^(18)F-FDG PET/MR在鼻咽癌分期中的价值研究及半定量分析

The Value and Semi⁃Quantitative Analysis of ^(18)F⁃FDG PET/MR in Staging of Nasopharyngeal Carcinoma

目的探讨^(18)F-FDG PET/MR在鼻咽癌分期中的价值及半定量分析。方法回顾性分析78例鼻咽癌患者相关资料,根据PET/MR显像结果按照AJCC第8版TNM分期标准,比较与其临床实际分期的准确性。采用两独立样本t检验和Mann-Whitney U检验分析数据,采用Kappa一致性检验评估PET/MR影像分期与临床实际分期的诊断一致性,行受试者工作特征(ROC)曲线分析计算各参数对T分期中的诊断效能。结果PET/MR在治疗前患者T分期、N分期、M分期及总体分期的准确性分别为:98.72%、93.59%、100%、94.87%,PET/MR分期与临床分期诊断一致性较高(Kappa值=0.926)。半定量参数分析SUV_(max)、SUV_(mean)、SUV_(max)/ADC_(min)与T分期有相关性(P=0.003、0.005、0.004,P<0.01);淋巴结的SUV_(max)与N分期有明显相关性(P=0.000,P<0.01),ROC曲线分析显示SUV_(max)/ADC_(min)对于T分期的诊断效能最高(0.876)。结论PET/MR对鼻咽癌的分期有较高的临床价值,可作为鼻咽癌的一站式检查,SUV_(max)/ADC_(min)可进一步有效提高鼻咽癌T分期的诊断效能。

Objective To explore the value and semi⁃quantitative analysis of ^(18)F⁃FDG PET/MR in staging of nasopha⁃ryngeal carcinoma.Methods A TNM staging was done by retrospective analysis of histologically confirmed nasopharynge⁃al carcinoma including 78 untreated treatment,for each of patients whole body imaging was conducted on the integrated TOF PET/MR(GE SIGNA).The results of TNM staging and re⁃staging according to the 8th edition of AJCC with PET/MR ima⁃ges were compared with the clinical diagnosis and staging.Independent⁃sample t test or Mann⁃Whitney U test were used for data analysis.Evaluation of the diagnostic consistency between PET/MR imaging staging and clinical staging using Kappa consistency test.Receiver operating characteristic(ROC)curve analysis was used to calculate the diagnostic performance of each parameter for T staging.Results The accuracy of PET/MR in T stage,N stage,M stage and overall stage were 98.72%,93.59%,100%and 94.87%.PET/MR staging is highly correlated with clinical staging diagnosis(Kappa value=0.926).SUV_(max)、SUV_(mean)、SUV_(max)/ADC_(min) are well correlated with T stage(P=0.003,0.005,0.004,P<0.01).SUV_(max) are well correlated with N staging of lymph nodes(P=0.000,P<0.01).ROC curve analysis showed that SUV_(max)/ADC_(min) had the highest diagnostic performance,the area under the curve(AUC)was 0.876.Conclusion ^(18)F⁃FDG PET/MR whole⁃body imaging can accurately stage and re⁃stage nasopharyngeal carcinoma.Compared with independent parameter of PET/MR,multiparametric model(SUV_(max)/ADC_(min))can further improve the diagnostic performance of T staging of naso⁃pharyngeal carcinoma.