18氟-氟代脱氧葡萄糖正电子发射断层显像/磁共振成像与头颈部鳞癌病理分化的相关性及诊断价值

摘要

目的 探讨头颈部鳞癌(HNSCC)术前正电子发射断层显像/磁共振成像(PET/MR)各参数与病理分化程度的相关性,并评价PET及扩散加权成像(DWI)序列独立及联合诊断HNSCC病理分化程度的价值.方法 选取2015年2月至2017年9月临床怀疑头颈部肿瘤的患者并进行PET/MR检查.PET/MR检查序列包括PET及T1加权成像、T2加权成像和DWI序列.所有最终入组患者均为术后病理诊断为HNSCC的病例.测量表观扩散系数平均值(ADCmean)、标准化摄取最大值(SUVmax)及标准化摄取平均值(SUVmean),比较PET/MR各参数在HNSCC高分化及中-低分化两组间的分布及其相关性.采用Logistic回归分析建立多参数对HNSCC分化程度的预测模型,根据受试者工作特征曲线计算PET/MR各参数独立及多参数联合应用诊断HNSCC病理分化程度的效能.结果 最终纳入23例患者,均为男性;高分化9例,平均年龄(61.0±6.8)岁;中—低分化14例(10例中分化及4例低分化),平均年龄(62.0±9.1)岁.PET/MR参数中,SUVmax和SUVmean具有强相关性(P ＜0.001),ADCmean和SUVmax、SUVmean无相关性(P =0.42,P=0.13).ADC mean和SUVmean在HNSCC高分化组及中—低分化组间差异有统计学意义(P =0.005,P=0.007).相较PET/MR各参数独立诊断,PET/MR多参数联合应用诊断HNSCC病理分化的曲线下面积为0.84.结论 ADCmean、SUVmax和SUV mean在HNSCC不同病理分化组间分布差异有统计学意义,相比较PET和MR的各参数独立预测病理分化程度,多参数联合应用可以更有效地提高HNSCC病理分化程度的预测效能.%Objective To evaluate the correlation of the positron emission tomography/magnetic resonance imaging (PET/MR) parameters with the pathological differentiation of head and neck squamous cell carcinoma (HNSCC) and the diagnostic efficiencies of PET/MR parameters.Methods Patients with clinical suspicion of HNSCC were included and underwent PET/MR scan.HNSCC was pathologically confirmed in all these patients.The PET/MR examination included PET and MR sequences of diffusion-weighted imaging (DWI) and T2-and T1-weighted imaging.The multiple parameters of PET/MR included the mean values of apparent diffusion coefficient (ADCmean) and the maximum and mean values of standardized uptake value (SUVmax and SUVmean) were measured and estimated.The correlations of all the parameters and distribution between the different tumor differentiation groups were analyzed.Logistic regression was utilized to build the model as the PET/MR combined parameter for predicting the differentiation by multiple parameters of PET/MR.The receiver operating characteristic curve was calculated for each parameter and the combination.Results Totally 23 patients were included in this study:9 patients (9 males and 0 female) had well-differentiated tumor,with an average age of (61.0 ±6.8) years;14 cases had moderately-differentiated (n =10) or poorly-differentiated tumors (n =4),with an average age of (62.0 ± 9.1) years.All the patients were males.There was statistical correlation between SUV and SUVmax (P ＜ 0.001);however,ADC showed no statistical correlation with SUVmax and with SUVmean (P =0.42,P =0.13).ADCmean and SUVmean showed significant difference between well-differentiated group and moderately-poorly-differentiated group (P =0.005,P =0.007).Compared with the individual parameters,the combination of PET/MR parameters with SUVmean and ADCmean had higher efficacy in predicting tumor differentiation,with an area under curve of 0.84.Conclusions The distributions of ADCmean,SUVmax and SUVmean differ among HNSCC with different pathological differentiation.Compared with the individual parameters,the combination of the PET/MR parameters has higher efficiency in predicting tumor differentiation.