Kim Yong-Il, Cheon Gi Jeong, Kang Seo Young, Paeng Jin Chul, Kang Keon Wook, Lee Dong Soo, Chung June-Key
Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
EJNMMI Res. 2018 Jan 10;8(1):2. doi: 10.1186/s13550-018-0357-9.
The aim of this study was to determine the usefulness of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous F-fluorodeoxyglucose (FDG) PET/MRI for the prediction of treatment failure in surgically resected head and neck cancer. We hypothesized that PET parameters corrected by tumor cellularity (combined PET/MRI parameters) could predict the prognosis. On regional PET, maximum standardized uptake value (SUVmax) was measured as metabolic parameters. In addition, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were checked as metabolo-volumetric parameters. Mean apparent diffusion coefficient (ADCmean) of tumor was evaluated as the MRI parameter on the ADC map. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated as combined PET/MRI parameters. PET, MRI, and combined PET/MRI parameters were compared with clinicopathologic parameters in terms of treatment failure.
Seventy-two patients (mean age = 55.9 ± 14.6 year, M: F = 45: 27) who underwent simultaneous F-FDG PET/MRI before head and neck cancer surgery were retrospectively enrolled. Twenty-two patients (30.6%) showed tumor treatment failure after head and neck cancer surgery (mean treatment failure = 13.0 ± 7.0 months). In the univariate analysis, MTV (P = 0.044) and ratios between metabolo-volumetric parameters and ADC (MTV/ADCmean, P = 0.022; TLG/ADCmean, P = 0.044) demonstrated significance among F-FDG PET/MRI parameters. Lymphatic invasion (P = 0.044) and perineural invasion (P = 0.046) revealed significance among clinicopathologic parameters. In the multivariate analysis, MTV (P = 0.026), MTV/ADCmean (P = 0.011), and TLG/ADCmean (P = 0.002) with lymphatic invasion (P = 0.026, 0.026, and 0.044, respectively) showed significance.
Combined PET/MRI parameters (PET metabolo-volumetric parameters corrected by tumor cellularity) could be effective predictors of tumor treatment failure after head and neck cancer surgery in addition to MTV and clinicopathologic parameter.
本研究旨在确定同步进行的氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/磁共振成像（MRI）所提供的联合PET/MRI参数对预测手术切除的头颈癌治疗失败的有用性。我们假设经肿瘤细胞密度校正的PET参数（联合PET/MRI参数）可以预测预后。在局部PET上，测量最大标准化摄取值（SUVmax）作为代谢参数。此外，检查代谢肿瘤体积（MTV）和总病变糖酵解（TLG）作为代谢体积参数。在ADC图上评估肿瘤的平均表观扩散系数（ADCmean）作为MRI参数。计算代谢/代谢体积参数与ADC之间的比值作为联合PET/MRI参数。将PET、MRI和联合PET/MRI参数与治疗失败方面的临床病理参数进行比较。
回顾性纳入了72例在头颈癌手术前接受同步F-FDG PET/MRI检查的患者（平均年龄=55.9±14.6岁，男：女=45：27）。22例患者（30.6%）在头颈癌手术后出现肿瘤治疗失败（平均治疗失败时间=13.0±7.0个月）。在单因素分析中，MTV（P=0.044）以及代谢体积参数与ADC之间的比值（MTV/ADCmean，P=0.022；TLG/ADCmean，P=0.044）在F-FDG PET/MRI参数中具有显著性。淋巴侵犯（P=0.044）和神经周围侵犯（P=0.046）在临床病理参数中具有显著性。在多因素分析中，MTV（P=0.026）、MTV/ADCmean（P=0.011）、TLG/ADCmean（P=0.002）以及淋巴侵犯（分别为P=0.026、0.026和0.044）具有显著性。
除MTV和临床病理参数外，联合PET/MRI参数（经肿瘤细胞密度校正的PET代谢体积参数）可能是头颈癌手术后肿瘤治疗失败的有效预测指标。
