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01-04-2014 | Original Article

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

Authors: Philipp Heusch, Christoph Sproll, Christian Buchbender, Elena Rieser, Jan Terjung, Christina Antke, Inga Boeck, Stephan Macht, Axel Scherer, Gerald Antoch, Till A. Heusner, Jörg Handschel

Published in: Clinical Oral Investigations | Issue 3/2014

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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Title: 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
Authors: Philipp Heusch
Christoph Sproll
Christian Buchbender
Elena Rieser
Jan Terjung
Christina Antke
Inga Boeck
Stephan Macht
Axel Scherer
Gerald Antoch
Till A. Heusner
Jörg Handschel
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 3/2014
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-013-1050-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Materials and methods

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

Clinical relevance

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