[F-18]FDG imaging of head and neck tumors: Comparison of hybrid PET, dedicated PET and CT

Summary

Aim: Aim of the study was to evaluate [F-18] FDG imaging of head and neck tumors using a Hybrid-PET device of the 2nd or 3rd generation. Examinations were compared to dedicated PET and Spiral-CT. Methods: 54 patients suffering from head and neck tumors were examined using dedicated PET and Hybrid-PET after injection of 185-350 MBq [F-18] FDG. Examinations were carried out on the dedicated PET first followed by a scan on the Hybrid-PET. Dedicated PET was acquired in 3D mode, Hybrid-PET was performed in list mode using an axial filter. Reconstruction of data was performed itera-tively on both, dedicated PET and Hybrid-PET. All patients received a CT scan in multislice technique. All finding have been verified by the goldstandard histology or in case of negative histology by follow up. Results: Using dedicated PET the primary or recurrent lesion was correctly diagnosed in 47/48 patients, using Hybrid-PET in 46/ 48 patients and using CT in 25/48 patients. Metastatic disease in cervical lymph nodes was diagnosed in 17/ 18 patients with dedicated PET, in 16/18 patients with Hybrid-PET and in 15/18 with CT. False positive results with regard to lymph node metastasis were seen with one patient for dedicated PET and Hybrid-PET, respectively, and with 18 patients for CT. In a total of 11 patients unknown metastastic lesions were seen with dedicated PET and with Hybrid-PET elsewhere in the body. Additional malignant disease other than the head and neck tumor was found in 4 patients. Conclusion: Using Hybrid-PET for [F-18] FDG imaging reveals a loss of sensitivity and specificity of about 1-5% as compared to dedicated PET in head and neck tumors. [F-18] FDG PET with both, dedicated PET and Hybrid-PET is superior to CT in the diagnosis of primary or recurrent lesions as well as in the assessment of lymph node involvement.

Zusammenfassung

Ziel: Erhebung des Stellenwertes von [F-18] FDG-Unter-suchungen mit einem Hybrid-PET Gerät im Vergleich zu Ring-PET und morphologischer Bildgebung (Spiral-CT) bei Patienten mit Kopf-Hals-Tumoren. Methoden: 54 Patienten mit Kopf-Hals-Tumoren wurden vergleichend mit Ring-PET und Hybrid-PET nach Injektion von 185-350 MBq [F-18] FDG untersucht. Die Aufnahmen wurden zuerst an einem Ring-PET und dann an einem Hybrid-PET durchgeführt. Die Ring-PET-Akquisition erfolgte im 3 D-Modus, die Hybiid-PET-Aufnahmen im List-Mode unter Verwendung des axialen Filters. Sämtliche Daten wurden iterativ rekonstruiert. Alle Patienten wurden zusätzlich in Multislice-Spiral-Technlk computertomo-graphisch untersucht. Sämtliche Bewertungen beruhen auf dem Goldstandard Histologie bzw. dem Verlauf bei negativer Histologie. Ergebnisse: Mit Ring-PET wurde der Primär-/Rezidivtumor bei 47/48 Patienten richtigpositiv diagnostiziert, mit Hybrid-PET bei 46/48 und mit CT bei 25/48 Patienten. Zervikale Lymphknotenmetastasen wurden bei 17/18 Patienten mit Ring-PET und bei 16/18 mit Hybrid-PET richtig-positiv diagnostiziert, während die CT bei 15/18 Patienten richtig-positive Befunde erhob. Falsch-positive Befunde hinsichtlich der Lymphknotendiagnostik lieferten Ring- und Hybrid-PET bei jeweils einem Patienten, die CT bei 18 Patienten. Bei insgesamt elf Patienten wurden bislang unbekannte Fernmetastasen mit Ring- und Hybrid-PET nachgewiesen. Zweittumoren wurden mittels Ring- und Hybrid-PET bei vier Patienten diagnostiziert. Schlussfolgerungen: Bei Messung des [F-18] FDG-Uptake mit einem Hybrid-PET muss im Vergleich zu Ring-PET-Geräten mit geringen Verlusten hinsichtlich Sensitivität und Spezifität in der Größenordnung von 1-5% gerechnet werden. Die Methode ist mit beiden Geräten der CT in der Diagnostik der Primär-/Rezidivtumoren und von zervikalen Lymphknotenmetastasen überlegen.

Keywords

Hybrid-PET - dedicated PET - [F-18] FDG - coincidence imaging - head and neck tumors

Schlüsselwörter

Hybrid-PET - Ring-PET - [F-18] FDG - Koinzidenzkamera - Kopf-Hals-fumoren

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