Skip to main content
Erschienen in: European Radiology 3/2009

01.03.2009 | Head and Neck

CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck

verfasst von: Dae Young Yoon, Hee Sung Hwang, Suk Ki Chang, Young-Soo Rho, Hwoe Young Ahn, Jin Hwan Kim, In Jae Lee

Erschienen in: European Radiology | Ausgabe 3/2009

Einloggen, um Zugang zu erhalten

Abstract

The purpose of this retrospective study was to compare the diagnostic value of four different imaging methods—computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT—and their combined use for preoperative detection of cervical nodal metastases in head and neck squamous cell carcinoma (SCC). Sixty-seven patients (58 men and 9 women; mean age, 60.1 years) with head and neck SCCs underwent CT, MR, US, and PET/CT before surgery. First, each study was reviewed separately for the presence of nodal metastases. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified, on a level-by-level basis, with histopathologic findings. Histopathologic examination revealed nodal metastases in 74 of 402 nodal levels. The sensitivity, specificity, and accuracy were 77.0%, 99.4%, and 95.3% for CT and MR; 78.4%, 98.5%, and 94.8% for US; and 81.1%, 98.2%, and 95.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (p > 0.05). The combination of CT, MR, US, and PET/CT improved sensitivity (86.5%), without loss of specificity (99.4%) and accuracy (97.0%), although the difference failed to reach statistical significance.
Literatur
1.
2.
Zurück zum Zitat Vokes EE, Weichselbaum RR, Lippman SM et al (1993) Head and neck cancer. N Engl J Med 328:184–194CrossRefPubMed Vokes EE, Weichselbaum RR, Lippman SM et al (1993) Head and neck cancer. N Engl J Med 328:184–194CrossRefPubMed
3.
Zurück zum Zitat Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194CrossRefPubMed Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194CrossRefPubMed
4.
Zurück zum Zitat Layland MK, Sessions DG, Lenox J (2005) The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+ . Laryngoscope 115:629–639PubMed Layland MK, Sessions DG, Lenox J (2005) The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+ . Laryngoscope 115:629–639PubMed
5.
Zurück zum Zitat Adams S, Baum RP, Stuckensen T, Bitter K, Hor G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MR imaging, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260CrossRefPubMed Adams S, Baum RP, Stuckensen T, Bitter K, Hor G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MR imaging, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260CrossRefPubMed
6.
Zurück zum Zitat Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MR imaging. J Nucl Med 36:211–216PubMed Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MR imaging. J Nucl Med 36:211–216PubMed
7.
Zurück zum Zitat Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorode-oxyglucose PET, MR imaging and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757PubMed Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorode-oxyglucose PET, MR imaging and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757PubMed
8.
Zurück zum Zitat Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM (2004) Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 231:65–72CrossRefPubMed Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM (2004) Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 231:65–72CrossRefPubMed
9.
Zurück zum Zitat Som PM, Curtin HD, Mancuso AA (2000) Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR 174:837–844PubMed Som PM, Curtin HD, Mancuso AA (2000) Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR 174:837–844PubMed
10.
Zurück zum Zitat Sakai O, Curtin HD, Romo LV, Som PM (2000) Lymph node pathology: benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 38:979–998CrossRefPubMed Sakai O, Curtin HD, Romo LV, Som PM (2000) Lymph node pathology: benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 38:979–998CrossRefPubMed
11.
Zurück zum Zitat Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMed Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMed
12.
Zurück zum Zitat Hayashi I, Kawata R, Lee K, Sakurai K, Tsuji Y, Takenaka H (2003) A clinical study of ultrasonography for lymph node metastases in head and neck cancer. Nippon Jibiinkoka Gakkai Kaiho 106:499–506PubMed Hayashi I, Kawata R, Lee K, Sakurai K, Tsuji Y, Takenaka H (2003) A clinical study of ultrasonography for lymph node metastases in head and neck cancer. Nippon Jibiinkoka Gakkai Kaiho 106:499–506PubMed
13.
Zurück zum Zitat Ariji Y, Kimura Y, Hayashi N et al (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol 19:303–307PubMed Ariji Y, Kimura Y, Hayashi N et al (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. AJNR Am J Neuroradiol 19:303–307PubMed
14.
Zurück zum Zitat Madison MT, Remley KB, Latchaw RE, Mitchell SL (1994) Radiologic diagnosis and staging of head and neck squamous cell carcinoma. Radiol Clin North Am 32:163–181PubMed Madison MT, Remley KB, Latchaw RE, Mitchell SL (1994) Radiologic diagnosis and staging of head and neck squamous cell carcinoma. Radiol Clin North Am 32:163–181PubMed
15.
Zurück zum Zitat Castelijns JA, van den Brekel MW (2001) Detection of lymph node metastases in the neck: radiologic criteria. AJNR Am J Neuroradiol 22:3–4PubMed Castelijns JA, van den Brekel MW (2001) Detection of lymph node metastases in the neck: radiologic criteria. AJNR Am J Neuroradiol 22:3–4PubMed
16.
Zurück zum Zitat Steinkamp HJ, Hosten N, Richter C, Schedel H, Felix R (1994) Enlarged cervical lymph nodes at helical CT. Radiology 191:795–798PubMed Steinkamp HJ, Hosten N, Richter C, Schedel H, Felix R (1994) Enlarged cervical lymph nodes at helical CT. Radiology 191:795–798PubMed
17.
Zurück zum Zitat Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMed Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMed
18.
Zurück zum Zitat Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR 158:961–969PubMed Som PM (1992) Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR 158:961–969PubMed
19.
Zurück zum Zitat van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384PubMed van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384PubMed
20.
Zurück zum Zitat Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194CrossRefPubMed Snow GB, Patel P, Leemans CR, Tiwari R (1992) Management of cervical lymph nodes in patients with head and neck cancer. Eur Arch Otorhinolaryngol 249:187–194CrossRefPubMed
21.
Zurück zum Zitat Don DM, Anzai Y, Lufkin RB et al (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674CrossRefPubMed Don DM, Anzai Y, Lufkin RB et al (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674CrossRefPubMed
22.
Zurück zum Zitat Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMed Curtin HD, Ishwaran H, Mancuso AA et al (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMed
23.
Zurück zum Zitat King AD, Tse GM, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726CrossRefPubMed King AD, Tse GM, Ahuja AT et al (2004) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726CrossRefPubMed
24.
Zurück zum Zitat de Bondt RB, Nelemans PJ, Hofman PA et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64:266–272CrossRefPubMed de Bondt RB, Nelemans PJ, Hofman PA et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64:266–272CrossRefPubMed
25.
Zurück zum Zitat Sumi M, Ohki M, Nakamura T (2000) Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR 176:1019–1024 Sumi M, Ohki M, Nakamura T (2000) Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR 176:1019–1024
26.
Zurück zum Zitat Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMed Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMed
27.
Zurück zum Zitat Yonetsu K, Sumi M, Izumi M, Ohki M, Eida S, Nakamura T (2001) Contribution of Doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck. AJNR Am J Neuroradiol 22:163–169PubMed Yonetsu K, Sumi M, Izumi M, Ohki M, Eida S, Nakamura T (2001) Contribution of Doppler sonography blood flow information to the diagnosis of metastatic cervical nodes in patients with head and neck cancer: assessment in relation to anatomic levels of the neck. AJNR Am J Neuroradiol 22:163–169PubMed
28.
Zurück zum Zitat Chikui T, Yonetsu K, Nakamura T (2000) Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol 21:561–567PubMed Chikui T, Yonetsu K, Nakamura T (2000) Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol 21:561–567PubMed
29.
Zurück zum Zitat Rege S, Maass A, Chaiken L et al (1994) Use of positron emission tomograpy with fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer 73:3047–3058CrossRefPubMed Rege S, Maass A, Chaiken L et al (1994) Use of positron emission tomograpy with fluorodeoxyglucose in patients with extracranial head and neck cancers. Cancer 73:3047–3058CrossRefPubMed
30.
Zurück zum Zitat Haberkorn U, Strauss LG, Reisser C et al (1991) Glucose uptake, perfusion and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med 32:1548–1555PubMed Haberkorn U, Strauss LG, Reisser C et al (1991) Glucose uptake, perfusion and cell proliferation in head and neck tumors: relation of positron emission tomography to flow cytometry. J Nucl Med 32:1548–1555PubMed
31.
Zurück zum Zitat Jabour BA, Choi Y, Hoh CK et al (1993) Extracranial head and neck: PET imaging with 2-[F-18]fluoro-2-deoxy-glucose and MR imaging correlation. Radiology 186:27–35PubMed Jabour BA, Choi Y, Hoh CK et al (1993) Extracranial head and neck: PET imaging with 2-[F-18]fluoro-2-deoxy-glucose and MR imaging correlation. Radiology 186:27–35PubMed
32.
Zurück zum Zitat Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 36:211–216PubMed Braams JW, Pruim J, Freling NJ et al (1995) Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 36:211–216PubMed
33.
Zurück zum Zitat Kau RJ, Alexiou C, Laubenbacher C, Werner M, Schwaiger M, Arnold W (1999) Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 125:1322–1328PubMed Kau RJ, Alexiou C, Laubenbacher C, Werner M, Schwaiger M, Arnold W (1999) Lymph node detection of head and neck squamous cell carcinomas by positron emission tomography with fluorodeoxyglucose F18 in a routine clinical setting. Arch Otolaryngol Head Neck Surg 125:1322–1328PubMed
34.
Zurück zum Zitat Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757PubMed Laubenbacher C, Saumweber D, Wagner-Manslau C et al (1995) Comparison of fluorine-18-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas. J Nucl Med 36:1747–1757PubMed
35.
Zurück zum Zitat Murakami R, Uozumi H, Hirai T et al (2007) Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 68:377–382PubMed Murakami R, Uozumi H, Hirai T et al (2007) Impact of FDG-PET/CT imaging on nodal staging for head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 68:377–382PubMed
36.
Zurück zum Zitat Gordin A, Golz A, Keidar Z, Daitzchman M, Bar-Shalom R, Israel O (2007) The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol Head Neck Surg 137:130–137CrossRefPubMed Gordin A, Golz A, Keidar Z, Daitzchman M, Bar-Shalom R, Israel O (2007) The role of FDG-PET/CT imaging in head and neck malignant conditions: impact on diagnostic accuracy and patient care. Otolaryngol Head Neck Surg 137:130–137CrossRefPubMed
37.
Zurück zum Zitat Jeong HS, Baek CH, Son YI et al (2007) Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 29:203–210CrossRefPubMed Jeong HS, Baek CH, Son YI et al (2007) Use of integrated 18F-FDG PET/CT to improve the accuracy of initial cervical nodal evaluation in patients with head and neck squamous cell carcinoma. Head Neck 29:203–210CrossRefPubMed
38.
Zurück zum Zitat Adams S, Baum RP, Stuckensen T, Bitter K, Hör G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260CrossRefPubMed Adams S, Baum RP, Stuckensen T, Bitter K, Hör G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260CrossRefPubMed
39.
Zurück zum Zitat Stuckensen T, Kovács AF, Adams S, Baum RP (2000) Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 28:319–324PubMed Stuckensen T, Kovács AF, Adams S, Baum RP (2000) Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 28:319–324PubMed
40.
Zurück zum Zitat Hannah A, Scott AM, Tochon-Danguy H et al (2002) Evaluation of 18F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer. Ann Surg 236:208–217CrossRefPubMed Hannah A, Scott AM, Tochon-Danguy H et al (2002) Evaluation of 18F-fluorodeoxyglucose positron emission tomography and computed tomography with histopathologic correlation in the initial staging of head and neck cancer. Ann Surg 236:208–217CrossRefPubMed
41.
Zurück zum Zitat Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143PubMed Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143PubMed
Metadaten
Titel
CT, MR, US, 18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck
verfasst von
Dae Young Yoon
Hee Sung Hwang
Suk Ki Chang
Young-Soo Rho
Hwoe Young Ahn
Jin Hwan Kim
In Jae Lee
Publikationsdatum
01.03.2009
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 3/2009
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-008-1192-6

Weitere Artikel der Ausgabe 3/2009

European Radiology 3/2009 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.