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Evaluation of dual-time-point FDG-PET in pre- and posttherapeutic head and neck malignancies

¹ Institute of Radiobiology. German Federal Armed Forces, Munich, Germany; ² German Federal Armed Forces Hospital Ulm, Ulm, Germany

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Objectives: Variable uptake of fluorine-18-fluorodeoxyglucose in the head-neck-region poses a challenge in differentiating malignant from benign lesions. This study investigates the impact of dual-time-point-FDG-PET in pts. with suspected head-neck-cancer.

Methods: 137 patients (97 primary, 40 recurrent lesions) were included. FDG-PET of the head-neck-region (30 min p.i.) and a whole-body scan (60 min p.i.) was performed. SUVs for 237 lesions (176 primary, 61 recurrent, 191 malignant, 46 benign) were determined. PET was coregistered with CT or MRI. Histopathology served as the standard of reference. The SUVs were analyzed with ROC-Analysis.

Results: Visual assessement had an overall sensitivity of 96,3% (specificity of 60,0%) (P<0,001). The sensitivity and specificity for primary lesions were 92,3%/90,5% (P<0,001) and 89,1%/57,1% for recurrent lesions (P<0,001). ROC analysis of dual-time-point SUVs was significant (P<0,001) for the first and second SUVmean/max and the SUVmean/max change over time. AUC for SUVmax at 60 min was 0,77, and for SUVmean 0,72 (0,78 and 0,74 for primary lesions; 0,81 and 0,75 for lymphnode detection). The overall SUVmax cut-off at 60 minutes was >3,34 (85% sens., 67% spec.) and >2% increase of SUVmean (82% sens., 51% spec.). For lymphnode detection 60min SUVmax cut-off was >3,36 (87% sens., 74% spec.) and >4,8% increase of SUVmean change (78% sens., 63% spec.).

Conclusions: The very high sensitivity of FDG-PET in head-neck cancer was confirmed. The assessment of FDG-uptake in benign lesions still remains a challenge. Best results can be achieved by fusion with MRI/CT. SUVmax cutoff and dual-time-point technique is helpful in individual pts., especially in lymphnode processes.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Hartenbach, M. Articles by Klemenz, B. PubMed Articles by Hartenbach, M. Articles by Klemenz, B.