Staging primary head and neck cancers with 18F-FDG PET/CT: is intravenous contrast administration really necessary?
Staging primary head and neck cancers with 18F-FDG PET/CT: is intravenous contrast administration really necessary?
复制标题
DOI：
10.1007/s00259-009-1127-8
复制
发表时间：
2009-09-01
影响因子：
9.1
通讯作者：
Inoue, Tomio
中科院分区：
文献类型：
--
作者：
Yoshida, Keisuke;Suzuki, Akiko;Inoue, Tomio
本研究的目的是前瞻性评价在正电子发射断层扫描和计算机断层扫描（PET/CT）中使用含氟脱氧葡萄糖（F-18）的静脉造影剂是否与未增强PET/CT相比，F-18-FDG显著有助于评价原发性头颈癌，头颈部区域增强CT（颈部CE-CT）和头颈部区域磁共振成像受试者是42名连续患者（35名男性，7名女性;年龄范围：36-91岁），其具有活检证实的原发性头颈癌。原发灶和淋巴结部位的病灶检测和TNM分类在每个患者的基础上进行评估。统计学分析采用McNemar检验和Kappa检验，40例（95%）患者获得随访，其中24例有淋巴结转移，3例有远处转移。对比增强和未增强PET/CT分别检测到98%和95%的原发性肿瘤，两者均检测到92%的淋巴结疾病患者，没有显示统计学显著差异。T状态的准确性分别为75%和73%，这被证明比颈部CE-CT的准确性显著更高，颈部CE-CT的准确性为53%（分别为p = 0.0133和0.0233）。颈部MRI正确分类了58%患者的T状态;然而，PET/CT和颈部MRI之间无统计学显著差异。对比增强PET/CT、未增强PET/CT、颈部CT和颈部MRI分别在90%、90%、79%和90%的患者中对N状态进行了正确分期，无统计学显著差异。分别有68和65%的患者的总体TNM分类正确。增强和未增强PET/CT对原发肿瘤检测、淋巴结检测、T状态和N状态的加权kappa值分别为0.655、1.000、0.935和1.000，我们发现增强和未增强PET/CT对原发性头颈部癌的病变检测和初始分期几乎完全相关。PET/CT成像的常规造影剂给药可能不合理。
The aim of our study was to prospectively evaluate whether intravenous contrast media in integrated positron emission tomography and computed tomography (PET/CT) with F-18-fluorodeoxyglucose (F-18-FDG) significantly contributes to evaluation of primary head and neck cancers compared with unenhanced PET/CT, regional contrast-enhanced CT of head and neck (neck CE-CT) and regional magnetic resonance imaging of head and neck (neck MRI).Subjects were 42 consecutive patients (35 men, 7 women; age range: 36-91 years) with biopsy-proven primary head and neck cancers. Lesion detection of primary and nodal sites and TNM classification were assessed on a per-patient basis. McNemar test and kappa statistics were employed for statistical analyses.Forty patients (95%) were successfully followed up: 24 patients had nodal disease and 3 had distant metastasis. Contrast-enhanced and unenhanced PET/CT detected 98 and 95% of the primary tumours, respectively, and both detected 92% of patients with nodal disease, which revealed no statistically significant difference. Accuracy for T status was 75 and 73%, respectively, which proved significantly more accurate than neck CE-CT, which had an accuracy of 53% (p = 0.0133 and 0.0233, respectively). Neck MRI correctly classified the T status in 58% of patients; however, no statistically significant difference was found between PET/CT and neck MRI. Contrast-enhanced PET/CT, unenhanced PET/CT, neck CT and neck MRI correctly staged the N status in 90, 90, 79 and 90% of patients, respectively, with no statistically significant difference. Overall TNM classification was correctly classified in 68 and 65% of patients, respectively. Weighted kappa values between enhanced and unenhanced PET/CT for primary tumour detection, nodal detection, T status and N status were 0.655, 1.000, 0.935 and 1.000, respectively.We found almost perfect correlation between enhanced and unenhanced PET/CT for lesion detection and initial staging of primary head and neck cancers. Routine contrast administration for PET/CT imaging may not be justified.