^(18)F-FDG PET/CT图像特征与代谢参数对胃肠道间质瘤恶性程度的预测价值  

Predictive values of ^(18)F-FDG PET/CT image feature and metabolic parameters for the malignant potential of gastrointestinal stromal tumor

作　　者：张立 田月丽[2] 何勇 李海燕[1] 王敏[1] 丁颖[1] 柳宇 张永学[1] 兰晓莉[1] 曹卫[1] Zhang Li;Tian Yuel:;He Yong;Li Haiyan;Wang Min;Ding Ying;Liu Yu;Zhang Yongxue;Lan Xiaoli;Cao Wei(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 Nuclear Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]华中科技大学同济医学院附属协和医院核医学科、分子影像湖北省重点实验室,武汉430022 [2]武汉大学中南医院核医学科,武汉430071

出　　处：《中华核医学与分子影像杂志》2023年第2期91-96,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：科技部国家重点研发计划(2017YFC0113302)。

摘　　要：目的探讨^(18)F-FDG PET/CT图像特征及代谢参数对胃肠道间质瘤(GIST)恶性危险度的预测价值。方法回顾性分析2014年3月至2020年6月间在华中科技大学同济医学院附属协和医院与武汉大学中南医院治疗前行^(18)F-FDG PET/CT检查的35例GIST患者(男27例、女8例,年龄44~84岁)临床及影像资料。将^(18)F-FDG PET/CT中GIST病灶按照图像特征分为环形摄取和非环形摄取,使用Fisher确切概率法分析图像特征不同分组间肿瘤坏死、美国国立卫生研究院(NIH)危险度分级(简称NIH分级)之间的差异。采用Mann-Whitney U检验分析SUV_(max)、基于SUV_(max)不同阈值(2.5、40%和50%)下的肿瘤代谢体积(MTV;MTV2.5、MTV40%、MTV50%)和病灶糖酵解总量(TLG;TLG2.5、TLG40%、TLG50%)与临床病理特征(病变部位、肿瘤最大径、核分裂象、细胞增殖核抗原Ki-67、坏死、图像特征、NIH分级)的关系。采用Spearman秩相关分析临床病理特征与代谢参数的相关性。绘制不同代谢参数诊断NIH分级的ROC曲线,采用Delong检验比较不同AUC间的差异。结果35例GIST患者中,环形摄取占31.4%(11/35),非环形摄取占68.6%(24/35),2组间的坏死[7/11和12.5%(3/24);P=0.004]、NIH分级高危构成[11/11和25.0%(6/24);P<0.001]差异有统计学意义。肿瘤最大径、核分裂象、坏死、图像特征、NIH分级不同分组间代谢参数的差异均具有统计学意义(z值:-4.70~-2.09,均P<0.05),但Ki-67不同分组的代谢参数差异均无统计学意义(z值:-0.83~-0.71,均P>0.05)。代谢参数与核分裂象、肿瘤最大径、坏死、图像特征、NIH分级之间均有相关性(rs值:0.36~0.81,均P<0.05),但与Ki-67之间的相关性均无统计学意义(rs值:0.12~0.14,均P>0.05)。SUV_(max)与MTV2.5、TLG2.5、TLG40%、TLG50%的AUC分别为0.752、0.856、0.856、0.882、0.886,差异有统计学意义(z值:1.96~2.12,均P<0.05)。结论在^(18)F-FDG PET/CT中图像特征呈环形摄取的GIST具有更高的NIH分级,肿瘤更易出现坏�Objective To investigate the predictive values of ^(18)F-FDG PET/CT image feature and metabolic parameters for the malignant potential of gastrointestinal stromal tumor(GIST).Methods From March 2014 to June 2020,the ^(18)F-FDG PET/CT imaging and surgical pathological data of 35 patients with GIST(27 males,8 females;age 44-84 years)from Union Hospital,Tongji Medical College,Huazhong University of Science and Technology and Zhongnan Hospital of Wuhan University were analyzed retrospectively.Patients were divided into ring-shaped uptake group and other uptake patterns group according to ^(18)F-FDG PET/CT image feature.Fisher′s exact test was used to analyze the differences of tumor necrosis and National Institutes of Health(NIH)risk classification(short for NIH classification)between different image feature groups.Mann-Whitney U test was used to analyze the differences of SUV_(max),metabolic parameters at different thresholds(2.5,40%,50%)of SUV_(max)(metabolic tumor volume(MTV;MTV2.5,MTV40%,MTV50%)and total lesion glycolysis(TLG;TLG2.5,TLG40%,TLG50%))between different clinicopathological features(lesion location,tumor diameter,mitotic count,Ki-67,necrosis,image feature,NIH classification)groups.Spearman rank correlation analysis was used to explore the correlation between clinicopathological features and metabolic parameters.ROC curve analysis was used to distinguish NIH classification of different metabolic parameters.Delong test was used to compared differences between different AUCs.Results Of 35 GIST patients,11(31.4%)were ring-shaped uptake and 24(68.6%)were other uptake patterns,and the differences of necrosis(7/11 vs 12.5%(3/24);P=0.004)and NIH classification(11/11 vs 25.0%(6/24);P<0.001)between the two groups were significant.There were significant differences of metabolic parameters between different groups of tumor diameter,mitotic count,necrosis,image feature,NIH classification(z values:from-4.70 to-2.09,all P<0.05),while there were no significant differences of Ki-67(z values:from-0.83 to-0.71,all P>0.

关 键 词：胃肠道间质肿瘤 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 预测 

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