Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and 18F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer
Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and 18F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer
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DOI：
10.2967/jnumed.117.189704
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发表时间：
2017-12-01
影响因子：
9.3
通讯作者：
Godballe, Christian
中科院分区：
文献类型：
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作者：
Rohde, Max;Nielsen, Anne L.;Godballe, Christian
本研究的目的是比较临床上常用的基于胸部X线片+头颈MRI(CXR/MRI)、胸部CT+头颈部MRI(CHCT/MRI)和F-18-FDG PET/CT的成像策略在口腔、咽或喉癌诊断中的远处转移和同步癌的检出率。方法：这是一项基于配对数据的前瞻性队列研究。2013年9月至2016年3月在欧登塞大学医院连续接受组织学证实的原发头癌和鳞状细胞癌患者为研究对象。包括在同一天和活检前接受CXR/MRI、CHCT/MRI和PET/CT检查的患者。扫描是由经验丰富的核医生或放射科医生组成的不同团队进行的。评估CXR/MRI、CHCT/MRI和PET/CT对远处转移和同步癌的真实诊断率。结果：共纳入307例患者。CXR/MRI检出远处转移3例(1%)，CHCT/MRI检出11例(4%)，PET/CT检出18例(6%)。绝对差值分别为5%和2%，对PET/CT有统计学意义。同时，PET/CT正确发现25例(8%)同步癌，显著高于CXR/MRI(3例，1%)和CHCT/MRI(6例，2%)。PET/CT对远处转移或同期癌的真实诊断率为13%(40例)，明显高于CXR/MRI的2%(6例)和CHCT/MRI的6%(17例)。结论：基于PET/CT的临床影像策略对远处转移或同步癌的检出率显著高于现行临床影像指南中的策略，其中欧洲指南主要推荐CXR/MRI，而美国指南更倾向于头颈部鳞状细胞癌患者的CHCT/MRI。
The purpose of this study was to determine the detection rate of distant metastasis and synchronous cancer, comparing clinically used imaging strategies based on chest x-ray + head and neck MRI (CXR/MRI) and chest CT + head and neck MRI (CHCT/MRI) with F-18-FDG PET/CT upfront in the diagnostic workup of patients with oral, pharyngeal, or laryngeal cancer. Methods: This was a prospective cohort study based on paired data. Consecutive patients with histologically verified primary head and squamous cell carcinoma at Odense University Hospital from September 2013 to March 2016 were considered for the study. Included patients underwent CXR/MRI and CHCT/MRI as well as PET/CT on the same day and before biopsy. Scans were read masked by separate teams of experienced nuclear physicians or radiologists. The true detection rate of distant metastasis and synchronous cancer was assessed for CXR/MRI, CHCT/MRI, and PET/CT. Results: A total of 307 patients were included. CXR/MRI correctly detected 3 (1%) patients with distant metastasis, CHCT/MRI detected 11 (4%) patients, and PET/CT detected 18 (6%) patients. The absolute differences of 5% and 2%, respectively, were statistically significant in favor of PET/CT. Also, PET/CT correctly detected 25 (8%) synchronous cancers, which was significantly more than CXR/MRI (3 patients, 1%) and CHCT/MRI (6 patients, 2%). The true detection rate of distant metastasis or synchronous cancer with PET/CT was 13% (40 patients), which was significantly higher than 2% (6 patients) for CXR/MRI and 6% (17 patients) for CHCT/MRI. Conclusion: A clinical imaging strategy based on PET/CT demonstrated a significantly higher detection rate of distant metastasis or synchronous cancer than strategies in current clinical imaging guidelines, of which European ones primarily recommend CXR/MRI, whereas U.S. guidelines preferably point to CHCT/MRI in patients with head and neck squamous cell carcinoma.