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肾上腺是恶性肿瘤常见的转移部位之一,在有恶性肿瘤病史的患者中发现的肾上腺异常中,高达50%为转移性病灶所致[1],是否发生肾上腺转移关系到恶性肿瘤的临床分期。同时,肾上腺良性病变如肾上腺腺瘤,是普通人群中常见的无症状肾上腺良性肿瘤,可以规律随访观察。因此,肾上腺病变的准确诊断对处理策略和治疗方案的选择至关重要。目前,CT和MRI是肾上腺病变常用的影像学诊断方法,但对于部分患者仍存在诊断困难的问题。18F-FDG PET/CT能够同时提供解剖信息和代谢信息,可进行相对定量分析,作为无创性影像学检查手段,对肾上腺转移瘤和良性病变的鉴别具有一定的优势[2]。笔者回顾性分析无症状肾上腺病变患者的18F-FDG PET/CT影像学检查资料,分析18F-FDG PET/CT对肾上腺良恶性病变诊断的准确程度,并探讨18F-FDG PET/CT各项参数对肾上腺转移瘤的预测诊断价值。
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95例患者中,共检查出110个肾上腺病灶,其中良性病变60个,转移瘤50个;双侧病灶15例,单侧病灶80例(其中左侧63例,右侧17例)。肾上腺良性病变组:41例为左侧肾上腺病变(图 1),9例为右侧肾上腺病变,5例为双侧肾上腺病变。肾上腺转移瘤组:22例为左侧肾上腺病变,8例为右侧肾上腺病变,10例为双侧肾上腺病变(图 2)。肾上腺良性病变组与转移瘤组在性别、年龄和病变部位间的差异均无统计学意义(χ2=2.408、t=-0.466、χ2=5.217,均P>0.05),见表 1。
图 1 左侧肾上腺良性结节18F-FDG PET/CT显像图
Figure 1. 18F-FDG PET/CT images of one benign nodule in the left adrenal gland
图 2 右上肺癌双侧肾上腺转移瘤18F-FDG PET/CT显像图
Figure 2. 18F-FDG PET/CT images of bilateral adrenal metastatic lesions in one patient with right upper lobe lung cancer
参数 性别(男/女) 年龄/岁 病变部位 左侧 右侧 双侧 良性病变组(n=55) 36/19 59.2±11.2 41 9 5 转移瘤组(n=40) 32/8 60.3±11.2 22 8 10 统计值(χ2或t值) 2.408 -0.466 5.217 P值 > 0.05 > 0.05 > 0.05 注:表中,“-”表示无统计值。 表 1 肾上腺良性病变组与转移瘤组间的患者性别、年龄、病变部位的比较
Table 1. The comparison of sex, age, lesion location between adrenal benign group and metastasis group
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110个肾上腺病灶的大小为0.65~5.70 cm,平均大小为(1.65±0.82)cm;CT值为-20.4~46.8 HU,平均CT值为(24.2±14.9)HU;SUVmax为1.1~31.9,平均SUVmax为4.5±4.6;肝脏本底SUVmax为1.7~4.0,平均肝脏本底SUVmax为2.4±0.4;SUVmax比值为0.44~14.5,平均SUVmax比值为1.99±2.15。肾上腺转移瘤组病灶的大小、CT值、SUVmax、SUVmax比值均高于良性病变组,两者间差异具有统计学意义(Z=-4.908、-6.030、-7.966、-8.252,均P < 0.001),见表 2。
组别 病灶大小 CT值/HU SUVmax SUVmax比值 良性病变组(n=55) 1.3±0.5 16.1±15. 2.1±0.9 0.8±0.4 转移瘤组(n=40) 2.0±0.9 33.9±5.6 7.5±5.6 3.3±2.6 Z值 -4.908 -6.03 -7.966 -8.252 P值 < 0.001 < 0.001 < 0.001 < 0.001 注:表中,CT:计算机体层摄影术;SUVmax:最大标准化摄取值。 表 2 肾上腺良性病变组与转移瘤组间单因素比较
Table 2. The comparison of monofactor between adrenal benign group and metastasis group
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将病灶大小、CT值、SUVmax、SUVmax比值纳入多因素Logistic回归分析,采用Enter法逐步回归,得出肾上腺转移瘤的独立危险因素是SUVmax比值(回归系数为2.581,P < 0.001),95%CI为3.806~45.870。将SUVmax比值进行ROC分析,曲线下面积为0.958,最佳诊断临界点为1.24,灵敏度、特异度分别为90.0%、93.3%,提示利用SUVmax比值诊断肾上腺转移瘤的准确率较高,为91.8%(曲线下面积>0.9),临界点为1.24时,正确诊断指数最大为83.3%,见图 3。
18F-FDG PET/CT显像在肾上腺转移瘤中的诊断价值和预测分析
18F-FDG PET/CT diagnostic value and predictive analysis in adrenal metastasis lesions
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摘要:
目的探讨18F-FDG PET/CT显像在肾上腺转移瘤中的诊断价值及预测价值。 方法回顾性分析2012年12月至2016年10月行PET/CT检查的95例无症状的肾上腺病变患者,分为肾上腺转移瘤组(40例)和肾上腺良性病变组(55例),分别测量肾上腺病灶大小、CT值、最大标准化摄取值(SUVmax)、肾上腺病灶SUVmax/肝脏本底SUVmax比值(SUVmax比值),分别进行单因素检验、独立样本t检验、Mann-Whitney U秩和检验统计分析。采用多因素Logistic回归分析肾上腺转移瘤的危险预测因素,并采用受试者工作特征(ROC)曲线分析确定肾上腺转移瘤与良性病变鉴别诊断的最佳临界点。 结果110个肾上腺病灶中良性病变60个,转移瘤50个,大小为0.65~5.70 cm,平均(1.65±0.82)cm。CT值-20.4~46.8 HU,平均(24.2±14.9)HU。SUVmax为1.1~31.9,平均4.5±4.6。SUVmax比值为0.44~14.5,平均1.99±2.15。单因素分析得出两者在病灶大小、CT值、SUVmax、SUVmax比值之间的差异均有统计学意义(Z=-4.908、-6.030、-7.966、-8.252,均P < 0.001);多因素Logistic回归分析显示SUVmax比值是影响肾上腺转移瘤发生的独立因素,ROC曲线分析得出SUVmax比值=1.24为鉴别诊断肾上腺转移瘤与良性病变的最佳临界点,灵敏度和特异度分别为90.0%和93.3%。 结论18F-FDG PET/CT显像对肾上腺转移瘤具有较高的诊断价值。SUVmax比值是肾上腺转移瘤的独立危险预测因素,鉴别诊断肾上腺良性病变与转移瘤的SUVmax比值最佳临界点为1.24。 -
关键词:
- 肾上腺疾病 /
- 肿瘤转移 /
- 正电子发射断层显像计算机体层摄影术 /
- 氟脱氧葡萄糖F18
Abstract:ObjectiveTo discuss 18F-FDG PET/CT diagnostic value and predictive analysis in adrenal metastasis lesions. MethodsA total of 110 adrenal lesions in 95 non-symptom patients who underwent 18F-FDG PET/CT examination were retrospectively analyzed. Patients were divided into adrenal benign group(55 cases) and metastasis group(40 coses). Adrenal lesion size, CT attenuation value, SUVmax(standard uptake value maximum), and SUVmax ratio between adrenal and liver lesions(SUVmax ratio) were measured and recorded for each lesion. Univariate χ2 test, independent sample t-test, and Mann-Whitney U rank test were used for the statistical analyses. Univariate analysis and multivariate logistic analysis were used for the evaluation of predictive risk factor. The author performed ROC(receiver operating characteristic) curve analysis to determine the cut-off value in the diagnosis of adrenal metastasis lesions. ResultsA total of 110 lesions, 60 benign and 50 metastasis, were detected. The lesions diameter was 0.65 cm~5.70 cm with the average diameter (1.65±0.82) cm; the lesions CT value were -20.4~46.8 HU with the average CT value(24.2±14.9) HU; the lesions SUVmax were 1.1~31.9 with the average SUVmax 4.5±4.6; the lesions SUVmax ratio were 0.44~14.5 with the average SUVmax ratio 1.99±2.15. Differences in size, CT attenuation value, SUVmax, and SUVmax ratio between the benign and adrenal metastasis lesions were statistically significant(Z=-4.908, -6.030, -7.966, -8.252, respectively; all P < 0.001). The SUVmax ratio was the independent risk factor of adrenal metastasis. The SUVmax ratio of 1.24 was the best cutoff in the ROC analysis, yielding a sensitivity of 90.0% and specificity of 93.3%. Conclusions18F-FDG PET/CT is valuable in diagnosing adrenal metastasis lesions. The adrenal-to-liver SUVmax ratio is the independent risk factor of adrenal metastasis, and the SUVmax ratio of 1.24 was the best cutoff in the ROC analysis. -
表 1 肾上腺良性病变组与转移瘤组间的患者性别、年龄、病变部位的比较
Table 1. The comparison of sex, age, lesion location between adrenal benign group and metastasis group
参数 性别(男/女) 年龄/岁 病变部位 左侧 右侧 双侧 良性病变组(n=55) 36/19 59.2±11.2 41 9 5 转移瘤组(n=40) 32/8 60.3±11.2 22 8 10 统计值(χ2或t值) 2.408 -0.466 5.217 P值 > 0.05 > 0.05 > 0.05 注:表中,“-”表示无统计值。 表 2 肾上腺良性病变组与转移瘤组间单因素比较
Table 2. The comparison of monofactor between adrenal benign group and metastasis group
组别 病灶大小 CT值/HU SUVmax SUVmax比值 良性病变组(n=55) 1.3±0.5 16.1±15. 2.1±0.9 0.8±0.4 转移瘤组(n=40) 2.0±0.9 33.9±5.6 7.5±5.6 3.3±2.6 Z值 -4.908 -6.03 -7.966 -8.252 P值 < 0.001 < 0.001 < 0.001 < 0.001 注:表中,CT:计算机体层摄影术;SUVmax:最大标准化摄取值。 -
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