Li P, Zhuang H, Mozley P D, Denittis A, Yeh D, Machtay M, Smith R, Alavi A
Department of Radiology, University of Pennsylvania, Philadelphia, USA.
Clin Nucl Med. 2001 Feb;26(2):131-5. doi: 10.1097/00003072-200102000-00008.
This study compared the effectiveness of fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography (CT), magnetic resonance imaging (MRI), or both for the assessment of recurrent squamous cell carcinoma of the head and neck. The value of quantifying the standardized uptake values (SUV) to distinguish recurrent neoplasm from inflammatory lesions and normal structures was also evaluated.
Forty-three patients with head and neck cancer were examined with F-18 FDG PET at least 4 months after their last course of radiation therapy (mean, 11 months). The SUVs were measured in visually identified regions of abnormally increased activity and were compared with the values in normal mucosa, the base of the tongue, and the hard palate to determine if an optimal cutoff value exists for diagnosing recurrence of malignant lesions. The final diagnosis of recurrence was made based on biopsy or at least 6 months' clinical follow-up.
FDG PET correctly detected recurrence in 20 of 22 patients who had 45 discrete lesions located in the field of the upper aerodigestive tract. Two false-negative and three false-positive results were identified. The accuracy of FDG PET was 88% (38 of 43 patients), compared with 66% (25 of 38 patients) for CT, MRI, or both. Although there was a significant difference of SUVs (P = 0.0036) between the recurrent lesions and normal structures, the optimal cutoff values were difficult to define.
Visual analysis of FDG PET is significantly more accurate in the diagnosis of recurrent squamous cell cancer of the head and neck than are CT or MRI. However, single SUV quantification does not significantly enhance efficacy.
本研究比较了氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与计算机断层扫描（CT）、磁共振成像（MRI）或两者联合用于评估头颈部复发性鳞状细胞癌的有效性。还评估了量化标准化摄取值（SUV）以区分复发性肿瘤与炎性病变及正常结构的价值。
43名头颈部癌患者在其最后一次放疗疗程至少4个月后（平均11个月）接受了F-18 FDG PET检查。在视觉上识别出的异常活性增加区域测量SUV，并与正常黏膜、舌根和硬腭的值进行比较，以确定是否存在诊断恶性病变复发的最佳临界值。复发的最终诊断基于活检或至少6个月的临床随访。
FDG PET正确检测出22例患者中20例的复发，这些患者在上呼吸道消化道区域有45个离散病变。发现2例假阴性和3例假阳性结果。FDG PET的准确率为88%（43例患者中的38例），而CT、MRI或两者联合的准确率为66%（38例患者中的25例）。尽管复发病变与正常结构之间的SUV存在显著差异（P = 0.0036），但最佳临界值难以确定。
在诊断头颈部复发性鳞状细胞癌方面，FDG PET的视觉分析比CT或MRI显著更准确。然而，单一的SUV量化并不能显著提高疗效。
