^(18)F-FDG PET/MR多参数模型在胰腺肿瘤良恶性鉴别中的应用  

Application of multiparametric diagnostic model based on the^(18)F-FDG PET/MR in the differential diagnosis of benign and malignant pancreatic tumors

作　　者：党浩丹[1] 王观筠 刘家金[1] 姚树林[1] 关志伟[1] 王瑞民[1] 徐白萱[1] Dang Haodan;Wang Guanyun;Liu Jiajin;Yao Shulin;Guan Zhiwei;Wang Ruimin;Xu Baixuan(Department of Nuclear Medicine,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心核医学科,北京100853

出　　处：《中华核医学与分子影像杂志》2021年第7期405-409,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：科技部国家重点研发计划 (2016YFC0103908)。

摘　　要：目的:研究一体化^(18)F-脱氧葡萄糖(FDG)PET/MR多个参数及组合模型在胰腺肿瘤良恶性鉴别诊断中的价值。 方法:回顾性选择2012年12月至2020年9月间解放军总医院第一医学中心临床怀疑胰腺占位性病变并行PET/MR检查的患者76例[男50例、女26例,年龄(45.2±18.0)岁],患者均获得明确诊断。PET/MR检查序列包括T 1加权成像(WI;平扫及增强)、T 2WI、弥散加权成像(DWI)及^(18)F-FDG PET序列。获得视觉评估病变MR形态学特征的MR评分;测量PET及DWI多个参数,包括基于直方图获得的标准摄取值(SUV)及表观弥散系数(ADC)纹理参数[最大值(max)、最小值(min)、均数、中位数、标准差(SD)、偏度、峰度和熵]。采用两独立样本 t检验或Mann-Whitney U检验分析数据。行受试者工作特征(ROC)曲线分析计算PET/MR各参数对胰腺病变良恶性的鉴别诊断效能,建立基于logistics多元逐步回归分析的PET/MR多参数模型并评估效能。 结果:76例患者中,恶性55例、良性21例。(1)视觉评估。胰腺恶性肿瘤主要表现为边缘不清晰,内部MR信号及强化异常,ADC减低,放射性摄取增高;胰腺良性肿瘤病变主要表现为边缘清晰,信号及强化均匀,ADC未见减低,放射性摄取减低。(2)诊断效能。依据logistic分析建立的多参数模型纳入指标为SUV max、SUV SD、ADC 熵及ADC 偏度。良恶性鉴别诊断效能依次为多参数模型>ADC 熵>MR评分>SUV max>SUV SD>ADC 偏度;多参数模型的诊断效能最好,曲线下面积(AUC)为0.86,灵敏度为69.1%(38/55),特异性为100%(21/21)( z=-8.73, P<0.001)。 结论:基于^(18)F-FDG PET/MR获得的MR评分及多个定量参数及纹理参数可以不同程度鉴别诊断胰腺肿瘤良恶性;而多参数模型可进一步有效提高诊断效能。Objective To investigate the value of multiple parameters and the combined model based on^(18)F-fluorodeoxyglucose(FDG)PET/MR in the differential diagnosis of benign and malignant pancreatic tumors.Methods A total of 76 patients(50 males,26 females,age(45.2±18.0)years)with clinically suspected pancreatic tumor who underwent PET/MR between December 2012 and September 2020 in First Medical Center of Chinese PLA General Hospital were retrospectively selected.All patients had definitive diagnoses.PET/MR sequences included T1 weighted imaging(WI;convention and contrast enhancement),T2WI,diffusion weighted imaging(DWI)and^(18)F-FDG PET sequences.Morphological characteristics and scores of lesions in MRI were evaluated.Parameters including parameters of PET and DWI,as well as parameters derived from histogram analysis of apparent diffusion coefficient(ADC)and standardized uptake value(SUV)(maximum(max),minimum(min),mean,median,standard deviation(SD),skewness,kurtosis,entropy)were measured.Independent-sample t test or Mann-Whitney U test were used for data analysis.PET/MR combined model was measured based on logistic regression analysis.Receiver operating characteristic(ROC)curve analysis was used to calculate the differential diagnosis efficacy of PET/MR multiparameters and combined model for benign and malignant lesions.Results Among 76 patients,55 were malignant and 21 were benign.(1)Visual evaluation.The main manifestations of pancreatic cancer were unclear margin,abnormal internal MR signal and enhancement,decreased ADC signal and increased radioactive uptake.The main manifestations of benign tumor lesions of pancreas were clear margin,even signal and enhancement,no reduction of ADC,decreased radioactive uptake.(2)Diagnostic efficacy.Multiparameter model established based on logistic regression analysis included SUVmax,SUVSD,ADCentropy and ADCskewness.The efficiency of differential diagnosis for benign and malignant pancreatic tumors were shown as follows:multiparametric diagnostic model>ADCentropy>MR score>SUVmax>

关 键 词：胰腺肿瘤 正电子发射断层显像术 磁共振成像 脱氧葡萄糖 诊断 鉴别 

分 类 号：R735.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44