From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).
Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
AJNR Am J Neuroradiol. 2019 Mar;40(3):543-550. doi: 10.3174/ajnr.A5974. Epub 2019 Feb 21.
Differentiating nodal metastases from reactive adenopathy in HIV-infected patients with [F] FDG-PET/CT can be challenging because lymph nodes in HIV-positive patients often show increased [F] FDG uptake. The purpose of this study was to assess CT textural analysis characteristics of HIV-positive and HIV-negative lymph nodes on [F] FDG-PET/CT to differentiate nodal metastases from disease-specific nodal reactivity.
Nine HIV-positive patients with head and neck squamous cell carcinoma (7 men, 2 women; 29-62 years of age; median age, 48 years) with 22 lymph nodes (≥1 cm) who underwent contrast-enhanced CT with [F] FDG-PET followed by pathologic evaluation of cervical lymph nodes were retrospectively reviewed. Twenty-six HIV-negative patients with head and neck squamous cell carcinoma with 61 lymph nodes were evaluated as a control group. Each lymph node was manually segmented, and an in-house-developed Matlab-based texture analysis program extracted 41 texture features from each segmented volume. A mixed linear regression model was used to compare the pathologically proved malignant lymph nodes with benign nodes in the 2 enrolled groups.
Thirteen (59%) lymph nodes in the HIV-positive group and 22 (36%) lymph nodes in the HIV-negative control group were confirmed as positive for metastases. There were 7 histogram features ( = .017-0.032), 3 gray-level co-occurrence features ( = .009-.025), and 9 gray-level run-length features ( < .001-.033) that demonstrated a significant difference in HIV-positive patients with either benign or malignant lymph nodes.
CT texture analysis may be useful as a noninvasive method of obtaining additional quantitative information to differentiate nodal metastases from disease-specific nodal reactivity in HIV-positive patients with head and neck squamous cell carcinoma.
在感染 HIV 的患者中，使用 [F]FDG-PET/CT 区分淋巴结转移与反应性淋巴结增生具有一定挑战性，因为 HIV 阳性患者的淋巴结常常表现出 [F]FDG 摄取增加。本研究旨在评估 [F]FDG-PET/CT 中 HIV 阳性与 HIV 阴性淋巴结的 CT 纹理分析特征，以区分淋巴结转移与疾病特异性淋巴结反应。
回顾性分析了 9 例经头颈部鳞状细胞癌（7 例男性，2 例女性；年龄 29-62 岁，中位年龄 48 岁）患者的影像资料，这些患者均行 [F]FDG-PET/CT 检查（共 22 个淋巴结[≥1cm]），且随后对颈部淋巴结进行了病理评估。另选择 26 例头颈部鳞状细胞癌患者（61 个淋巴结）作为对照组。手动对每个淋巴结进行分割，使用内部开发的基于 Matlab 的纹理分析程序从每个分割体积中提取 41 个纹理特征。使用混合线性回归模型比较了 2 个纳入组中经病理证实的恶性淋巴结与良性淋巴结。
在 HIV 阳性组的 22 个淋巴结中，有 13 个（59%）淋巴结和在 HIV 阴性对照组的 61 个淋巴结中，有 22 个（36%）淋巴结被证实为转移性病变。在 HIV 阳性患者中，良性或恶性淋巴结之间存在 7 个直方图特征（ =.017-0.032）、3 个灰度共生矩阵特征（ =.009-.025）和 9 个灰度游程长度特征（ <.001-.033），这些特征具有显著差异。
CT 纹理分析可能是一种有用的非侵入性方法，可以提供额外的定量信息，有助于区分 HIV 阳性头颈部鳞状细胞癌患者的淋巴结转移与疾病特异性淋巴结反应。
