Abstract
Purpose
To evaluate the accuracy of integrated 18F-FDG PET/MR imaging for locoregional tumour evaluation compared to 18F-FDG PET/CT and MR imaging in initial tumour and recurrence diagnosis in histopathologically confirmed head and neck squamous cell carcinoma (HNSCC).
Methods
18F-FDG PET/CT and integrated 18F-FDG PET/MR imaging were performed for initial tumour staging or recurrence diagnosis in 25 patients with HNSCC. MR, fused 18F-FDG PET/CT and fused 18F-FDG PET/MR images were analysed by two independent readers in separate sessions in random order. In initial tumour staging, T and N staging was performed while individual lesions were analysed in patients with suspected cancer recurrence. In T and N staging, histopathological results after tumour resection served as the reference standard while histopathological sampling as well as cross-sectional and clinical follow-up were accepted in cancer recurrence diagnosis. The diagnostic accuracy of each modality was calculated separately for T and N staging as well as for tumour recurrence, and compared using McNemar’s test. Values of p <0.017 were considered statistically significant after Bonferroni correction.
Results
In 12 patients undergoing 18F-FDG PET/CT and 18F-FDG PET/MR for initial tumour staging, T staging was accurate in 50 % with MRI, in 59 % with PET/CT and in 75 % with PET/MR while N staging was accurate in 75 % with MRI, in 77 % with PET/CT and in 71 % with PET/MR in relation to the reference standard. No significant differences were observed in T and N staging among the three modalities (p > 0.017). In 13 patients undergoing hybrid imaging for cancer recurrence diagnosis, diagnostic accuracy was 57 % with MRI and in 72 % with 18F-FDG PET/CT and 18F-FDG PET/MR, respectively. Again, no significant differences were found among the three modalities (p > 0.017).
Conclusion
In this initial study, no significant differences were found among 18F-FDG PET/MR, 18F-FDG PET/CT and MRI in local tumour staging and cancer recurrence diagnosis.
Similar content being viewed by others
References
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.
Wolff K-D, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Dtsch Arztebl Int. 2012;109:829–35.
Howaldt HP, Vorast H, Blecher JC, Reicherts M, Kainz M. Results of the DOSAK tumor register. Mund Kiefer Gesichtschir. 2000;4 Suppl 1:S216–25.
Kalnins IK, Leonard AG, Sako K, Razack MS, Shedd DP. Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity. Am J Surg. 1977;134:450–4.
Grégoire V, Lefebvre J-L, Licitra L, Felip E. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:184–6.
Held P, Breit A. MRI and CT of tumors of the pharynx: comparison of the two imaging procedures including fast and ultrafast MR sequences. Eur J Radiol. 1994;18:81–91.
Leslie A, Fyfe E, Guest P, Goddard P, Kabala J. Staging of squamous cell carcinoma of the oral cavity and oropharynx: a comparison of MRI and CT in T- and N-staging. J Comput Assist Tomogr. 1999;23:43–9.
Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MR imaging in staging of neck metastases. Radiology. 1998;207:123–30.
Wax MK, Myers LL, Gona JM, Husain SS, Nabi HA. The role of positron emission tomography in the evaluation of the N-positive neck. Otolaryngol Head Neck Surg. 2003;129:163–7.
Yen T-C, Chang JT-C, Ng S-H, Chang Y-C, Chan S-C, Wang H-M, et al. Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology. J Nucl Med. 2005;46:775–81.
Hafidh MA, Lacy PD, Hughes JP, Duffy G, Timon CV. Evaluation of the impact of addition of PET to CT and MR scanning in the staging of patients with head and neck carcinomas. Eur Arch Otorhinolaryngol. 2006;263:853–9.
Nahmias C, Carlson ER, Duncan LD, Blodgett TM, Kennedy J, Long MJ, et al. Positron emission tomography/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J Oral Maxillofac Surg. 2007;65:2524–35.
Seitz O, Chambron-Pinho N, Middendorp M, Sader R, Mack M, Vogl TJ, et al. 18F-Fluorodeoxyglucose-PET/CT to evaluate tumor, nodal disease, and gross tumor volume of oropharyngeal and oral cavity cancer: comparison with MR imaging and validation with surgical specimen. Neuroradiology. 2009;51:677–86.
Loeffelbein DJ, Souvatzoglou M, Wankerl V, Martinez-Möller A, Dinges J, Schwaiger M, et al. PET-MRI fusion in head-and-neck oncology: current status and implications for hybrid PET/MRI. J Oral Maxillofac Surg. 2012;70:473–83.
Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Kitzler HH, Maus J, et al. FDG PET/MR for lymph node staging in head and neck cancer. Eur J Radiol. 2014;83:1163–8.
Boss A, Stegger L, Bisdas S, Kolb A, Schwenzer N, Pfister M, et al. Feasibility of simultaneous PET/MR imaging in the head and upper neck area. Eur Radiol. 2011;21:1439–46.
Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging. 2013;40:6–11.
Lee SJ, Seo HJ, Cheon GJ, Kim JH, Kim EE, Kang KW, et al. Usefulness of integrated PET/MRI in head and neck cancer: a preliminary study. Nucl Med Mol Imaging. 2014;48:98–105.
Buchbender C, Heusner TA, Lauenstein TC, Bockisch A, Antoch G. Oncologic PET/MRI, Part 1: tumors of the brain, head and neck, chest, abdomen, and pelvis. J Nucl Med. 2012;53:928–38.
Partovi S, Kohan A, Rubbert C, Vercher-Conejero JL, Gaeta C, Yuh R, et al. Clinical oncologic applications of PET/MRI: a new horizon. Am J Nucl Med Mol Imaging. 2014;4:202–12.
Becker M, Zaidi H. Imaging in head and neck squamous cell carcinoma: the potential role of PET/MRI. Br J Radiol. 2014;87:20130677.
Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Delso G, Wollenweber S, Lonn A, Wiesinger F, Veit-Haibach P. MR-driven metal artifact reduction in PET/CT. Phys Med Biol. 2013;58:2267–80.
Purohit BS, Ailianou A, Dulguerov N, Becker CD, Ratib O, Becker M. FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging. 2014:5;585–602
AAssar OS, Fischbein NJ, Caputo GR, Kaplan MJ, Price DC, Singer MI, et al. Metastatic head and neck cancer: role and usefulness of FDG PET in locating occult primary tumors. Radiology. 1999;210:177–81.
Wong W-L, Gibson D, Sanghera B, Goodchild K, Saunders M. Evaluation of normal FDG uptake in palatine tonsil and its potential value for detecting occult head and neck cancers: a PET CT study. Nucl Med Commun. 2007;28:675–80.
Klinke T, Daboul A, Maron J, Gredes T, Puls R, Jaghsi A, et al. Artifacts in magnetic resonance imaging and computed tomography caused by dental materials. PLoS One. 2012;7:e31766.
Stokkel MPM, ten Broek F-W, Hordijk G-J, Koole R, van Rijk PP. Preoperative evaluation of patients with primary head and neck cancer using dual-head 18fluorodeoxyglucose positron emission tomography. Ann Surg. 2000;231:229–34.
Schroeder U, Dietlein M, Wittekindt C, Ortmann M, Stuetzer H, Vent J, et al. Is there a need for positron emission tomography imaging to stage the N0 neck in T1-T2 squamous cell carcinoma of the oral cavity or oropharynx? Ann Otol Rhinol Laryngol. 2008;117:854–63.
Heusch P, Sproll C, Buchbender C, Rieser E, Terjung J, Antke C, et al. Diagnostic accuracy of ultrasound, 18F-FDG-PET/CT, and fused 18F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig. 2014;18:969–78.
Hartung-Knemeyer V, Beiderwellen KJ, Buchbender C, Kuehl H, Lauenstein TC, Bockisch A, et al. Optimizing positron emission tomography image acquisition protocols in integrated positron emission tomography/magnetic resonance imaging. Invest Radiol. 2013;48:290–4.
Schillaci O. Use of dual-point fluorodeoxyglucose imaging to enhance sensitivity and specificity. Semin Nucl Med. 2012;42:267–80.
Cheng G, Torigian DA, Zhuang H, Alavi A. When should we recommend use of dual time-point and delayed time-point imaging techniques in FDG PET? Eur J Nucl Med Mol Imaging. 2013;40:779–87.
Hahn S, Hecktor J, Grabellus F, Hartung V, Pöppel T, Kimmig R, et al. Diagnostic accuracy of dual-time-point 18F-FDG PET/CT for the detection of axillary lymph node metastases in breast cancer patients. Acta Radiol. 2012;53:518–23.
Oehmigen M, Ziegler S, Jakoby BW, Georgi J-C, Paulus DH, Quick HH. Radiotracer dose reduction in integrated PET/MR: implications from National Electrical Manufacturers Association phantom studies. J Nucl Med. 2014;55:1361–7.
Sigal R, Zagdanski AM, Schwaab G, Bosq J, Auperin A, Laplanche A, et al. CT and MR imaging of squamous cell carcinoma of the tongue and floor of the mouth. Radiographics. 1996;16:787–810.
Paes FM, Singer AD, Checkver AN, Palmquist RA, La Vega GD, Sidani C. Perineural spread in head and neck malignancies: clinical significance and evaluation with 18F-FDG PET/CT. Radiographics. 2013;33:1717–36.
Compliance with ethical standars
ᅟ
Conflicts of interest
None.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schaarschmidt, B.M., Heusch, P., Buchbender, C. et al. Locoregional tumour evaluation of squamous cell carcinoma in the head and neck area: a comparison between MRI, PET/CT and integrated PET/MRI. Eur J Nucl Med Mol Imaging 43, 92–102 (2016). https://doi.org/10.1007/s00259-015-3145-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-015-3145-z