Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT, and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC

Autor: Christoph Sproll, Philipp Heusch, Christian Buchbender, Christina Antke, Inga Boeck, Jan Terjung, Elena Rieser, Till A. Heusner, Stephan Macht, Axel Scherer, Jörg Handschel, Gerald Antoch
Rok vydání: 2013
Předmět:
Zdroj: Clinical Oral Investigations. 18:969-978
ISSN: 1436-3771
1432-6981
Popis: This study aimed to compare 18F-fluorodesoxyglucose positron emission tomography/MRI (18F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), 18F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC). Eighteen patients prospectively underwent ultrasound examination, 18F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference. The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for 18F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for 18F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for 18F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between 18F-FDG-PET-MRI and 18F-FDG-PET/CT (p = 0.839) and between 18F-FDG-PET-MRI plus DWI and 18F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than 18F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between 18F-FDG-PET-MRI and US (p = 0.223) or 18F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by 18F-FDG-PET-MRI in eight patients, 18F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and 18F-FDG-PET/CT in five out of 18 patients. Software-based fusion of 18F-FDG-PET-MRI and 18F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and 18F-FDG-PET/CT. Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.
Databáze: OpenAIRE
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