背景:18F-氟脱氧葡萄糖(18F-FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)作为全身成像模式已显示出其在检测偶发结直肠腺瘤中的价值。在临床实践中,腺瘤性息肉可分为三组:低度上皮内瘤变(LGIN),高级别上皮内瘤变(HGIN)和癌症,这可能导致不同的临床管理。然而,18F-FDGPET/CTSUVmax与腺瘤性息肉组织学分级的关系仍未确立,这是一项具有挑战性但有价值的任务。
方法:这项回顾性研究包括255例结直肠腺瘤(CRA)或结直肠腺癌(AC)患者,这些患者在PET/CT上偶然发现了相应的18F-FDG摄取。评估SUVmax与病理特征和肿瘤大小的相关性。肿瘤分为LGIN,HGIN,根据组织学分级和AC。应用受试者工作特征(ROC)分析来评估SUVmax-only模型和综合模型的预测价值,这些模型是通过单变量和多变量分析确定的影像学和临床预测因子建立的。
结果:SUVmax与组织学分级呈正相关(r=0.529,P<0.001)。单因素和多因素分析显示,除HGIN和AC之间外,SUVmax是所有组的独立危险因素。区分AC和腺瘤的综合模型的曲线下面积(AUC),LGIN和HIGN,LGIN和AC,HGIN和AC分别为0.886、0.780、0.945、0.733,在统计学上高于SUVmax-only模型的AUC,分别为0.812、0.733、0.863和0.688。
结论:作为独立危险因素,基于18F-FDGPET/CT的SUVmax与CRA的组织学分级高度相关。因此,18F-FDGPET/CT可以作为精确诊断的非侵入性工具,并有助于术前制定偶然CRA患者的治疗策略。
BACKGROUND: 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT) as an imaging modality for the whole body has shown its value in detecting incidental colorectal adenoma. In clinical practice, adenomatous polyps can be divided into three groups: low-grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN) and cancer, which can lead to different clinical management. However, the relationship between the
18F-FDG PET/CT SUV
max and the histological grade of adenomatous polyps is still not established, which is a challenging but valuable task.
METHODS: This retrospective study included 255 patients with colorectal adenoma (CRA) or colorectal adenocarcinomas (AC) who had corresponding 18F-FDG uptake incidentally found on PET/CT. The correlations of SUV
max with pathological characteristics and tumor size were assessed. Neoplasms were divided into LGIN, HGIN, and AC according to histological grade. Receiver operating characteristic (ROC) analysis was applied to evaluate the predictive value of the SUV
max-only model and comprehensive models which were established with imaging and clinical predictors identified by univariate and multivariate analysis.
RESULTS: The SUV
max was positively correlated with histological grades (r=0.529, P<0.001). Univariate and multivariate analysis showed that SUV
max was an independent risk factor among all groups except between HGIN and AC. The area under the curves (AUCs) of the comprehensive model for distinguishing between AC and adenoma, LGIN and HIGN, LGIN and AC, and HGIN and AC were 0.886, 0.780, 0.945, 0.733, respectively, which is statistically higher than the AUCs of the SUV
max-only model with 0.812, 0.733, 0.863, and 0.688, respectively.
CONCLUSIONS: As an independent risk factor, SUV
max based on 18F-FDG PET/CT is highly associated with the histological grade of CRA. Thus, 18F-FDG PET/CT can serve as a noninvasive tool for precise diagnosis and assist in the preoperative formulation of treatment strategies for patients with incidental CRA.