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PET/MRI在头颈部肿瘤中的应用价值

  • 陈萌萌

    机 构：

    南京医科大学第一附属医院核医学科，江苏 南京 210029

    ×
  • ，高珂梦

    机 构：

    南京医科大学第一附属医院核医学科，江苏 南京 210029

    ×
  • ，沈楠

    机 构：

    南京医科大学第一附属医院核医学科，江苏 南京 210029

    ×
  • ，唐立钧

    机 构：

    南京医科大学第一附属医院核医学科，江苏 南京 210029

    ×
  • ，李天女

    机 构：

    南京医科大学第一附属医院核医学科，江苏 南京 210029

    ×

南京医科大学第一附属医院核医学科，江苏 南京 210029；

Application value of PET/MRI in head and neck cancer

  • CHEN Mengmeng

    Affiliation：

    Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China

    ×
  • ，GAO Kemeng

    Affiliation：

    Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China

    ×
  • ，SHEN Nan

    Affiliation：

    Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China

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  • ，TANG Lijun

    Affiliation：

    Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China

    ×
  • ，LI Tiannü

    Affiliation：

    Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China

    ×

Department of Nuclear Medicine，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029 ，China；

通讯作者:

李天女，E-mail: litiannv@126.com

中图分类号:R814.42

文献标识码:A

文章编号:1007-4368(2024)10-1428-07

DOI:10.7655/NYDXBNSN240287

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目录contents

    摘要

    头颈部肿瘤是常见的恶性肿瘤之一，多数患者确诊时已处于疾病中晚期，因此头颈部肿瘤的早期诊断、准确分期及疗效监测是优化治疗策略及改善预后的关键。一体化正电子发射断层扫描/磁共振成像（positron emission tomography/magnetic resonance imaging，PET/MRI）整合了分子功能与解剖结构成像，实现了PET与MRI的优势互补，将PET代谢功能信息与MRI良好软组织对比度相结合，真正实现多模态成像，在肿瘤诊疗过程中具有重要临床意义。文章主要探讨PET/MRI在头颈部肿瘤诊断分期、监测疗效、预测预后及制定放疗计划等方面的应用及进展。

    Abstract

    Head and neck cancer is one of the common malignant tumors，and most patients are diagnosed in the middle or late stages of the disease. Therefore，early diagnosis，accurate staging，and efficacy monitoring are the key to optimizing treatment strategies and improving prognosis of head and neck cancer. Integrated positron emission tomography/magnetic resonance imaging（PET/MRI） combines molecular function and anatomical structure imaging，harnessing the complementary advantages of PET and MRI. By combining the metabolic information of PET with the excellent soft tissue contrast of MRI，it truly achieves multimodal imaging，which is of significant clinical importance in the diagnosis，treatment，and monitoring of tumors. This review mainly focuses on the application and progress of PET/MRI in the diagnosis，staging，monitoring of efficacy，prognosis prediction，and development of radiotherapy plans for head and neck cancer.

  • 头颈部肿瘤（head and neck cancer，HNC）指发生于口腔颌面、咽、喉、鼻腔及鼻窦等部位的恶性肿瘤[1]，病理类型大多是鳞癌，是常见恶性肿瘤，每年新增病例超 66 万例，死亡病例超 32.5 万例[2-3]。近年来，正电子发射断层扫描/计算机断层扫描（posi⁃ tron emission tomography/computed tomography，PET/ CT）广泛应用于HNC[4]，但PET的分辨率较低，CT的软组织对比度欠佳，二者均无法充分显示病灶受累范围，因此在HNC早期诊断及临床分期等方面存在局限。相比之下，一体化正电子发射断层扫描/磁共振成像（positron emission tomography/magnetic reso⁃ nance imaging，PET/MRI）将分子功能与解剖结构成像相结合，兼具 PET 与 MRI 的优点，且为非侵入性检查，为揭示肿瘤的异质性及反映治疗变化提供了新思路。此外，已有研究显示，一体化 PET/MRI 有助于准确预测 HNC 的病理分化程度[5] 及表皮生长因子受体（epidermal growth factor receptor，EGFR）表达水平[6-7]，为个体化治疗提供了重要信息。本文主要就氟代脱氧葡萄糖（18F⁃fludeoxyglucose，18F⁃FDG） PET/MRI 在 HNC 诊断分期、监测疗效、预测预后及制定放疗计划等方面的应用及进展进行大致探讨。

  • 1 18F⁃FDG PET/MRI在头颈部肿瘤中的诊断价值

  • HNC患者常因颈部转移性淋巴结肿大就诊，而寻找原发灶对患者来说至关重要。由于CT软组织分辨率较低，并且头颈区域解剖结构较为复杂，微小或隐匿性肿瘤的漏诊率较高。此外，在 18F⁃FDG PET/CT中，咽淋巴环及肌肉等组织的18F⁃FDG高代谢常会干扰原发肿瘤的识别。与此相比，18F⁃FDG PET/MRI可通过多序列成像进行鉴别，提高原发灶的检测精准度[8]。一项诊断全身各部位原发癌的研究结果提示，18F⁃FDG PET/MRI在显示头颈部病变的效果优于18F⁃FDG PET/CT[9]。Park等[10] 研究进一步证明，与单纯 PET 和 MRI 相比，一体化 PET/MRI 显示头颈部恶性病变及可疑转移灶的能力更佳，在 HNC的精准诊断方面具有重要价值。

  • 2 18F⁃FDG PET/MRI 在头颈部肿瘤临床分期中的价值

  • 2.1 18F⁃FDG PET/MRI在头颈部肿瘤T分期中的价值

  • 早期HNC 常采用手术或单纯放化疗的治疗方式，而局部晚期HNC通常需手术治疗联合放疗、放化疗及靶向治疗来提高患者的生存率，因此准确评估肿瘤的大小、位置及侵犯范围并进行精准T分期对于选择合适治疗方案至关重要。一项研究结果显示， 18F⁃FDG PET/MRI、18F⁃FDG PET/CT和MRI对下咽癌 T分期的准确率分别为81.8%、63.6%和72.7%[11]，表明18F⁃FDG PET/MRI 在 T 分期中具有较高的准确性。与此同时，在鼻咽癌与口咽癌中均有研究证实 18F⁃FDG PET/MRI 局部肿瘤分期优于18F⁃FDG PET/CT[12-13]。Kuhn 等[14] 研究表明，18F ⁃ FDG PET/ MRI成像可准确显示咽部原发灶、邻近结构浸润和周围神经侵犯，对 HNC 精准 T 分期具有良好效能。然而，头颈部区域的图像质量易被患者的呼吸、吞咽甚至心跳所产生的运动伪影所影响，这一问题需依靠新兴技术来克服。

  • 2.2 18F⁃FDG PET/MRI在头颈部肿瘤N分期中的价值

  • 在头颈部鳞癌患者中，若出现单个淋巴结转移时患者 5 年生存率约为 50%，然而，若再增加对侧淋巴结转移则生存率降至 33%[15]，该数据强调了淋巴结转移是影响HNC治疗效果及预后的关键因素[16-17]，因此准确鉴别良恶性颈部淋巴结对预测患者预后及制定治疗方案至关重要。Van等[18] 通过对 109个经组织学验证的颈部淋巴结进行MRI和PET 纹理分析，发现将MRI纹理特征结合至传统PET特征中，可将 PET 评估淋巴结的特异性从 70.6%提高至88.2%，表明纹理特征有助于区分HNC患者的良恶性颈部淋巴结。Cebeci等[19] 探讨了18F⁃FDG PET/ MRI、PET及MRI在预测HNC患者无颈部淋巴结转移中的作用，发现18F⁃FDG PET/MRI的灵敏度、特异度和准确度分别为 83.3%、92.1%、90.9%，均优于 PET及MRI，并且具有良好的诊断效能，可使部分无淋巴结转移的患者避免不必要的颈部淋巴结清扫术，从而提高患者的生存质量。

  • 2.3 18F⁃FDG PET/MRI在头颈部肿瘤M分期中的价值

  • HNC最常见的远处转移部位是肺，其次是骨和肝[20]。尽管 HNC 远处转移率相对较低，但一旦出现远处转移，患者的生存率明显降低[21]。一项涵盖 2 289 例患者和 2 072 个转移灶的荟萃分析发现，利用全身 18F⁃FDG PET/MRI 检测恶性肿瘤远处转移具有高灵敏度及特异度[22]。Piao 等[23] 研究表明，18F⁃FDG PET/MRI 在诊断鼻咽癌远处转移的总体准确率高达88.3%。类似地，Yeh等[24] 也发现，相比MRI及18F⁃FDG PET/CT，18F⁃FDG PET/MRI在发现下咽癌远处转移病灶数目及灵敏度方面更为优越，显示出更好的诊断效能。尽管如此，采用 18F⁃FDG PET/MRI进行M分期的HNC患者数量相对较少，可能是因为初诊患者出现远处转移的概率较低[25-26]，同时在评估肺转移时，18F⁃FDG PET/MRI的作用尚有争议。Sara等[27] 研究显示，对18F⁃FDG代谢增高的肺结节和直径>10 mm 的肺结节，18F⁃FDG PET/MRI 与 18F⁃FDG PET/CT 灵敏度相同，但对直径<5 mm 且无 18F⁃FDG代谢的肺结节，18F⁃FDG PET/CT 的检出率更高。Raad 等[28] 发现，18F⁃FDG PET/MRI 漏诊的肺结节中，97%的肺结节未继续生长，且98%的无 18F⁃FDG代谢的亚厘米结节为良性。目前新兴MRI 序列如零回波时间（zero echo time，ZTE）成像已应用于PET/MRI，在评估肺实质方面展现出良好性能[29]。

  • 一项涵盖超过45万例HNC患者的大型Meta分析显示，约5.3%的患者同时存在第二原发肿瘤（sec⁃ ond primary tumor，SPT），而在2年内有13.2%的患者可能发展出异时性 SPT，大多数 SPT 发生在上呼吸道，其次是肺部[25]。有证据表明，18F⁃FDG PET/MRI 检测头颈部隐匿性原发灶优于18F⁃FDG PET/CT，这提示18F⁃FDG PET/MRI 在发现SPT方面可能也有良好的表现[9，30]。因此，18F⁃FDG PET/MRI在发现远处转移和SPT方面可能具有一定的价值。

  • 3 18F⁃FDG PET/MRI在头颈部肿瘤放化疗疗效监测中的价值

  • 虽然最新的免疫治疗药物为HNC 的治疗带来了一线希望，仍然有约40%的局部晚期HNC患者在治疗后面临失败的局面[31]。因此，准确评估治疗效果并及时发现治疗后残留肿瘤或疾病复发是临床管理的关键。Kim 等[32] 对比了 CT、MRI 和 18F⁃FDG PET/CT 独立及联合应用在检测 HNC 局部复发的诊断效能，研究结果显示18F⁃FDG PET/CT结合MRI 在受试者操作特性（receiver operating characteristic， ROC）曲线分析中展现出最佳性能：原发部位复发的 ROC 曲线下面积（area under curve，AUC）为 0.958，而淋巴结复发的 AUC 值为 0.929，这提示 18F ⁃FDG PET/MRI 在诊断 HNC 复发方面可能更具优势。此外，Patel 等[33] 基于颈部影像报告和数据系统（neck imaging reporting and data system，NI⁃RADS）记录的 MRI 和 18F⁃FDG PET/MRI 评分揭示，与单独 MRI 相比，18F⁃FDG PET/MRI 图像评分在预测 HNC 复发方面显示出更强的相关性，对监测HNC的局部复发有重要作用。治疗后HNC患者可能出现的组织结构变化（如炎症、水肿或坏死）经常导致异常 18F⁃FDG 代谢，由此为临床及影像科医生区分放化疗后改变和肿瘤复发带来了挑战，而PET/MRI可通过使用弥散加权成像（diffusion weighted imaging，DWI）、动脉自旋标记（arterial spin labeling，ASL）等技术来鉴别。此外，随着新型分子探针的不断研发，氨基酸类显像剂（如11C⁃蛋氨酸及11C⁃酪氨酸等）有望在鉴别两者中发挥重要作用[34]。

  • 4 18F⁃FDG PET/MRI在预测头颈部肿瘤患者预后中的价值

  • 精确的预后指标可为HNC 患者制定更优的治疗模式。Pace等[35] 研究评估了18F⁃FDG PET/MRI融合参数在局部晚期口咽及下咽癌患者预后预测中的价值，多因素分析揭示，原发肿瘤的峰值标准化摄取值（peak standardized uptake value，SULpeak）是预测口咽及下咽癌总生存期（overall survival，OS）的关键因子，根据Kaplan⁃Meier 生存曲线分析，SULpeak 值较高的患者预后较差。同时，Kulanthaivelu 等[36] 应用影像组学技术评估了124例鼻咽癌患者的预后情况，发现MRI联合18F⁃FDG PET/CT的影像组学特征与 OS 及无进展生存期（progression⁃free survival，PFS）相关，这提示基于 18F⁃FDG PET/MRI 的影像组学特征有助于改进鼻咽癌患者的预后预测。一项 21 例下咽癌行 18F⁃FDG PET/MRI 检查的研究[37] 发现，肿瘤代谢体积（metabolic tumor volume，MTV）是 PFS的独立预测因子，而病灶糖酵解总量（total lesion glycolysis，TLG）是 OS 的独立预测因子。此外，T 分期、临床分期、平均表观扩散系数（mean apparent diffusion coefficient，ADCmean）和最小表观扩散系数 （minimum apparent diffusion coefficient，ADCmin）亦是下咽癌预后的潜在预测指标。Chan 等[38] 评估了 18F⁃FDG PET/MRI联合体素内不相干运动（intravoxel incoherent motion，IVIM）及动态增强 MRI（dynamic contrast enhanced MRI，DCE⁃MRI）多参数对口咽或下咽癌患者预后的影响，指出了MTV和假扩散系数是OS的独立影响因素，而容量转移常数是预测无复发生存期（recurrence ⁃free survival，RFS）的重要指标。IVIM和DCE⁃MRI的功能参数结合18F⁃FDG PET 代谢参数，在预测口咽或下咽鳞癌患者生存方面优于传统TNM分期。

  • 5 18F⁃FDG PET/MRI在头颈部肿瘤放疗靶区勾画中的应用

  • 放疗是治疗HNC的关键手段之一，其中准确界定肿瘤边缘和估算其体积对患者的治疗计划至关重要。一项前瞻性研究发现，通过DWI与PET图像勾画HNC的感兴趣体积（volume of interest，VOI），其重叠率高达 82%，这一发现支持了将 18F⁃FDG PET 与 DWI 联合应用来优化放疗计划的观点[39]。 Sameolyk⁃kogaczewska 等[40] 发现在勾画原发灶大体肿瘤靶区（gross tumor volume，GTV）及转移淋巴结 GTV 时，将最大标准化摄取值（maximum standard uptake value，SUVmax）阈值分别设定为 30%及 30%~40%能够带来更佳的治疗效果，且相比其他传统成像技术，18F⁃FDG PET/MRI在为舌鳞癌患者勾画放疗靶区时能够提供更丰富的信息。然而，基于 PET/ MRI的放疗计划设计存在一定的技术难题，尤其是在使用PET/MRI专用定位设备（如面罩和平板桌面） 时，与PET/MRI设备狭窄的扫描孔径之间的兼容性问题限制了PET/MRI在HNC放疗计划设计中的广泛应用，但该领域的持续研究和技术进步有望解决当前的限制，进一步推动PET/MRI技术在临床的应用。

  • 6 其他PET显像剂在头颈部肿瘤中的应用

  • 目前，除了广泛使用的 18F⁃FDG 外，用于 HNC PET/MRI的特异性显像剂相对有限，更常见于PET/ CT的应用。当前研究较多的PET显像剂主要分为靶向肿瘤微环境类和代谢类。

  • 1⁃H⁃1⁃（3⁃[18F]氟⁃2⁃羟基丙基）⁃2⁃硝基咪唑（18F⁃ fluoromisonidazole，18F⁃FMISO）是一种乏氧显像剂，研究发现其代谢与组织低氧诱导因子⁃1a（hypoxia inducible factor⁃1a，HIF⁃1a）和组织增殖指数Ki⁃67密切相关，可用于制定放疗计划和监测治疗反应[41]。 Carles等[42] 在治疗前18F⁃FMISO PET/CT图像提取了 130个放射组学特征，计算治疗前、治疗2周及治疗 5周后患者图像上放射组学特征的相对差异，评估其与疗效的相关性，结果发现18个组学特征与其具有明显相关性，并在验证组得到验证，提示18F⁃FMISO PET/CT组学特征可预测患者放化疗后的疗效，有助于优化HNC患者放疗计划。此外，1⁃α⁃D⁃[5′⁃脱氧⁃ 5′⁃氟阿拉伯呋喃糖基]⁃2⁃硝基咪唑（18F⁃fluoroazomy⁃ cinarabinoside，18F⁃FAZA）是第 2 代硝基咪唑类化合物，具有血浆清除率快、图像对比度高的优点，一项研究[43] 评价了 HNC 18F⁃FAZA PET/CT 代谢活性与 DWI参数的相关性，探索反映缺氧细胞结构变化的指标，结果发现 18F⁃FAZA 代谢活性与扩散系数呈正相关，与峰度呈负相关。18F⁃氟代氮杂蒽啉（18F⁃ flortanidazole，18F⁃HX4）作为第 2 代低氧靶向 PET 显像剂，与 18F⁃FMISO 及 18F⁃FAZA 相比，清除率更高，靶本底比值及图像对比度亦有所提升[44]。联合两项前瞻性临床试验的数据指出，18F⁃HX4 PET/CT成像可预测头颈部鳞癌的OS及RFS，为临床上针对预后较差患者的强化治疗提供依据[45]。

  • 肿瘤相关成纤维细胞（cancer ⁃associated fibro⁃ blast，CAF）是肿瘤基质中的主要细胞类型，可提供有利的微环境支持肿瘤细胞的生长及增殖[46]。成纤维细胞激活蛋白（fibroblast activation protein， FAP）在CAF表面过度表达，可在90%的上皮性肿瘤中出现，其中包括HNC[47]。68Ga⁃FAPI是利用68Ga标记成纤维细胞激活蛋白抑制剂（fibroblast activation protein inhibitor，FAPI）与FAP结合来进行肿瘤的可视化显像。Jiang等[48] 研究发现，与18F⁃FDG PET/CT 相比，68Ga⁃FAPI⁃04 PET/CT诊断头颈部鳞癌颈部淋巴结转移具有更高的特异度及准确度，为患者的治疗前准确N分期提供了新的可能性。

  • 11 C⁃蛋氨酸（11C⁃methionine，11C⁃MET）是常用的氨基酸类显像剂，在肿瘤细胞中的摄取与氨基酸转运增加有关，其在炎症细胞的摄取有限，可更好也显示HNC。然而，与18F⁃FDG PET/CT相比，11C⁃MET⁃PET/CT在检测HNC放疗后复发方面无明显优势[49]。 11C⁃MET 参与多种代谢途径，其反映代谢的精确度较差，更适合于测定肿瘤蛋白质合成活性的显像剂有 11C⁃酪氨酸（11C⁃tyrosine，11C⁃TYR）。De Boer 等[50] 对 31 例 T1~T4 期喉癌或下咽癌患者在治疗前行动态 11C⁃TYR PET 检查，通过评估蛋白质合成率（pro⁃ tein synthesis rate，PSR）来量化肿瘤活性，发现原发肿瘤的 PSR 显著高于周围正常组织，提示 11C⁃TYR 可作为评估喉和下咽部肿瘤的一种潜在显像方法，为更准确地评价肿瘤活性和引导治疗决策提供了新视角。

  • 3 ′⁃脱氧⁃3′⁃18F⁃氟代胸苷（18F⁃fluorothymidine， 18F⁃FLT）是一种胸腺嘧啶类似物，通过被动扩散和 Na+ 依赖的载体进入细胞后被磷酸化，但其磷酸化的代谢物不能继续参与DNA的合成，只能滞留在细胞内，从而可间接反映肿瘤细胞的活性。Kazmierska 等[51] 研究发现，治疗前18F⁃FLT PET/CT参数MTV与 HNC 的局部控制（local control，LC）及无病生存期 （disease⁃free survival，DFS）相关，而与OS无关。Cegla 等[52] 通过累计 SUV 体积直方图曲线下面积（area under the curve of cumulative SUV⁃volume histograms， AUC⁃CSH）在18F⁃FDG、18F⁃FMISO及18F⁃FLT PET/CT 检查中评估肿瘤的异质性，发现AUC⁃CSH值越低，患者预后越差。值得注意的是，相比 18F⁃FDG 的评估结果，18F⁃FLT 和 18F⁃FMISO 揭示的肿瘤异质性更能体现出严峻的预后情况。

  • 尽管这些显像剂目前还不能在临床实践中取代 18F⁃FDG，但它们为深入理解 HNC 的生物学机制提供了宝贵的补充信息，且将来有可能应用到PET/ MRI中去。

  • 7 总结

  • PET可从分子水平上无损伤且定量地获得组织结构的生化、生理及功能代谢变化的影像信息，为临床应用提供重要价值。不断涌现的新型分子探针为 PET 在肿瘤诊疗方面提供了更广阔的应用前景。一体化 PET/MRI 将 PET 与 MRI 多参数联合应用，提高了软组织对比度，在HNC的分期方面具有明显的优势。尽管其在预测预后、靶区勾画及疗效监测方面的应用仍存在争议，未来发展需解决成本高昂、扫描时间长等问题。然而，随着新技术如先进成像序列、影像组学及人工智能的不断发展，以及新型分子探针的研发，一体化PET/MRI在HNC个性化诊疗中的价值将日益凸显。

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    • [29] ZENG F,NOGAMI M,UENO Y R,et al.Diagnostic performance of zero ⁃TE lung MR imaging in FDG PET/MRI for pulmonary malignancies[J].Eur Radiol,2020,30(9):4995-5003

    • [30] SEKINE T,BARBOSA F G,SAH B R,et al.PET/MR outperforms PET/CT in suspected occult tumors[J].Clin Nucl Med,2017,42(2):e88-e95

    • [31] WANGARYATTAWANICH P,AGARWAL M,RATH T J.PET/CT and PET/MRI evaluation of posttreatment head and neck[J].Semin Roentgenol,2023,58(3):331-346

    • [32] KIM E S,YOON D Y,MOON J Y,et al.Detection of loco⁃regional recurrence in malignant head and neck tumors:a comparison of CT,MRI,and FDG PET⁃CT[J].Acta Radiol,2019,60(2):186-195

    • [33] PATEL L D,BRIDGHAM K,CIRIELLO J,et al.PET/MR imaging in evaluating treatment failure of head and neck malignancies:a neck imaging reporting and data system-based study[J].Am J Neuroradiol,2022,43(3):435-441

    • [34] HOFFMAN R M.L⁃Methyl⁃(11)C methionine⁃positron-emission tomography(MET⁃PET)[J].Methods Mol Biol,2019,1866:267-271

    • [35] PACE L,NICOLAI E,CAVALIERE C,et al.Prognostic value of 18F⁃FDG PET/MRIin patientswith advanced oropharyngeal and hypopharyngeal squamous cell carcinoma[J].Ann Nucl Med,2021,35(4):479-484

    • [36] KULANTHAIVELU R,KOHAN A,HINZPETER R,et al.Prognostic value of PET/CT and MR-based baseline radiomics among patients with non ⁃metastatic nasopharyngeal carcinoma[J].Front Oncol,2022,12:952763

    • [37] HUANG C,ZHANG L,MENG Z,et al.Prognostic value of 18F ⁃fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging in patients with hypopharyn⁃geal squamous cell carcinoma[J].J Comput Assist Tomogr,2022,46(6):968-977

    • [38] CHAN S,YEH C,NG S,et al.Prospective investigation of 18FDG ⁃PET/MRI with intravoxel incoherent motion diffusion ⁃weighted imaging to assess survival in patients with oropharyngeal or hypopharyngeal carcinoma[J].Cancers,2022,14(24):6104

    • [39] RASMUSSEN J H,NORGAARD M,HANSEN A E,et al.Feasibility of multiparametric imaging with PET/MR in head and neck squamous cell carcinoma[J].J Nucl Med,2017,58(1):69-74

    • [40] SAMOLYK⁃KOGACZEWSKA N,SIERKO E,ZUZDA K,et al.PET/MRI⁃guided GTV delineation during radiotherapy planning in patients with squamous cell carcinoma of the tongue[J].Strahlenther Onkol,2019,195(9):780-791

    • [41] SATO J,KITAGAWA Y,WATANABE S,et al.(18)F⁃Flu-oromisonidazole positron emission tomography(FMISO-PET)may reflect hypoxia and cell proliferation activity in oral squamous cell carcinoma[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2017,124(3):261-270

    • [42] CARLES M,FECHTER T,GROSU A L,et al.18F⁃FMISO-PET hypoxia monitoring for head-and ⁃ neck cancer patients:radiomics analyses predict the outcome of chemo-radiotherapy[J].Cancers,2021,13(14):3449

    • [43] IMAIZUMI A,OBATA T,KERSHAW J,et al.Imaging of hypoxic tumor:correlation between diffusion-weighted MR imaging and 18F ⁃fluoroazomycin arabinoside positron emission tomography in head and neck carcinoma[J].Magn Reson Med Sci,2020,19(3):276-281

    • [44] WACK L J,MONNICH D,VAN ELMPT W,et al.Comparison of[18F]⁃ FMISO,[18F]⁃ FAZA and[18F]⁃ HX4 for PET imaging of hypoxia⁃⁃a simulation study[J].Acta Oncol,2015,54(9):1370-1377

    • [45] SANDULEANU S,HAMMING⁃VRIEZE O,WESSELING F W R,et al.[18F]⁃ HX4 PET/CT hypoxia in patients with squamous cell carcinoma of the head and neck treated with chemoradiotherapy:prognostic results from two prospective trials[J].Clin Transl Radiat Oncol,2020,23:9-15

    • [46] PELTANOVA B,RAUDENSKA M,MASARIK M.Effect of tumor microenvironment on pathogenesis of the head and neck squamous cell carcinoma:a systematic review[J].Mol Cancer,2019,18(1):63

    • [47] XIE C,JI N,TANG Z,et al.The role of extracellular vesicles from different origin in the microenvironment of head and neck cancers[J].Mol Cancer,2019,18(1):83

    • [48] JIANG Y,WEN B,LI C,et al.The performance of 68Ga⁃FAPI⁃04 PET/CT in head and neck squamous cell carcinoma:a prospective comparison with 18F⁃FDG PET/CT[J].Eur J Nucl Med Mol Imaging,2023,50(7):2114-2126

    • [49] WEDMAN J,PRUIM J,VAN DER PUTTEN L,et al.Is C⁃ 11 methionine PET an alternative to 18F FDG⁃PET for identifying recurrent laryngeal cancer after radiotherapy?[J].Clin Otolaryngol,2019,44(2):124-130

    • [50] DE BOER J R,VAN DER LAAN B F,PRUIM J,et al.Carbon⁃11 tyrosine PET for visualization and protein synthesis rate assessment of laryngeal and hypopharyngeal carcinomas[J].Eur J Nucl Med Mol Imaging,2002,29(9):1182-1187

    • [51] KAZMIERSKA J,CHOLEWINSKI W,PIOTROWSKI T,et al.Assessment of tumour hypoxia,proliferation and glucose metabolism in head and neck cancer before and during treatment[J].Br J Radiol,2020,93(1106):20180781

    • [52] CEGLA P,KAZMIERSKA J,GWOZDZ S,et al.Assessment of biological parameters in head and neck cancer based on in vivo distribution of 18F-FDG ⁃ FLT ⁃ FMISO-PET/CT images[J].Tumori,2020,106(1):33-38

  • 基本信息

    中图分类号: R814.42
    文献标识码: A
    DOI: 10.7655/NYDXBNSN240287
    文章编号: 1007-4368(2024)10-1428-07

    基金信息

    国家卫生健康委核医学重点实验室；
    江苏省分子核医学重点实验室项目（KF202206）；

    引用信息

    稿件历史

    收稿日期: 2024-03-19

  • 参考文献

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    • [28] RAAD R A,FRIEDMAN K P,HEACOCK L,et al.Outcome of small lung nodules missed on hybrid PET/MRI in patients with primary malignancy[J].J Magn Reson Imaging,2016,43(2):504-511

    • [29] ZENG F,NOGAMI M,UENO Y R,et al.Diagnostic performance of zero ⁃TE lung MR imaging in FDG PET/MRI for pulmonary malignancies[J].Eur Radiol,2020,30(9):4995-5003

    • [30] SEKINE T,BARBOSA F G,SAH B R,et al.PET/MR outperforms PET/CT in suspected occult tumors[J].Clin Nucl Med,2017,42(2):e88-e95

    • [31] WANGARYATTAWANICH P,AGARWAL M,RATH T J.PET/CT and PET/MRI evaluation of posttreatment head and neck[J].Semin Roentgenol,2023,58(3):331-346

    • [32] KIM E S,YOON D Y,MOON J Y,et al.Detection of loco⁃regional recurrence in malignant head and neck tumors:a comparison of CT,MRI,and FDG PET⁃CT[J].Acta Radiol,2019,60(2):186-195

    • [33] PATEL L D,BRIDGHAM K,CIRIELLO J,et al.PET/MR imaging in evaluating treatment failure of head and neck malignancies:a neck imaging reporting and data system-based study[J].Am J Neuroradiol,2022,43(3):435-441

    • [34] HOFFMAN R M.L⁃Methyl⁃(11)C methionine⁃positron-emission tomography(MET⁃PET)[J].Methods Mol Biol,2019,1866:267-271

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    • [44] WACK L J,MONNICH D,VAN ELMPT W,et al.Comparison of[18F]⁃ FMISO,[18F]⁃ FAZA and[18F]⁃ HX4 for PET imaging of hypoxia⁃⁃a simulation study[J].Acta Oncol,2015,54(9):1370-1377

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    • [49] WEDMAN J,PRUIM J,VAN DER PUTTEN L,et al.Is C⁃ 11 methionine PET an alternative to 18F FDG⁃PET for identifying recurrent laryngeal cancer after radiotherapy?[J].Clin Otolaryngol,2019,44(2):124-130

    • [50] DE BOER J R,VAN DER LAAN B F,PRUIM J,et al.Carbon⁃11 tyrosine PET for visualization and protein synthesis rate assessment of laryngeal and hypopharyngeal carcinomas[J].Eur J Nucl Med Mol Imaging,2002,29(9):1182-1187

    • [51] KAZMIERSKA J,CHOLEWINSKI W,PIOTROWSKI T,et al.Assessment of tumour hypoxia,proliferation and glucose metabolism in head and neck cancer before and during treatment[J].Br J Radiol,2020,93(1106):20180781

    • [52] CEGLA P,KAZMIERSKA J,GWOZDZ S,et al.Assessment of biological parameters in head and neck cancer based on in vivo distribution of 18F-FDG ⁃ FLT ⁃ FMISO-PET/CT images[J].Tumori,2020,106(1):33-38

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