nach oben

European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

01.09.2009 | Original Article

Incidental head and neck ¹⁸F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?

verfasst von: Till A. Heusner, Steffen Hahn, Monia E. Hamami, Svenja Kögel, Michael Forsting, Andreas Bockisch, Gerald Antoch, Alexander R. Stahl

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 9/2009

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To retrospectively determine whether increased/asymmetric FDG uptake on PET without a correlating morphological lesion on fully diagnostic CT indicates the development of a head and neck malignancy.

Methods

In 590 patients (mean age 55.4 ± 13.3 years) without a head and neck malignancy/inflammation FDG uptake was measured at (a) Waldeyer’s ring, (b) the oral floor, (c) the larynx, and (d) the thyroid gland, and rated as absent (group A), present (group B), symmetric (group B1) or asymmetric (group B2). Differences between groups A and B and between B1 and B2 were tested for significance with the U-test (p < 0.05). An average follow-up of about 2.5 years (mean 29.5 ± 13.9 months) served as the reference period to determine whether patients developed a head and neck malignancy.

Results

Of the 590 patients, 235 (40%) showed no evidence of enhanced FDG uptake in any investigated site, and 355 (60%) showed qualitatively elevated FDG uptake in at least one site. FDG uptake values (SUV_max, mean±SD) for Waldeyer’s ring were 3.0 ± 0.89 in group A (n = 326), 4.5 ± 2.18 in group B (n = 264; p < 0.01), 5.4 ± 3.35 in group B1 (n = 177), and 4.1 ± 1.7 in group B2 (n = 87; p < 0.01). Values for the oral floor were 2.8 ± 0.74 in group A (n = 362), 4.7 ± 2.55 in group B (n = 228; p < 0.01), 4.4 ± 3.39 in group B1 (n = 130), and 5.1 ± 2.69 in group B2 (n = 98, p = 0.01). Values for the larynx were 2.8 ± 0.76 in group A (n = 353), 4.2 ± 2.05 in group B (n = 237; p < 0.01), 4.0 ± 2.02 in group B1 (n = 165), and 4.6 ± 2.8 in group B2 (n = 72; p = 0.027). Values for the thyroid were 2.4 ± 0.63 in group A (n = 404), 3.0 ± 1.01 in group B (n = 186; p < 0.01), 2.6 ± 0.39 in group B1 (n = 130), and 4.0 ± 1.24 in group B2 (n = 56; p < 0.01). One patient developed a palatine tonsil carcinoma (group B1, SUV_max 3.2), and one patient developed an oral floor carcinoma (group B1, SUV_max 3.7).

Conclusion

Elevated/asymmetric head and neck FDG accumulation without a correlating morphological lesion can frequently be found and does not predict cancer development. In populations in which goitre is endemic, FDG uptake by the thyroid is common and not associated with thyroid cancer.

Pentenero M, Cistaro A, Brusa M, Ferraris MM, Pezzuto C, Carnino R, et al. Accuracy of 18F-FDG-PET/CT for staging of oral squamous cell carcinoma. Head Neck. 2008;30:1488–96.PubMedCrossRef

Chen YK, Su CT, Chi KH, Cheng RH, Wang SC, Hsu CH. Utility of 18F-FDG PET/CT uptake patterns in Waldeyer’s ring for differentiating benign from malignant lesions in lateral pharyngeal recess of nasopharynx. J Nucl Med. 2007;48:8–14.PubMed

Cook GJ, Maisey MN, Fogelman I. Normal variants, artefacts and interpretative pitfalls in PET imaging with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med. 1999;26:1363–78. doi: 10.1007/s002590050597.PubMedCrossRef

Nakamoto Y, Tatsumi M, Hammoud D, Cohade C, Osman MM, Wahl RL. Normal FDG distribution patterns in the head and neck: PET/CT evaluation. Radiology 2005;234:879–85. doi: 10.1148/radiol.2343030301.PubMedCrossRef

Kostakoglu L, Hardoff R, Mirtcheva R, Goldsmith SJ. PET-CT fusion imaging in differentiating physiologic from pathologic FDG uptake. Radiographics 2004;24:1411–31. doi: 10.1148/rg.245035725.PubMedCrossRef

Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake – the role of PET/CT. Eur Radiol 2006;16:1054–65. doi: 10.1007/s00330-005-0088-y.PubMedCrossRef

Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996;23:1409–15. doi: 10.1007/BF01367602.PubMedCrossRef

Stahl A, Dzewas B, Schwaiger M, Weber WA. Excretion of FDG into saliva and its significance for PET imaging. Nuklearmedizin 2002;41:214–6.PubMed

Wong RJ. Current status of FDG-PET for head and neck cancer. J Surg Oncol 2008;97:649–52. doi: 10.1002/jso.21018.PubMedCrossRef

10.

Del Rocio Estrada-Sanchez G, Altamirano-Ley J, Ochoa-Carrillo FJ. Normal variants and frequent pitfalls with (18)FDG PET/CT study. Cir Cir. 2007;75:491–7.

11.

Blodgett TM, Fukui MB, Snyderman CH, Branstetter BF 4th, McCook BM, Townsend DW, et al. Combined PET-CT in the head and neck: part 1. Physiologic, altered physiologic, and artifactual FDG uptake. Radiographics 2005;25:897–912. doi: 10.1148/rg.254035156.PubMedCrossRef

12.

Blodgett TM, Meltzer CC, Townsend DW. PET/CT: form and function. Radiology 2007;242:360–85. doi: 10.1148/radiol.2422051113.PubMedCrossRef

13.

Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357–68. doi: 10.1200/JCO.2004.08.120.PubMedCrossRef

14.

Antoch G, Vogt FM, Bockisch A, Ruehm SG. Whole-body tumor staging: MRI or FDG-PET/CT? Radiologe 2004;44:882–8. doi: 10.1007/s00117-004-1093-x.PubMedCrossRef

15.

Antoch G, Vogt FM, Freudenberg LS, Nazaradeh F, Goehde SC, Barkhausen J, et al. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA 2003;290:3199–206. doi: 10.1001/jama.290.24.3199.PubMedCrossRef

16.

Stahl A, Stollfuss J, Ott K, Wieder H, Fink U, Schwaiger M, et al. FDG PET and CT in locally advanced adenocarcinomas of the distal oesophagus. Clinical relevance of a discordant PET finding. Nuklearmedizin 2005;44:249–55.PubMed

17.

Kapoor V, Fukui MB, McCook BM. Role of 18FFDG PET/CT in the treatment of head and neck cancers: principles, technique, normal distribution, and initial staging. AJR Am J Roentgenol 2005;184:579–87.PubMed

18.

Kapoor V, Fukui MB, McCook BM. Role of 18FFDG PET/CT in the treatment of head and neck cancers: posttherapy evaluation and pitfalls. AJR Am J Roentgenol 2005;184:589–97.PubMed

19.

Ng SH, Chan SC, Yen TC, Chang JT, Liao CT, Ko SF, et al. Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up. Eur J Nucl Med Mol Imaging 2008;36:12–22.PubMedCrossRef

20.

Ha PK, Hdeib A, Goldenberg D, Jacene H, Patel P, Koch W, et al. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced-stage primary head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2006;132:12–6. doi: 10.1001/archotol.132.1.12.PubMedCrossRef

21.

Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65–72. doi: 10.1148/radiol.2311030271.PubMedCrossRef

22.

Abouzied MM, Crawford ES, Nabi HA. 18F-FDG imaging: pitfalls and artifacts. J Nucl Med Technol 2005;33:145–55.PubMed

23.

Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308–14. doi: 10.1016/S0001-2998(96)80006-7.PubMedCrossRef

24.

Basu S, Houseni M, Alavi A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 2008;29:367–73.PubMedCrossRef

25.

Antoch G, Kuehl H, Kanja J, Lauenstein TC, Schneemann H, Hauth E, et al. Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation. Radiology 2004;230:879–85. doi: 10.1148/radiol.2303021287.PubMedCrossRef

26.

Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging 2003;30:588–96.PubMed

27.

Wong WL, Gibson D, Sanghera B, Goodchild K, Saunders M. Evaluation of normal FDG uptake in palatine tonsil and its potential value for detecting occult head and neck cancers: a PET CT study. Nucl Med Commun 2007;28:675–80. doi: 10.1097/MNM.0b013e32829152b1.PubMedCrossRef

28.

Goerres GW, Hany TF, Kamel E, von Schulthess GK, Buck A. Head and neck imaging with PET and PET/CT: artefacts from dental metallic implants. Eur J Nucl Med Mol Imaging 2002;29:367–70. doi: 10.1007/s00259-001-0721-1.PubMedCrossRef

29.

Kamel EM, Burger C, Buck A, von Schulthess GK, Goerres GW. Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol 2003;13:724–8.PubMed

30.

Schoder H, Yeung HW. Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 2004;34:180–97. doi: 10.1053/j.semnuclmed.2004.03.004.PubMedCrossRef

31.

Macapinlac HA. FDG-PET in head and neck, and thyroid cancer. Chang Gung Med J 2005;28:284–95.PubMed

32.

Pfannenberg AC, Aschoff P, Brechtel K, Muller M, Bares R, Paulsen F, et al. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2007;34:36–44. doi: 10.1007/s00259-006-0186-3.PubMedCrossRef

33.

Syed R, Bomanji JB, Nagabhushan N, Hughes S, Kayani I, Groves A, et al. Impact of combined (18)F-FDG PET/CT in head and neck tumours. Br J Cancer 2005;92:1046–50. doi: 10.1038/sj.bjc.6602464.PubMedCrossRef

34.

Pfannenberg AC, Aschoff P, Brechtel K, Muller M, Klein M, Bares R, et al. Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Radiol 2007;80:437–45. doi: 10.1259/bjr/34082277.PubMedCrossRef

35.

Antoch G, Forsting M. How much CT does PET/CT need? Nuklearmedizin 2004;43:141–2.PubMed

36.

Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 2004;45(Suppl 1):56S–65S.PubMed

37.

Jackson RS, Schlarman TC, Hubble WL, Osman MM. Prevalence and patterns of physiologic muscle uptake detected with whole-body 18F-FDG PET. J Nucl Med Technol 2006;34:29–33.PubMed

38.

Kawabe J, Okamura T, Shakudo M, Koyama K, Sakamoto H, Ohachi Y, et al. Physiological FDG uptake in the palatine tonsils. Ann Nucl Med 2001;15:297–300. doi: 10.1007/BF02987850.PubMedCrossRef

39.

Barrington SF, Maisey MN. Skeletal muscle uptake of fluorine-18-FDG: effect of oral diazepam. J Nucl Med 1996;37:1127–9.PubMed

40.

Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–80.PubMed

41.

Scadding GK. Immunology of the tonsil: a review. J R Soc Med 1990;83:104–7.PubMed

42.

Paik JY, Lee KH, Choe YS, Choi Y, Kim BT. Augmented 18F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein kinase C. J Nucl Med 2004;45:124–8.PubMed

43.

Babior BM. The respiratory burst of phagocytes. J Clin Invest 1984;73:599–601. doi: 10.1172/JCI111249.PubMedCrossRef

44.

Wang Y, Chiu E, Rosenberg J, Gambhir SS. Standardized uptake value atlas: characterization of physiological 2-deoxy-2-[18F]fluoro-D-glucose uptake in normal tissues. Mol Imaging Biol 2007;9:83–90. doi:10.1007/s11307-006-0075-y.PubMedCrossRef

45.

Zincirkeser S, Sahin E, Halac M, Sager S. Standardized uptake values of normal organs on 18F-fluorodeoxyglucose positron emission tomography and computed tomography imaging. J Int Med Res 2007;35:231–6.PubMed

46.

Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am 2008;52:61–77. doi: 10.1016/j.cden.2007.10.002.PubMedCrossRef

47.

Kang KW, Kim SK, Kang HS, Lee ES, Sim JS, Lee IG, et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab 2003;88:4100–4. doi: 10.1210/jc.2003-030465.PubMedCrossRef

48.

Mikosch P, Wurtz FG, Gallowitsch HJ, Kresnik E, Lind P. F-18-FDG-PET in a patient with Hashimoto’s thyroiditis and MALT lymphoma recurrence of the thyroid. Wien Med Wochenschr 2003;153:89–92. doi: 10.1046/j.1563-258X.2003.02007.x.PubMedCrossRef

49.

Rohren EM. Intense FDG uptake in a benign Hurthle cell adenoma. Clin Nucl Med 2004;29:664–6. doi: 10.1097/00003072-200410000-00021.PubMedCrossRef

50.

King DL, Stack BC Jr, Spring PM, Walker R, Bodenner DL. Incidence of thyroid carcinoma in fluorodeoxyglucose positron emission tomography-positive thyroid incidentalomas. Otolaryngol Head Neck Surg 2007;137:400–4. doi: 10.1016/j.otohns.2007.02.037.PubMedCrossRef

51.

Kurata S, Ishibashi M, Hiromatsu Y, Kaida H, Miyake I, Uchida M, et al. Diffuse and diffuse-plus-focal uptake in the thyroid gland identified by using FDG-PET: prevalence of thyroid cancer and Hashimoto’s thyroiditis. Ann Nucl Med 2007;21:325–30. doi: 10.1007/s12149-007-0030-2.PubMedCrossRef

52.

Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK. 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 2005;115:1074–8. doi: 10.1097/01.MLG.0000163098.01398.79.PubMedCrossRef

53.

Donta TS, Smoker WR. Head and neck cancer: carcinoma of unknown primary. Top Magn Reson Imaging 2007;18:281–92. doi:10.1097/RMR.0b0113e3181570c6c.PubMedCrossRef

54.

Revel MP, Merlin A, Peyrard S, Triki R, Couchon S, Chatellier G, et al. Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules. AJR Am J Roentgenol 2006;187:135–42. doi: 10.2214/AJR.05.1228.PubMedCrossRef

Titel: Incidental head and neck 18F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?
verfasst von: Till A. Heusner
Steffen Hahn
Monia E. Hamami
Svenja Kögel
Michael Forsting
Andreas Bockisch
Gerald Antoch
Alexander R. Stahl
Publikationsdatum: 01.09.2009
Verlag: Springer-Verlag
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 9/2009
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1113-1

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Incidental head and neck ¹⁸F-FDG uptake on PET/CT without corresponding morphological lesion: early predictor of cancer development?

Abstract

Purpose

Methods

Results

Conclusion

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2009

Eugene C. Lin, Edward J. Escott, Kavita D. Garg, Andrew G. Bleicher, David Alexander: Practical differential diagnosis for CT and MRI

Darwinian molecular imaging

Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients

68Ga-labeled NOTA-RGD-BBN peptide for dual integrin and GRPR-targeted tumor imaging

99Mo supply—the times they are a-changing

Characterization of choline uptake in prostate cancer cells following bicalutamide and docetaxel treatment