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PET/CT and PET/MRI in head and neck malignancy.

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Clinical Radiology
|October 15, 2017
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Summary

Positron-emission tomography (PET)/computed tomography (CT) aids in head and neck squamous cell carcinoma (HNSCC) staging and recurrence detection. Combined PET/MRI shows promise for improved accuracy in HNSCC staging and treatment evaluation.

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Area of Science:

  • Radiology
  • Oncology
  • Nuclear Medicine

Background:

  • Combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT) is vital for staging difficult head and neck (HN) squamous cell carcinoma (SCC) cases.
  • It aids in identifying unknown primaries, assessing chemotherapy response, and differentiating tumor recurrence from treatment effects.

Purpose of the Study:

  • To review the established and emerging roles of PET-based imaging in head and neck squamous cell carcinoma (HNSCC).
  • To compare the efficacy and cost-effectiveness of PET/CT surveillance versus neck dissection.
  • To explore the potential of novel PET tracers and combined PET/magnetic resonance imaging (MRI) in HNSCC management.

Main Methods:

  • Review of the PET NECK trial comparing PET/CT surveillance with neck dissection.
  • Discussion of emerging PET tracers (hypoxia, 68Ga peptide) and combined PET/MRI technology.
  • Comparison of PET/CT and PET/MRI performance in HNSCC staging and treatment response evaluation.

Main Results:

  • The PET NECK trial indicated similar survival rates between PET/CT-guided surveillance and planned neck dissection, with surveillance being more cost-effective.
  • PET/MRI offers enhanced anatomical detail and reduced radiation dose compared to PET/CT, though PET/CT excels in detecting lung metastases.
  • High correlation exists between PET/CT and PET/MRI in imaging various HNSCC lesions.

Conclusions:

  • PET/CT is a valuable tool for HNSCC staging, recurrence detection, and treatment response assessment.
  • PET/MRI demonstrates potential for greater accuracy in HNSCC staging and treatment response evaluation compared to current imaging methods.
  • Emerging PET tracers and hybrid imaging techniques like PET/MRI are expanding the diagnostic capabilities in HNSCC management.