Gődény Mária, Lengyel Zsolt, Polony Gábor, Nagy Zoltán Takácsi, Léránt Gergely, Zámbó Orsolya, Remenár Éva, Tamás László, Kásler Miklós
Department of Diagnostic Radiology, National Institute of Oncology, Ráth György street 7-9, Budapest, 1122, Hungary.
Department of Postgraduate Education and Scientific Research, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Cancer Imaging. 2016 Nov 4;16(1):38. doi: 10.1186/s40644-016-0097-x.
This study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis.
The study group comprised 38 retrospectively analysed consecutive patients with LN metastasis in the head and neck (HN) region without known primary tumours (PTs). Statistical values of 3T-MRI and of FDG-PET/CT scans were evaluated.
Of the 38 CUPs, conventional native T1-, T2-weighted and STIR sequences detected 6 PTs. Native sequences plus diffusion-weighted imaging (DWI) found 14-, and with fat suppression contrast-enhanced T1-weighted measurement as well as with the complex MPMRI found 15 primaries and with PET/CT 17 CUPs could be evaluated, respectively. The detection rates were 15.8, 36.8, 39.5, 39.5 and 44.7 % for conventional native MRI, native plus DWI, native with contrast-enhanced MRI (CE-MRI), for MPMRI, and for PET/CT, respectively. The overall detection rate proved by histology was 47.4 %. PET/CT provided the highest sensitivity (Sv: 94.4 %) but a lower specificity (Sp: 65.0 %), using MPMRI (Sv: 88.2 %) the specificity increased to 71.4 %. DWIincreased specificity of the native sequences (Sp: 76.2 %). Conventional native sequences plus DWI as well as 3T-MPMRI and PET/CT were same accurate (Acc: 79.0 %) and had similar likelihood ratio (LR: 3.42, 3.03 and 2.62) in detecting unknown PT sites.
The accuracy of FDG-PET/CT and MPMRI in case of CUP in finding the primary cancer in the neck regions is identical. While using PET/CT whole body information can be obtained in one examination. MPMRI shows the local soft tissue status more accurately. In cases of CUP PET/CT should be the first method of choice if it is available. MPMRI can clarify the exact primary tumor stage, and it can be advantageous in clarifying the prognostic factors, which is necessary in case of advanced tumor stage and when surgery is under consideration. In case low N stage is likely after the clinical examination and wait and see policy can be considered, MPMRI is recommended, and in this case the significance the of radiation free MPMRI is increasing.
本研究旨在确定多参数3T磁共振成像（MPMRI）和正电子发射断层扫描-计算机断层扫描（PET/CT）的多模态评估检测伴有颈部淋巴结（LN）转移的原发灶不明癌症（CUP）的能力。
研究组包括38例回顾性分析的连续性患者，这些患者头颈部（HN）区域有LN转移但无已知原发肿瘤（PT）。评估3T-MRI和FDG-PET/CT扫描的统计值。
在38例CUP中，传统的T1加权、T2加权和短TI反转恢复（STIR）序列检测到6个PT。T1加权、T2加权和STIR序列加上扩散加权成像（DWI）发现14个，T1加权脂肪抑制对比增强测量以及复杂的MPMRI发现15个原发灶，PET/CT分别可评估17个CUP。传统MRI、T1加权、T2加权和STIR序列加上DWI、T1加权脂肪抑制对比增强MRI（CE-MRI）、MPMRI以及PET/CT的检出率分别为15.8%、36.8%、39.5%、39.5%和44.7%。经组织学证实的总体检出率为47.4%。PET/CT的敏感性最高（Sv：94.4%），但特异性较低（Sp：65.0%），使用MPMRI（Sv：88.2%）时特异性提高到71.4%。DWI提高了T1加权、T2加权和STIR序列的特异性（Sp：76.2%）。传统的T1加权、T2加权和STIR序列加上DWI以及3T-MPMRI和PET/CT在检测不明PT部位时准确性相同（Acc：79.0%），似然比相似（LR：3.42、3.03和2.62）。
在CUP病例中，FDG-PET/CT和MPMRI在发现颈部区域原发癌方面的准确性相同。使用PET/CT可在一次检查中获得全身信息。MPMRI能更准确地显示局部软组织状况。对于CUP病例，如果有PET/CT，应作为首选方法。MPMRI可以明确原发肿瘤的确切分期，在明确预后因素方面具有优势，这在肿瘤晚期和考虑手术时是必要的。如果临床检查后可能处于低N分期且可考虑观察等待策略，推荐使用MPMRI，在这种情况下，无辐射的MPMRI的重要性日益增加。
