Manca Gianpiero, Vanzi Eleonora, Rubello Domenico, Giammarile Francesco, Grassetto Gaia, Wong Ka Kit, Perkins Alan C, Colletti Patrick M, Volterrani Duccio
Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
Service of Medical Physics, University Hospital of Siena, Viale Bracci 16, Siena, 53100, Italy.
Eur J Nucl Med Mol Imaging. 2016 Jul;43(7):1360-75. doi: 10.1007/s00259-015-3294-0. Epub 2016 Jan 19.
(18)F-FDG PET/CT plays a crucial role in the diagnosis and management of patients with head and neck squamous cell cancer (HNSCC). The major clinical applications of this method include diagnosing an unknown primary tumour, identifying regional lymph node involvement and distant metastases, and providing prognostic information. (18)F-FDG PET/CT is also used for precise delineation of the tumour volume for radiation therapy planning and dose painting, and for treatment response monitoring, by detecting residual or recurrent disease. Most of these applications would benefit from a quantitative approach to the disease, but the quantitative capability of (18)F-FDG PET/CT is still underused in HNSCC. Innovations in PET/CT technology promise to overcome the issues that until now have hindered the employment of dynamic procedures in clinical practice and have limited "quantification" to the evaluation of standardized uptake values (SUV), de facto a semiquantitative parameter, the limits of which are well known to the nuclear medicine community. In this paper the principles of quantitative imaging and the related technical issues are reviewed so that professionals involved in HNSCC management can reflect on the advantages of "true" quantification. A discussion is then presented on how semiquantitative information is currently used in clinical (18)F-FDG PET/CT applications in HNSCC, by discussing the improvements that could be obtained with more advanced and "personalized" quantification techniques.
（18）F - FDG PET/CT在头颈部鳞状细胞癌（HNSCC）患者的诊断和管理中起着关键作用。该方法的主要临床应用包括诊断不明原发肿瘤、识别区域淋巴结受累和远处转移，以及提供预后信息。（18）F - FDG PET/CT还用于精确勾勒肿瘤体积以进行放射治疗计划和剂量描绘，以及通过检测残留或复发性疾病来监测治疗反应。这些应用中的大多数将受益于对疾病的定量方法，但（18）F - FDG PET/CT的定量能力在HNSCC中仍未得到充分利用。PET/CT技术的创新有望克服迄今为止阻碍动态程序在临床实践中应用的问题，并将“定量”限制在标准化摄取值（SUV）的评估上，事实上SUV是一个半定量参数，其局限性核医学领域是众所周知的。本文回顾了定量成像的原理和相关技术问题，以便参与HNSCC管理的专业人员能够思考“真正”定量的优势。然后通过讨论更先进和“个性化”定量技术可能带来的改进，阐述目前半定量信息在HNSCC临床（18）F - FDG PET/CT应用中的使用情况。
