<sup>18</sup>F-FDG PET/CT和MRI及血浆EB病毒水平对鼻咽癌局部复发的诊断价值研究

许昀; 郭岚晏; 彭荷苇; 林城; 王杰松; 庄晴阳; 张瑜; 林庆良

doi:10.12354/j.issn.1000-8179.2022.20220822

¹⁸F-FDG PET/CT和MRI及血浆EB病毒水平对鼻咽癌局部复发的诊断价值研究

doi: 10.12354/j.issn.1000-8179.2022.20220822

许昀^1,,
郭岚晏²,
彭荷苇³,
林城¹,
王杰松⁴,
庄晴阳¹,
张瑜¹,
林庆良^5, ,

1.
福建医科大学附属肿瘤医院放疗科，福建省肿瘤医院（福州市350108）
2.
福建医科大学医学技术与工程学院
3.
福建医科大学公共卫生学院流行病与卫生统计学系
4.
福建医科大学附属肿瘤医院淋巴瘤头颈肿瘤内科
5.
福建医科大学附属协和医院放疗科，福建省肿瘤智能影像与精准放疗重点实验室，福建省消化、血液系统与乳腺恶性肿瘤放射与治疗临床医学研究中心

基金项目: 本文课题受福建省科技计划项目（编号：2019Y0061）资助

详细信息

作者简介:
许昀：专业方向为头颈部肿瘤的放射治疗

通讯作者:
林庆良　lql2306@sina.com

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出版历程
- 收稿日期: 2022-05-28
- 录用日期: 2022-08-11
- 修回日期: 2022-08-09

Diagnostic value of ¹⁸F-fluorodeoxyglucose positron emission computed tomography, magnetic resonance imaging, and plasma EBV levels on local recurrence of nasopharyngeal carcinoma

1.
Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
2.
School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350108, China
3.
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350108, China
4.
Department of Head-neck Tumor & Lymphoma, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
5.
Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive，Hematological and Breast Malignancies ), Fuzhou 350108, China

Funds: This work was supported by the Natural Science Foundation of Fujian Province (No. 2019Y0061)

More Information

Corresponding author: Qingliang Lin; E-mail: lql2306@sina.com

摘要

摘要: 目的比较¹⁸F-FDG PET/CT、MRI在鼻咽癌局部复发和放疗后改变的鉴别诊断中的应用价值，并确定更合适的SUV_max诊断阈值，探索血浆EBV-DNA在发现鼻咽癌复发转移方面的意义。方法选取2015年1月至2020年2月期间放疗结束至少6个月后在福建省肿瘤医院进行复查的鼻咽癌患者208例，均进行MRI、PET/CT及EB病毒DNA检查（均在1个月内完成）。以活检病理结果或影像学的密切随访（至少1年）作为诊断鼻咽癌是否局部复发的标准，对患者的影像检查结果及相关参数进行比较分析。结果共有83例患者确诊为鼻咽癌局部复发，125例确诊为无局部复发，后者中77例伴有区域复发和（或）远处转移。PET/CT和MRI对鼻咽癌局部复发的诊断敏感性、特异性、准确性分别为89.2% vs. 67.5%，90.4% vs. 92.0%，89.9% vs. 82.2%。当诊断临界值SUV_max=3.85时，PET/CT的诊断准确性最高，与SUV_max=2.5相比，特异性（89.6% vs. 68.0%）和准确性（89.4% vs. 78.4%）均有显著提升。对纳入患者中治疗失败患者的EB病毒DNA分析发现，局部复发患者的血浆EBV-DNA检测敏感性低于区域复发或远处转移患者。局部复发肿瘤患者的SUV_max值与血浆EBV-DNA存在相关性。结论 ¹⁸F-FDG PET/CT对鼻咽癌局部复发和放疗后改变的鉴别诊断效能优于MRI。SUV_max诊断阈值设为3.85时可获得更好的诊断效能。血浆EBV-DNA检测在鼻咽癌区域复发和远处转移方面较灵敏，局部复发者的阳性率并不高，对这部分患者的诊断价值仅提供参考。
- 鼻咽癌 /
- 局部肿瘤复发 /
- 核磁共振成像 /
- 正电子发射计算机断层显像 /
- EB病毒感染
Abstract: Objective To compare the application value of ¹⁸F-fluorodeoxyglucose positron emission computed tomography (¹⁸F-FDG PET/CT) and magnetic resonance imaging (MRI) in the differential diagnosis of local recurrence and post-radiotherapy changes in nasopharyngeal carcinoma (NPC); to determine a more appropriate diagnostic threshold for maximum standardized uptake value (SUV_max); and to explore the significance of plasma EBV-DNA in detecting recurrent metastases in NPC. Methods Patients with NPC, who underwent review at Fujian Cancer Hospital between January 2015, and February 2020, 6 months after the end of radiotherapy, underwent MRI, PET/CT, and EBV DNA examinations (all within a month). Close follow-up (at least 1 year) of their biopsy pathology results or imaging was used as basis to verify whether NPC was locally recurrent. The patients' imaging findings and related parameters were compared and analyzed. Results A total of 83 patients were diagnosed with a local recurrence of NPC. Besides, 125 were diagnosed without local recurrence. Seventy-seven of the patients without local recurrence had a regional recurrence and/or distant metastases. The sensitivity, specificity, and accuracy of PET/CT and MRI for local recurrence of NPC were 89.2% vs. 67.5%, 90.4% vs. 92.0%, and 89.9% vs. 82.2%, respectively. The diagnostic accuracy of PET/CT was highest when the diagnostic threshold SUV_max=3.85. The specificity (89.6% vs. 68.0%) and accuracy (89.4% vs. 78.4%) significantly improved compared with a SUV_max=2.5. Analysis of EBV-DNA from patients with treatment failure revealed that plasma EBV-DNA detection sensitivity was lower in patients with local recurrence than in patients with regional recurrence or distant metastases. This highlights the correlation between SUV_max values and plasma EBV-DNA in patients with locally recurrent tumors. Conclusions ¹⁸F-FDG PET/CT is more effective than MRI for the differential diagnosis of local recurrence and post-radiation changes in NPC. Better diagnostic efficacy is obtained when the SUV_max diagnostic threshold is set at 3.85. Plasma EBV-DNA testing is more sensitive in regional recurrence and distant metastasis of NPC. Still, the positive rate in those with local recurrence is not high, and the diagnostic value for this group should only be used as a reference.
- nasopharyngeal carcinoma (NPC) /
- local neoplasm recurrence /
- magnetic resonance imaging (MRI) /
- positron emission tomography computed tomography (PET/CT) /
- Epstein-Barr virus infection

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图 1 SUV_max值的分布情况及不同SUV_max诊断阈值的诊断效能

A：SUV_max值在局部复发组及无局部复发组的分布范围；B：不同SUV_max诊断阈值的ROC曲线分析

下载: 全尺寸图片幻灯片

图 2 局部复发肿瘤的SUV_max与血浆EBV-DNA水平相关性分析

下载: 全尺寸图片幻灯片

表 1 患者基本特征例（%）

特征	总例数（n=208）	局部复发（n=83）	无局部复发（n=125）	P
性别				0.686
男	165（79.3）	67（80.7）	98（78.4）
女	43（20.7）	16（19.3）	27（21.6）
原发T分期（期）				0.368
1～2	83（39.9）	30（36.1）	53（42.4）
3～4	125（60.1）	53（63.9）	72（57.6）
原发N分期（期）				0.065
0～1	94（45.2）	44（53.0）	50（40.0）
2～3	114（54.8）	39（47.0）	75（60.0）
原发临床分期（期）				0.357
Ⅰ	0（0）	0（0）	0（0）
Ⅱ	31（14.9）	12（14.5）	19（15.2）
Ⅲ	96（46.2）	43（51.8）	53（42.4）
Ⅳ	81（38.9）	28（33.7）	53（42.4）
局部复发肿瘤分期（期）				−
Ⅰ	15（18.1）	15（18.1）	0（0）
Ⅱ	10（12.0）	10（12.0）	0（0）
Ⅲ	21（25.3）	21（25.3）	0（0）
ⅣA+ⅣB	37（44.6）	37（44.6）	0（0）

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表 2 MRI与PET/CT的诊断效能比较例

项目	TP	FP	TN	FN	合计
MRI	56	10	121	27	214
PET/CT	74	12	119	9	214
TP：真阳性；FP假阳性；TN：真阴性；FN：假阴性

下载: 导出CSV

表 3 血浆EBV-DNA与鼻咽癌复发的相关性分析

项目	例数	EB阳性	敏感性（%）	特异性（%）	准确性（%）	M（IQR）（copies/mL）
复发转移	160	101	63.1	95.8	70.7	2 350.0（25 116.4）
局部复发	83	44	53.0	52.8	52.9	601.0（6 470.0）
区域复发	65	51	78.5	63.6	68.3	5 400.0（53 588.5）
远处转移复发	63	51	81.0	64.1	69.2	15 100.0（77 520.0）
仅局部复发	53	20	37.7	95.8	65.3	185.0（1 930.0）
仅区域复发	27	19	70.4	95.8	86.7	4 120.0（9 727.0）
仅远处转移复发	39	27	69.2	95.8	83.9	6 620.0（60 026.0）
M：中位数；IQR：四分位间距

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参考文献(18)

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