Département d'imagerie médicale, Institut Gustave-Roussy, 94805, Villejuif, France.
UMR1015, Institut Gustave Roussy, 94800, Villejuif, France.
Eur Radiol. 2018 Apr;28(4):1761-1770. doi: 10.1007/s00330-017-5063-x. Epub 2017 Oct 30.
We assessed whether quantitative imaging biomarkers derived from fluorodeoxyglucose-positron emission tomography (18F-FDG PET) could be extracted from perineural spread (PNS) in head and neck malignancies (HNM) to improve patient risk stratification.
A case-control exploratory study (1:2 ratio) enrolled 81 patients with FDG-avid HNM. The case-group comprised 28 patients with documented PNS (reference: expert consensus), including 14 squamous cell carcinomas (SCC). Imaging biomarkers were extracted from the PNS on 18F-FDG PET, CT-scan, and MRI. The control-group enrolled 53 SCCs. The Cox proportional-hazards regression model explored the association with overall survival by univariate and multivariate analyses.
The rate of PNS detection by 18F-FDG PET was 100% in the case-group. Quantitative imaging biomarkers were not associated with the presence of sensory (p>0.20) or motor (p>0.10) symptoms. In SCC patients (case: 14; control: 53), PNS was associated with a hazard ratio of death of 5.5 (95%CI: 1.4:20.9) by multivariate analysis. Increased cranial nerve SUV was significantly associated with poorer overall survival by univariate analysis (p=0.001).
Our pilot study showed the feasibility of extracting 18F-FDG PET biomarkers from PNS in FDG-avid HNM. Our results encourage the development of new PET/CT- or PET/MRI-guided management strategies in further prospective studies.
• 18F-FDG PET/CT detects PNS in FDG-avid HNM. • PNS metabolism is more heterogeneous than healthy tissue. • PNS diagnosis is crucial: most patients were asymptomatic, N0 and M0. • PNS diagnosis is associated with poorer overall survival in SCC. • PET/CT- or PET/MRI-guided management strategies should be evaluated.
我们评估了源自头颈部恶性肿瘤（HNM）神经周围扩散（PNS）的氟脱氧葡萄糖正电子发射断层扫描（18F-FDG PET）定量成像生物标志物是否可用于改善患者风险分层。
一项病例对照探索性研究（1:2 比例）纳入了 81 例 FDG 摄取的 HNM 患者。病例组包括 28 例有记录的 PNS 患者（参考：专家共识），其中包括 14 例鳞状细胞癌（SCC）。从 18F-FDG PET、CT 扫描和 MRI 上的 PNS 提取成像生物标志物。对照组纳入了 53 例 SCC。Cox 比例风险回归模型通过单变量和多变量分析探讨了与总生存的相关性。
病例组中 18F-FDG PET 检测 PNS 的检出率为 100%。定量成像生物标志物与感觉（p＞0.20）或运动（p＞0.10）症状的存在无关。在 SCC 患者中（病例：14 例；对照：53 例），多变量分析显示 PNS 与死亡风险比为 5.5（95%CI：1.4:20.9）相关。单变量分析显示颅神经 SUV 增加与总生存较差显著相关（p=0.001）。
我们的初步研究表明，从 FDG 摄取的 HNM 中的 PNS 提取 18F-FDG PET 生物标志物是可行的。我们的结果鼓励在进一步的前瞻性研究中开发新的 PET/CT 或 PET/MRI 引导的管理策略。
18F-FDG PET/CT 可检测 FDG 摄取的 HNM 中的 PNS。
PNS 的代谢比健康组织更为异质。
PNS 的诊断至关重要：大多数患者无症状、N0 和 M0。
PNS 的诊断与 SCC 患者的总体生存率较差相关。
应评估 PET/CT 或 PET/MRI 引导的管理策略。
