^(18)F-FDG PET/MRI对女性生殖系统恶性肿瘤转移淋巴结的诊断价值

^(18)F-FDG PET/MRI in Diagnosis of Metastatic Lymph Nodes of Female Gynecologic Cancer

目的探讨18氟-脱氧葡萄糖(^(18)F-FDG)PET/MRI对女性生殖系统恶性肿瘤转移淋巴结的诊断价值。资料与方法回顾性分析我院术前行PET/MRI检查的68例女性生殖系统恶性肿瘤患者,观测PET/MRI图像上转移及非转移淋巴结的短径(S)、长径(L)、最小表观扩散系数(ADC_(min))及最大标准化摄取值(SUVmax),计算PET/MRI诊断转移淋巴结的敏感度、特异度、准确性、阳性预测值与阴性预测值。比较转移及非转移淋巴结各观测指标,并绘制受试者工作特性曲线。结果病理结果显示13例患者共出现30枚转移淋巴结,PET/MRI正确探测到22枚,诊断的敏感度、特异度、准确率、阳性预测值及阴性预测值分别为73.3%(22/30)、97.5%(356/365)、95.7%(378/395)、71.0%(22/31)和97.8%(356/364)。转移及非转移淋巴结之间的S、ADC_(min)及SUVmax差异有统计学意义(P均<0.05);S/L差异无统计学意义(P>0.05),但值越大,发生淋巴结转移的可能性越大。受试者工作特性曲线显示S、S/L、ADC_(min)及SUVmax最佳阈值分别为8.80 mm、0.765、766.15×10^(-6) mm^2/s及3.25。结论 PET/MRI对女性生殖系统恶性肿瘤转移淋巴结具有较高的诊断价值,能较好地鉴别转移及非转移淋巴结。

Purpose To investigate the diagnostic value of 18F-deoxyglucose （18F-FDG） positron emission tomography/magnetic resonance imaging （PET/MRI） in metastatic lymph nodes of female patients with gynecologic cancer. Materials and Methods Sixty-eight patients with gynecologic cancer who underwent preoperative PET/MRI were retrospectively analyzed to obtain the short-axis diameter （S）, the long-axis diameter （L）, the minimum apparent diffusion coefficient （ADCmin） and the maximum standard uptake value （SUVmax） of metastatic and non-metastatic lymph nodes on PET/MR images. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/MR imaging in detecting lymph nodes metastases were calculated. These indicators between and metastatic lymph nodes and non-metastatic lymph nodes were compared, and the ROC curve was plotted. Results There were 30 pathology-confirmed metastatic lymph nodes in 13 patients, in which 22 ones were correctly detected by PET/MRI. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the diagnosis were 73.3% （22/30）, 97.5% （356/365）, 95.7% （378/395）, 71.0% （22/31） and 97.8% （356/364）, respectively. There were significant differences in S, ADCmin and SUVmax between metastatic and non-metastatic lymph nodes （P〈0.05）; while there was no significant difference in S/L （P〉0.05）, but the larger the value, the more likely the metastasis occurred. The ROC curve revealed that the cutoff values of S, S/L, ADCmin and SUVmax were 8.80 mm, 0.765, 766.15×10-6 mm2/s and 3.25, respectively. Conclusion PET/MRI is of high diagnostic value for metastatic lymph nodes in patients with gynecologic cancer, and can better differentiate metastatic from non-metastatic lymph nodes.