^18F-FLTPET／CT与^18F—FDGPET／CT在鼻咽癌诊断和分期中的应用比较

A comparative study of ^18F-FLT PET/CT and ^18F-FDG PET/CT in patients with nasopharyngeal carcinoma

目的通过与^18F-FDGPET／CT显像对比，探讨^18F-FLTPET／CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性。方法12例初治且经病理确诊的鼻咽癌患者（年龄22-62岁）自愿进入该前瞻．陛临床研究。每位患者先行^18F-FDGPET／CT检查，次日行^18F-FLTPET／CT检查。至少有2位核医学科和放射科医师阅片，比较^F-8FDGPET／CT和^18F-FLTPET／CT图像，采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对^18F-FDG、^18F-FLT的SUVmax、SUVmean。和MTV。采用非参数Wilcoxon秩和检验比较组问摄取和MTV差异。结果12例鼻咽癌患者病灶均明显摄取^18F-FLToTMF-FuPET／CT和^18F-FDGPET／CT均可准确诊断该组病例，二者对原发灶和淋巴结转移灶的检测结果无明显差别。鼻咽癌病灶的^18F-FDG和^18F-FLT SUVmax分别为10．7±5．8和6．0±2．4，SUVmean。分别为5．8±3．0和3．6±1．5；SUVmax和SUVmean。组间差异均有统计学意义（Z=-2．589和-2．353，P均〈0．05），而MTV在^18F-FDG和^18F-FLTPET／CT2种显像方法之间的差异无统计学意义（15．9±9．2和18．1±11．1；Z=-0．786，P〉0．05）。6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义（8．5±6．2比6．4±2．5、5．3±4．2比3．8±1．4、6．5±4．8比6．0±4．4；Z=-0．734、-0．734和-0．674，P均〉0．05）。^18F-FLT在颞叶摄取（SUVmax0．7±0．3）明显低于^18F-FDG（SUVmax8．3±2．7；Z=-3．062，P〈0．01），其对于原发灶颅内浸润显示较^18F-FDG更清晰。结论”F-FLT PET／CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与^18F-FDGPET／CT相当，对于显示原发灶的颅底附近侵犯更有利，其临床应用值得进-步研究。

Objective To investigate the value of ^18 F-FLT compared to ^18 F-FDG in PET/CT diag- nosis of nasopharyngeal carcinoma （NPC）. Methods Twelve newly biopsy-proven NPC patients （age range： 22 -62 years） were prospectively enrolled into this study after obtaining patient consent. They un- derwent ^18F-FDG FET/CT first, followed by ^18F-FLT PET/CT on the consecutive day before treatment. ROIs were drawn on the primary tumor, involved lymph nodes and normal tissues. Wilcoxon rank sum test was used to compare the uptake differences between ^18F-FLT and ^18F-FDG for both the primary tumor and metastatic lymph nodes. Results All 12 patients showed increased uptake of ^18F-FLT by the primary tumor and metastatic lymph nodes, which were consistent with the findings by ^18F-FDG PET/CT. The SUVmax and SUV of ISF-FLT in the primary NPC （SUVmax 6. 0 ±2. 4, SUV 3.6 ± 1.5） were lower than those of ^18 F-FDG （ SUVmax 10.7 ± 5.8, SUVmcan 5.8 ± 3.0 ;Z = - 2. 589 and - 2. 353, both P 〈 0.05）. However,the MTV on ^18F-FDG and ^18F-FLT PET/CT showed no significant difference （15.9 ±9.2 vs 18.1 ±11.1, Z= -0.786, P 〉 0.05）. The SUV SUV and MTV of the metastatic cervical lymph nodes in 6 patients showed no significant difference between the 2 tracers （8.5 ± 6.2 vs 6.4 ± 2.5, 5.3 ±4.2 vs 3.8 ± 1.4, 6.5 ± 4.8 vs 6.0 ± 4.4 ; Z = - 0.734, - 0.734, - 0.674, respectively, all P 〉 0.05）. The ^18F-FLT up- take in the normal temporal lobe （SUVmax 0. 7 ± 0. 3 ） was significantly lower than that of ^18F-FDG（ SUVmax 8. 3 ±2. 7, Z = -3. 062, P 〈 0. 01 ）. The skull base involvement by NPC could be better delineated on ^18F-FLT PET/CT. Conclusions ^18F-FLT PET/CT has comparable diagnostic efficacy for primary NPC and metastatic cervical lymph nodes to ^18 F-FDG PET/CT. It might he better than ^18F-FDG for the evaluation of skull base involvement in NPC patients.