Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion.
OBJECTIVE
To compare diagnostic accuracy of attenuation-corrected positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with head and neck cancer and to evaluate the effect of PET/CT findings on patient care.


METHODS
Studies of 68 patients were reviewed by two physicians in consensus. Focal fluorodeoxyglucose (FDG) uptake in the head and neck on attenuation-corrected PET images was graded as benign, equivocal, or malignant. CT and PET/CT images were then reviewed, and initial findings were amended if necessary. Comparison was performed on a lesion-by-lesion basis. Accuracy was evaluated on the basis of follow-up and histopathologic findings. Potential effects on patient care were assessed by a head and neck surgeon. PET and PET/CT accuracy was compared with a McNemar test adjusted for clustering.


RESULTS
A total of 157 foci with abnormal FDG uptake were noted, two of which were seen only on PET/CT images. PET/CT images were essential in determining the exact anatomic location for 100 lesions (74% better localization in regions previously treated surgically or with irradiation vs 58% in untreated areas; P =.06). On the basis of PET findings alone, 45 lesions were considered benign; 39, equivocal; and 71, malignant. With PET/CT, the fraction of equivocal lesions decreased by 53%, from 39 of 155 to 18 of 157 (P <.01). PET/CT had a higher accuracy of depicting cancer than did PET (96% vs 90%, P =.03). Six proved malignancies were missed with PET, but only one was missed with PET/CT. PET/CT findings altered the care for 12 (18%) of 68 patients.


CONCLUSIONS
PET/CT is more accurate than PET alone in the detection and anatomic localization of head and neck cancer and has the clear potential to affect patient care.
Department of Radiology, Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, Box 77, 1275 York Ave, New York, NY 10021, USA. schoderh@mskcc.org
Heiko
H
Schöder
Henry W D
HW
Yeung
Mithat
M
Gonen
Dennis
D
Kraus
Steven M
SM
Larson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000378:metabolism; D005791:Patient Care; D019275:Radiopharmaceuticals / Q000378:metabolism; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18