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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

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Abstract

Objective

This study aimed to compare 18F-fluorodesoxyglucose positron emission tomography/MRI (18F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), 18F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC).

Materials and methods

Eighteen patients prospectively underwent ultrasound examination, 18F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference.

Results

The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for 18F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for 18F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for 18F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between 18F-FDG-PET-MRI and 18F-FDG-PET/CT (p = 0.839) and between 18F-FDG-PET-MRI plus DWI and 18F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than 18F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between 18F-FDG-PET-MRI and US (p = 0.223) or 18F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by 18F-FDG-PET-MRI in eight patients, 18F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and 18F-FDG-PET/CT in five out of 18 patients.

Conclusion

Software-based fusion of 18F-FDG-PET-MRI and 18F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and 18F-FDG-PET/CT.

Clinical relevance

Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany

    Philipp Heusch, Christian Buchbender, Stephan Macht, Axel Scherer, Gerald Antoch & Till A. Heusner

  2. Department for Oral-, Maxillo- and Plastic Facial Surgery, Medical Faculty, University of Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany

    Christoph Sproll, Elena Rieser & Jörg Handschel

  3. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Medical Faculty, University of Duisburg-Essen, 45122, Essen, Germany

    Jan Terjung

  4. Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, 45141, Essen, Germany

    Jan Terjung

  5. Department of Nuclear Medicine, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany

    Christina Antke

  6. Institute of Pathology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany

    Inga Boeck

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  1. Philipp Heusch
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Correspondence to Christoph Sproll.

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Heusch, P., Sproll, C., Buchbender, 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 Invest 18, 969–978 (2014). https://doi.org/10.1007/s00784-013-1050-z

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