Functional imaging in head and neck cancer

Functional imaging has become an increasingly important diagnostic tool for head and neck cancer, and as its availability increases so will its utilization. Positron emission tomography (PET) with the radiotracer 18-fluorodeoxyglucose (18FDG) is the most commonly used functional imaging technology, and it has the potential to improve the staging and detection of head and neck tumors compared with conventional cross-sectional imaging techniques such as CT or magnetic resonance imaging. Specifically, PET contributes valuable information for localizing a primary tumor in patients with an unknown primary and neck metastasis, in the staging of untreated head and neck cancer, in the detection of residual disease after definitive radiotherapy or chemoradiotherapy, and in the detection of recurrent disease. New technologies have been introduced using the combination of CT and PET, which allows exact anatomic correlation with areas of increased tracer uptake. In addition, new tracers may allow quantification of important cellular processes related to tumor proliferation or identification of tumors that may respond to certain targeted therapies. This strategy will eventually enable physicians to tailor therapy to molecular characteristics and therefore improve outcomes for patients with head and neck cancer.