18F-FDG PET显像在肺癌预后评价中的应用

目的 探讨^18F-FDG PET显像评价新诊断肺癌患者的预后价值。方法 回顾性分析201例新诊断肺癌患者资料，以肺部原发病灶的SUV为显像的预后评价指标，采用SPSS11．5软件行单因素和多因素生存分析。结果 单因素分析显示：TNM分期、原发病灶大小及SUV均为影响预后的重要因素（P〈0．05），而性别、年龄与预后无明显相关性（P〉0．05）。SUV对不同分期患者的预后价值不同，对Ⅲ期患者预后评价的价值最大。Cox比例风险模型分析显示：TNM分期及原发病灶的SUV是影响预后的最重要的因素（P〈0．05）。SUV〉8患者的死亡风险是SUV≤8患者的2．19倍。SUV每升高“1”，患者死亡风险升高7％。结论 肺癌原发病灶的SUV是独立于TNM分期外的另一个重要的预后因子。分期相同的肺癌患者根据SUV的不同可以划分为不同危险组，制定个性化的治疗方案。     

Reproducibility of standardized uptake value measurements determined by 18F-FDG PET in malignant tumors

18F-FDG PET is increasingly being used to monitor the early response of malignant tumors to chemotherapy. Understanding the reproducibility of standardized uptake values (SUVs) is an important prerequisite in estimating what constitutes a significant change. METHODS: Twenty-six patients were studied on 2 separate occasions (mean interval +/- SD, 3 +/- 2 d; range, 1-5 d). A static PET/CT scan was performed 94 +/- 9 min after the intravenous injection of 383 +/- 15 MBq of 18F-FDG. Mean and maximum SUVs (SUVmean and SUVmax, respectively) were determined for regions of interest drawn around the tumor on the first study and for the same regions of interest transferred to the second study. RESULTS: SUVmean in tumors ranged from 1.49 to 17.48 and SUVmax ranged from 2.99 to 24.09. The correlation between SUVmean determined on the 2 separate visits was 0.99; the mean difference between the 2 measurements was 0.01 +/- 0.27 SUV. The 95% confidence limits for the measurements were +/-0.53. For SUVmax, the mean difference was -0.05 +/- 1.14 SUV. CONCLUSION: Our study demonstrates that repeated measurements of SUVmean performed a few days apart are highly reproducible. A decrease of 0.5 in the SUV is statistically significant.     

Glucose-normalized standardized uptake value from (18)F-FDG PET in classifying lymphomas.

Our objective was to derive the best glucose sensitivity factor (g-value) and the most discriminating standardized uptake value (SUV) normalized to glucose for classifying indolent and aggressive lymphomas. METHODS: The maximum SUV obtained from (18)F-FDG PET over the area of biopsy in 102 patients was normalized by serum glucose ([Glc]) to a standard of 100 mg/dL. Discriminant analysis was performed by using each SUV(100) (SUV x {100/[Glc]}(g), calculated using various g-values ranging from -3.0 to 0, one at a time) as a variable against the lymphoma grades, and plotting the percentage of correct classifications against g (g-plot) to search for the best g-value in normalizing SUV(100) for classifying grades. To address the influence of the extreme glucose conditions, we repeated the same analyses in 12 patients with [Glc] < or = 70 mg/dL or [Glc] > or = 110 mg/dL. RESULTS: SUV(100) correctly classified lymphoma grades ranging from 62% to 73% (P < 0.0005), depending on the g-value, with a maximum at a g-value of -0.5. For the subgroup with extreme glucose values, the g-plot also revealed higher and more optimal discrimination at a g-value of -0.5 (92%) than at a g-value of 0 (83%) (P = 0.03). The discrimination deteriorated at g < -1 in both analyses. The box plot for all cases using a g-value of -0.5 showed little overlap in classifying lymphoma grades. For a visually selected threshold SUV(100) of 7.25, the sensitivity, specificity, and accuracy of identifying aggressive grades were 82%, 79%, and 81%, respectively. CONCLUSION: The results suggest that metabolic discrimination between lymphoma grades using a glucose-normalized SUV from (18)F-FDG PET is improved by introducing g-value as an extra degree of freedom.     

18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate?

PET with (18)F-FDG has been used in radiation treatment planning for non-small cell lung cancer (NSCLC). Thresholds of 15%-50% the maximum standardized uptake value (SUV(max)) have been used for gross tumor volume (GTV) delineation by PET (PET(GTV)), with 40% being the most commonly used value. Recent studies indicated that 15%-20% may be more appropriate. The purposes of this study were to determine which threshold generates the best volumetric match to GTV delineation by CT (CT(GTV)) for peripheral NSCLC and to determine whether that threshold can be generalized to tumors of various sizes. METHODS: Data for patients who had peripheral NSCLC with well-defined borders on CT and SUV(max) of greater than 2.5 were reviewed. PET/CT datasets were reviewed, and a volume of interest was determined to represent the GTV. The CT(GTV) was delineated by using standard lung windows and reviewed by a radiation oncologist. The PET(GTV) was delineated automatically by use of various percentages of the SUV(max). The PET(GTV)-to-CT(GTV) ratios were compared at various thresholds, and a ratio of 1 was considered the best match, or the optimal threshold. RESULTS: Twenty peripheral NSCLCs with volumes easily defined on CT were evaluated. The SUV(max) (mean +/- SD) was 12 +/- 8, and the mean CT(GTV) was 198 cm(3) (97.5% confidence interval, 5-1,008). The SUV(max) were 16 +/- 5, 13 +/- 9, and 3.0 +/- 0.4 for tumors measuring greater than 5 cm, 3-5 cm, and less than 3 cm, respectively. The optimal thresholds (mean +/- SD) for the best match were 15% +/- 6% for tumors measuring greater than 5 cm, 24% +/- 9% for tumors measuring 3-5 cm, 42% +/- 2% for tumors measuring less than 3 cm, and 24% +/- 13% for all tumors. The PET(GTV) at the 40% and 20% thresholds underestimated the CT(GTV) for 16 of 20 and 14 of 20 lesions, respectively. The mean difference in the volumes (PET(GTV) minus CT(GTV) [PET(GTV) - CT(GTV)]) at the 20% threshold was 79 cm(3) (97.5% confidence interval, -922 to 178). The PET(GTV) at the 20% threshold overestimated the CT(GTV) for all 4 tumors measuring less than 3 cm and underestimated the CT(GTV) for all 6 tumors measuring greater than 5 cm. The CT(GTV) was inversely correlated with the PET(GTV) - CT(GTV) at the 20% threshold (R(2) = 0.90, P < 0.0001). The optimal threshold was inversely correlated with the CT(GTV) (R(2) = 0.79, P < 0.0001). CONCLUSION: No single threshold delineating the PET(GTV) provides accurate volume definition, compared with that provided by the CT(GTV), for the majority of NSCLCs. The strong correlation of the optimal threshold with the CT(GTV) warrants further investigation.     

Bone marrow hypermetabolism on 18F-FDG PET as a survival prognostic factor in non-small cell lung cancer.

PET is now widely used in the diagnosis and staging of lung cancer with (18)F-FDG. The purpose of the study was to evaluate the prognostic value of diffuse bone marrow hypermetabolism along with other PET prognostic factors with respect to survival and compare them with other established prognostic factors in a large cohort of patients. METHODS: Of 255 patients referred for evaluation of a suspicious lung lesion by PET over an 8-mo period (May 1999 to January 2000), the outcome of 120 patients with a final diagnosis of primary non-small cell lung cancer was analyzed retrospectively after excluding subjects with benign, metastatic, or recurrent lesions, using the available follow-up information and a provincial mortality database. Kaplan-Meier survival curves were compared using the mean and the maximal tumor standardized uptake value (SUV), bone marrow SUV, PET stage, various laboratory parameters, sex, age, conventional imaging stage, and pathologic stage. A stepwise Cox proportional hazard model was built using the significant variables on univariate analysis. RESULTS: The primary tumor SUV (>10), bone marrow uptake of (18)F-FDG, (18)F-FDG PET stage, pathologic stage, hypercalcemia, lactate dehydrogenase, hemoglobin, albumin, thrombocytopenia, thrombocytosis, and leukocytosis were predictors of mortality on univariate analysis. On multivariate analysis, bone marrow hypermetabolism, (18)F-FDG PET nodal stage, and some hematologic parameters (hemoglobin, platelets, white blood cell counts) remained significant independent predictors of mortality. CONCLUSION: Bone marrow hypermetabolism and the PET nodal stage were strong independent predictors of mortality in patients with lung cancer. The primary tumor SUV, though predictive on univariate analysis, was not an independent predictor of mortality in our model.     

Imaging of proliferation with 18F-FLT PET/CT versus 18F-FDG PET/CT in non-small-cell lung cancer

Purpose  

To compare the diagnostic efficacies of ¹⁸F-FLT and ¹⁸F-FDG PET/CT in non-small-cell lung cancer (NSCLC), focusing on the correlation between FLT and FDG tumour uptake and tumour cell proliferation as indicated by the cyclin D1 labelling index.     

非小细胞肺癌组织学类型和分化程度对^18F—FDG PET／CT标准摄取值的影响

目的探讨非小细胞肺癌（NSCLC）组织学类型和分化程度对其^18F—脱氧葡萄糖（FDG）PET／CT显像标准摄取值（SUV）的影响。方法260例NSCLC患者,按组织学类型不同分为腺癌、鳞癌、腺鳞癌和其他类型4组,按组织分化不同分为Ⅰ（高分化）、Ⅱ（中分化）、Ⅲ（低分化＋未分化）3个级别,回顾其治疗前的^18F—FDGPET／CT显像结果,测量肺内原发灶最大SUV（SUVmax）。用多元回归分析方法提取SUVmax的影响因素,采用协方差分析修正病灶大小（取最大长径）对SUVmax的影响后,比较不同组织学类型和分化程度NSCLC病灶SUVmax的差异。结果260例患者共260个原发NSCLC病灶,腺癌161个（10个细支气管肺泡癌归于Ⅰ级腺癌,Ⅰ级15个、Ⅱ级88个、Ⅲ级58个）,鳞癌74个（Ⅰ级6个、Ⅱ级39个、Ⅲ级29个）,腺鳞癌15个（Ⅱ级7个、Ⅲ级8个）,其他类型10个。只有病灶大小（F=87．046,P〈0．001）、分化程度（F=87．604,P〈0．001）和组织学类型（F=66．663,P〈0．001）被纳入SUVmax多元回归方程,标准化回归系数分别为0．436（t=8．910,P〈0．001）,0．391（t=8．322,P〈0．001）,0．190（t=3．885,P=0．0001）。修正病灶大小对SUVmax的影响后,SUVmax由小到大依次为腺癌Ⅰ级〈腺癌Ⅱ级〈鳞癌Ⅰ级〈腺鳞癌Ⅱ级〈鳞癌Ⅱ级〈其他类型NSCLC〈腺癌Ⅲ级〈腺鳞癌Ⅲ级〈鳞癌Ⅲ级,其均数及95％可信区间分别为3．3（2．1～4．5）、6．0（5．5～6．6）、6．1（4．2～8．0）、6．6（4．8～8．4）、7．8（7．0～8．6）、8．1（6．6～9．6）、8．3（7．6～8．9）、8．7（7．0—10．4）、8．9（8．0～9．8）。分化较好的Ⅰ、Ⅱ级腺癌SUVmax均分别低于Ⅰ、Ⅱ级鳞癌,差异有统计学意义（q值分别为-2．786,-1．776,P值分别为0．017,〈0．001）,分化较差的Ⅲ级腺癌、鳞癌以及腺鳞癌间SUVmax差异均无统计学意义（q值分别为-0．593,-0．422,0．171,P值分别为0．288,0．642,0．860）;随细胞分化变差,腺癌、鳞癌及腺鳞癌组病灶SUVmax升高,腺癌Ⅰ、Ⅱ、Ⅲ级间（g值分别为-2．720,-4．943,-2．223,P均〈0．001）以及鳞癌Ⅰ、Ⅲ级间（g=-2．751,P=0．012）SUVmax差异均有统计学意义。结论NSCLC病灶的组织学类型和分化程度都可以影响其^18F-FDG摄取,分化程度对^18F—FDG摄取的影响意义更大。     

18F-FDG PET显像在肺癌中的应用

18F-FDG(18F-氟代脱氧葡萄糖)PET可以反映正常机体组织和肿瘤细胞的功能状态,在对肺部病变的定性诊断、肺癌的临床分期、疗效评价、复发监测以及预后估计上都明显优于CT、MRI等形态解剖学检查,而且能间接提供瘤组织细胞分化程度和增殖潜能的判断依据,具有重要的临床应用价值。由于PET在空间分辨率上存在不足,应与其他影像学检查相结合,以提高其准确性。     

Comparison of lesion-to-cerebellum uptake ratios and standardized uptake values in the evaluation of lung nodules with 18F-FDG PET

OBJECTIVE: To evaluate the clinical performance of the lesion-to-cerebellum uptake ratio (LCR), a semiquantitative index for differentiating malignant from benign lung nodules with [F]fluorodeoxyglucose positron emission tomography (F-FDG PET). METHODS: Thirty-six patients (16 females, 20 males; median age, 73 years; range, 41-87 years) with 42 known or suspected malignant lung nodules underwent whole-body PET imaging after an intravenous injection of a mean dose of 543+/-69 MBq (14.7+/-1.9 mCi) of F-FDG. The standardized uptake value (SUV) and the LCR were calculated for each nodule and receiver operating characteristic (ROC) curves were analysed using the ROCKIT 0.9B software package. RESULTS: Surgical pathology and follow-up with serial computed tomography scans for at least 24 months revealed 18 malignant lung lesions and 24 benign lesions less than 3.0 cm in size. The mean LCR was 0.70+/-0.40 for malignant nodules and 0.23+/-0.12 for benign nodules (P<0.001, two-tailed test). The area under the estimated ROC curve was 0.8660 for SUV data and 0.9197 for LCR data (P=0.2408, two-tailed test). CONCLUSIONS: The LCR method appears to be a valuable semiquantitative index for the evaluation of malignancy in pulmonary nodules with F-FDG PET, which is simple to perform clinically and does not require accurate measurements of body weight or the residual activity in the syringe utilized for F-FDG injection.     

18F-FDG PET/CT最大标准摄取值联合HRCT在肺癌诊断中的价值和影响因素分析

目的 探讨18F-FDG PET/CT联合高分辨率CT(HRCT)诊断肺癌的价值和主要影响因素.方法 回顾分析2010年8月至2011年8月因肺实性病灶行18F-FDG PET/CT检查及肺部HRCT扫描的122例患者资料,所有病例均经病理证实或影像学检查随访8个月以上确诊.利用x2检验对HRCT上不同影像特征在良恶性病变中的构成比差异进行比较,单因素方差分析比较不同病理类型病灶的SUVmax差异,多因素logistic回归分析SUVmax及HRCT影像特征等影响因素,探讨最佳SUVmax诊断界值和18F-FDG PET/CT对肺癌的诊断价值.结果 122例肺实性病灶患者中,恶性82例,良性40例.肺癌HRCT影像特征中前3位依次为毛刺征64.6％ (53/82)、分叶征63.4％(52/82)和胸膜牵拉征39.0％(32/82),高于在良性病变中的比例(x2=19.08、30.89、10.88,均P＜0.01).肺部鳞状细胞癌(简称鳞癌)、小细胞癌和腺癌的SUVmax依次为12.57±4.34、10.66±2.90和8.19±6.01,与肺部良性病变SUVmax (3.01±3.62)相比差异有统计学意义(F =20.83,P＜0.01).不同病理类型肺癌SUVmax从大到小依次为鳞癌、小细胞癌和腺癌,其中鳞癌与腺癌SUVmax差异有统计学意义(P＜0.01);SUVmax的ROC AUC为0.863,SUVmax界值2.99和2.50对肺癌诊断的灵敏度、特异性分别为89.0％(73/82)、75.0％ (30/40)和91.5％ (75/82)、65.0％(26/40);诊断一致性SUVmax 2.99优于SUVmax 2.50,Kappa值分别为0.644和0.597.多因素logistic回归分析显示SUVmax 2.99的诊断比值比(OR)优于SUVmax 2.50的OR,分别为5.42和3.93;SUVmax (OR=5.42,P=0.01)、肿瘤最大径(OR=7.27,P=0.02)、毛刺征(OR =7.70,P＜0.01))和分叶征(OR=12.38,P＜0.01)均为肺癌与良性病灶鉴别诊断有统计学意义的影响因素.结论 SUVmax对肺癌的诊断和鉴别诊断有较高价值.18F-FDGPET/CT联合HRCT诊断肺实性病灶时,SUVmax、肿瘤最大径、毛刺征和分叶征为其鉴别诊断的主要影响因素.     

^18F-FDG符合线路显像最大标准摄取值在胃癌评估中的价值

目的研究^18F—FDG符合线路显像SUVmax在胃癌评估中的意义。方法回顾性分析92例胃部疾病患者[男60例,女32例,平均年龄65（32～85）岁;其中胃癌78例]。78例胃癌中,残胃癌3例、原发性胃癌75例（Eis期4例、T1期13例、T2期9例、T3期33例、T4期11例,5例未手术）;高分化腺癌22例,中分化腺癌15例,低分化腺癌28例。采用ROI技术分析图像并计算SUVmax,分别用视觉法与SUVmax分析^18F—FDG符合线路显像资料,并以组织病理学或活组织检查结果为标准计算两者检验效能。使用ROC曲线分析评价SUVmax;采用Pearson相关分析评估SUVmax与病灶大小的关系,Wilcoxon秩和检验分析SUVmax在进展期胃癌和早期胃癌的差异,Kruskal—Wallis检验分析SUVmax与不同分化程度腺癌的关系。结果^18F—FDG符合线路显像视觉法与SUVmax诊断胃癌的灵敏度均为64．1％（50／78）,特异性均为64．3％（9／14）,准确性均为64．1％（59／92）。SUVmax ROCAUC为0．695,最佳临界值为0．700;SUVmax与病灶最大径呈正相关（r=0．489,P〈0．001）,Tis-1期病灶SUVmax（0．676±1．288）与L～4期SUVmax（3．851±3．764）差异有统计学意义（Z=-3．754,P〈0．001）,而高、中、低分化腺癌间SUVmax（分别为2．805±4．008,3．447±2．365,3．413±3．737）差异无统计学意义（X2=2．459,P〉0．05）。结论在^18F-FDG符合线路显像评估胃癌中,SUVmax较视觉法提供了更多的信息,但其与胃癌T分期、组织学类型、分化程度等的关系需进一步研究。     

18F-FDG uptake as a biologic prognostic factor for recurrence in patients with surgically resected non-small cell lung cancer.

Among patients with resected non-small cell lung cancer (NSCLC), approximately 50% present with a recurrent tumor. The clinical or pathologic TNM staging does not always provide a satisfactory explanation for differences in relapse and survival. Thus, it is of major importance to be able to predict these relapses and to prevent them with an active chemotherapy or radiotherapy program (or both). 18F-FDG uptake on PET could be of prognostic significance in patients with resected NSCLC. The goal of this study was to determine whether the level of metabolic activity observed with 18F-FDG uptake correlates with the probability of postoperative recurrence in patients with NSCLC. METHODS: Fifty-seven patients with NSCLC were examined with 18F-FDG PET. For semiquantitative analysis, standardized uptake values (SUVs) were calculated. Patients were classified into high-SUV (> 5.0) and low-SUV (< or = 5.0) groups. All patients underwent thoracotomy within 4 wk after the 18F-FDG PET study. Tumor 18F-FDG uptake (SUV), pathologic stage, and lesion size were analyzed for their possible association with disease-free survival. RESULTS: Forty-six patients had pathologic stage I NSCLC and 11 had pathologic stage II or stage III NSCLC. In a univariate analysis, patients with an SUV of < or = 5 had a much better disease-free survival than did patients with an SUV of > 5 (P < 0.0001). In patients with pathologic stage I and stage IA NSCLC, the SUV was also correlated with disease-free survival (P < 0.0001 and P = 0.0012, respectively). Patients with pathologic stage I disease had an expected 5-y disease-free survival rate of 88% if the SUV was < or = 5 and a survival rate of < or = 17% if the SUV was > 5. A multivariate Cox analysis identified the SUV as the most significant independent factor for disease-free survival. CONCLUSION: We conclude that the 18F-FDG uptake in primary NSCLC determined by PET has a significant independent postoperative prognostic value for recurrence, especially in patients with pathologic stage I NSCLC. 18F-FDG uptake was superior to pathologic stage in predicting relapse of patients with NSCLC.     

Glucose corrected standardized uptake value (SUVgluc) in the evaluation of brain lesions with 18F-FDG PET

Purpose

To retrospectively assess the utility of ¹⁸F fluorodeoxyglucose (FDG) positron emission tomography (PET) images of standardized uptake values corrected for blood glucose (SUV_gluc), and to compare this to various quantitative methods to identify the presence or absence of high grade malignancy.

Methods

A retrospective review in 42 patients, found 81 central nervous system (CNS) lesions. Fifty one were malignant and 30 were benign or post treatment changes based on pathology (n?=?32) and on clinical outcome (n?=?49). Dynamic FDG PET scans were processed to generate parametric images of SUV_gluc, SUV, glucose metabolic rate (GMR), and lesion to cerebellum ratios (SUV_Rc), and contralateral white matter ratios (SUV_Rw). The SUV_gluc was calculated from $ {{{\mathrm{SU}{{\mathrm{V}}_{\max }}*\mathrm{BG}}} \left/ {{\left[ {100\,\mathrm{mg}/\mathrm{dl}} \right]}} \right.} $ , where SUV_max is the maximum SUV and BG is the blood glucose level (mg/dL).

Results

Using a malignant threshold for SUV_gluc of 4.5 and GMR of 13.0 μmole/min/100 g, the accuracies were similar for the SUV_gluc (80 %) and GMR (81 %) and were higher than the conventional SUV_max (73 %). The area under the receiver operating characteristic (ROC) curve for the SUV_gluc (0.8661) was better than that for the SUV_max (0.7955) (p?<?0.02) and was similar to those of the GMR (0.8694), SUV_Rc (0.8278), and SUV_Rw (0.8559).

Conclusion

These results suggest that the SUV_gluc may assist in the interpretation of FDG PET brain images in patients with CNS lesions. The SUV_gluc method avoids the complexity of kinetic modeling and the definition of a reference region.