鼻咽癌PET/CT影像表现及临床价值

The imaging manifestation and clinical value of PET/CT in nasopharyngeal carcinoma

目的研究鼻咽癌及其颈部淋巴结转移的 PET/CT 影像表现。方法初诊鼻咽癌患者51例、鼻咽部炎症患者14例及鼻咽癌治疗后患者36例。皆行^(18)F-脱氧葡萄糖(FDG)PET/CT 显像。鼻咽部炎症患者和鼻咽癌治疗后患者临床随访时间皆>6个月,淋巴结随访时间6～14个月。结果①51例鼻咽癌初诊患者和14例鼻咽部炎症患者的 PET 和 CT 影像表现差异明显。以鼻咽部软组织肿块(或组织增厚)处 PET 呈结节状、块状代谢增高为鼻咽癌 PET/CT 诊断标准,则灵敏度为96.0%,特异性为85.7%。PET/CT 在鼻咽癌病灶的定位、病灶边界的确定及显示病灶对周围组织的侵犯方面优于 PET 和CT。②36例鼻咽癌治疗后患者,以鼻咽部软组织肿块(或组织增厚)处 PET 呈结节状或块状代谢增高为 PET/CT 诊断鼻咽癌复发、残余的标准,而以鼻咽部组织增厚作为 CT 诊断鼻咽癌复发、残余的标准,则 PET/CT 和 CT 对复发、残余病灶的检出灵敏度分别为84.6%和92.3%,特异性分别为91.3%和56.5%,假阳性率分别为8.6%和43.4%。③87例鼻咽癌患者中,61例有颈部淋巴结增大,PET/CT 和 MRI 诊断淋巴结转移的灵敏度分别为91.8%和88.8%(P>0.05),特异性分别为82.2%和51.1%(P<0.05)。结论 PET/CT 显像在诊断鼻咽癌及其淋巴结转移和复发方面优于单纯 PET 和 CT。

Objective To study the imaging manifestation of PET/CT in nasopharyngeal carcinoma （NPC） and with lymph node metastasis. Methods 101 patients performed PET/CT were studied including 51 cases of initial diagnosis of NPC, 36 cases of treated NPC and 14 cases of nasopharyngitis. The patients with nasopharyngitis and treated NPC were followed up for more than 6 months, as lymph node metastasis 6～14 months. Results ①In 51 cases of initial NPC and 14 cases of nasopharyngitis, there was obvious difference among them in PET and CT manifestation. In NPC patients when nodular or massive hypermetabolism area in nasopharynx was detected in PET, the soft tissue mass or thickening was also detected in same region in CT, the diagnostic sensitivity and the specificity of PET/CT in NPC were 96.0% and 85.7%. PET/CT was superior to PET and CT in localization of tumor site, delineation of tumor border and demonstration if its invasion to surrounding tissues. ②If the nodular or massive hypermetabolism area in nasopharynx in PET and soft tissue mass or thickening in same region in CT was considered as the remnant or relapse NPC, then the diagnostic sensitivity, specificity and false positive of PET/CT and CT was 84.6% , 91.3% , 8.6% and 92.3% , 56.5% , 43.4% , respectively. ③Among 87 cases of NPC, lymph node accretion in neck were proved in 61 cases. The sensitivity of PET/CT and MRI were 91.8% , 88.8% （ P 〉0. 05 ） and the specificity were 82.2% , 51.1% （ P 〈0.05） , respectively. Conclusion PET/CT imaging is superior to PET and CT alone in the diagnosis of NPC and also for detection of lymph node metastasis and relapse.