的骨髓^18F-FDG摄取情况与骨髓组织学检查结果一致，其中骨髓有淋巴细胞浸润7例，无淋巴细胞浸润19例。有3例骨髓组织学检查阴性的患者，^18F-FDG PET示骨髓^18F-FDG摄取异常、骨髓有淋巴细胞浸润；1例NHL患者，骨髓组织学检查阳性但^18F-FDG PET示骨髓^18F-FDG摄取正常。结论 ^18F-DG PET全身显像能正确评价骨髓淋巴细胞浸润情况，减少对淋巴瘤分期所进行的骨髓组织学检查。     

18F-FDG PET for the diagnosis and grading of soft-tissue sarcoma: a meta-analysis.

PET using (18)F-FDG is increasingly used for the diagnosis and grading of tumors. Several studies have been performed that evaluate the diagnostic and grading performance of (18)F-FDG PET for soft-tissue sarcoma, but each study has had a limited sample size. Therefore, we undertook a comprehensive meta-analysis of the evidence. METHODS: Relevant studies were identified from MEDLINE and EMBASE. Diagnostic and grading performance were evaluated for qualitative visualization; standard uptake value (SUV, cutoffs of 2.0 and 3.0); and metabolic rate of glucose (MRG, cutoff of 6.0 micro mol/100 g/min). Quantitative data synthesis included independent weighting of sensitivity and specificity, construction of summary receiver operating characteristic curves, and pooled analyses. RESULTS: The meta-analysis included 15 studies with 441 soft-tissue lesions (227 malignant, 214 benign). For diagnosis of malignant versus benign lesions, typical pairs of sensitivity and specificity estimates from the summary receiver operating characteristic curves were 92% and 73% for qualitative visualization; 87% and 79% for SUV 2.0; 70% and 87% for SUV 3.0; and 74% and 73% for MRG 6.0. Diagnostic performance was similar for primary and recurrent lesions. By qualitative interpretation, (18)F-FDG was positive in all intermediate/high-grade tumors (95% confidence interval [CI], 97.3%-100%), 74.4% (95% CI, 58.6%-85.9%) of low-grade tumors, and 39.3% (95% CI, 29.1%-50.3%) of benign lesions (including 11 of 12 inflammatory lesions). Using an SUV cutoff of 2.0, respective rates were 89.4% (95% CI, 79.4%-95.6%), 33.1% (95% CI, 15.6%-55.3%), and 19.1% (95% CI, 10.6%-30.5%). Limited data on comparisons with MRI and CT showed no differences against (18)F-FDG PET in diagnosing recurrent and metastatic disease. CONCLUSION: (18)F-FDG PET has very good discriminating ability in the evaluation of both primary and recurrent soft-tissue lesions. (18)F-FDG PET may be helpful in tumor grading but offers inadequate discrimination between low-grade tumors and benign lesions.     

Role of F-18 FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin’s lymphoma

Objectives

The aim of the current study was to assess the utility of F-18-fluoro-2-deoxy-d-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared to bone marrow biopsy (BMB) in initial staging of Hodgkin’s lymphoma (HL) in pediatric patients.

Methods

Data of 38 pediatric patients (mean age 9.8 years, range 3–18 years) with HL were analyzed for the involvement of bone marrow. All patients underwent non-contrast F-18 FDG PET/CT study. BMB was done in 31 patients from the bilateral iliac crests. Scans were interpreted by two nuclear medicine physicians blinded to the details of BMB.

Results

Of the 31 patients who underwent BMB, 5 patients had lymphomatous involvement on BMB. PET/CT was positive in four of these five patients. In 26 patients negative on BMB, PET was negative in 23 patients and positive in 3 patients for BMI. The sensitivity and negative predictive value of F-18 FDG PET/CT was 87.5 and 96 %, respectively, for BMI.

Conclusions

F-18 FDG PET/CT can predict BMB results with high accuracy. F-18 FDG PET/CT may be used at initial staging of pediatric Hodgkin’s lymphoma as it uncovers unsuspected BMI and BMB may be omitted in patients with PET-positive BMI.     

Meta-analysis of the performance of 18F-FDG PET in primary tumor detection in unknown primary tumors.

Detection of the primary tumor has a key role in the management of patients with unknown primary tumors (UPT). The aim of this study was to perform a meta-analysis of the literature to evaluate the accuracy of (18)F-FDG PET in primary tumor detection in patients with UPT. METHODS: Systematic methods were used to identify, select, and evaluate the methodologic quality of the studies as well as to summarize the overall findings of sensitivity, specificity, and detection capacity of the primary tumor. The search strategy consisted of identifying studies published between January 1994 and May 2001 indexed in MEDLINE and CANCERLIT. Studies identified by manually searching reference lists of retrieved studies or by reviewing abstracts from recent conference proceedings were also included. Inclusion criteria were studies that evaluated primary tumor detection with (18)F-FDG PET in patients with UPT. Exclusion criteria were duplicated studies or those outdated by subsequent ones. The statistical analysis included 95% confidence intervals (CI) of sensitivity and specificity, both in the pooled data and in the types of studies found. Variation in accuracy between studies was analyzed calculating the natural logarithm of the odds ratio (ln OR) due to study characteristics. Funnel plots of sensitivity and specificity and the summary receiver-operating-characteristic (ROC) curve were also represented. RESULTS: Fifteen studies met the inclusion criteria and were analyzed. Although sample sizes were small, compliance with the methodologic quality criteria was adequate. Heterogeneity analysis showed that differences in the study quality did not correlate with differences in study results. The 95% CI of sensitivity and specificity presented global homogeneity, estimating the sensitivity at 0.87 (95% CI, 0.81-0.92) and the specificity at 0.71 (95% CI, 0.64-0.78). The summary ROC curve showed a good relationship between sensitivity and specificity. The ln OR presented significant values in >75% of the studies. CONCLUSION: (18)F-FDG PET could be useful in patients with UPT for the detection of the primary tumor. (18)F-FDG PET has intermediate specificity and high sensitivity, indicating the existence of few false-negative results, an important feature in the management of oncologic patients that could suggest its utility in the initial stages of the management process.     

Whole-body MRI for the detection of bone marrow involvement in lymphoma: prospective study in 116 patients and comparison with FDG-PET

Objective

To assess and compare the value of whole-body MRI with FDG-PET for detecting bone marrow involvement in lymphoma.

Methods

A total of 116 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI and blind bone marrow biopsy (BMB) of the posterior iliac crest. Of 116 patients, 80 also underwent FDG-PET. Patient-based sensitivities of whole-body MRI for detecting bone marrow involvement were calculated using BMB as reference standard and compared with FDG-PET in aggressive and indolent lymphomas separately.

Results

Sensitivity of whole-body MRI in all lymphomas was 45.5 % [95 % confidence interval (CI): 29.8–62.0 %]. Sensitivity of whole-body MRI in aggressive lymphoma [88.9 % (95 % CI: 54.3–100 %)] was significantly higher (P?=?0.0029) than that in indolent lymphoma [23.5 % (95 % CI: 9.1–47.8 %)]. Sensitivity of FDG-PET in aggressive lymphoma [83.3 % (95 % CI: 41.8–98.9 %)] was also significantly higher (P?=?0.026) than that in indolent lymphoma [12.5 % (95 % CI: 0–49.2 %)]. There were no significant differences in sensitivity between whole-body MRI and FDG-PET (P?=?1.00)

Conclusion

Sensitivity of whole-body MRI for detecting lymphomatous bone marrow involvement is too low to (partially) replace BMB. Sensitivity of whole-body MRI is significantly higher in aggressive lymphoma than in indolent lymphoma and is equal to FDG-PET in both entities.

Key Points

? Bone marrow involvement in lymphoma has prognostic and therapeutic implications. ? Blind bone marrow biopsy (BMB) is standard for bone marrow assessment. ? Neither whole-body MRI nor FDG-PET can yet replace BMB. ? Both techniques have higher sensitivity in aggressive than in indolent lymphoma. ? Both imaging techniques are complementary to BMB.     

^18F-FDG PET显像用于脑胶质瘤分级的Meta分析

目的用Meta分析法综合评价18F—FDGPET显像对脑胶质瘤分级的能力。方法搜索Medline、中国期刊网关于”F-FDGPET显像诊断脑胶质瘤的中英文文献。提取文献中用半定量法或目测法判定胶质瘤恶性程度的数据,同时按照Cochrane工作组推荐的诊断评价标准进行文献的质量方法学评估。用Meta分析软件（Meta—Disc）对纳入文献汇总分析,获得汇总灵敏度（Se）和特异性（Sp）及其95％可信区间（a）,并绘制汇总受试者工作特征（SROC）曲线,计算曲线下面积（AUC）。结果共获取文献17篇（英文16篇、中文1篇）,其中11篇可获取用半定量法[肿瘤／皮质放射性比值（T／C）组及肿瘤／白质放射性比值（T／W）组]判定胶质瘤恶性程度的数据,共272例患者;9篇可获取以目测法判定胶质瘤恶性程度的数据,共481例患者（目测组,部分文献包含2种以上判定方法）。通过异质性检验,分别采用不同效应模型进行分析。T／C组、T／W组和目测组的汇总Se分别为0．952,0．857和0．810;Sp分别为0．409,0．538和0．870;诊断比值（DOR）分别为11．746,22．066和15．282。汇总Se的95％CI分别为0．903—0．980、0．768～0．922和0．757—0．855;汇总Sp的95％凹分别为0．318～0．504,0．431—0．642和0．819～0．911;汇总DOR的95％口分别为5．368—25．702,7．077～68．800和3．716～62．851。3组AUC分别为0．8604,0．8373和0．8724。结论利用18F-FDGPET显像对脑胶质瘤进行恶性程度预测时,半定量组的Se较高,有利于阳性病例的检出,目测组sp较高,有利于阴性病例的排除。根据AUC判断,目测组总体诊断效能最高,T／C组次之,T／W组再次。     

18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者的诊断效能:Meta分析

目的 系统评价18F-氟脱氧葡萄糖（FDG）PET/CT对甲状腺球蛋白（Tg）表达阳性（简称Tg阳性）且131I全身显像（WBS）结果阴性（简称131I-WBS阴性）的分化型甲状腺癌（DTC）复发患者的诊断效能。 方法 检索PubMed、Embase、Cochrane Library和万方数据知识服务平台、中国知网、维普数据库、中国生物医学文献数据库中关于18F-FDG PET/CT对DTC复发患者诊断的相关研究,检索时间从建库至2020年12月。根据纳入和排除标准筛选文献,提取研究的基本特征和诊断参数,采用Spearman相关系数分析文献是否存在阈值效应,对纳入文献进行异质性Q检验,采用Deeks线性回归分析法评价文献的发表偏倚。绘制综合受试者工作特征（SROC）曲线,计算曲线下面积（AUC）,采用Z检验分析行诊断性全身显像（Dx-WBS）与治疗性全身显像（Rx-WBS）的患者18F-FDG PET/CT诊断效能的差异,并分析在促甲状腺激素（TSH）刺激状态与抑制状态下18F-FDG PET/CT诊断效能的差异。 结果 最终纳入16篇文献,共1 036例DTC复发患者,纳入研究的异质性较低（I2=47.5%,P=0.018）,异质性可能源于病例数（r=1.462,P=0.021）,存在较小的发表偏倚（P=0.070）。18F-FDG PET/CT诊断Tg阳性且131I-WBS阴性的DTC复发患者的合并灵敏度为0.87（95%CI:0.82~0.91）、特异度为0.79（95%CI:0.68~0.86）、阳性似然比为3.76（95%CI:2.32~6.09）、阴性似然比为0.20（95%CI:0.14~0.27）、诊断优势比为23.89（95%CI:13.23~43.12）、SROC的AUC=0.91（标准误0.02）、Q指数为0.837（标准误0.023）。行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异无统计学意义（Z=0.041,P>0.05）。在TSH刺激状态与抑制状态下,行Dx-WBS与Rx-WBS的DTC复发患者18F-FDG PET/CT诊断效能的差异均无统计学意义（Z=1.864、0.525,均P>0.05）。 结论 18F-FDG PET/CT对Tg阳性且131I-WBS阴性的DTC复发患者具有较高的诊断效能,行Dx-WBS与Rx-WBS、在TSH刺激状态与抑制状态下患者18F-FDG PET/CT的诊断效能均相当。     

Accuracy of whole-body FDG-PET and FDG-PET/CT in M staging of nasopharyngeal carcinoma: A systematic review and meta-analysis

Background

A meta-analysis was conducted to evaluate the accuracy of whole-body positron emission tomography (PET) or PET/CT in M staging of nasopharyngeal carcinoma (NPC).

Methods

Through a search of relevant English language studies from October 1996 to September 2011, pooled estimated sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and summary receiver operating characteristic (SROC) curves of whole-body PET or PET/CT in M staging of NPC were calculated.

Results

Three PET and 5 PET/CT studies were identified. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of FDG-PET or PET/CT were 0.83 (95% confidence interval [CI], 0.77–0.88), 0.97 (95% CI, 0.95–0.98), 23.38 (95% CI, 16.22–33.69), and 0.19 (95% CI, 0.13–0.25), respectively. The area under curve was 0.9764 and Q* index estimate was 0.9307 for FDG-PET or PET/CT.

Conclusion

Current evidence confirms the good diagnostic performance of the whole-body FDG-PET or PET/CT in M staging of NPC.     

Whole body MRI with qualitative and quantitative analysis of DWI for assessment of bone marrow involvement in lymphoma

Aim

Our study aimed to investigate the role of qualitative and quantitative whole body MRI with DWI for assessment of bone marrow involvement (BMI) in newly diagnosed lymphoma using FDG PET–CT and bone marrow biopsy (BMB) as reference standard.

Materials and methods

We retrospectively evaluated 56 patients with newly diagnosed lymphoma (21 Hodgkin’s lymphoma and 35 non-Hodgkin’s lymphoma) who underwent random unilateral BMB, FDG PET–CT and Wb-MRI-DWI for initial staging. In a patient-based analysis, results of Wb-MRI-DWI were compared with FDG PET–CT and BMB. For quantitative analysis, mean ADC values of posterior iliac crest were correlated with BMI and bone marrow cellularity.

Results

WB-MR-DWI obtained excellent concordance with FDG PET–CT both in HL (k = 1.000; 95% CI 1.000–1.000) and in DLBCL (k = 1.000; 95% CI 1.000–1.000). In other NHL, WB-MRI-DWI obtained a good correlation with BMB (k = 0.611; 95% CI 0.295–0.927) while FDG PET–CT had poor concordance (k = 0.067; 95% CI 0.372–0.505). WB-MR-DWI has no false negative errors but 4 false positive results consisting in focal lesions consensually reported by FDG PET–CT and resolved after therapy. No significant correlation between ADC mean value and BMI was found (p = 0.0586).

Conclusion

Our data suggest that Wb-MRI-DWI is a valid technique for BMI assessment in lymphoma patients, thanks to its excellent concordance with FDG PET–CT and good concordance with BMB (superior than FDG PET–CT). If further investigations will confirm our results on larger patient groups, it could become a useful tool in the clinical workup.

     

Detection of Richter's transformation of chronic lymphocytic leukemia by PET/CT.

Our objective was to evaluate the accuracy of PET/CT for the diagnosis of Richter's transformation of chronic lymphocytic leukemia (CLL) to diffuse large cell lymphoma. METHODS: A retrospective study was performed of 37 patients with CLL who underwent 18F-FDG PET/CT at our institution between March 2003 and July 2005. All PET/CT scans were reviewed in consensus by 2 diagnostic radiologists. Sites of abnormal 18F-FDG uptake with a maximum standardized uptake value (SUVmax) of greater than 5 were considered highly suggestive of Richter's transformation. The PET/CT findings were correlated with histologic findings from bone marrow or lymph node biopsy performed within 6 wk of PET/CT and with clinical follow-up. RESULTS: The 37 patients (26 men and 11 women; mean age, 61 y, range, 40-82 y) underwent 57 PET/CT scans. In 10 (91%) of 11 patients with Richter's transformation, PET/CT detected sites of abnormal 18F-FDG uptake having an SUVmax of greater than 5. Richter's transformation was missed in 1 patient who had only low-grade 18F-FDG uptake (SUVmax < 5). Nine patients had false-positive PET/CT findings; in 3 of these patients, alternative malignancies were diagnosed (Hodgkin's disease; metastatic neuroendocrine carcinoma; non-small cell lung cancer). In all remaining patients, PET/CT correctly excluded Richter's transformation. For the specific diagnosis of Richter's transformation of CLL to diffuse large B-cell lymphoma, PET/CT had overall sensitivity, specificity, and positive and negative predictive values of 91%, 80%, and 53% and 97%, respectively. CONCLUSION: PET/CT can detect Richter's transformation of CLL to diffuse large B-cell lymphoma with a high sensitivity and a high negative predictive value.     

Diagnostic test accuracies of F-18 FDG PET/CT for prediction of microvascular invasion of hepatocellular carcinoma: A meta-analysis

PurposeThe aim of the current meta-analysis was to evaluate diagnostic accuracies of preoperative F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) for prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients.MethodsThe scientific database such as PubMed, Cochrane, and Embase database were searched for studies evaluating diagnostic accuracies of preoperative F-18 FDG PET or PET/CT for prediction of MVI in HCC patients up to November 30, 2020.ResultsFourteen eligible studies (1276 patients) were enrolled. The pooled sensitivity for F-18 FDG PET or PET/CT was 0.67 (95% CI; 0.57–0.76) with heterogeneity and a pooled specificity of 0.80 (95% CI; 0.74–0.85) with heterogeneity. Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 3.3 (95% CI; 2.5–4.5) and negative likelihood ratio (LR−) of 0.41 (95% CI; 0.31–0.55). The pooled diagnostic odds ratio (DOR) was 8 (95% CI; 5–14). Summary receiver operating characteristic (ROC) curve indicates that the area under the curve was 0.81 (95% CI; 0.78–0.84).ConclusionThe current meta-analysis showed a low sensitivity and moderate specificity of F-18 FDG PET or PET/CT for the prediction of MVI in HCC patients. F-18 FDG PET or PET/CT might not be useful for the preoperative prediction of MVI in HCC patients and should not be used to exclude MVI. Therefore, cautious application and interpretation should be paid to the F-18 FDG PET or PET/CT for the prediction of MVI in HCC patients preoperatively.     

DWI联合增强MRI对肝硬化背景下小肝癌诊断价值的Meta分析

目的 应用Meta分析评价磁共振弥散加权成像（DWI）联合增强MRI对肝硬化背景下小肝癌的诊断价值。 方法 检索PubMed、Web of Science、中国学术期刊网全文数据库、万方数据库、中文科技期刊数据库（VIP）,按纳入和排除标准收集2000年1月至2017年12月的文献。采用诊断性试验质量评价表（QUADAS）进行诊断性试验的评价。使用Meta-Disc 1.4及Stata 12.0软件进行统计学分析,采用χ2检验对各研究的诊断比值比（DOR）进行异质性检验,用I2评估异质性的大小。通过综合受试者工作特征（SROC）曲线及Spearman相关系数检验纳入文献是否存在阈值效应,根据异质性检测结果选择合适的效应模型,通过计算合并灵敏度、特异度、阳性似然比、阴性似然比、DOR、SROC曲线下面积评价DWI联合增强MRI对肝硬化背景下小肝癌的诊断准确率。 结果 共纳入文献7篇,均为英文文献,包含836例患者,共计1112个病灶。异质性I2=76.6%,这表明纳入的文献有高度异质性,Spearman检验r=?0.14（P=0.76）,这说明不存在由阈值效应导致的异质性。DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值的合并灵敏度、特异度、阳性似然比、阴性似然比、DOR分别为0.90（95%CI:0.88～0.92）、0.90（95% CI:0.86～0.93）、7.09（95%CI:3.40～14.80）、0.13（95% CI:0.08～0.21）、64.15（95% CI:24.22～169.88）。SROC曲线下面积为0.95。 结论 DWI联合增强MRI对肝硬化背景下小肝癌的诊断具有较高的灵敏度和特异度,可为肝硬化背景下小肝癌的早期诊断及早期治疗提供重要的依据。