Synergistic application of pulmonary 18 F-FDG PET/HRCT and computer-based CT analysis with conventional severity measures to refine current risk stratification in idiopathic pulmonary fibrosis (IPF)
European Journal of Nuclear Medicine and Molecular Imaging(2019)
摘要
Introduction To investigate the combined performance of quantitative CT (qCT) following a computer algorithm analysis (IMBIO) and 18 F-FDG PET/CT to assess survival in patients with idiopathic pulmonary fibrosis (IPF). Methods A total of 113 IPF patients (age 70 ± 9 years) prospectively and consecutively underwent 18 F-FDG PET/CT and high-resolution CT (HRCT) at our institution. During a mean follow-up of 29.6 ± 26 months, 44 (48%) patients died. As part of the qCT analysis, pattern evaluation of HRCT (using IMBIO software) included the total extent (percentage) of the following features: normal-appearing lung, hyperlucent lung, parenchymal damage (comprising ground-glass opacification, reticular pattern and honeycombing), and the pulmonary vessels. The maximum (SUV max ) and minimum (SUV min ) standardized uptake value (SUV) for 18 F-FDG uptake in the lungs, and the target-to-background (SUV max /SUV min ) ratio (TBR) were quantified using routine region-of-interest (ROI) analysis. Pulmonary functional tests (PFTs) were acquired within 14 days of the PET/CT/HRCT scan. Kaplan–Meier (KM) survival analysis was used to identify associations with mortality. Results Data from 91 patients were available for comparative analysis. The average ± SD GAP [gender, age, physiology] score was 4.2 ± 1.7 (range 0–8). The average ± SD SUV max , SUV min , and TBR were 3.4 ± 1.4, 0.7 ± 0.2, and 5.6 ± 2.8, respectively. In all patients, qCT analysis demonstrated a predominantly reticular lung pattern (14.9 ± 12.4%). KM analysis showed that TBR ( p = 0.018) and parenchymal damage assessed by qCT ( p = 0.0002) were the best predictors of survival. Adding TBR and qCT to the GAP score significantly increased the ability to differentiate between high and low risk ( p < 0.0001). Conclusion 18 F-FDG PET and qCT are independent and synergistic in predicting mortality in patients with IPF.
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关键词
Idiopathic pulmonary fibrosis, Quantitative computer analysis, Positron emission tomography, Fluorine-18 FDG and pulmonary vessels
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