PET/MRI和PET/CT在恶性胸腔积液诊断中的比较研究  

Value of PET/MRI in the diagnosis of malignant pleural effusion in comparison with PET/CT

作　　者：彭文贝 孙逊[2] 周玫[1] 韦晓山 吴秀芝 阮伟伟 施焕中[3] 兰晓莉[2] 周琼[1] Peng Wenbei;Sun Xun;Zhou Mei;Wei Xiaoshan;Wu Xiuzhi;Ruan Weiwei;Shi Huanzhong;Lan Xiaoli;Zhou Qiong(Department of Respiratory and Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Nuclear Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology/Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,China;Department of Respiratory and Critical Care Medicine,Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]华中科技大学同济医学院附属协和医院呼吸与危重症医学科,武汉430022 [2]华中科技大学同济医学院附属协和医院核医学科,湖北省分子影像重点实验室,武汉430022 [3]首都医科大学附属北京呼吸医学研究所北京朝阳医院呼吸与危重症医学科,北京100020

出　　处：《中华医学杂志》2021年第30期2363-2369,共7页National Medical Journal of China

基　　金：国家自然科学基金(81973990)。

摘　　要：目的探讨PET/MRI对恶性胸腔积液(MPE)的诊断价值,并比较其与PET/CT的诊断差异。方法前瞻性收集2017年10月至2020年1月在华中科技大学同济医学院附属协和医院就诊的57例疑似MPE的患者资料,最终纳入53例患者,分别对其进行全身PET/CT和胸腔PET/MRI检查。评估PET/CT和PET/MRI图像的形态学特征,勾画感兴趣区(ROI),获取PET/CT和PET/MRI图像中ROI的最大标准摄取值(SUVmax),计算出病灶的靶本比(TBR)。分析PET/MRI图像中胸膜的弥散加权成像(DWI)特征。以病理诊断为金标准,评价PET/CT和PET/MRI对MPE的诊断效果。结果53例患者年龄(62.8±1.7)岁,男31例。病理结果显示41例为MPE,12例为良性胸腔积液(BPE)。两组之间年龄、性别和吸烟史差异均无统计学意义(P>0.05)。PET/MRI显示胸膜病灶的SUVmax高于PET/CT(6.4±0.6比5.3±0.5,P<0.001)。PET/MRI的TBR高于PET/CT(2.2±0.2比1.8±0.2,P<0.001)。PET/MRI通过联合胸膜病变部位SUVmax和DWI等影像学特征对MPE诊断的灵敏度、特异度、准确度分别为75.6%、100%、81.1%。而PET/CT联合胸膜病变部位SUVmax和影像学特征对MPE诊断的灵敏度、特异度、准确度分别为85.4%、83.3%、77.4%。PET/MRI和PET/CT对于诊断MPE的曲线下面积(AUC)差异无统计学意义(0.934比0.873,P>0.05)。结论PET/MRI与PET/CT在MPE中的诊断效率相当。但PET/MRI对胸膜病灶显示更高的SUVmax和更高的TBR,并具有特异的胸膜DWI影像学特征,值得临床进一步研究。Objective To investigate the diagnostic value of PET/MRI for malignant pleural effusion(MPE),and compare its diagnostic difference with PET/CT.Methods The data of 57 patients with suspected MPE admitted into Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2017 to January 2020 was analyzed.A total of 53 patients were included in the prospective study,and the whole body PET/CT and thoracic PET/MRI were performed on them respectively.Two physicians used a blind method to evaluate the morphological features of PET/CT and PET/MRI images,delineate the region of interest(ROI),obtain the maximum standard uptake value(SUVmax)of the ROI in the PET/CT and PET/MRI images.The target-to-background ratio(TBR)of the lesion was calculated.The diffusion-weighted imaging(DWI)characteristics of the pleura in PET/MRI images were analyzed.Taking pathological diagnosis as the gold standard,the diagnostic effect of PET/CT and PET/MRI on MPE were evaluated.Results The 53 patients who were finally included were(62.8±1.7)years old,consisting of 31 males.Pathological results showed that 41 cases were MPE and 12 cases were benign pleural effusion(BPE).There were no statistical differences in age,gender and smoking history between the two groups(P>0.05).Bland-Altman analysis showed that the SUVmax of pleural lesions by PET/MRI was higher than that by PET/CT(6.4±0.6 vs 5.3±0.5,P<0.001).The TBR of PET/MRI was higher than that of PET/CT(2.2±0.2 vs 1.8±0.2,P<0.001).The sensitivity,specificity,and accuracy of PET/MRI in the diagnosis of MPE by combining imaging features such as SUVmax and DWI of pleural lesions were 75.6%,100%,and 81.1%,respectively.The sensitivity,specificity,and accuracy of PET/CT combined with SUVmax and imaging features of pleural lesions in the diagnosis of MPE were 85.4%,83.3%,and 77.4%,respectively.There was no statistically significant difference between PET/MRI and PET/CT in the area under the curve(AUC)for diagnosing MPE(0.934 vs 0.873,P>0.05).Conclusions PET/MR

关 键 词：胸腔积液 恶性 磁共振成像 正电子发射断层扫描 

分 类 号：R730.6[医药卫生—肿瘤]