Baek Chung-Hwan, Chung Man Ki, Son Young-Ik, Choi Joon Young, Kim Hyung-Jin, Yim Yoo Jeong, Ko Young Hyeh, Choi Jeesun, Cho Jae Keun, Jeong Han-Sin
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Nucl Med. 2008 Sep;49(9):1422-8. doi: 10.2967/jnumed.108.051649. Epub 2008 Aug 14.
The purpose of this study was to investigate the clinical usefulness of PET/CT or CT-attenuated PET in the evaluation of patients with oral cavity cancer (OCC) in whom dental artifacts distorted the conventional CT or MR images of the oral cavity.
A PET/CT scan, in addition to a CT or MRI scan, was performed in 69 patients with OCC who had dentures or dental implants. A total of 64 PET/CT, 64 CT, and 27 MR images were analyzed including images from scans performed on 40 patients with OCC without dental artifacts on the conventional images; these were used for comparison. The CT-attenuated PET scan for the detection of primary tumors was compared with the CT or MRI scan. We also evaluated the correlation between the PET/CT volume and the pathologic volume using a regression analysis. In addition, subgroup analysis was performed to determine what proportion of subjects benefited most from the PET/CT.
CT-attenuated PET detected more primary tumors than did CT in patients with OCC with dental artifacts (95.3% vs. 75.0%, respectively; P=0.0016). PET/CT volume with a standardized uptake value (SUV) cutoff point of 3.5 predicted the pathologic volume more accurately than did the other cutoff points in patients with OCC with or without artifacts. After comparing pathologic volume and PET/CT(SUV 3.5) volume, the following regression equation was developed: log (pathologic volume)=0.6 x log (PET/CT(SUV 3.5) volume) + 1.3 (R(2) = 0.42, P<0.0001). Subgroup analysis showed that the prediction of the pathologic volume from the PET/CT images was more reliable for tumors that were more than 2 cm in depth (R(2)=0.72).
For patients with OCC with dental artifacts on the conventional imaging, PET/CT could provide useful clinical information about the primary tumors, particularly in cases with advanced tumors.
本研究的目的是调查正电子发射断层显像/计算机断层扫描（PET/CT）或CT衰减PET在评估口腔癌（OCC）患者中的临床实用性，这些患者的假牙或牙种植体导致牙齿伪影使口腔的传统CT或磁共振成像（MR）图像失真。
对69例佩戴假牙或有牙种植体的OCC患者进行了PET/CT扫描，同时还进行了CT或磁共振成像扫描。共分析了64例PET/CT、64例CT和27例MR图像，其中包括对40例传统图像上无牙齿伪影的OCC患者扫描所得的图像；这些图像用于比较。将用于检测原发性肿瘤的CT衰减PET扫描与CT或磁共振成像扫描进行比较。我们还使用回归分析评估了PET/CT体积与病理体积之间的相关性。此外，进行了亚组分析以确定哪些受试者从PET/CT中获益最大。
在有牙齿伪影的OCC患者中，CT衰减PET检测到的原发性肿瘤比CT更多（分别为95.3%和75.0%；P = 0.0016）。标准化摄取值（SUV）截断点为3.5时的PET/CT体积比其他截断点更准确地预测了有或无伪影的OCC患者的病理体积。在比较病理体积和PET/CT（SUV为3.5）体积后，得出以下回归方程：log（病理体积）= 0.6×log（PET/CT（SUV为3.5）体积）+ 1.3（R² = 0.42，P < 0.0001）。亚组分析表明，对于深度超过2 cm的肿瘤，从PET/CT图像预测病理体积更可靠（R² = 0.72）。
对于传统成像上有牙齿伪影的OCC患者，PET/CT可为原发性肿瘤提供有用的临床信息，尤其是在肿瘤晚期的病例中。
