| Part ? Comparative study on the diagnostic cutoff value of tumor using radioactive counting ratio of lesion to different reference points by 18F-FDG coincidence SPECT/CT imagingObjective To compare the diagnostic cutoff value of tumor using radioactive counting ratio of lesion to different reference points by 18F-fluorodeoxyglucose(FDG)coincidence SPECT/CT imaging,and find the best semi-quantitative threshold for each reference point.Methods All 176 patients(438 lesions)with tumors[119 males and 57 females,aged 31 to 85,with an average(64.33±11.18)years old]underwent 18F-FDG coincidence SPECT/CT imaging.All 146 benign lesions and 292 malignant lesions were detected.The maximum radioactive counting in region of interest(ROI)of the same size as tumor lesion(target,T),liver(L),mediastinum(Me),normal tissue(N)on the opposite or around side,muscle(Mu)in the non-focal area of the right thigh root,and the corresponding site of the lesion:wall of chest(Wch),wall of abdomen(Wab),wall of pelvis(Wpe)and wall of cranium(Wcr)were measured,and then the tumor semi-quantitative uptake ratios:R1(T/L),R2(T/Me),R3(T/N),R4(T/Mu),R5(T/Wch),R6(T/Wab),R7(T/Wpe)and R8(T/Wcr)were calculated.Using SPSS 17.0 software,the receiver operating characteristic(ROC)curve analysis was performed to calculate the area under the curve(AUC)and determine the best cutoff value of the semi-quantitative uptake ratio of different reference points for benign and malignant tumors:R1 cutoff to R8cutoff.And their corresponding sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV),accuracy were calculate separately.Comparison of the difference between the diagnostic efficacy calculated by R1 cutoff to R8cutoff value and the diagnostic efficacy calculated by the target to no-target ratio of 2.5 in R1 to R8 groups using Cartesian inspection.Comparison of average numbers using two independent sample t test or non-parameter rank and test.Results When calculating the target to no-target ratio using live(R1),mediastinum(R2),normal tissue on the opposite or around side(R3),muscle in the non-focal area of the right thigh root(R4),and the corresponding site of the lesion:wall of chest(R5),wall of abdomen(R6),wall of pelvis(R7)and wall of cranium(R8)as reference point,the difference between malignant and benign lesions was statistically significant(validation value were 10.833,12.362,-10.981,-11.567,-9.813,5.282,3.234,4.927,all P<0.05).AUC1 to AUC8 were 0.868,0.882,0.822,0.839,0.869,0.990,0.779,0.877.Youden index were 0.644,0.644,0.524,0.575,0.620,0.923,0.456,0.618.And cutoff values were 1.25,1.45,1.95,3.55,2.40,2.85,4.05,2.15 separately.The sensitivity,specificity,PPV,NPV and accuracy of F-FDG coincidence SPECT/CT imaging in detecting tumor were Rl:85.62%,78.77%,88.97%,73.25%,83.33%;R2:88.36%,76.03%,88.05%,76.55%,84.25%;R3:84.59%,67.81%,84.01%,68.75%,79.00%;R4:84.93%,72.60%,86.11%,70.67%,80.82%,R5:84.57%,77.42%,86.71%,74.23%,81.96%;R6:92.31%,100%,100%,73.68%,93.67%;R7:69.09%,76.47%,90.48%,43.33%,70.83%;R8:80.00%,81.82%,66.67%,90.00%,81.25%.And the comparison which take 2.5 as a standard comparison with R1 to R8 showed,When using the liver(R1),mediastinum(R2),normal tissue on the opposite or around side(R3)as reference points,the diagnosis sensitivity,NPV and accuracy of R1 cutoff(1.25),R2cutoff(1.45)and R3cutoff(1.95)were obviously higher than cutoff value=2.5(?2=131.427,91.980,20.282,36.932,29.505,6.141,69.996,40.814 and 5.942,all P<0.05).But the specificity was lower than 2.5(?2=12.513,14.863,3.904,all P<0.05).Conclusion When 18F-FDG coincidence SPECT/CT imaging was used to diagnose benign and malignant tumors,if the live(T/L=1.25),mediastinum(T/Me=1.45)and normal tissue on the opposite or around side(T/N=1.95)was used as the reference point with different cutoff value separately,the sensitivity and accuracy might be higher than cutoff value=2.5.Part ? Analysis of influencing factors of radiation count ratios calculated by different reference points in 18F-FDG coincidence SPECT/CT imagingObjective The aim of this study was to research the factors influencing the diagnosis of benign and malignant tumors with radiation count ratios calculated by different reference points in 18F-fluorodeoxyglucose(FDG)coincidence SPECT/CT imaging.Methods Same as part ?,all 176 patients(438 lesions)with tumors underwent 18F-FDG coincidence SPECT/CT imaging.The tumor semi-quantitative uptake ratios:R1 to R8 were calculated.And then,the R1 to R8 values of the lesions were grouped by sex,age,fasting blood sugar concentration,course,treatment status,degree of differentiation,pathological type,and size of lesion(maximum cross-sectional length*vertical short diameter),respectively.Multiple regression analysis was performed with SAS 8.1.0.9 statistical software.Results(1)Single factor variance analysis results:When the T/no target(NT)ratio of 18F-FDG coincidence SPECT/CT imaging was calculated by a reference point of L,N on the opposite or around side,and Mu in the non-focal area of the right thigh root,the male group was significantly higher than the female group(test value=4.841,7.426,51.038,all P<0.001).The difference between age groups was only statistically significant when the Me(test value=2.673,P=0.047),Mu in the non-focal area of the right thigh root(test value=4.834,P=0.003),Wab(test value=3.060,P=0.033)and Wpe(test value=3.426,P=0.022)were used as reference points.The differences in fasting blood sugar concentration among the different groups were no statistically significant with each reference point.Except for the Wab,Wpe and Wcr as reference points,the differences between other groups of different tumor courses were statistically significant(test value=8.027,7.383,3.287,5.086,6.171,and P values were<0.001,<0.001,=0.011,=0.001,<0.001,respectively).The differences between the different treatment groups were statistically significant when the reference points were not the Wpe and Wcr(test value=10.118,27.434,48.223,342.432,5.867,3.765,and P values were<0.001,<0.001,<0.001,<0.001,=0.001,0.014,respectively).The difference between different differentiation groups was statistically significant except the Wpe and Wcr as the reference points(test value=32.550,47.048,13.029,9.687,23.313,3.879,and P values were<0.001,<0.001,<0.001,<0.001,<0.001,=0.028,respectively).The differences among the different pathological types were statistically significant with each reference point(test value=49.788,65.248,46.588,715.786,28.159,7.890,6.610,8.412,all P<0.001).There was statistically significance in groups of different size of lesions with each reference point(test value=45.609,58.053,28.672,3.086,31.778,4.857,7.295,4.306,P values were<0.001,<0.001,<0.001,=0.016,<0.001,=0.002,<0.001,=0.013 respectively).(2)Multiple regression analysis result:When using the L and Me as reference points,Y1(T/NT ratio)=1.548 51-0.140 44X3(fasting blood sugar concentration)+1.262 03X7(whether malignant carcinoma)+0.057 63X8(size of lesions),Y2=1.544 92-0.12336XG+1.442 70X7+0.066 07X8.When N on the opposite or around side and the Wch,Wab were used as the reference points,Y3=1.597 16+1.493 64X7+0.134 39X8,Y5=1.14691+3.280 48X7+0.137 04X8,Y6=1.195 59+3.400 51X7+0.063 36X8.When the reference points were Mu in the non-focal area of the right thigh root,the Wpe and Wcr,Y4=0.19756+0.771 22X7,Y7=3.352 94+3.017 89X7,Y8=1.395 65+2.804 35X7.Conclusion When the 18F-FDG coincidence SPECT/CT imaging was performed for tumors,the calculation of the T/NT ratio using different parts as reference points should consider different influencing factors,especially the fasting blood sugar concentration,pathological type,and the size of lesion.Part ? Analysis the value of 18F-FDG coincidence SPECT/CT imaging combined serum tumor markers in detecting tumorsObjective The aim of this study was to research the value of 18F-fluorodeoxyglucose(FDG)coincidence SPECT/CT imaging with radiation count ratios calculated by different reference points combined with serum tumor markers to diagnose the benign and malignant tumor,and the efficacy of individual and joint diagnosis was compared.Methods All 163 patients(399 lesions)with tumors[110 males and 53 females,aged 31 to 85,with an average(64.77±11.22)years old]underwent 18F-FDG coincidence SPECT/CT imaging.The tumor semi-quantitative uptake ratios:R1 to R8 were calculated using the same method of part I.Then the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy were calculate separately.Comparison of the difference between the diagnostic efficacy calculated by R1-8 cutoff value(previous research)and the diagnostic efficacy calculated by the serum tumor markers[carcinoembryonic antigen(CEA),alpha fetal protein(AFP),squamous cell carcinoma antigen(SCC),human testosterone 4,neuron-specific enolase(NSE),carbohydrate antigen(CA)125,CA15-3,CA19-9,CA242,CA50,CA72-4,ferritin,cytokeratin fragment 19(CYFRA21-1),free prostate specific antigen(FPSA),total prostate specific antigen(TPSA)]in R1 to R8 groups were analyzed using Cartesian inspection(?2)with SPSS 17.0 statistical software.Results(1)The sensitivity,specificity,PPV,NPV and accuracy of the diagnosis of tumors by 18F-FDG coincidence SPECT/CT imaging,serum tumor markers,and joint examination were:R1:18F-FDG imaging:84.50%,78.72%,87.90%,73.51%,82.46%,tumor markers:75.58%,34.04%,67.71%,43.24%,60.90%,joint examination:94.96%,25.53%,70.00%,73.47%,70.43%.R2:18F-FDG imaging:87.60%,75.89%,86.92%,76.98%,83.46%,tumor markers:75.58%,34.04%,67.71%,43.24%,60.90%,joint examination:95.74%,24.82%,69.97%,76.09%,70.68%.R3:18F-FDG imaging:83.72%,67.38%,82.44%,69.34%,77.94%,tumor markers:75.58%,34.04%,67.71%,43.24%,60.90%,joint examination:94.19%5 21.99%,68.84%,67.39%,68.67%,R4:18F-FDG imaging:84.11%,72.34%,84.77%,71.33%,79.95%,tumor markers:75.58%,34.04%,67.71%,43.24%,60.90%,joint examination:93.80%,23.40%,69.14%,67.35%,68.92%,R5:18F-FDG imaging:83.89%,76.67%,85.62%,74.19%,81.17%,tumor markers:81.88%,25.56%,64.55%,46.00%,60.67%,joint examination:95.97%,17.78%,65.90%,72.73%,66.53%,R6:18F-FDG imaging:91.23%,100%,100%,73.68%,92.96%,tumor markers:59.65%,50.00%,82.93%,23.33%,57.75%,joint examination:94.74%,50.00%,88.52%,70.00%,85,92%,R7:18F-FDG imaging:64.29%,76.47%,87.10%,46.43%,67.80%,tumor markers:78.57%,52.94%,80.49%,50.00%,71.19%,joint examination:88.10%,47.06%,80.43%,61.54%,76.27%,R8:18F-FDG imaging:80.00%,80.00%,66.67%,88.89%,80.00%,tumor markers:60.00%,45.00%,35.29%,69.23%,50.00%,joint examination:100%,45.00%,47.62%,100%,63.33%.(2)The sensitivity,specificity,PPV,NPV and accuracy of the 18F-FDG imaging was significantly higher than that of tumor markers in groups with R1,R2,R3,R4,R6(?2=5.273-57.231,all P<0.05)separately.The specificity,PPV,NPV and accuracy of the F-FDG imaging was significantly higher than that of tumor markers in groups with R5(?2=47.045,18.873,11.265,24.356,all P<0.05).The specificity and accuracy of the 18F-FDG imaging were significantly higher than that of tumor markers in R8 group(?2=5.227,5.934,all P<0.05).The sensitivity of the joint examination was significantly higher than that of the single 18F-FDG imaging in groups with Rl,R2,R3,R4,R5,R7(?2=15.329,11.188,14.378,12.327,12.009,6.563,all P<0.05),but the specificity,PPV and accuracy were lower except R7 group(?2=8.767-79.932,all P<0.05).The sensitivity of the joint examination was significantly higher than that of the single tumor makers in groups with R1,R2,R3,R4,R5,R6 and R8(?2=4.750-42.658,all P<0.05),The NPV and accuracy of the joint examination were significantly higher than that of the single tumor makers in groups with R1,R2,R3,R4 and R6(?2=5.279-45.656,all P<0.05).In addition,the specificity of the former was significantly lower than that of the latter in groups R3 and R4(?2=5.082,3.897,all P<0.05).Conclusion When the 18F-FDG coincidence SPECT/CT imaging was used to diagnose tumors with the liver(R1>or=1.25),mediastinum(R2>or=1.45),normal tissue on the opposite or around side(R3>or=1.95),muscle in the non-focal area of the right thigh root(R4>or=3.55)and the corresponding site of the lesion:wall of chest(R5>or=2.40),wall of pelvis(R7>or=4.05)as reference points,especially in the first five groups,if you could combine with various serum tumor markers,the sensitivity may be higher. |
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