18F-FDG PET/CT联合磁共振体素内不相干运动成像预测肺癌表皮生长因子受体表达的价值分析  

The 18F-FDG positron emission tomography integrated computed tomography associate with intravoxel incoherent motion in prediction of EGFR expression in lung cancer

作　　者：薛丹丹 徐俊玲[2] 史大鹏[2] Xue Dandan;Xu Junling;Shi Dapeng(Department of Radiology,Dongguan Branch,Affiliated Hospital of Yan′an University,Yan′an 716000,China;Department of Radiology,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]延安大学附属医院东关分院放射科,延安716000 [2]河南省人民医院放射科,郑州450003

出　　处：《中华医学杂志》2020年第15期1159-1163,共5页National Medical Journal of China

摘　　要：目的探讨18F-氟代脱氧葡萄糖正电子发射计算机断层显像(18F-FDG PET/CT)与磁共振体素内不相干运动(IVIM)对肺癌表皮生长因子受体(EGFR)基因分型的诊断价值潜能。方法回顾性收集河南省人民医院2017年8月至2019年3月116例经病理证实的肺癌患者,男72例、女44例,年龄31~85岁。高分化37例,中分化53例,低分化26例,做EGFR基因检测者共50例(突变型30例,野生型20例)。所有患者在做EGFR基因检测前均行全身PET/CT及肺部MR-IVIM成像检查。采用Student-t检验或Mann-Whitney U检验比较EGFR阴阳性间PET/CT,IVIM半定量参数的差异;绘制受试者工作特征(ROC)曲线评价各参数对基因EGFR的诊断效能,并计算出最佳诊断阈值、特异度、敏感度、阳性预测值、阴性预测值,从而计算出诊断正确率。将18F-FDG PET/CT联合IVIM,计算其诊断正确率。结果EGFR突变组的定量参数标准摄取值(SUV)、表观扩散系数(ADC)、真扩散系数(D),伪扩散系数(D*)、灌注分数(f)分别为8.7±3.5,(1.59±0.26)×10^-3 mm^2/s,(1.04±0.12)×10^-3 mm^2/s,(3.9±3.0)×10^-2 mm^2/s,0.43±0.16。EGFR野生组的上述参数分别是14.3±3.3,(1.34±0.26)×10^-3 mm^2/s,(0.89±0.12)×10^-3 mm^2/s,(3.5±2.5)×10^-2 mm^2/s,0.40±0.11。EGFR突变组与野生组之间的定量参数SUV(t=4.196,P=0.0001)、ADC(t=2.502,P=0.0018)、D(t=3.158,P=0.006)差异有统计学意义,定量参数D*(t=0.361,P=0.721)、f(t=0.627,P=0.536)差异无统计学意义。绘制ROC曲线图,得到SUV、ADC、D、D*、f诊断EGFR突变的曲线下面积分别为0.880、0.755、0.820、0.575、0.550。上述参数的诊断正确率分别为80.0%、76.7%、73.3%、66.7%、53.3%。将SUV与ADC、D值分别联合应用后,准确率分别为83.3%,80.0%。结论PET/CT与磁共振IVIM对肺癌基因EGFR分型均具有诊断价值。Objective To discuss the diagnostic value potential of 18F-FDG PET/CT and intravoxel incoherent motion(IVIM)in genotype EGFR of lung cancer.Methods A total of 116 cases proved pathologically pulmonary space occupying lesions(72 males,44 females;age range was 31-85 years;37 cases of high differentiation;53 cases of middle differentiation,26 cases of low differentiation)were prospectively collected from August 2017 to March 2019 in Henan Provincial People′s Hospital.EGFR gene detection was performed in 50 patients(wild type 20 cases,mutant 30 cases).Whole body PET/CT and lung MR-imaging were performed before treatment in all patients.Comparison of PET/CT,IVIM semi-quantitative parameters between positive and negative of EGFR by Student-t test or Mann-Whitney U test.Evaluation diagnostic efficacy of each parameter to EGFR by drawing ROC curves.The optimum diagnostic threshold,specificity,sensitivity,positive predictive value,negative predictive value and the diagnostic accuracy were calculated.The diagnostic accuracy of 18F-FDG PET/CT combined with IVIM was calculated.Results The quantitative parameters standard intake(SUV),apparent diffusion coefficient(ADC),true diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction(f)were 8.7±3.5,(1.59±0.26)×10^-3 mm^2/s,(1.04±0.12)×10^-3 mm^2/s,(3.9±3.0)×10^-2 mm^2/s,0.43±0.16 and the above parameters of the wild group were 14.3±3.3,(1.34±0.26)×10^-3 mm^2/s,(0.89±0.12)×10^-3 mm^2/s,(3.5±2.5)×10^-2 mm^2/s,0.40±0.11,respectively.The difference of quantitative parameters SUV(t=4.196,P=0.0001),ADC(t=2.502,P=0.0018),D(t=3.158,P=0.006)between the EGFR mutant group and the wild group was statistically significant.The difference of quantitative parameters D*(t=0.361,P=0.721),f(t=0.627,P=0.536)was not statistically significant.ROC curve was drawn and the area under the curves for diagnosis of EGFR mutations by SUV,ADC,D,D*,f was 0.880,0.755,0.820,0.575,0.550.The diagnostic accuracy of these parameters above mentioned was 80.0%,76.7%,73.3%,66.7%,53.

关 键 词：氟脱氧葡萄糖F18 正电子发射断层显像术 磁共振成像 受体 表皮生长因子 

分 类 号：R734[医药卫生—肿瘤]