title: Incidental head and neck (18)F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?
abstract: OBJECTIVE
  To retrospectively determine whether increased/asymmetric FDG uptake on PET without a correlating morphological lesion on fully diagnostic CT indicates the development of a head and neck malignancy.
  
  
  METHODS
  In 590 patients (mean age 55.4 +/- 13.3 years) without a head and neck malignancy/inflammation FDG uptake was measured at (a) Waldeyer's ring, (b) the oral floor, (c) the larynx, and (d) the thyroid gland, and rated as absent (group A), present (group B), symmetric (group B1) or asymmetric (group B2). Differences between groups A and B and between B1 and B2 were tested for significance with the U-test (p < 0.05). An average follow-up of about 2.5 years (mean 29.5 +/- 13.9 months) served as the reference period to determine whether patients developed a head and neck malignancy.
  
  
  RESULTS
  Of the 590 patients, 235 (40%) showed no evidence of enhanced FDG uptake in any investigated site, and 355 (60%) showed qualitatively elevated FDG uptake in at least one site. FDG uptake values (SUV(max), mean+/-SD) for Waldeyer's ring were 3.0 +/- 0.89 in group A (n = 326), 4.5 +/- 2.18 in group B (n = 264; p < 0.01), 5.4 +/- 3.35 in group B1 (n = 177), and 4.1 +/- 1.7 in group B2 (n = 87; p < 0.01). Values for the oral floor were 2.8 +/- 0.74 in group A (n = 362), 4.7 +/- 2.55 in group B (n = 228; p < 0.01), 4.4 +/- 3.39 in group B1 (n = 130), and 5.1 +/- 2.69 in group B2 (n = 98, p = 0.01). Values for the larynx were 2.8 +/- 0.76 in group A (n = 353), 4.2 +/- 2.05 in group B (n = 237; p < 0.01), 4.0 +/- 2.02 in group B1 (n = 165), and 4.6 +/- 2.8 in group B2 (n = 72; p = 0.027). Values for the thyroid were 2.4 +/- 0.63 in group A (n = 404), 3.0 +/- 1.01 in group B (n = 186; p < 0.01), 2.6 +/- 0.39 in group B1 (n = 130), and 4.0 +/- 1.24 in group B2 (n = 56; p < 0.01). One patient developed a palatine tonsil carcinoma (group B1, SUV(max) 3.2), and one patient developed an oral floor carcinoma (group B1, SUV(max) 3.7).
  
  
  CONCLUSIONS
  Elevated/asymmetric head and neck FDG accumulation without a correlating morphological lesion can frequently be found and does not predict cancer development. In populations in which goitre is endemic, FDG uptake by the thyroid is common and not associated with thyroid cancer.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany. till.heusner@uni-due.de
authors.forename: Till A
authors.initials: TA
authors.lastname: Heusner
authors.forename: Steffen
authors.initials: S
authors.lastname: Hahn
authors.forename: Monia E
authors.initials: ME
authors.lastname: Hamami
authors.forename: Svenja
authors.initials: S
authors.lastname: Kögel
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Stahl
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D055088:Early Detection of Cancer; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006257:Head; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D006801:Humans; D007830:Larynx / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000000981:diagnostic imaging / Q000378:metabolism; D009333:Neck; D014066:Palatine Tonsil / Q000000981:diagnostic imaging / Q000378:metabolism; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18