Head and neck cancer: Clinical usefulness and accuracy of PET/CT image fusion Journal Article

Authors: Schöder, H.; Yeung, H. W. D.; Gonen, M.; Kraus, D.; Larson, S. M.
Article Title: Head and neck cancer: Clinical usefulness and accuracy of PET/CT image fusion
Abstract: PURPOSE: 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. MATERIALS AND 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. CONCLUSION: 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. © RSNA, 2004.
Keywords: adolescent; adult; cancer chemotherapy; human tissue; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; major clinical study; histopathology; cancer localization; carcinoma, squamous cell; cancer radiotherapy; cancer staging; positron emission tomography; follow up; follow-up studies; antineoplastic agent; lymph nodes; diagnostic accuracy; sensitivity and specificity; radiopharmaceuticals; computer assisted tomography; image analysis; image interpretation, computer-assisted; tomography, x-ray computed; diagnostic imaging; retrospective study; imaging system; patient care; evaluation; head and neck cancer; head and neck neoplasms; contrast enhancement; fluorodeoxyglucose f18; reliability; parameter; false positive reactions; fluorodeoxyglucose; bioaccumulation; positron emission tomography (pet); tomography, emission-computed; muscle, skeletal; computed tomography (ct); humans; human; male; female; priority journal; article; mcnemar test; dual-modality imaging, pet/ct; images, fusion
Journal Title: Radiology
Volume: 231
Issue: 1
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2004-04-01
Start Page: 65
End Page: 72
Language: English
DOI: 10.1148/radiol.2311030271
PROVIDER: scopus
PUBMED: 14990824
Notes: Radiology -- Cited By (since 1996):269 -- Export Date: 16 June 2014 -- CODEN: RADLA -- Source: Scopus
Citation Impact
MSK Authors
  1. Dennis Kraus
    268 Kraus
  2. Henry W D Yeung
    126 Yeung
  3. Mithat Gonen
    946 Gonen
  4. Heiko Schoder
    480 Schoder
  5. Steven M Larson
    936 Larson