Kubota Kazuo, Yokoyama Jyunkichi, Yamaguchi Keiichiro, Ono Shuichi, Qureshy Ahmad, Itoh Masatoshi, Fukuda Hiroshi
Division of Nuclear Medicine, Department of Radiology, International Medical Center of Japan, 1-21-1 Toyama, 162-8655 Shinjuku, Tokyo, Japan.
Eur J Nucl Med Mol Imaging. 2004 Apr;31(4):590-5. doi: 10.1007/s00259-003-1408-6. Epub 2004 Jan 14.
In advanced head and neck cancer, an organ-sparing approach comprising radiation therapy combined with intra-arterial chemotherapy has become an important technique. However, the high incidence of residual masses after therapy remains a problem. In this study, we prospectively evaluated the use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) delayed imaging for the detection of recurrence of head and neck cancer after radio-chemotherapy, and compared the FDG-PET results with those of magnetic resonance imaging (MRI) or computed tomography (CT). Forty-three lesions from 36 patients with head and neck cancer suspected to represent recurrence after radio-chemotherapy (median interval from therapy, 4 months) were studied. PET was performed at 2 h after FDG injection, and evaluated. The results were compared to those of contrast studies with MRI or CT performed within 2 weeks of the PET study, and to histological diagnosis (in all patients suspected of having recurrence) or clinical diagnosis. The lesion-based sensitivity (visual interpretation) and negative predictive value of FDG-PET (88% and 91%, respectively) were higher than those of MRI/CT (75% and 67% respectively). The specificity, accuracy and positive predictive value of FDG-PET (78%, 81% and 70%, respectively) were significantly ( P<0.05) higher than those of MRI/CT (30%, 47% and 39% respectively). Three of six patients with false positive findings had post-therapy inflammation. Receiver operating characteristic (ROC) analysis showed that retrospective evaluation with the standardised uptake ratio yielded the best results (sensitivity 87.5%, specificity 81.5%), followed by visual interpretation and then the tumour/neck muscle ratio. An FDG-PET delayed imaging protocol yielded significantly better results for the detection of recurrence of head and neck cancer after radio-chemotherapy than MRI/CT. Because of the high negative predictive value of FDG-PET (91.3%), if PET is negative, further invasive procedures may be unnecessary.
在晚期头颈癌中，一种包括放射治疗联合动脉内化疗的器官保留方法已成为一项重要技术。然而，治疗后残留肿块的高发生率仍然是一个问题。在本研究中，我们前瞻性评估了2-[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）延迟成像用于检测头颈癌放化疗后复发的情况，并将FDG-PET结果与磁共振成像（MRI）或计算机断层扫描（CT）结果进行比较。对36例疑似放化疗后复发的头颈癌患者的43个病灶进行了研究（治疗后的中位间隔时间为4个月）。在注射FDG后2小时进行PET检查并评估结果。将结果与PET检查后2周内进行的MRI或CT对比研究结果以及组织学诊断（所有疑似复发的患者）或临床诊断结果进行比较。基于病灶的FDG-PET敏感性（视觉解读）和阴性预测值（分别为88%和91%）高于MRI/CT（分别为75%和67%）。FDG-PET的特异性、准确性和阳性预测值（分别为78%、81%和70%）显著高于MRI/CT（分别为30%、47%和39%）（P<0.05）。6例假阳性结果的患者中有3例存在治疗后炎症。受试者操作特征（ROC）分析表明，使用标准化摄取值进行回顾性评估的结果最佳（敏感性87.5%，特异性81.5%），其次是视觉解读，然后是肿瘤/颈部肌肉比值。对于检测头颈癌放化疗后复发，FDG-PET延迟成像方案的结果明显优于MRI/CT。由于FDG-PET的阴性预测值较高（91.3%），如果PET结果为阴性，可能无需进一步的侵入性检查。
