FDG PET-CT imaging in head and neck paragangliomas: A centre experience

Area of Science:

• Nuclear Medicine
• Oncology
• Radiology

Background:

• Head and neck paragangliomas (HNPGLs) are rare tumors with frequent genetic mutations, primarily in succinate dehydrogenase (SDHx) genes.
• The diagnostic utility of FDG PET-CT in HNPGLs is under scrutiny due to emerging novel radiotracers.

Purpose of the Study:

• To evaluate the clinical utility of FDG PET-CT in the detection and management of HNPGLs.
• To compare PET parameters between HNPGL patients with clinical events and those without, and between SDHx-mutated and sporadic cases.

Main Methods:

• Retrospective analysis of FDG PET-CT scans from 153 HNPGL patients (2004-2016).
• Receiver operator characteristic (ROC) analysis to compare standardized uptake values (SUVs), metabolic tumor volume (MTV), and total lesion glycolysis (TLG).
• Comparison of PET parameters between patients with clinical events versus those without, and between SDHx+ patients and a low-probability control group.

Main Results:

• FDG PET-CT demonstrated high accuracy (96.6%) in detecting HNPGLs, with 93 FDG-positive lesions identified.
• Patients experiencing clinical events (progression, recurrence, death) had lesions with significantly higher SUVmax.
• No significant differences in PET parameters were observed between SDHx+ patients and the control group.

Conclusions:

• FDG PET-CT retains clinical utility in HNPGL management, particularly for pre-therapeutic assessment.
• Elevated SUVmax in HNPGL lesions is a predictor of adverse clinical outcomes, irrespective of SDHx mutation status.
• PET parameters do not differ significantly between SDHx-mutated and sporadic HNPGL populations.