PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值

目的:通过与MRI检查比较,评价PET/CT(integrated PET-CT system)在诊断口腔颌面部肿瘤颈部淋巴结转移中的临床价值.方法:前瞻性分析2008-2011年47例口腔颌面部肿瘤患者,于术前2周内分别进行PET/CT、MRI检查.分别获取PET/CT影像和MRI影像.以病理结果为金标准,分析2种方法判断颈部淋巴结转移的敏感度、特异度及准确率方面的差异.采用SPSS13.0软件包对数据进行x2检验.结果:PET/CT、MRI判定颈淋巴结转移的敏感度分别为89.5％和73.7％(P＜0.05);特异度分别为89.3％和78.6％(P＞0.05);准确率分别为89.4％和76.6％(P＜0.05).结论:PET/CT在口腔颌面部肿瘤颈部淋巴结转移判定中的敏感度及准确率均优于MRI,差异具有统计学意义;PET/CT在口腔颌面部肿瘤颈淋巴结转移判定中作为一种辅助诊断方法,具有重要的临床价值.     

口腔颌面部鳞癌颈淋巴结转移的超声诊断标准

颈部淋巴结转移是决定头颈癌患者预后和选择治疗方案的重要因素,常用的诊断方法包括触诊、CT、MRI和超声(US)检查。触诊的准确率低,结果不可靠。CT及MRT可发现临床不能触及的淋巴结及隐匿转移,但其花费昂贵,难以重复应用。US具有花费低、可反复使用的优点,能发现小淋巴结,诊     

头颈部恶性肿瘤颈淋巴转移的MRI诊断

MRI成像技术。由于其良好的软组织分辨率。对头颈部恶性肿瘤颈部淋巴结转移的诊断有独特的优点及相当高的准确率。远远超过传统的颈部触诊。因此。MRI可指导头颈部恶性肿瘤的临床分级、分期、放疗和化疗和疗效评估。帮助选择较佳的颈淋巴清扫的术式、作者就MRI的技术特征。颈部转移性淋巴结的MRI特征表现及颈部淋巴结MRI的诊断价值等方面的最近进展进行了综述报道。     

头颈部恶性肿瘤颈淋巴结隐匿性转移的MRI诊断

目的：确定磁共振（MRI）诊断口腔癌的颈淋巴结隐匿性的效果。方法：41例临床触诊检查颈部淋巴结转移阴性的头颈部恶性肿瘤病人,术前行MRI颈部扫描,了解颈淋巴结转移阳性和阴性的情况,并在术后同病理诊断对照。结果：41例病人被手术切除的颈淋巴清扫标本内有12例经病理证实为颈淋巴结转移,其中MRI发现9例,其敏感性为75％,特异性为87％,3列假阴性,主要是转移的淋巴结体积小,形态无明显的变化,其内部信号变化不明显,结论：MRI技术可作为临床诊断颈淋巴结隐匿性转移的有效手段之一。     

前哨淋巴结活检在头颈部鳞状细胞癌的应用

头颈部鳞状细胞癌临床N0患者是否进行颈淋巴结清扫术一直存在争议。临床N0患者行预防性颈淋巴结清扫后病理检查发现有 30 %左右的患者已经发生淋巴结转移 ,而术前进行CT、MRI、PET等检查也难以发现颈部隐匿的淋巴结转移 ,因此临床上只能根据原发灶部位、大小、浸润深度等因素决     

正电子发射型计算机断层头颈部肿瘤显像的特点及其临床价值

正电子发射型计算机断层(PET)是目前世界上最为先进的功能性影像诊断技术,是一种观察示踪物质在体内脏器组织分布及动态变化过程的显像设备。本文介绍了PET的基本原理及特点、PET头颈部显像特点,并重点综述了PET头颈部肿瘤显像的临床价值:早期发现并判定头颈部恶性肿瘤;判断其有无颈部淋巴结及全身脏器转移;查找隐匿性原发病灶;判断恶性肿瘤的治疗疗效,判断恶性肿瘤手术后有无复发。     

头颈部癌颈部淋巴结转移的CT诊断

头颈部癌颈部淋巴结转移的ＣＴ诊断汪卫东，罗济程，邱蔚六，孙大熙恶性肿瘤的重要生物学特性之一是其能发生转移，就头颈部癌而言，主要向颈淋巴结转移。头颈部癌是否出现颈淋巴结转移对其预后的影响较大￣［１］，并影响肿瘤的分期及治疗。目前，临床医师主要采用触诊检...     

磁共振弥散加权成像在口腔鳞癌颈部淋巴结转移中的初步应用

目的：评价磁共振弥散加权成像（MR-DWI）在口腔鳞状细胞癌（OSCC）颈部转移性淋巴结诊断中的应用价值。方法：结合术后病理结果,分别分析51例OSCC患者的CT检查资料及20例OSCC患者的MR-DWI影像资料,采用SPSS16.0软件包中的χ2检验,比较不同检查方法对OSCC颈部转移淋巴结诊断的准确性,确定OSCC患者头颈部MR-DWI扫描的最佳参数设置。结果 ：CT、MR-DWI扫描检查淋巴结转移情况与术后病理结果的符合率分别为69.2%和85.0%。MR-DWI取b值为800s/mm2时图像质量最佳,其诊断的敏感度及特异性分别为87.5%和83.3%,CT为76.2%和63.3%。经χ2检查,MR-DWI扫描诊断结果与术后病理诊断结果具有中等相关性,Kappa值=0.694（P〈0.005）。结论：OSCC颈部转移淋巴结的MR-DWI影像特征与病理诊断结果具有较好的相关性,且与CT检查相比,MR-DWI能够更准确地预测OSCC颈部淋巴结转移情况。     

头颈部癌颈部淋巴结转移的CT诊断

综述了应用CT诊断头颈部癌颈部淋巴结转移的技术及方法,并综述了颈部淋巴组织的正常解剖、CT图像上正常淋巴结的形态及密度和头颈部癌颈部淋巴结转移的CT诊断标准。CT诊断与触诊法相比,CT是一种更为客观、准确、较为可靠的诊断头颈部癌颈部淋巴结转移的方法。     

颈部淋巴结转移性肿瘤的诊断

头颈部恶性肿瘤有较高的颈部淋巴结转移率,较大的淋巴结可经触诊诊断,而较小的淋巴结则需借助影像学检查或其他方法检测。笔者从临床触诊、影像学检查、前哨淋巴结活检术等方面对颈淋巴结转移诊断的方法及优缺点作一综述。     

18F-FDG PET显像在头颈肿瘤诊断中的作用评价

目的:比较~(18)F脱氧葡萄糖正电子发射体层显像(~(18)F-FDG PET)与CT/MRI检查在头颈肿瘤诊断中的应用价值。方法:54例头颈肿瘤患者在术前2周分别进行PET与CT、MRI检查,以病理结果为金标准,分析2种方法在敏感度、特异度及准确率方面的差异,采用SPSS13.0软件包对数据进行X~2检验。结果:PET和CT、MRI分别准确判断了54例肿瘤中的48和43例,PET在敏感度、特异度及准确率方面分别比CT、MRI高7.4%、15.3%和9.3%,但差异均无显著性。结论:PET在头颈肿瘤诊断的敏感度、特异度及准确率方面优于CT、MRI,但结果无统计学差异。     

口咽鳞癌颈淋巴结临床触诊、B超和MRI检查的对比分析

目的：比较临床触诊、B超和磁共振（MRI）诊断口咽鳞癌颈淋巴结转移的准确性,分析B超、MRI在口咽鳞癌颈淋巴结转移术前评估中的临床价值。方法：对20例口咽鳞癌患者的100个颈部分区行术前临床触诊、B超和MRI检查,以术后病理诊断为金标准,双盲法分析临床触诊、B超和MRI所见,将其结果在SPSS13.0软件中分别采用χ2检验或Fisher确切概率法进行统计学处理。结果：术后病理证实16个区存在淋巴结转移,临床触诊检出其中的7个区（敏感度43.8%,特异度96.4%,准确度88.0%）;B超确诊其中的10个区（敏感度60.0%,特异度97.6%,准确度92.0%）,可以发现33.3%的临床触诊隐匿性转移区;MRI确诊其中的13个区（敏感度81.3%,特异度96.4%,准确度94.0%）;可以发现66.7%的临床触诊隐匿性转移区。B超联合MRI检出其中的13个区（敏感度81.3%,特异度95.2%,准确度93.0%）。结论：B超或MRI评价口咽鳞癌颈淋巴结转移的敏感度、准确度均优于临床触诊,B超联合MRI的可靠性并不优于单独使用MRI,但两者存在互补性。     

Radioimmunodiagnosis of lymph node metastases in head and neck cancer

INTRODUCTION: Reliable staging of the neck remains a diagnostic challenge in head and neck squamous cell carcinoma (HNSCC) patients. Monoclonal antibodies (MAbs) directed against tumour-associated antigens can be used for selective tumour targeting. When labelled with a gamma-emitting radionuclide like 99mTechnetium, such MAbs can be used for tumour detection by radioimmunoscintigraphy (RIS). OBJECTIVE: The aim of this study was to assess the potential of RIS for the detection of lymph node metastases in HNSCC patients. PATIENTS AND METHODS: In 49 patients with HNSCC, who were scheduled to undergo surgery including neck dissection, RIS using 99mTc-labelled squamous cell specific MAb E48 or U36 administered intravenously was compared with clinical palpation, computed tomography (CT), magnetic resonance imaging (MRI) and histopathological outcome. RESULTS: RIS detected lymph node metastases in 35 of 51 positive sides (sensitivity 69%). Interpretation of RIS was correct in 47 of 65 sides (accuracy 72%). Accuracy of palpation, CT and MRI were comparable. Immunohistochemical staining of lymph node metastases missed by RIS showed that the injected MAb had targeted these small tumour deposits but these were not visualized. CONCLUSIONS: RIS at its current stage of development is not superior to CT or MRI for the detection of lymph node metastases. As small tumour deposits were probably not visualized because of the limited sensitivity and/or spatial resolution of the gamma camera, positron emission tomography (PET) using MAbs labelled with positron emitters may improve the detection. As MAb-PET studies in an animal model showed promising results we will soon start a clinical MAb-PET study.     

正电子发射体层成像/计算机断层扫描在口腔颌面部肿瘤颈部淋巴结转移中的诊断价值

目的评价正电子发射体层成像/计算机断层扫描（PET/CT）在口腔颌面部肿瘤颈部淋巴结转移诊断中的价值。方法检索中国生物医学文献数据库、Medline（OVID）和EMBASE（检索时间为2010年12月13日）,并采用手工检索19种中文口腔医学期刊的方法收集PET/CT对口腔颌面部肿瘤颈部淋巴结转移的诊断性试验。由2名研究者分别进行文献纳入及文献质量评价,应用MetaDisc 1.4进行Meta分析。结果共9篇文献符合纳入标准。Meta分析结果显示PET/CT对口腔颌面部肿瘤颈部淋巴结转移（以淋巴结分区为单位）的合并敏感度、合并特异度分别为0.84、0.93;诊断比值比为47.89;工作曲线下面积为0.973 8。结论PET/CT对口腔颌面部肿瘤颈部淋巴结转移的诊断准确性很高,可以作为诊断口腔颌面部肿瘤颈部淋巴结转移的选择,但在选择时应该充分考虑其诊断费用和安全性。     

Lymphoscintigraphy for interpretation of changes of cervical lymph node function in patients with oral malignant tumors: comparison of Tc-99m-Re and Tc-99m-HSA-D

OBJECTIVE: The purpose of this study is to compare the usefulness of technetium-99m-rhenium colloid (Tc-99m-Re) and technetium-99m-human serum albumin diethylene-triamine-pentaacetic acid (Tc-99m-HSA-D) as lymphoscintigraphic agents and to discuss the significance of lymphoscintigraphy in comparison with computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). STUDY DESIGN: Dynamic and static lymphoscintigraphies were performed with Tc-99m-Re and Tc-99m-HSA-D. The usefulness of the 2 agents was evaluated statistically in comparison with pathologic findings and palpation. The significance of lymphoscintigraphy is discussed in comparison with CT, MRI, and US (by the literature of CT, MRI, and US). RESULTS: Lymphoscintigraphy was superior to palpation, and Tc-99m-Re was superior to Tc-99m-HSA-D in accuracy, specificity, and the incidence of true-positive and false-positive. Statistical significance was shown between the static lymphoscintigraphy with Tc-99m-Re and palpation. The reliability of lymphoscintigraphy seemed to be slightly inferior to CT and MRI in specificity and accuracy. However, lymphoscintigraphy had some advantages that CT and MRI lacked; for example, it showed very high sensitivity (100%) and no false-negative (0%). It also showed changes of lymph node function, showed all levels of neck nodes at one time, and showed a possibility of detecting small lymph node metastases. CONCLUSION: Lymphoscintigraphy was more useful than palpation in detecting lymph node metastases, and Tc-99m-Re was superior to Tc-99m-HSA-D as an agent. Lymphoscintigraphy is significant when it is performed as a preliminary examination before CT or MRI.     

Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI

BACKGROUND: The choice of treatment in patients with oral malignancies depends on accurate pretreatment staging and particularly the detection of lymph node involvement. Therefore staging of the neck should be as accurate as possible. PATIENTS: One hundred and six patients with histologically proven squamous cell carcinoma of the oral cavity. STUDY DESIGN: In a prospective study, PET using fluoro-desoxy-glucose (18F-FDG), ultrasound, CT and MRI of head and neck were compared with the postoperative histologic tissue evaluation. Two thousand one hundred and ninety-six neck lymph nodes of 106 patients were investigated. In all patients the tumour was resected and a lymph node dissection was performed. Results: The diagnostic procedures showed the following results when compared with the histological findings: PET: sensitivity 70%, specificity 82%, accuracy 75%; Ultrasound: 84%, 68%, 76%; CT: 66%, 74%, 70%; MRI: 64%, 69% 66%. Thus PET showed the highest specificity while ultrasound had the highest sensitivity compared with the other staging procedures. A nonsignificant correlation was found between the size of a lymph node metastasis and the ability to detect it. In 10 patients, second primary tumours or distant metastases were detected by PET only. CONCLUSION: Due to the high number of small lymph node metastases from oral cavity carcinoma, the non-invasive neck staging methods are limited to a maximum accuracy of 76%. Elective neck treatment should be mandatory for all patients with squamous cell carcinoma of the oral cavity.     

PET/CT in the evaluation of patients with squamous cell cancer of the head and neck

The purpose of this study was to compare the findings of positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with suspected locoregional and distant head and neck cancer and to evaluate the impact of those findings on clinical management. Studies of 25 patients were retrospectively evaluated. PET findings were classified as malignant, benign or equivocal. PET/CT findings were then similarly classified and the PET-only results were amended accordingly. Comparison of findings was done on lesion and patient levels. A total of 45 foci of increased 18F-fluorodeoxyglucose (FDG) uptake were noted in 18 patients. PET/CT imaging defined anatomic localization of 41/45 lesions and clarified 6/10 equivocal PET findings. Additional information was provided by PET/CT regarding 9/45 (20%) of the lesions. PET/CT significantly affected patient management in 3/25 patients (12%) by limiting the extent of disease in one and excluding viable disease in two others. The accuracy of PET/CT was 88%, the sensitivity 100% and the specificity was 77%. The negative predictive value was 100% in this combined group of patients with locoregional and distant head and neck cancer. PET/CT is highly contributory for initial staging and in the evaluation of patients with suspected recurrent SCC of the head and neck, in whom anatomic imaging is inconclusive due to the locoregional distortions rendered by surgery and radiotherapy.     

Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT,and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC

Objective

This study aimed to compare ¹⁸F-fluorodesoxyglucose positron emission tomography/MRI (¹⁸F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), ¹⁸F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC).

Materials and methods

Eighteen patients prospectively underwent ultrasound examination, ¹⁸F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference.

Results

The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for ¹⁸F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for ¹⁸F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for ¹⁸F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between ¹⁸F-FDG-PET-MRI and ¹⁸F-FDG-PET/CT (p?=?0.839) and between ¹⁸F-FDG-PET-MRI plus DWI and ¹⁸F-FDG-PET/CT (p?=?0.286), respectively. US was significantly more accurate than ¹⁸F-FDG-PET/CT (p?=?0.009), whereas no significant difference was seen between ¹⁸F-FDG-PET-MRI and US (p?=?0.223) or ¹⁸F-FDG-PET-MRI plus DWI and US (p?=?0.115). The nodal stage was correctly rated by ¹⁸F-FDG-PET-MRI in eight patients, ¹⁸F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and ¹⁸F-FDG-PET/CT in five out of 18 patients.

Conclusion

Software-based fusion of ¹⁸F-FDG-PET-MRI and ¹⁸F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and ¹⁸F-FDG-PET/CT.

Clinical relevance

Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.