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

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.