Department of Radiology, Yokohama City University, 3-9 Fukuura, Yokohama, Japan.
Eur J Nucl Med Mol Imaging. 2009 Sep;36(9):1417-24. doi: 10.1007/s00259-009-1127-8. Epub 2009 Apr 8.
The aim of our study was to prospectively evaluate whether intravenous contrast media in integrated positron emission tomography and computed tomography (PET/CT) with (18)F-fluorodeoxyglucose ((18)F-FDG) significantly contributes to evaluation of primary head and neck cancers compared with unenhanced PET/CT, regional contrast-enhanced CT of head and neck (neck CE-CT) and regional magnetic resonance imaging of head and neck (neck MRI).
Subjects were 42 consecutive patients (35 men, 7 women; age range: 36-91 years) with biopsy-proven primary head and neck cancers. Lesion detection of primary and nodal sites and TNM classification were assessed on a per-patient basis. McNemar test and kappa statistics were employed for statistical analyses.
Forty patients (95%) were successfully followed up: 24 patients had nodal disease and 3 had distant metastasis. Contrast-enhanced and unenhanced PET/CT detected 98 and 95% of the primary tumours, respectively, and both detected 92% of patients with nodal disease, which revealed no statistically significant difference. Accuracy for T status was 75 and 73%, respectively, which proved significantly more accurate than neck CE-CT, which had an accuracy of 53% (p = 0.0133 and 0.0233, respectively). Neck MRI correctly classified the T status in 58% of patients; however, no statistically significant difference was found between PET/CT and neck MRI. Contrast-enhanced PET/CT, unenhanced PET/CT, neck CT and neck MRI correctly staged the N status in 90, 90, 79 and 90% of patients, respectively, with no statistically significant difference. Overall TNM classification was correctly classified in 68 and 65% of patients, respectively. Weighted kappa values between enhanced and unenhanced PET/CT for primary tumour detection, nodal detection, T status and N status were 0.655, 1.000, 0.935 and 1.000, respectively.
We found almost perfect correlation between enhanced and unenhanced PET/CT for lesion detection and initial staging of primary head and neck cancers. Routine contrast administration for PET/CT imaging may not be justified.
本研究旨在前瞻性评估与未经增强的 PET/CT、头颈部区域增强 CT（颈 CE-CT）和头颈部区域磁共振成像（颈 MRI）相比，静脉内对比剂在正电子发射断层扫描和计算机断层扫描（PET/CT）联合（18）F-氟脱氧葡萄糖（（18）F-FDG）中的应用是否对头颈部原发性癌症的评估具有显著意义。
本研究纳入了 42 例经活检证实的头颈部原发性癌症患者（35 名男性，7 名女性；年龄范围：36-91 岁）。基于每位患者的情况，评估了原发灶和淋巴结部位的病变检测以及 TNM 分类。采用 McNemar 检验和 Kappa 统计分析进行统计学分析。
40 例患者（95%）成功随访：24 例患者有淋巴结疾病，3 例患者有远处转移。增强和未经增强的 PET/CT 分别检测到 98%和 95%的原发性肿瘤，并且均检测到 92%的淋巴结疾病患者，这两者之间没有统计学上的显著差异。T 分期的准确性分别为 75%和 73%，这明显优于颈 CE-CT 的 53%（p=0.0133 和 0.0233）。颈 MRI 正确分类了 58%的患者的 T 分期；然而，PET/CT 与颈 MRI 之间没有统计学上的显著差异。增强和未经增强的 PET/CT、颈 CT 和颈 MRI 分别对头颈部 N 分期的正确分类率为 90%、90%、79%和 90%，无统计学差异。总体 TNM 分类的正确分类率分别为 68%和 65%。增强和未经增强的 PET/CT 在检测原发性肿瘤、淋巴结、T 分期和 N 分期方面的加权 Kappa 值分别为 0.655、1.000、0.935 和 1.000。
我们发现增强和未经增强的 PET/CT 在检测头颈部原发性癌症的病变和初始分期方面几乎存在完美相关性。对于 PET/CT 成像，常规给予对比剂可能没有理由。
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