Dokument: Inzidenteller Traceruptake in 18F-FDG-PET/CT Untersuchungen: Nutzen der kontrastmittelgestützten Computertomographie zur diagnostischen Einordnung in Korrelation zur Koloskopie

Titel:

Inzidenteller Traceruptake in 18F-FDG-PET/CT Untersuchungen: Nutzen der kontrastmittelgestützten Computertomographie zur diagnostischen Einordnung in Korrelation zur Koloskopie

URL für Lesezeichen:

https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=65269

URN (NBN):

urn:nbn:de:hbz:061-20240408-090015-3

Kollektion:

Dissertationen

Sprache:

Deutsch

Dokumententyp:

Wissenschaftliche Abschlussarbeiten » Dissertation

Medientyp:

Text

Autor:

Kour, Firas Saleh [Autor]

Dateien:

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Dateien vom 20.03.2024 / geändert 20.03.2024

Beitragende:

Kirchner, Julian [Gutachter]
Matuschek, Christiane [Gutachter]

Dewey Dezimal-Klassifikation:

600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit

Beschreibungen:

Ziel dieser Dissertation war es, den Nutzen morphologischer Informationen aus der kontrastmittelgestützten Computertomographie (CT) für die weitere Charakterisierung der zufälligen fokalen FDG-Aufnahme im Kolon in 18F-Fluordesoxyglucose-Positronenemissionstomographie (18F-FDG-PET) /CT-Untersuchungen zu evaluieren. Die vorliegende retrospektive Studie schloss 125 Patienten (weiblich: n = 53, männlich: n = 72) ein, bei denen innerhalb von sechs Monaten nach kontrastmittelgestützter PET/CT-Untersuchung eine Koloskopie durchgeführt wurde. Alle PET/CT-Untersuchungen wurden zunächst auf eine umschriebene Tracer-Aufnahme im Bereich des Kolons analysiert. Anschließend wurden die sich daraus ergebenden Befunde mit morphologischen Veränderungen der Kolonwand (zum Beispiel Wandverdickung, intraluminale knotige Veränderungen und Kontrastmittelaufnahme) aus den kontrastmittelgestützten CT-Bildern verglichen. Die zugehörigen Koloskopieberichte und Pathologiebefunde wurden hinsichtlich benigner, entzündlicher, polypoider, prämaligner und maligner Läsionen ausgewertet und dienten als Referenzstandard. Es wurden die Sensitivität, die Spezifität, der positive (PPV) und negative (NPV) prädiktive Wert und die diagnostische Genauigkeit zum Nachweis therapeutisch relevanter Befunde für (a) eine alleinige fokale Tracer-Aufnahme sowie (b) eine fokale Tracer-Aufnahme mit korrelierenden, kontrastmittelgestützten CT-Befunden berechnet. Im Ergebnis konnte bei 38,4% (48/125) der Patienten in 67 Läsionen eine fokale 18F-FDG-Aufnahme festgestellt werden. Bei elf Patienten wurden maligne Läsionen endoskopisch und histopathologisch diagnostiziert, neun von diesen wurden durch die fokale 18F-FDG-Aufnahme nachgewiesen. Insgesamt wurden 34 Läsionen, entweder prä- oder maligne, mit Auswirkungen auf das kurz- oder langfristige Patientenmanagement festgestellt. Von den prämalignen wurden 14, von den malignen Läsionen zwei übersehen. Die Sensitivität betrug 54%, die Spezifität konnte mit 69% festgestellt werden. Der PPV, NPV und die diagnostische Genauigkeit für die alleinige 18F-FDG-Aufnahme für diese kombinierte Gruppe betrugen 29%, 85% und 65%. Entsprechende Ergebnisse für die fokale 18F-FDG-Aufnahme mit korrelierenden CT-Befunden waren 38%, 90%, 50%, 86% und 80%. Dies führte zu einem statistisch signifikanten Unterschied für die diagnostische Genauigkeit (p = 0,0001). Durch die Analyse zusätzlicher morphologischer Informationen aus der kontrastmittelgestützten CT-Bildgebung kann die Spezifität der fokalen 18F-FDG-Aufnahme im Kolon für präkanzeröse und kanzeröse Läsionen zwar gesteigert werden, führt jedoch gleichzeitig zu einem nicht unerheblichen Verlust an Sensitivität. Daher sollte jede fokale18F-FDG-Aufnahme im Bereich des Kolons ergänzend mit Hilfe der Koloskopie überprüft werden.

The aim of this study was to evaluate the utility of morphologic information from contrast-enhanced computed tomography (CT) for further characterization of incidental focal FDG uptake in the colon in 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/CT examinations. The present retrospective study included 125 patients (female: n = 53, male: n = 72) who underwent colonoscopy within six months of contrast-enhanced PET/CT examination. All PET/CT examinations were first analysed for circumscribed tracer uptake in the colon. Subsequently, the resulting findings were compared with morphologic changes of the colon wall (for example, wall thickening, intraluminal nodular changes, and contrast uptake) from the contrast-enhanced CT images. The associated colonoscopy reports and pathology findings were evaluated for benign, inflammatory, polypoid, premalignant, and malignant lesions and served as a reference standard. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, as well as diagnostic accuracy for detecting therapeutically relevant findings were calculated for (a) focal tracer imaging alone and (b) focal tracer imaging with correlating contrast-enhanced CT findings. As a result, focal 18F-FDG uptake was detected in 67 lesions in 38.4% (48/125) of patients. Malignant lesions were diagnosed endoscopically and histopathologically in 11 patients, nine of whom were detected by focal 18F-FDG uptake. A total of 34 lesions, either premalignant or malignant, were identified with implications for short- or long-term patient management. Of the premalignant lesions, 14 were missed, and of the malignant lesions, two were missed. Sensitivity was 54%, and specificity was found to be 69%. The PPV, NPV, and diagnostic accuracy for 18F-FDG uptake alone for this combined group were 29%, 85%, and 65%, respectively. Corresponding results for focal 18F-FDG uptake with correlating CT findings were 38%, 90%, 50%, 86%, and 80%. This resulted in a statistically significant difference for diagnostic accuracy (p = 0.0001). Analysis of additional morphologic information from contrast-enhanced CT imaging may increase the specificity of focal 18F-FDG imaging in the colon for precancerous and cancerous lesions, but at the same time results in a loss of sensitivity. Therefore, any focal 18F-FDG uptake in the colon should be complementarily verified by colonoscopy.

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Heinrich-Heine-Universität Düsseldorf

Dokument: Inzidenteller Traceruptake in 18F-FDG-PET/CT Untersuchungen: Nutzen der kontrastmittelgestützten Computertomographie zur diagnostischen Einordnung in Korrelation zur Koloskopie