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[18F]FDG PET/MRI versus contrast-enhanced MRI in detecting regional HNSCC metastases

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Abstract

Objective

To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard.

Methods

We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard.

Results

Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%).

Conclusions

Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.

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Acknowledgements

The acquisition of PET/MRI system of the University-Hospital of Padova was founded by the “Fondazione Cassa di Risparmio di Padova e Rovigo” and co-founded by the Hospital of Padova.

Funding

None.

Author information

Author notes

  1. Filippo Crimì and Daniele Borsetto were contributed equally to this paper.

Authors and Affiliations

  1. Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy

    Filippo Crimì, Roberto Stramare & Arcangelo Merola

  2. Guy’s and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK

    Daniele Borsetto

  3. Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy

    Roberto Di Carlo, Enzo Emauelli, Piero Nicolai & Giulia Oliveri

  4. Radiology Unit, University-Hospital of Padova, Padua, Italy

    Carmelo Lacognata

  5. Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy

    Pietro Zucchetta, Valentina Bodanza & Diego Cecchin

  6. Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy

    Laura Albertoni

  7. Department of Mathematics “Tullio Levi-Civita”, University of Padova, Padua, Italy

    Cristina Campi

Authors
  1. Filippo Crimì
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Correspondence to Daniele Borsetto.

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Crimì, F., Borsetto, D., Stramare, R. et al. [18F]FDG PET/MRI versus contrast-enhanced MRI in detecting regional HNSCC metastases. Ann Nucl Med 35, 260–269 (2021). https://doi.org/10.1007/s12149-020-01565-5

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  • DOI: https://doi.org/10.1007/s12149-020-01565-5

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