18F-FDG PET/CT不同肿瘤代谢体积测算方法对宫颈鳞癌原发灶体积准确度的比较研究

Comparative study of18F-FDG positron emission tomography/computed tomography in evaluating tumor volume of primary cervical squamous cell carcinoma based on different tumor metabolic volume measurement methods

摘要:

目的： 比较¹⁸F-FDG正电子发射体层成像/计算机体层成像（positron emission tomography/computed tomography，PET/CT）基于不同最大标准摄取值（maximum standardized uptake value，SUV_max）阈值（迭代自适应法、30%、40%、50%）的肿瘤代谢体积（metabolic tumor volume，MTV）测算方法对宫颈鳞癌原发灶体积准确度。方法： 回顾性纳入符合要求的ⅠB~ⅣA期宫颈鳞癌患者，所有患者均行¹⁸F-FDG PET/CT及MRI检查。MTV阈值法以不同的SUV_max的固定阈值（30%、40%和50%）进行病灶体积测算，MTV_{迭代自适应法}直接通过AW VolumeShare5系统PET VCAR软件进行测算；MRI通过Reformat软件分别测量T2WI横断位及矢状位肿瘤体积。以MRI测量结果（MRIv）为“金标准”，比较不同MTV测算方法结果与MRI之间的差异；并通过MTV与MRIv进行线性拟合和相关性分析，最后绘制ROC曲线。结果： 117名患者符合纳入标准。MTV_30%和MTV_{迭代自适应法}与MRIv结果最接近，线性相关更靠近对角线；MTV_{迭代自适应法}与MRIv的相关性最强（r=0.98，P=0.000），其次为MTV_30%（r=0.96，P=0.000）；ROC曲线显示MTV_30%和MTV_{迭代自适应法}对病灶的测算结果接近（z=0.145，P=0.885）。结论： MTV_{迭代自适应法}和MTV_30%对宫颈鳞癌病灶大小和靶区勾画的计算较为准确，可以作为宫颈鳞癌诊断和治疗的可靠依据。

Abstract:

Objective: To compare the accuracy of ¹⁸F-FDG PET/CT in measuring the tumor metabolic volume (MTV) of primary tumor volume of cervical squamous cell carcinoma based on different thresholds of maximum standardized uptake value (SUV_max) (iterative adaptive algorithm and 30%, 40%, 50%). Methods: All the included patients withⅠB-ⅣA stage cervical squamous cell carcinoma underwent ¹⁸F-FDG PET/CT and MRI. Threshold MTV method was used to calculate the lesion volumes with different fixed thresholds (30%, 40% and 50% SUV_max) and MTV iterative method was used to calculate the lesion volume directly through AW VolumeShare5 system, and MRI was used to measure the tumor volume in transverse and sagittal position on T2WI by Reformat software. Taking MRI measurement results (MRIv) as the "gold standard", the differences between the results of different MTV measurement methods and MRI were compared, and the linear fitting and correlation analysis were conducted between MTVs and MRIv, and finally the ROC curve was drawn to compare the accuracy. Results: A total of 117 patients met the inclusion criteria. The MTV_30%method and the MTV_iterativemethod were closest to MRIv results, with linear correlation closer to the diagonal; the MTV_iterativemethod had the strongest correlation with MRIv (r=0.98, P=0.000), followed by MTV_30% (r=0.96, P=0.000); the ROC curve showed that the MTV_30%method and the MTV_iterative method were close to the measurement of lesions (z=0.145, P=0.885). Conclusion: MTV_iterativemethod and MTV_30%methods are more accurate in the calculation of lesion size and target delineation of cervical squamous cell carcinoma, which can be used as a reliable basis for the diagnosis and treatment of cervical squamous cell carcinoma.