In this study, we investigate the feasibility of using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI), and dynamic positron emission tomography (PET) for detection of metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) cases. Twenty HNSCC patients scheduled for lymph node dissection underwent DCE-MRI, dynamic PET, and DWI using a PET-MR scanner within one week prior to their planned surgery. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. Quantitative parameters of metastatic and normal nodes were calculated from DCE-MRI (v_e, v_p, PS, F_p, K^trans), DWI (ADC) and PET (K_i, K₁, k₂, k₃) to assess if an individual or a combination of parameters can classify normal and metastatic lymph nodes accurately. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. 34% of all normal nodes had volumes greater than or equal to the smallest metastatic node while 4 normal nodes had SUV > 4.5. Among the MRI parameters, the median v_p, F_p, PS, and K^trans values of the metastatic lymph nodes were significantly lower (p = <0.05) than those of normal nodes. v_e and ADC did not show any statistical significance. For the dynamic PET parameters, the metastatic nodes had significantly higher k₃ (p value = 8.8 × 10⁻⁸) and K_i (p value = 5.3 × 10⁻⁸) than normal nodes. K₁ and k₂ did not show any statistically significant difference. K_i had the best separation with accuracy = 0.96 (sensitivity = 1, specificity = 0.95) using a cutoff of K_i = 5.3 × 10⁻³ mL/cm³/min, while k₃ and volume had accuracy of 0.94 (sensitivity = 0.82, specificity = 0.97) and 0.90 (sensitivity = 0.64, specificity = 0.97) respectively. 100% accuracy can be achieved using a multivariate logistic regression model of MRI parameters after thresholding the data with K_i < 5.3 × 10⁻³ mL/cm³/min. The results of this preliminary study suggest that quantitative MRI may provide additional value in distinguishing metastatic nodes, particularly among small nodes, when used together with FDG-PET.

在这项研究中，我们研究了使用动态对比增强磁共振成像 (DCE-MRI)、弥散加权成像 (DWI) 和动态正电子发射断层扫描 (PET) 检测头颈部鳞状细胞癌转移淋巴结的可行性(HNSCC) 案例。20 名计划进行淋巴结清扫术的 HNSCC 患者在计划手术前一周内使用 PET-MR 扫描仪接受了 DCE-MRI、动态 PET 和 DWI。在手术过程中，切除的淋巴结被标记以识别它们的淋巴结水平，并送去进行常规临床病理学评估。从 DCE-MRI（ve _、 v _p、PS、F _p、K ^trans）、DWI（ADC）和 PET（_Ki, K ₁ , k ₂ , k ₃ ) 以评估个体或参数组合是否可以准确分类正常和转移性淋巴结。所有三种成像方法均覆盖并经病理证实的 38 个正常淋巴结和 11 个转移淋巴结。所有正常节点中有 34% 的体积大于或等于最小转移节点，而 4 个正常节点的 SUV > 4.5。在 MRI 参数中，转移淋巴结的中位 vp、Fp、PS 和 Ktrans 值显着低于正常淋巴结₍ p ₌ < ^0.05 )  。v _{_}ADC 没有显示任何统计显着性。对于动态 PET 参数，转移节点的 k ₃（p值 = 8.8 × 10 ^-8）和 K _i（p值 = 5.3 × 10 ^-8）明显高于正常节点。K ₁和k ₂没有显示任何统计显着差异。K _{i具有最佳分离精度 = 0.96（灵敏度 = 1，特异性 = 0.95），使用 K i}  = 5.3 × 10 ⁻³  mL/cm ³ /min的截止值，而 k ₃和体积的准确度分别为 0.94（灵敏度 = 0.82，特异性 = 0.97）和 0.90（灵敏度 = 0.64，特异性 = 0.97）。_{在对 K i}  < 5.3 × 10 ^-3  mL/cm ³ /min的数据进行阈值处理后，使用 MRI 参数的多元逻辑回归模型可以实现 100% 的准确度。这项初步研究的结果表明，当与 FDG-PET 一起使用时，定量 MRI 可能在区分转移性淋巴结方面提供额外的价值，特别是在小淋巴结中。