DOI: 10.1148/radiol.2352040134
Head and Neck Malignancy: Is PET/CT More Accurate than PET or CT Alone?1
Barton F. Branstetter, IV, MD,
Todd M. Blodgett, MD,
Lee A. Zimmer, MD, PhD,
Carl H. Snyderman, MD,
Jonas T. Johnson, MD,
Subha Raman, MD and
Carolyn C. Meltzer, MD
1 From the Departments of Radiology (B.F.B., T.M.B., S.R., C.C.M.), Otolaryngology (B.F.B., L.A.Z., C.H.S., J.T.J.), Neurology (C.C.M.), and Psychiatry (C.C.M.), University of Pittsburgh School of Medicine, 200 Lothrop St, PUH Rm D-132, Pittsburgh, PA 15213. Received January 23, 2004; revision requested April 2; final revision received October 4; accepted October 12. Address correspondence to B.F.B. (e-mail: bfb1@pitt.edu).
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Figure 1a. (a) ROC curve generated for presence of malignancy in a lesion (n = 125) demonstrates improved accuracy of PET/CT over that of PET or CT alone. (b) ROC curve generated for the overall presence of a tumor in a patient (n = 64) demonstrates a more modest improvement of PET/CT over PET but a continued superiority of PET/CT over CT. All comparisons are statistically significant except the comparison of PET/CT with PET in b.
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Figure 1b. (a) ROC curve generated for presence of malignancy in a lesion (n = 125) demonstrates improved accuracy of PET/CT over that of PET or CT alone. (b) ROC curve generated for the overall presence of a tumor in a patient (n = 64) demonstrates a more modest improvement of PET/CT over PET but a continued superiority of PET/CT over CT. All comparisons are statistically significant except the comparison of PET/CT with PET in b.
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Figure 2. False-negative CT findings. Squamous cell carcinoma of the nasal bridge (arrow) is evident on contrast-enhanced transverse CT scan (A) after analysis of transverse fused PET/CT image (B).
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Figure 3. False-negative CT findings. A, Transverse contrast-enhanced CT scan demonstrates metastatic lesion (arrowhead) on the right side of the neck but no primary lesion is identified, even in retrospect. Findings of clinical examination of the upper airway, including panendoscopy, were normal. B, Sagittal and, C, coronal PET images demonstrate a focus of pharyngeal uptake (arrow) and metastatic neck node (not shown). D, Transverse fused PET/CT image shows uptake in the tongue base (arrow) on the right side. Findings of blind biopsies of the right-side tongue base revealed squamous cell carcinoma.
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Figure 4. False-negative PET findings. A, B, Transverse PET images obtained through the mid-neck are normal. C, D, Corresponding transverse CT images reveal metastatic lymph nodes (arrow) from medullary thyroid carcinoma, which is frequently not FDG avid.
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Figure 5. False-positive PET findings. A, Coronal PET image demonstrates an area of avid FDG uptake in the right infratemporal fossa (arrow). B, Transverse CT image obtained in this region is normal. C, Transverse fused PET/CT image reveals that the uptake is physiologic (pterygoid muscles, arrow).
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Figure 6. Improved localization with CT. A, Coronal PET image demonstrates recurrent squamous cell carcinoma (arrow), but the relationship to the reconstruction flap is uncertain. B, Transverse fused PET/CT image allows precise localization of the tumor (arrow) to the lateral aspect of the flap, allowing partial flap preservation at surgery.
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Copyright © 2005 by the Radiological Society of North America.
