Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Human Resource Cultivation Center, Gunma University, Kiryu, Gunma, Japan Department of Radiology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; and.
J Nucl Med. 2015 Jan;56(1):16-21. doi: 10.2967/jnumed.114.144014. Epub 2014 Dec 4.
The accurate depiction of both biologic and anatomic profiles of tumors has long been a challenge in PET imaging. An inflammation, which is innate in the carcinogenesis of oral squamous cell carcinoma (OSCC), frequently complicates the image analysis because of the limitations of (18)F-FDG and maximum standardized uptake values (SUV(max)). New PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as well as (18)F-fluoro-α-methyltyrosine ((18)F-FAMT), a malignancy-specific amino acid-based PET radiotracer, are considered more comprehensive in tumor image analysis. Here, we showed the substantial effects of the intratumoral inflammatory process on (18)F-FDG uptake and further study the possibility of MTV and TLG to predict both tumor biology (proliferation activity) and anatomy (pathologic tumor volume).
(18)F-FDG and (18)F-FAMT PET images from 25 OSCC patients were analyzed. SUV(max) on the tumor site was obtained. PET volume computerized-assisted reporting was used to generate a volume of interest to obtain MTV and TLG for (18)F-FDG and total lesion retention (TLR) for (18)F-FAMT. The whole tumor dissected from surgery was measured and sectioned for pathologic analysis of tumor inflammation grade and Ki-67 labeling index.
The high SUV(max) of (18)F-FDG was related to the high inflammation grade. The SUV(max )ratio of (18)F-FDG to (18)F-FAMT was higher in inflammatory tumors (P < 0.05) whereas the corresponding value in tumors with a low inflammation grade was kept low. All (18)F-FAMT parameters were correlated with Ki-67 labeling index (P < 0.01). Pathologic tumor volume predicted from MTV of (18)F-FAMT was more accurate (R = 0.90, bias = 3.4 ± 6.42 cm(3), 95% confidence interval = 0.77-6.09 cm(3)) than that of (18)F-FDG (R = 0.77, bias = 8.1 ± 11.17 cm(3), 95% confidence interval = 3.45-12.67 cm(3)).
(18)F-FDG uptake was overestimated by additional uptake related to the intratumoral inflammatory process, whereas (18)F-FAMT simply accumulated in tumors according to tumor activity as evaluated by Ki-67 labeling index in OSCC.
本研究旨在评估（18）F-氟-α-甲基酪氨酸（（18）F-FAMT）正电子发射断层扫描（PET）在口腔鳞状细胞癌（OSCC）中的应用价值，及其与肿瘤代谢体积（MTV）和总病变糖酵解（TLG）的相关性。
纳入 25 例 OSCC 患者，分析其（18）F-FDG 和（18）F-FAMT PET 图像。获取肿瘤部位的最大标准摄取值（SUVmax）。采用 PET 容积计算机辅助报告系统生成感兴趣区，获取（18）F-FDG 的 MTV 和 TLG，以及（18）F-FAMT 的总病变滞留（TLR）。对手术切除的整个肿瘤进行测量和切片，用于肿瘤炎症分级和 Ki-67 标记指数的病理分析。
（18）F-FDG 的高 SUVmax 与高炎症分级相关。炎症肿瘤的（18）F-FDG/（18）F-FAMT SUVmax 比值较高（P<0.05），而炎症分级较低的肿瘤相应值较低。所有（18）F-FAMT 参数均与 Ki-67 标记指数相关（P<0.01）。（18）F-FAMT 的 MTV 预测的病理肿瘤体积更准确（R=0.90，偏倚=3.4±6.42cm3，95%置信区间=0.77-6.09cm3），优于（18）F-FDG（R=0.77，偏倚=8.1±11.17cm3，95%置信区间=3.45-12.67cm3）。
（18）F-FDG 摄取被肿瘤内炎症过程相关的额外摄取所高估，而（18）F-FAMT 则简单地根据 Ki-67 标记指数评估的肿瘤活性在 OSCC 中积聚于肿瘤内。
