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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-09-2009 | Original Article

Staging primary head and neck cancers with ¹⁸F-FDG PET/CT: is intravenous contrast administration really necessary?

Authors: Keisuke Yoshida, Akiko Suzuki, Toshiyuki Nagashima, Jin Lee, Choichi Horiuchi, Mamoru Tsukuda, Tomio Inoue

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2009

Abstract

Purpose

The aim of our study was to prospectively evaluate whether intravenous contrast media in integrated positron emission tomography and computed tomography (PET/CT) with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) significantly contributes to evaluation of primary head and neck cancers compared with unenhanced PET/CT, regional contrast-enhanced CT of head and neck (neck CE-CT) and regional magnetic resonance imaging of head and neck (neck MRI).

Methods

Subjects were 42 consecutive patients (35 men, 7 women; age range: 36–91 years) with biopsy-proven primary head and neck cancers. Lesion detection of primary and nodal sites and TNM classification were assessed on a per-patient basis. McNemar test and κ statistics were employed for statistical analyses.

Results

Forty patients (95%) were successfully followed up: 24 patients had nodal disease and 3 had distant metastasis. Contrast-enhanced and unenhanced PET/CT detected 98 and 95% of the primary tumours, respectively, and both detected 92% of patients with nodal disease, which revealed no statistically significant difference. Accuracy for T status was 75 and 73%, respectively, which proved significantly more accurate than neck CE-CT, which had an accuracy of 53% (p = 0.0133 and 0.0233, respectively). Neck MRI correctly classified the T status in 58% of patients; however, no statistically significant difference was found between PET/CT and neck MRI. Contrast-enhanced PET/CT, unenhanced PET/CT, neck CT and neck MRI correctly staged the N status in 90, 90, 79 and 90% of patients, respectively, with no statistically significant difference. Overall TNM classification was correctly classified in 68 and 65% of patients, respectively. Weighted κ values between enhanced and unenhanced PET/CT for primary tumour detection, nodal detection, T status and N status were 0.655, 1.000, 0.935 and 1.000, respectively.

Conclusion

We found almost perfect correlation between enhanced and unenhanced PET/CT for lesion detection and initial staging of primary head and neck cancers. Routine contrast administration for PET/CT imaging may not be justified.

Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008;371:1695–709. doi:10.1016/S0140-6736(08)60728-X.PubMedCrossRef

Dammann F, Horger M, Mueller-Berg M, Schlemmer H, Claussen CD, Hoffman J, et al. Rational diagnosis of squamous cell carcinoma of the head and neck region: comparative evaluation of CT, MRI, and 18FDG PET. AJR Am J Roentgenol 2005;184:1326–31.PubMed

Veit-Haibach P, Luczak C, Wanke I, Fischer M, Egelhof T, Beyer T, et al. TNM staging with FDG-PET/CT in patients with primary head and neck cancer. Eur J Nucl Med Mol Imaging 2007;34:1953–62. doi:10.1007/s00259-007-0564-5.PubMedCrossRef

Nakamura T, Sumi M. Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol 2007;17:1235–41. doi:10.1007/s00330-006-0490-0.PubMedCrossRef

Stokkel MP, Terhaard CH, Hordijk GJ, van Rijk PP. The detection of local recurrent head and neck cancer with fluorine-18 fluorodeoxyglucose dual-head positron emission tomography. Eur J Nucl Med 1999;26:767–73. doi:10.1007/s002590050448.PubMedCrossRef

Kresnik E, Mikosch P, Gallowitsch HJ, Kogler D, Wiesser S, Heinisch M, et al. Evaluation of head and neck cancer with 18F-FDG PET: a comparison with conventional methods. Eur J Nucl Med 2001;28:816–21. doi:10.1007/s002590100554.PubMedCrossRef

Zanation AM, Sutton DK, Couch ME, Weissler MC, Shockley WW, Shores CG. Use, accuracy, and implications for patient management of [18F]-2-fluorodeoxyglucose-positron emission/computerized tomography for head and neck tumors. Laryngoscope 2005;115:1186–90. doi:10.1097/01.MLG.0000163763.89647.9F.PubMedCrossRef

Fleming AJ Jr, Smith SP Jr, Paul CM, Hall NC, Daly BT, Agrawal A, et al. Impact of [18F]-2-fluorodeoxyglucose-positron emission tomography/computed tomography on previously untreated head and neck cancer patients. Laryngoscope 2007;117:1173–9. doi:10.1097/MLG.0b013e31805d017b.PubMedCrossRef

Connell CA, Corry J, Milner AD, Hogg A, Hicks RJ, Rischin D, et al. Clinical impact of, and prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinoma. Head Neck 2007;29:986–95. doi:10.1002/hed.20629.PubMedCrossRef

10.

von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and future directions. Radiology 2006;238:405–22. doi:10.1148/radiol.2382041977.CrossRef

11.

Endo K, Oriuchi N, Higuchi T, Iida Y, Hanaoka H, Miyakubo M, et al. PET and PET/CT using 18F-FDG in the diagnosis and management of cancer patients. Int J Clin Oncol 2006;11:286–96. doi:10.1007/s10147-006-0595-0.PubMedCrossRef

12.

Czernin J, Allen-Auerbach M, Schelbert HR. Improvements in cancer staging with PET/CT: literature-based evidence as of September 2006. J Nucl Med 2007;48:78S–88S.PubMed

13.

Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Fukasawa I, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging 2008;35:1439–48. doi:10.1007/s00259-008-0776-3.PubMedCrossRef

14.

Rodríguez-Vigil B, Gómez-León N, Pinilla I, Hernández-Maraver D, Coya J, Martín-Curto L, et al. PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 2006;47:1643–8.PubMed

15.

Goerres GW, Schuknecht B, Schmid DT, Stoeckli SJ, Hany TF. Positron emission tomography/computed tomography for staging and restaging of head and neck cancer: comparison with positron emission tomography read together with contrast-enhanced computed tomography. Clin Imaging 2008;32:431–7. doi:10.1016/j.clinimag.2008.04.012.PubMedCrossRef

16.

Ng SH, Yen TC, Liao CL, Chang JT, Chan SC, Ko SF, et al. 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 2005;46:1136–43.PubMed

17.

Green FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York, NY: Springer; 2002.

18.

Kundel HL, Polansky M. Measurement of observer agreement. Radiology 2003;228:303–8. doi:10.1148/radiol.2282011860.PubMedCrossRef

19.

Jeong HS, Baek CH, Son YI, Chung M, Kyung Lee D, Young Choi J, et al. Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 2007;29:203–10. doi:10.1002/hed.20504.PubMedCrossRef

20.

Branstetter BF 4th, Blodgett TM, Zimmer LA, Snyderman CH, Johnson JT, Raman S, et al. Head and neck malignancy: is PET/CT more accurate than PET or CT alone? Radiology 2005;235:580–6. doi:10.1148/radiol.2352040134.PubMedCrossRef

21.

Jones AS, Morar P, Phillips DE, Field JK, Husband D, Helliwell TR. Second primary tumors in patients with head and neck squamous cell carcinoma. Cancer 1995;75:1343–53. doi:10.1002/1097-0142(19950315)75:6<1343::AID-CNCR2820750617>3.0.CO;2-T.PubMedCrossRef

22.

Caldemeyer KS, Mathews VP, Righi PD, Smith RR. Imaging features and clinical significance of perineural spread or extension of head and neck tumors. Radiographics 1998;18:97–110.PubMed

23.

Yoo GH, Hocwald E, Korkmaz H, Du W, Logani S, Kelly JK, et al. Assessment of carotid artery invasion in patients with head and neck cancer. Laryngoscope 2000;110:386–90. doi:10.1097/00005537-200003000-00010.PubMedCrossRef

24.

Fung K, Lyden TH, Lee J, Urba SG, Worden F, Eisbruch A, et al. Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. Int J Radiat Oncol Biol Phys 2005;63:1395–9. doi:10.1016/j.ijrobp. 2005.05.004.PubMedCrossRef

25.

Genden EM, Ferlito A, Rinaldo A, Silver CE, Fagan JJ, Suárez C, et al. Recent changes in the treatment of patients with advanced laryngeal cancer. Head Neck 2008;30:103–10. doi:10.1002/hed.20715.PubMedCrossRef

Title: Staging primary head and neck cancers with 18F-FDG PET/CT: is intravenous contrast administration really necessary?
Authors: Keisuke Yoshida
Akiko Suzuki
Toshiyuki Nagashima
Jin Lee
Choichi Horiuchi
Mamoru Tsukuda
Tomio Inoue
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1127-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Staging primary head and neck cancers with ¹⁸F-FDG PET/CT: is intravenous contrast administration really necessary?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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