King A D, Ma B B, Yau Y Y, Zee B, Leung S F, Wong J K T, Kam M K M, Ahuja A T, Chan A T C
Department of Diagnostic Radiology & Organ Imaging, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Br J Radiol. 2008 Apr;81(964):291-8. doi: 10.1259/bjr/73751469.
The aim of this study was to determine whether the use of whole-body (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET)/CT alters staging and management of nasopharyngeal carcinoma (NPC) when compared with current staging practice. 52 patients with Stage III-IV NPC without distant metastases on chest X-ray/CT, abdominal ultrasound or bone scan were recruited for the study. Whole-body (18)F-FDG PET/CT and MRI of the head and neck were performed. The scans were compared for extent of the primary tumour (PT), cervical nodal metastases (CNM) and distant metastases (DM). Any discordance in results was assessed with respect to staging and impact on management. MRI and (18)F-FDG PET/CT scans were discordant in 28 (54%) patients. There was discordance in the extent of PT at 28 sites; in all sites, MRI showed more extensive tumour involving the nasopharynx (n = 8), skull base (n = 14), brain (n = 4) and orbit (n = 2). There was also variation among the extent of CNM in four nodes of the retropharyngeal region, with the nodes being positive on MRI. (18)F-FDG PET /CT did not identify any additional distant metastases but did identify a second primary tumour in the colon. The additional use of (18)F-FDG PET/CT did not "up-stage" the overall stage or change management in any patient. In conclusion, there is discordance between MRI and (18)F-FDG PET/CT, and the additional use of (18)F-FDG PET/CT for the current assessment of NPC at diagnosis does not appear to be justified in this cohort of patients.
本研究的目的是确定与当前分期实践相比，全身（18）F-氟-2-脱氧-D-葡萄糖（（18）F-FDG）正电子发射断层扫描（PET）/CT的使用是否会改变鼻咽癌（NPC）的分期和治疗管理。招募了52例胸部X线/CT、腹部超声或骨扫描未发现远处转移的III-IV期NPC患者进行研究。进行了全身（18）F-FDG PET/CT以及头颈部MRI检查。比较了扫描结果中原发肿瘤（PT）、颈部淋巴结转移（CNM）和远处转移（DM）的范围。评估了结果中任何不一致之处对分期和治疗管理的影响。MRI和（18）F-FDG PET/CT扫描在28例（54%）患者中结果不一致。在28个部位的PT范围存在不一致；在所有部位，MRI显示肿瘤累及鼻咽（n = 8）、颅底（n = 14）、脑（n = 4）和眼眶（n = 2）的范围更广。在咽后区的四个淋巴结中，CNM的范围也存在差异，MRI显示这些淋巴结为阳性（18）F-FDG PET/CT未发现任何额外的远处转移，但发现了结肠的第二原发肿瘤。（18）F-FDG PET/CT的额外使用并未使任何患者的总体分期“上调”或改变治疗管理。总之，MRI和（18）F-FDG PET/CT之间存在不一致，在这组患者中，目前在NPC诊断时额外使用（18）F-FDG PET/CT似乎没有依据。
