超声、¹⁸F-FDG-PET/CT以及¹⁸F-FDG-PET-MR融合图像联合弥散加权成像（DWI）检测头颈部鳞状细胞癌（HNSCC）颈部淋巴结转移的诊断准确性
Diagnostic accuracy of ultrasound, ¹⁸F-FDG-PET/CT, and fused ¹⁸F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC.
作者信息
Heusch Philipp, Sproll Christoph, Buchbender Christian, Rieser Elena, Terjung Jan, Antke Christina, Boeck Inga, Macht Stephan, Scherer Axel, Antoch Gerald, Heusner Till A, Handschel Jörg
机构信息
Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany.
出版信息
Clin Oral Investig. 2014 Apr;18(3):969-78. doi: 10.1007/s00784-013-1050-z. Epub 2013 Jul 27.
OBJECTIVE
This study aimed to compare (18)F-fluorodesoxyglucose positron emission tomography/MRI ((18)F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), (18)F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC).
MATERIALS AND METHODS
Eighteen patients prospectively underwent ultrasound examination, (18)F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference.
RESULTS
The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for (18)F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for (18)F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for (18)F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between (18)F-FDG-PET-MRI and (18)F-FDG-PET/CT (p = 0.839) and between (18)F-FDG-PET-MRI plus DWI and (18)F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than (18)F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between (18)F-FDG-PET-MRI and US (p = 0.223) or (18)F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by (18)F-FDG-PET-MRI in eight patients, (18)F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and (18)F-FDG-PET/CT in five out of 18 patients.
CONCLUSION
Software-based fusion of (18)F-FDG-PET-MRI and (18)F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and (18)F-FDG-PET/CT.
CLINICAL RELEVANCE
Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.
目的
本研究旨在比较¹⁸F - 氟脱氧葡萄糖正电子发射断层扫描/磁共振成像（¹⁸F - FDG - PET - MRI）融合图像，包括扩散加权成像（DWI）、¹⁸F - FDG - PET/CT和超声（US）在头颈部鳞状细胞癌（HNSCC）患者淋巴结分期中的表现。
材料与方法
18例患者在口腔肿瘤切除和双侧颈清扫术前前瞻性地接受了超声检查、¹⁸F - FDG - PET/CT和MRI检查。PET数据集与增强T1加权MR图像融合。计算所有成像方式检测淋巴结的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。此外，计算所有方法正确N分期的准确性。详细的组织病理学作为参考标准。
结果
超声检测淋巴结转移的敏感性、特异性、PPV、NPV和准确性分别为63%、99%、86%、96%和95%；¹⁸F - FDG - PET/CT分别为30%、97%、56%、92%和90%；¹⁸F - FDG - PET - MRI分别为52%、96%、59%、94%和91%；¹⁸F - FDG - PET - MRI加DWI分别为53%、97%、67%、95%和92%。¹⁸F - FDG - PET - MRI与¹⁸F - FDG - PET/CT之间（p = 0.839）以及¹⁸F - FDG - PET - MRI加DWI与¹⁸F - FDG - PET/CT之间（p = 0.286）在检测淋巴结转移的诊断准确性上无显著差异。超声比¹⁸F - FDG - PET/CT显著更准确（p = 0.009），而¹⁸F - FDG - PET - MRI与超声之间（p = 0.223）或¹⁸F - FDG - PET - MRI加DWI与超声之间（p = 0.115）无显著差异。¹⁸F - FDG - PET - MRI正确对8例患者进行了淋巴结分期，¹⁸F - FDG - PET - MRI加DWI正确对9例患者进行了分期，超声正确对12例患者进行了分期，¹⁸F - FDG - PET/CT在18例患者中正确对5例进行了分期。
结论
与超声和¹⁸F - FDG - PET/CT相比，基于软件的¹⁸F - FDG - PET - MRI融合以及¹⁸F - FDG - PET - MRI加DWI可能不会提高口腔恶性肿瘤患者的淋巴结检测和N分期性能。
临床意义
即使在不久的将来，先进的成像方式也不会取代颈部淋巴结的手术分期。
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