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Diagnostic and prognostic value of 18F-FDG PET, CT, and MRI in perineural spread of head and neck malignancies

  • Head and Neck
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Abstract

Objectives

We assessed whether quantitative imaging biomarkers derived from fluorodeoxyglucose-positron emission tomography (18F-FDG PET) could be extracted from perineural spread (PNS) in head and neck malignancies (HNM) to improve patient risk stratification.

Methods

A case–control exploratory study (1:2 ratio) enrolled 81 patients with FDG-avid HNM. The case-group comprised 28 patients with documented PNS (reference: expert consensus), including 14 squamous cell carcinomas (SCC). Imaging biomarkers were extracted from the PNS on 18F-FDG PET, CT-scan, and MRI. The control-group enrolled 53 SCCs. The Cox proportional-hazards regression model explored the association with overall survival by univariate and multivariate analyses.

Results

The rate of PNS detection by 18F-FDG PET was 100% in the case-group. Quantitative imaging biomarkers were not associated with the presence of sensory (p>0.20) or motor (p>0.10) symptoms. In SCC patients (case: 14; control: 53), PNS was associated with a hazard ratio of death of 5.5 (95%CI: 1.4:20.9) by multivariate analysis. Increased cranial nerve SUVmax was significantly associated with poorer overall survival by univariate analysis (p=0.001).

Conclusions

Our pilot study showed the feasibility of extracting 18F-FDG PET biomarkers from PNS in FDG-avid HNM. Our results encourage the development of new PET/CT- or PET/MRI-guided management strategies in further prospective studies.

Key Points

• 18F-FDG PET/CT detects PNS in FDG-avid HNM.

• PNS metabolism is more heterogeneous than healthy tissue.

• PNS diagnosis is crucial: most patients were asymptomatic, N0 and M0.

• PNS diagnosis is associated with poorer overall survival in SCC.

• PET/CT- or PET/MRI-guided management strategies should be evaluated.

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Abbreviations

PNS:

Perineural spread

SUV:

Standardised uptake value

HISUV:

Heterogeneity index of the standardised uptake value

V1 :

Ophthalmic branch of the trigeminal nerve

V2 :

Maxillary branch of the trigeminal nerve

V3 :

Mandibular branch of the trigeminal nerve

VII:

Facial nerve

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Funding

Laurent Dercle is funded by Fondation Philanthropia (Geneva, Switzerland) and the ARC Foundation (Villejuif, France).

Author information

Author notes

  1. François Bidault and Samy Ammari Contributed equally to this work

Authors and Affiliations

  1. Département d’imagerie médicale, Institut Gustave-Roussy, 94805, Villejuif, France

    Laurent Dercle, Laura Rozenblum-Beddok, Romain-David Seban, François Bidault & Samy Ammari

  2. UMR1015, Institut Gustave Roussy, 94800, Villejuif, France

    Laurent Dercle

  3. Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, 10039, USA

    Laurent Dercle & Randy Yeh

  4. Département d’oto-rhino-laryngologie, Institut Gustave-Roussy, 94805, Villejuif, France

    Dana Hartl

  5. Radiology department, Rangueil University Hospital, 1 avenue du Professeur Jean Poulhes. 31059 CEDEX, Toulouse, France

    Fatima-Zohra Mokrane

  6. French National Center for Scientific Research, AMIS Laboratory: University of Toulouse, UMR 5288, 37 allées Jules Guesde, 31073, Toulouse, France

    Fatima-Zohra Mokrane

Authors
  1. Laurent Dercle
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  2. Dana Hartl
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  7. François Bidault
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Corresponding author

Correspondence to Laurent Dercle.

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Guarantor

The scientific guarantor of this publication is Laurent Dercle.

Conflict of interest

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.

Statistics and biometry

One of the authors has significant statistical expertise, and no complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

Retrospective case–control study, performed at one institution

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Cite this article

Dercle, L., Hartl, D., Rozenblum-Beddok, L. et al. Diagnostic and prognostic value of 18F-FDG PET, CT, and MRI in perineural spread of head and neck malignancies. Eur Radiol 28, 1761–1770 (2018). https://doi.org/10.1007/s00330-017-5063-x

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  • DOI: https://doi.org/10.1007/s00330-017-5063-x

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