Quantitative imaging in medicine and surgery · 2025
The diagnostic value of the multiparameter combination diagnostic model based on 2-[18F]FDG PET/CT metabolic parameters and clinical variables in distinguishing non-metastatic cholangiocarcinoma from cholangitis.
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Zhang Jingfeng, Cui Jianbo, Han Yun, Li Can, Pan Yue, Liu Jiajin, Xu Xiaodan, Sun Yabing, Wang Guanyun, Xu Baixuan
Аннотация
BACKGROUND: The clinical value of 2-[18F]fluoro-D-glucose {2-[18F]FDG} positron emission tomography (PET)/computed tomography (CT) has been demonstrated in the staging, evaluation of treatment response, and prediction of prognosis across various anatomical subtypes of cholangiocarcinoma (CCA). However, the same uptake of FDG in inflammatory diseases of the biliary tract may lead to misdiagnosis and unnecessary treatment. This study explored the 2-[18F]FDG PET/CT metabolic parameters in the differential diagnosis of different anatomical subtypes of non-metastatic CCA [including intrahepatic CAA (iCAA) and extrahepatic CCA (eCCA)] with those of the corresponding pathological location cholangitis.
METHODS: A total of 181 patients [137 patients with non-metastatic CCA (iCCA n=48, eCCA n=89) and 44 patients with cholangitis (intrahepatic n=15, extrahepatic n=29)] who underwent 2-[18F]FDG PET/CT were included. The baseline characteristics, clinical variables, and 2-[18F]FDG PET/CT metabolic parameters were collected. The discriminatory performance of both single biomarkers and the multi-parameter composite model was evaluated through receiver operating characteristic (ROC) curve analysis. The incremental diagnostic value achieved by combining multiple parameters was quantitatively measured using two established metrics: integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
RESULTS: The ROC curve analysis demonstrated that peak standardized uptake value (SUVpeak) [area under the ROC curve (AUC) =0.740, sensitivity =0.625, specificity =0.867] and metabolic tumor volume (MTV =0.669, sensitivity =0.655, specificity =0.663) had the highest differential diagnostic ability among 2-[18F]FDG PET/CT metabolic parameters in non-metastatic iCCA and intrahepatic cholangitis and non-metastatic eCCA and extrahepatic cholangitis, respectively. For the combined diagnostics model (intrahepatic) of cholecystolithiasis, carbohydrate antigen 19-9 (CA19-9) >37 ng/mL and SUVpeak showed an AUC of 0.853 (sensitivity =0.833, specificity =0.800); for the combined diagnostics model (extrahepatic) of cholecystolithiasis, fever, CA19-9 >37 ng/mL and MTV showed AUC of 0.863 (sensitivity =0.884, specificity =0.724). Through IDI and NRI, the diagnostic efficiency of the model was shown to be significantly improved compared to individual 2-[18F]FDG PET/CT metabolic parameters.
CONCLUSIONS: The 2-[18F]FDG PET/CT metabolic parameters and combined diagnostics models can help to distinguish between non-metastatic iCCA and intrahepatic cholangitis, and non-metastatic eCCA and extrahepatic cholangitis, respectively.
METHODS: A total of 181 patients [137 patients with non-metastatic CCA (iCCA n=48, eCCA n=89) and 44 patients with cholangitis (intrahepatic n=15, extrahepatic n=29)] who underwent 2-[18F]FDG PET/CT were included. The baseline characteristics, clinical variables, and 2-[18F]FDG PET/CT metabolic parameters were collected. The discriminatory performance of both single biomarkers and the multi-parameter composite model was evaluated through receiver operating characteristic (ROC) curve analysis. The incremental diagnostic value achieved by combining multiple parameters was quantitatively measured using two established metrics: integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
RESULTS: The ROC curve analysis demonstrated that peak standardized uptake value (SUVpeak) [area under the ROC curve (AUC) =0.740, sensitivity =0.625, specificity =0.867] and metabolic tumor volume (MTV =0.669, sensitivity =0.655, specificity =0.663) had the highest differential diagnostic ability among 2-[18F]FDG PET/CT metabolic parameters in non-metastatic iCCA and intrahepatic cholangitis and non-metastatic eCCA and extrahepatic cholangitis, respectively. For the combined diagnostics model (intrahepatic) of cholecystolithiasis, carbohydrate antigen 19-9 (CA19-9) >37 ng/mL and SUVpeak showed an AUC of 0.853 (sensitivity =0.833, specificity =0.800); for the combined diagnostics model (extrahepatic) of cholecystolithiasis, fever, CA19-9 >37 ng/mL and MTV showed AUC of 0.863 (sensitivity =0.884, specificity =0.724). Through IDI and NRI, the diagnostic efficiency of the model was shown to be significantly improved compared to individual 2-[18F]FDG PET/CT metabolic parameters.
CONCLUSIONS: The 2-[18F]FDG PET/CT metabolic parameters and combined diagnostics models can help to distinguish between non-metastatic iCCA and intrahepatic cholangitis, and non-metastatic eCCA and extrahepatic cholangitis, respectively.