PET/MRI in head and neck cancer: initial experience

Ivan Platzek,Jörg Kotzerke,Volker Gudziol,Jörg Van Den Hoff,Jens Langner,Michael Laniado,Matthias Schneider,Georg Schramm,Bettina Beuthien-Baumann

doi:10.1007/s00259-012-2248-z

Abstract

PurposeTo evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG (18F-fluorodeoxyglucose) for initial staging of head and neck cancer.MethodsThe study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267–395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUVmax) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets.ResultsNo MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUVmax than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001).ConclusionThe current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality.

Highlights

Head and neck cancer ranks among the ten most common malignant diseases [1]
The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a wholebody PET/MRI system without impairment of PET or MR image quality
Using the stand-alone PET scanner, 39 cervical lymph nodes with increased FDG uptake were detected visually, and using the PET datasets from the PET/MRI system, 64 were detected

Summary

Introduction

Head and neck cancer ranks among the ten most common malignant diseases [1]. The vast majority of head and neck malignancies are squamous cell carcinomas [2]. The choice of therapy in patients with head and neck cancer depends mainly on tumour location, the invasion of adjacent structures and on the presence of metastases [3]. MRI provides excellent soft tissue contrast, which is useful for differentiating masses from neighbouring tissues and has facilitated the widespread use of MRI for head and neck imaging. MRI is considered the modality of choice for imaging tumours of the oral cavity [4] and the pharynx [5]. The sensitivity of MRI for metastatic lymph node disease is rather low, as it relies on morphologic criteria for lymph node

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Conclusion