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FDG-PET/contrast-enhanced CT as a post-treatment tool in head and neck squamous cell carcinoma: comparison with FDG-PET/non-contrast-enhanced CT and contrast-enhanced CT

  • Head and Neck
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Abstract

Objective

To evaluate the accuracy of PET/CT using 18F-fluorodeoxyglucose (FDG) with IV contrast for suspected recurrent head and neck squamous cell carcinoma (HNSCC).

Methods

One hundred and seventy patients previously treated for HNSCC underwent PET/CT, consisting of non-contrast-enhanced and contrast-enhanced CT, to investigate suspected recurrence. Diagnostic performance of PET/contrast-enhanced CT (PET/ceCT), PET/non-contrast-enhanced CT (PET/ncCT) and contrast-enhanced CT (ceCT) for local or regional recurrence, distant metastasis, overall recurrence and second primary cancer was evaluated. The reference standard included histopathology, treatment change and imaging follow-up.

Results

The patient-based areas under the receiver operating characteristic curves (AUC) for ceCT, PET/ncCT and PET/ceCT were 0.82, 0.96 and 0.98 for local recurrence, 0.73, 0.86 and 0.86 for regional recurrence, 0.86, 0.91 and 0.92 for distant metastasis, 0.72, 0.86 and 0.87 for overall recurrence, and 0.86, 0.89 and 0.91 for a second primary cancer. Both PET/ceCT and PET/ncCT statistically showed larger AUC than ceCT for recurrence, and the difference between PET/ceCT and PET/ncCT for local recurrence reached a significant level (p = 0.039). The accuracy of PET/ceCT for diagnosing overall recurrence was high, irrespective of the time interval after the last treatment (83.3–94.1 %).

Conclusion

FDG-PET/CT was a more accurate HNSCC restaging tool than ceCT. The added value of ceCT at FDG-PET/CT is minimal.

Key Points

• FDG-PET/CT is a more accurate post-treatment surveillance tool than ceCT for HNSCC.

• FDG-PET/ceCT was useful, irrespective of the time interval after the last treatment.

• FDG-PET/ceCT showed high negative predictive value and limited positive predictive value.

• The added value of ceCT at FDG-PET/CT is minimal and likely not clinically relevant.

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Acknowledgments

The scientific guarantor of this publication is Kazuro Sugimura M.D., Ph.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic or prognostic study/observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Yuko Suenaga, Kazuhiro Kitajima & Kazuro Sugimura

  2. Department of Radiology, Division of Radiation Oncology, Kobe University Graduate, School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takeaki Ishihara & Ryohei Sasaki

  3. Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate, School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Naoki Otsuki & Ken-ichi Nibu

  4. Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Tsutomu Minamikawa

  5. Department of Medical Oncology and Hematology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Naomi Kiyota

Authors
  1. Yuko Suenaga
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Correspondence to Kazuhiro Kitajima.

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Suenaga, Y., Kitajima, K., Ishihara, T. et al. FDG-PET/contrast-enhanced CT as a post-treatment tool in head and neck squamous cell carcinoma: comparison with FDG-PET/non-contrast-enhanced CT and contrast-enhanced CT. Eur Radiol 26, 1018–1030 (2016). https://doi.org/10.1007/s00330-015-3902-1

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  • DOI: https://doi.org/10.1007/s00330-015-3902-1

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