Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy.
Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
Ann Nucl Med. 2021 Feb;35(2):260-269. doi: 10.1007/s12149-020-01565-5. Epub 2021 Jan 17.
To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard.
We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard.
Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%).
Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
比较使用既定的二维和形态学标准的对比增强 MRI 与整合 [F]FDG PET/MRI 在识别新诊断的头颈部鳞状细胞癌（HNSCC）患者的区域淋巴结转移中的准确性。为此，我们将 MRI 和 PET/MRI 与淋巴结的组织病理学发现进行比较，以作为金标准。
我们回顾性分析了 26 例经组织学证实的 HNSCC 患者，这些患者在分期过程中接受了钆增强 [F]FDG PET/MRI。所有颈部淋巴结均在 MRI 上使用二维和/或形态学标准进行分类。然后，核医学医师和放射科医师使用整合的 [F]PET/MR 图像进行联合评估。获得 ROC 曲线以比较技术。将淋巴结的组织病理学作为参考标准。
在 865 个淋巴结中，有 35 个在组织病理学上为恶性（3 个为微转移）。使用二维标准的 MRI 的灵敏度和特异性分别为 48.6%和 99.5%；使用形态学标准的 MRI 为 60.0%和 99.6%；使用两者的 MRI 为 60.0%和 99.4%；使用 PET 作为解剖定位的 MRI 为 74.3%和 97.6%。ROC 曲线下面积对于 PET 和 MRI 定位（0.859）高于 MRI 使用二维（0.740；p<0.05）、形态学（0.798；p<0.05）或两者标准（0.797；p<0.05）。使用 PET SUVmax 截断值为 5.7 的 PET/MR 与使用二维和/或形态学标准的 MRI 相结合，达到了高准确性（98.2%）、阴性预测值（98.2%）和阳性预测值（95.2%）。
与传统的对比增强 MRI 或单独的 PET 相比，整合的 PET/MRI 可以提高 HNSCC 患者检测转移性淋巴结的诊断准确性。
