~(18)F-FDG PET/CT显像对鼻咽癌放疗后复发早期诊断的临床价值

目的探讨18F-FDGPET/CT对鼻咽癌(nasopharygeal carcinoma,NPC)放射治疗后复发早期诊断的临床价值。方法20例NPC病人于放疗后12～18个月同期行18F-FDGPET/CT和MRI检查,分别由两位核医学科及放射科主治医生进行独立诊断,将18F-FDGPET/CT与MRI结果进行比较,其中12例经活检病理证实。结果11例MRI检查未见明显肿瘤复发征象,18F-FDG PET/CT显像提示其中5例有局灶性FDG摄取明显增高,诊断为复发,5例经活检未发现复发。7例CT和MRI提示肿瘤复发,18F-FDG PET/CT均显示局部病变有放射性摄取浓聚,该7例18F-FDGPET/CT摄取浓聚的病变处均经活检病理证实为肿瘤复发。另两例MRI提示鼻咽癌颅内侵犯,而18F-FDG PET/CT诊断为放射治疗后脑损伤,后经随访证实,其余经临床随访证实,随访中位时间为13个月。结论与MRI检查相比,18F-FDG PET/CT在鼻咽癌放射治疗后肿瘤复发的早期定性诊断上具有明显的优势。

The significance of 18F-FDG PET/CT imaging in the follow up of nasopharyngeal carcinoma after radio therapy

Objective To investigate the clinical value of whole-bocy 18F-FDG PET/CT imaging in early detecting the recurrence of nasopharyngeal carcinoma after radiotherapy. Methods 20 patients with nasopharyngeal carcinoma underwent 18F-FDG PET/CT and MRI examination during the following 12 to 18 months after radiotherapy. The diagnoses of 18F-FDG PET/CT、MRI were obtained by nuclear physicians and radiologists independently. The results of them were compared with each other. The final results were proved by follow up and pathological evidence. The recurrent lesions in 12 of these patients were pathologically confirmed. Results 11 patients did not show any recurrence on MRI scans. However, 18F-FDG PET/CT scans showed focal FDG uptake activity in the region of primary tumor , indicating recurrence in 5 patients. In 7 patients , both MRI and 18F-FDG PET/CT indicated recurrence. The remaining two patients had radiotherapy induced reaction. They was wrongly diagnosed as an intracranial recurrence by MRI, but 18F-FDG PET/CT scan showed no recurrence and suggested radiation encephalopathy. Conclusions Compared to MRI 18F-FDG PET/CT imaging has an advantage in distinguishing the relapse or post-radiotherapy changes in. nasopharyngeal carcinoma patients.