<sup>18</sup>F-FDG PET/MRI与PET/CT在肾细胞癌原发灶与转移灶诊断中的对比研究

doi:10.3760/cma.j.cn101202-20230428-00120

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摘要目的探讨¹⁸F-脱氧葡萄糖（FDG）正电子发射体层摄影（PET）/MRI在诊断肾细胞癌原发灶及转移灶中的应用价值。方法横断面研究。纳入2018年3月—2023年4月于武汉大学人民医院经组织学病理确诊的68例肾细胞癌患者临床资料。患者均于同一天先后行全身¹⁸F-FDG PET/CT及MRI检查。由2名阅片者观察PET检出的肾细胞癌阳性病灶,包括原发灶及转移灶,在相应的¹⁸F-FDG PET/CT和PET/MRI图像上评价清晰度并比较PET阳性病灶的清晰度评分,通过病灶诊断信心评分结果来评价¹⁸F-FDG PET/CT或¹⁸F-FDG PET/MRI对肾细胞癌的诊断信心评分。结果 68例肾癌患者中,结合早期及延迟显像,58例患者¹⁸F-FDG PET/CT和¹⁸F-FDG PET/MRI检出相同数量阳性病灶150个,其中原发灶共58个、淋巴结转移灶44个、肝转移灶28个及骨转移灶20个,PET阳性病灶检出率为85.29%（58/68）。¹⁸F-FDG PET/CT原发灶清晰度评分为[3.00（2.00,3.25）分],低于¹⁸F-FDG PET/MRI T₁加权像（T₁WI）的[4.00（3.00,4.00）分]、T₂加权像（T₂WI）的[4.00（4.00,4.00）分]及弥散加权成像（DWI）的[4.00（4.00,4.00）分],差异均有统计学意义（Z=4.91、5.78、5.97,P值均<0.001）。¹⁸F-FDG PET/MRI T₁WI、T₂WI、DWI对肝转移灶的清晰度评分为[3.00（3.00,4.00）]、[4.00（3.00,4.00）]、[4.00（4.00,4.00）],均优于¹⁸F-FDG PET/CT清晰度评分[2.50（1.00,3.00）],差异均有统计学意义（Z=3.86、3.76、3.96,P值均<0.001）。¹⁸F-FDG PET/MRI T₁WI、T₂WI、DWI对骨转移灶的清晰度评分分别为[3.00（3.00,4.00）]、[4.00（3.00,4.00）]、[4.00（4.00,4.00）],均优于¹⁸F-FDG PET/CT[2.00（1.00,3.00）],差异均有统计学意义（Z=3.37、3.32、3.55,P值均<0.001）。对于淋巴结转移灶,¹⁸F-FDG PET/MRI DWI清晰度评分[3.50（3.00,4.00）]高于¹⁸F-FDG PET/CT[3.00（3.00,4.00）],差异有统计学意义（Z=2.44,P=0.014）。68例患者中阅片人对¹⁸F-FDG PET/MRI的诊断信心评分[2.00（2.00,2.00）分]高于¹⁸F-FDG PET/CT[1.00（1.00,1.00）分], 差异有统计学意义（Z=4.47,P<0.001）。结论 ¹⁸F-FDG PET/CT和¹⁸F-FDG PET/MRI对PET阳性病灶的检出率无差异,但后者可提供更好的病灶清晰度和更高的诊断信心评分,且对淋巴结、肝脏及骨转移的显示优于¹⁸F-FDG PET/CT。

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	刘烜利
	姜双士
	么雨彤
	周莹
	冯洪燕
	涂宁
	谢新立
	卜丽红
	韩芳

关键词 ：肾肿瘤, 肾细胞癌, ¹⁸F-脱氧葡萄糖, 图像融合, 正电子发射体层摄影, 磁共振成像

Abstract：Objective This study aims to investigate the diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance imaging (MRI) in primary lesions and metastases of renal carcinoma by comparing the overall detection rate, lesion conspicuity, and reader confidence of ¹⁸F-FDG PET and computed tomography (CT) with hetero-computer fused ¹⁸F-FDG PET/MRI. Methods A cross-sectional study was conducted by retrospectively analyzing 68 patients with renal carcinoma diagnosed by histological pathology at the People's Hospital of Wuhan University from March 2018 to April 2023. All patients underwent whole-body ¹⁸F-FDG PET/CT and all-machine fusion ¹⁸F-FDG PET/MR examinations on the same day. Two readers observed PET-positive lesions, including primary and metastatic lesions, and evaluated and compared the clarity of PET-positive lesions on corresponding ¹⁸F-FDG PET/CT and PET/MRI images. The diagnostic confidence score was used to evaluate the diagnostic rate of ¹⁸F-FDG PET/CT or ¹⁸F-FDG PET/MRI in renal cell carcinoma. Results Sixty-eight patients with renal carcinoma, by combining early and delayed imaging, ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET/MRI detected the same number of positive lesions, including 58 primary lesions, 44 lymph node metastasis, 28 liver metastases, and 20 bone metastases. The ¹⁸F-FDG PET/CT primary focal clarity score was [3.00 (2.00, 3.25) points], which was lower than those of ¹⁸F-FDG PET/MRI T₁ weighted image (T₁WI) [4.00 (3.00, 4.00) points], T₂ weighted image (T₂WI) [4.00 (4.00, 4.00) points] and diffusion weighted image (DWI) [4.00 (4.00, 4.00) points], and the differences were statistically significant (Z=4.91, 5.78, 5.97; all P values <0.001). The resolution scores of ¹⁸F-FDG PET/MRI T₁WI, T₂WI, and DWI for hepatic metastasis were [3.00 (3.00, 4.00)], [4.00 (3.00, 4.00)], and [4.00 (4.00, 4.00)], respectively. All of them were better than the ¹⁸F-FDG PET/CT resolution score of [2.50 (1.00, 3.00)], and the difference was statistically significant (Z=3.86, 3.76, 3.96; all P values < 0.05). For bone metastases, the articulation scores of ¹⁸F-FDG PET/MRI T₁WI, T₂WI and DWI were [3.00 (3.00, 4.00)], [4.00 (3.00, 4.00)], and [4.00 (4.00, 4.00)], which were better than that of ¹⁸F-FDG PET/CT [2.00 (1.00, 3.00)], and the difference was statistically significant (Z = 3.37, 3.32, 3.55; all P values < 0.05). For lymph node metastasis, the resolution score of ¹⁸F-FDG PET/MRI DWI [3.50 (3.00, 4.00)] was higher than that of ¹⁸F-FDG PET/CT[3.00 (3.00, 4.00)], and the difference was statistically significant (Z=2.44, P=0.014). Among the 68 patients, the diagnostic confidence score of ¹⁸F-FDG PET/MRI [2.00 (2.00, 2.00)] was significantly higher than that of ¹⁸F-FDG PET/CT [1.00 (1.00, 1.00)], and the difference was statistically significant (Z=4.47, P<0.001). Conclusion No difference was found in the detection rate of PET-positive lesions between ¹⁸F-FDG PET/CT and ¹⁸F-FDG PET/MRI, but the latter provided better focal clarity and higher diagnostic confidence scores. ¹⁸F-FDG PET/MRI is better than ¹⁸F-FDG PET/CT in displaying lymph node, liver, and bone metastases.

Key words： Kidney neoplasms Renal cell carcinoma ¹⁸F-fluorodeoxyglucose Image fusion Positron emission tomography Magnetic resonance imaging

收稿日期: 2023-04-28

基金资助:国家自然科学基金（81871419）; 辽宁省科技计划（2022JH2/101300021）

通讯作者: 韩芳, Email: dlhanfang@163.com

引用本文:

刘烜利, 姜双士, 么雨彤, 周莹, 冯洪燕, 涂宁, 谢新立, 卜丽红, 韩芳. ¹⁸F-FDG PET/MRI与PET/CT在肾细胞癌原发灶与转移灶诊断中的对比研究[J]. 中华解剖与临床杂志, 2024, 29(1): 15-23.
Liu Xuanli, Jiang Shuangshi, Yao Yutong, Zhou Ying, Feng Hongyan, Tu Ning, Xie Xinli, Bu Lihong, Han Fang. Comparative study of ¹⁸F-FDG PET/MRI and ¹⁸F-FDG PET/CT in the diagnosis of renal cell carcinoma. Chinese Journal of Anatomy and Clinics, 2024, 29(1): 15-23.

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