title: Head and neck malignancy: is PET/CT more accurate than PET or CT alone?
abstract: OBJECTIVE
  To prospectively determine whether combined positron emission tomography (PET) and computed tomography (CT) is more accurate than either PET or CT alone in depicting malignant lesions in the head and neck.
  
  
  METHODS
  Study was approved by the institutional review board, and patient informed consent was waived. Sixty-five consecutive patients (42 men, 23 women; age range, 43-83 years) known to have or suspected of having head and neck cancer were examined with combined PET/CT. CT was performed with intravenous administration of a contrast agent, and the CT data were used for attenuation correction. Each examination was interpreted in three ways: PET images in the absence of CT data, CT images in the absence of PET data, and fused PET/CT images. Probability of malignancy of each lesion was assigned a score by using a five-point scale. Receiver operating characteristic (ROC) analyses were performed by using biopsy, imaging, or clinical follow-up as the reference standard. The minimum follow-up was 6 months (range, 6-12 months). The results were additionally analyzed to assess the degree of radiologist confidence.
  
  
  RESULTS
  Follow-up was available for 64 (98%) of 65 patients. ROC analyses demonstrated that PET/CT is significantly superior to PET or CT alone for depiction of malignancy in the head and neck (P < .05). In this series, PET/CT had a sensitivity of 98%, a specificity of 92%, and an accuracy of 94%. Radiologist confidence was substantially higher with the combined modality.
  
  
  CONCLUSIONS
  Combined PET/CT is more accurate than PET or CT alone for the depiction of malignancy in the head and neck. Radiologist confidence is improved with the combined modality.
authors.affiliation: Departments of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop St, PUH Rm D-132, Pittsburgh, PA 15213, USA. bfb1@pitt.edu
authors.forename: Barton F
authors.initials: BF
authors.lastname: Branstetter
authors.forename: Todd M
authors.initials: TM
authors.lastname: Blodgett
authors.forename: Lee A
authors.initials: LA
authors.lastname: Zimmer
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Subha
authors.initials: S
authors.lastname: Raman
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Meltzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D001786:Blood Glucose / Q000378:metabolism; D003951:Diagnostic Errors; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000556:secondary; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18