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01.09.2009 | Original Article | Ausgabe 9/2009

European Journal of Nuclear Medicine and Molecular Imaging 9/2009

Staging primary head and neck cancers with 18F-FDG PET/CT: is intravenous contrast administration really necessary?

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 9/2009
Autoren:
Keisuke Yoshida, Akiko Suzuki, Toshiyuki Nagashima, Jin Lee, Choichi Horiuchi, Mamoru Tsukuda, Tomio Inoue

Abstract

Purpose

The aim of our study was to prospectively evaluate whether intravenous contrast media in integrated positron emission tomography and computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) significantly contributes to evaluation of primary head and neck cancers compared with unenhanced PET/CT, regional contrast-enhanced CT of head and neck (neck CE-CT) and regional magnetic resonance imaging of head and neck (neck MRI).

Methods

Subjects were 42 consecutive patients (35 men, 7 women; age range: 36–91 years) with biopsy-proven primary head and neck cancers. Lesion detection of primary and nodal sites and TNM classification were assessed on a per-patient basis. McNemar test and κ statistics were employed for statistical analyses.

Results

Forty patients (95%) were successfully followed up: 24 patients had nodal disease and 3 had distant metastasis. Contrast-enhanced and unenhanced PET/CT detected 98 and 95% of the primary tumours, respectively, and both detected 92% of patients with nodal disease, which revealed no statistically significant difference. Accuracy for T status was 75 and 73%, respectively, which proved significantly more accurate than neck CE-CT, which had an accuracy of 53% (p = 0.0133 and 0.0233, respectively). Neck MRI correctly classified the T status in 58% of patients; however, no statistically significant difference was found between PET/CT and neck MRI. Contrast-enhanced PET/CT, unenhanced PET/CT, neck CT and neck MRI correctly staged the N status in 90, 90, 79 and 90% of patients, respectively, with no statistically significant difference. Overall TNM classification was correctly classified in 68 and 65% of patients, respectively. Weighted κ values between enhanced and unenhanced PET/CT for primary tumour detection, nodal detection, T status and N status were 0.655, 1.000, 0.935 and 1.000, respectively.

Conclusion

We found almost perfect correlation between enhanced and unenhanced PET/CT for lesion detection and initial staging of primary head and neck cancers. Routine contrast administration for PET/CT imaging may not be justified.

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