Diagnostic Evaluation of Malignant Head and Neck Cancer by F-18-FDG PET Compared to CT/MRI

Summary

Aim: Evaluation of F-18-FDG PET in comparison to CT/MRI as diagnostic tool in primary and recurrent head and neck cancer. Methods: 78 F-18-FDG PET studies were performed in 71 patients with known or suspected primary (n=48) or recurrent (n=30) head and neck cancer and compared to CT (n=75) or MRI investigations (n=3) concerning detection of the primary or recurrent tumor and detection of regional lymph node metastases in the ipsilateral and contralateral neck sides. Glucose uptake (SUV) of PET findings was correlated to tumor location, grading and dignity of the lesion. Results: Sensitivity and specificity for PET in detection of primary tumors were 87%* and 67%, respectively (CT/MRI 67%* and 44%) (*p<0.05), in detection of local recurrence 86% and 75%, respectively (CT/MRI 57% and 92%), in detection of necks affected by lymph node metastases 80% and 92%, respectively (CT/MRI 80% and 84%). Laryngeal, buccal (cheek) and salivary gland tumors had significant lower glucose uptake (SUV) when compared to tumors of the hypopharynx (p<0.05). G1-tumors (mean SUV 4.26) had significant (p<0.05) lower glucose uptake when compared to G2- and G3-tumors (mean SUV 7.73 and 8.19, respectively). Mean SUV of malignant PET findings (7.88) was significant (p<0.05) higher than mean SUV of benign PET findings (5.70). However, a SUV threshold to improve diagnostic accuracy could not be defined. Conclusion: F-18-FDG PET is significantly more accurate than CT/MRI for detection of head and neck cancer. Both methods are valuable for detection of cervical lymph node metastases. Glucose uptake shows correlation to histological grading. A quantitative SUV analysis does not improve diagnostic accuracy.

Zusammenfassung

Ziel: Evaluation der F-18-FDG-PET in der Primär- und Rezidivdiagnostik von Kopf-Hals-Tumoren im Vergleich zur CT/MRT. Methoden: Es wurden 78 F-18-FDG-PET-Untersuchungen bei 71 Patienten mit gesichertem odervermutetem primärem (n=48) oder rezidiviertem (n=30) Kopf-Hals-Tumor durchgeführt und mit CT- (n=75) bzw. MRT-Untersuchungen (n=3) hinsichtlich des Nachweises des Primärtumors bzw. des Lokalrezidivs sowie von Lymphknotenmetastasen in den ipsi- und kontralateralen Halsseiten verglichen. Der Glukose-Uptake (SUV) der PET-Herdbefunde wurde korreliert zu Tumorlokalisation, Grading sowie zur Dignität der Befunde. Ergebnisse: Sensitivitäten und Spezifitäten der PET betrugen zum Nachweis des Primärtumors 87%* bzw. 67% (CT/MRT 67%* bzw. 44%) (*p<0,05), zum Lokalrezidivnachweis 86% bzw. 75% (CT/MRT 57% bzw. 92%), zur Erkennung von Lymphknotenmetastasen der Halsseiten 80% bzw. 92% (CT/MRT 80% bzw. 84%). Larynx- und Wangen/Speicheldrüsentumoren wiesen signifikant niedrigere SUVWerte auf als Hypopharynxtumoren (p<0,05). Der Glukosemetabolismus war bei G1-Tumorherden (mittlerer SUV 4,26) signifikant (p<0,05) niedriger als bei G2- und G3-Tumorherden (mittlerer SUV 7,73 bzw. 8,19). Der SUV-Mittelwert maligner PET-Herdbefunde (7,88) war signifikant (p<0,05) höher als der benigner PET-Herdbefunde (5,70), ein SUVSchwellenwert zur Verbesserung der diagnostischen Genauigkeit konnte jedoch nicht definiert werden. Schlußfolgerung: F-18-FDG-PET ist signifikant genauer als CT/MRT beim Nachweis von Kopf-Hals-Tumoren. Beide Verfahren eignen sich in gleicher Weise zur Detektion von Halslymphknotenmetastasen. Der Glukose-Uptake korreliert zum histologischen Grading. Eine quantitative SUV-Analyse führt nicht zur Verbesserung der diagnostischen Genauigkeit.

Key words

Head and neck cancer - F-18-FDG PET - computerized tomography - magnetic resonance imaging - grading

Schlüsselwörter

Kopf-Hals-Tumor - F-18-FDG-PET Computertomographie - Magnetresonanztomographie - Grading

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