摘要
目的比较目测法和T/Lratio-ROC分析法在^68Ga-DOTATATE PET/CT显像对神经内分泌肿瘤(neuroendocrine tumors,NETs)的诊断效能。方法回顾性分析2018年7月-2019年1月于我中心行^68Ga-DOTATATE PET/CT检查疑似神经内分泌肿瘤并经病理确诊的32例患者,其中男性18例,女性14例;年龄15~84岁。在肝及病变部位勾画感兴趣区,测定肝部位平均SUV值(SUVmean)及病变部位的最大SUV值(SUVmax),肿瘤/肝比值(T/Lratio)定义为TumorSUVmax/LiverSUVmean。分别使用目测法和T/Lratio-ROC分析法进行诊断。目测法以肉眼观察^68Ga-DOTATATE PET/CT成像中病变部位的放射性浓聚程度超过肝实质作为NETs阳性的标准。T/Lratio-ROC分析法是对T/Lratio进行ROC分析,以大于cut-off值为阳性标准。以上两种方法均以病理结果为金标准进行诊断性评价。结果1)病理结果:NETs 26例,其中嗜铬细胞瘤10例,嗜铬细胞瘤合并副神经节瘤2例,副神经节瘤3例,胰腺NETs 5例,直肠NETs 2例,嗜铬细胞瘤合并甲状腺髓样癌1例,肝门区神经内分泌癌1例,肝及十二指肠NETs各1例。非NETs 6例,其中肾上腺皮质腺癌、肾神经源性肿瘤、肾血管平滑肌脂肪瘤、肾上腺节细胞神经瘤、孤立性纤维瘤及骨纤维不良各1例。2)目测法:^68Ga-DOTATATE阳性23例,22例为NETs。^68Ga-DOTATATE阴性9例,4例为假阴性。目测法诊断NETs的灵敏度、特异度和准确度分别为84.62%、83.33%、84.38%,阳性预测值和阴性预测值分别为95.65%、55.56%。3)T/Lratio-ROC分析法(T/Lratio cut-off值=1.48):^68Ga-DOTATATE阳性21例均为NETs。^68Ga-DOTATATE阴性11例,5例为假阴性。T/Lratio-ROC分析法诊断NETs的灵敏度、特异度和准确度分别为80.80%、100%、84.38%,阳性预测值和阴性预测值分别为100%、54.55%。结论目测法和T/Lratio-ROC分析法在^68Ga-DOTATATE PET/CT显像中对NETs均具有较好的诊断效能,可用于NETs的定位及定性诊断。
Objective To compare the diagnostic efficacy of visual interpretation versus T/Lratio-ROC method based on ^68Ga-DOTATATE PET/CT imaging for neuroendocrine tumors (NETs).Methods A total of 32 patients (18 males and 14 females with age of 15-84 yeas) underwent ^68Ga-DOTATATE PET/CT in our center from July 2018 to January 2019 and confirmed by pathology were included in the retrospective analysis.Their clinical data and pathological results were collected.The area of interest (ROI) was delineated in the liver and the lesion site.The mean SUV value (SUVmean) of the liver and the maximum SUV value (SUVmax) of the lesion were measured.The ratio of tumor to liver (T/Lratio) was defined as TSUVmax/LSUVmean.Visual interpretation and T/Lratio-ROC methods were used to analyze the diagnostic accuracy.By visual interpretation,uptake in the lesion higher than that in the liver was regarded as positive to diagnosis of NETs.ROC analysis was used to analyze the performance of T/Lratio to diagnose NETs.The pathological result was the golden standard.Results Pathological results showed that 26 cases had NETs,including 10 cases of pheochromocytoma,2 cases of pheochromocytoma combined with paraganglioma,3 cases of paraganglioma,5 cases of pancreatic neuroendocrine tumors,2 cases of rectal neuroendocrine tumors,1 case of pheochromocytoma combined with medullary thyroid carcinoma,1 case of hilar neuroendocrine carcinoma,1 case of hepatic and 1 case of duodeneal NET.Six cases had non-NETs,including 1 case of adrenal cortical adenocarcinoma,1 case of renal neurogenic tumor,1 case of renal angiomyolipoma,1 case of adrenal ganglion cell neuroma,1 case of solitary fibrous tumor and 1 case of osteofibroma.There were 23 cases diagnosed as NETs by visual interpretation,of which 22 cases were NETs;9 cases were diagnosed as non-NETs,of which 4 cases were false negative.The sensitivity,specificity and accuracy of visual method to diagnose NETs were 84.62%,83.33%,84.38%,and the positive and negative predictive values were 95.65% and 55.56%,respectively.According to ROC analysis (T/Lratio cut-off value=1.48),21 cases were diagnosed as NETs and they were all consistent with pathological results;11 cases were diagnosed as non-NETs and false negative results were found in 5 cases.The sensitivity,specificity and accuracy of T/Lratio-ROC method to diagnose NETs were 80.80%,100%,84.38%,and the positive and negative predictive values were 100% and 54.55%,respectively.Conclusion Both visual interptetation and T/Lratio-ROC method have good diagnostic efficacy for NETs based on ^68Ga-DOTATATE PET/CT imaging.They can be used for the localization and diagnosis of NETs.
作者
麻广宇
关志伟
张晓军
张锦明
徐白萱
MA Guangyu;GUAN Zhiwei;ZHANG Xiaojun;ZHANG Jinming;XU Baixuan(Department of Nuclear Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing,100853,China)
出处
《解放军医学院学报》
CAS
2020年第2期128-132,共5页
Academic Journal of Chinese PLA Medical School
基金
科技部国际合作项目(2009DFA32960).
作者简介
麻广宇,男,硕士,主治医师。研究方向:PET肿瘤显像。Email:mgy301@163.com;通信作者:张锦明,男,博士,研究员,副主任。Email:zhangjm301@163.com
