Combined image interpretation of computed tomography and hybrid PET in head and neck cancer

M. Zimny; J. E. Wildberger; U. Cremerius; E. DiMartino; S. Jaenicke; B. Nowak; U. Büll

doi:10.1055/s-0038-1623998

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2002; 41(01): 14-21
DOI: 10.1055/s-0038-1623998

Originalarbeiten – Original Articles

Schattauer GmbH

Combined image interpretation of computed tomography and hybrid PET in head and neck cancer

Kombinierte Befundung von Computertomographie und Hybrid-PET bei Kopf-Hals-Tumoren

Authors

M. Zimny

¹Department of 1Nuclear Medicine (Head: Prof. Dr. med. U. Büll)
J. E. Wildberger

²Diagnostic Radiology (Head: Prof. Dr. med. R. Günther)
U. Cremerius

¹Department of 1Nuclear Medicine (Head: Prof. Dr. med. U. Büll)
E. DiMartino

³Otorhinolaryngology (Head: Prof. Dr. med. M. Westhofen)
S. Jaenicke

⁴Maxillofacial and Facial Plastic Surgery (Head: Prof. Dr. med. Dr. med. dent. D. Riediger), University of Technology, Aachen, Germany
B. Nowak

¹Department of 1Nuclear Medicine (Head: Prof. Dr. med. U. Büll)
U. Büll

¹Department of 1Nuclear Medicine (Head: Prof. Dr. med. U. Büll)

Abstract

Summary

Aim: Evaluation of potential synergistic effects of combined image interpretation of FDG PET using a gamma camera modified for coincidence detection (hybrid PET) and computed tomography (CT) and comparison of the diagnostic accuracy of hybrid PET and dedicated PET in patients with head and neck cancer. Methods: Forty-two patients with suspected primary or recurrent cancer were included. Twenty-four patients underwent dedicated PET in addition to attenuationcorrected hybrid PET using a one-day protocol. Results: Sensitivity, specificity and accuracy for detection of primary or recurrent head and neck cancer were 74, 73, and 74% for hybrid PET, 52, 82, and 60% for CT and 77, 82, and 79% for combined reading. With the combination of CT and hybrid PET all cases of recurrent disease were detected. The largest tumour not detected was 1.7 cm in diameter. Sensitivity, specificity and accuracy for the detection of neck sides with lymph node metastases were 69, 88, and 85% for hybrid PET, 62, 88, and 84% for CT, 69, 99, and 94% for combined image interpretation. With combined interpretation four involved neck sides were missed including two cases of microscopic metastases. Hybrid PET revealed concordant results to dedicated PET in all patients with respect to the detection of primary or recurrent tumour and in 45 of 48 neck sides (94%) with the same number of false negative findings. Conclusion: The combination of functional information of hybrid PET and morphological information of CT by the simple approach of combined image interpretation improves the sensitivity for the detection of primary/recurrent head and neck cancer and increases the specificity of lymph node staging compared to CT alone. The accuracy of hybrid PET and dedicated PET was almost identical.

Zusammenfassung

Ziel: Untersuchung potentieller synergistischer Effekte der gemeinsamen Befundung von Patienten mit Kopf- Hals-Tumoren von FDG-PET mit einer Gammakamera (Hybrid-PET) und Computertomographie (CT) und Vergleich der diagnostischen Genauigkeit von Hybrid-PET und Ring-PET. Methoden: Bei 42 Patienten mit gesichertem oder vermutetem Primärtumor/Lokalrezidiv eines Malignoms der Kopf-Hals-Region erfolgte eine Untersuchung mit CT und schwächungskorrigiertem Hybrid-PET, bei 24 Patienten zusätzlich mit Ring-PET. Ergebnisse: Die Sensitivität, Spezifität und Genauigkeit zur Erkennung eines Primärtumors/Lokalrezidivs lag für Hybrid-PET bei 74, 73 und 74%, für CT bei 52, 82 und 60% gegenüber 77, 82 und 79% bei kombinierter Befundung. Bei kombinierter Befundung wurden alle Rezidive detektiert. Der größte nicht erkannte Tumor war 1,7 cm im Durchmesser. Die Sensitivität, Spezifität und Genauigkeit zur Erkennung von Lymphknotenmetastasen betrug 69, 88 und 85% für Hybrid-PET, 62, 88 und 84% für CT gegenüber 69, 99 und 94% bei kombinierter Befundung. Auch mit kombinierter Befundung wurden vier betroffene Halsseiten nicht erkannt, hierunter zwei Fälle mit mikroskopischem Lymphknotenbefall. Hybrid-PET erbrachte im Vergleich zu Ring-PET bezogen auf Primärtumore/Rezidive bei allen Patienten das gleiche Resultat. Befundkonkordanz bezüglich Lymphknotenmetastasen lag bei 94% der Halsseiten vor, bei gleicher Anzahl falsch negativer Befunde. Schlussfolgerung: Die Kombination der funktionellen Bildgebung mit Hybrid-PET und der morphologischen Information von CT führte im Vergleich zu CT allein zu einer Steigerung der Sensitivität bei der Diagnostik von Primärtumoren/Rezidiven und zu einer Steigerung der Spezifität bezogen auf das Lymphknoten-Staging. Die Genauigkeit von Hybrid-PET und Ring-PET war nahezu identisch.

Keywords

Head and neck tumours - fluorodeoxyglucose - hybrid PET - CT

Schlüsselwörter

Kopf-Hals-Tumor - Fluordeoxyglukose - Hybrid-PET - Computertomographie

Full Text

References

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