Detection of distant metastases and distant second primary cancers in head and neck squamous cell carcinoma: comparison of [18F]FDG PET/MRI and [18F]FDG PET/CT

• Published in: Insights into imaging Vol. 13; no. 1; p. 121
• Main Authors: Katirtzidou, Eirini, Rager, Olivier, Varoquaux, Arthur Damien, Poncet, Antoine, Lenoir, Vincent, Dulguerov, Nicolas, Platon, Alexandra, Garibotto, Valentina, Zaidi, Habib, Becker, Minerva
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 28-07-2022; Springer Nature B.V; Springer; SpringerOpen
• Subjects: Cancer; Clustering; Diagnostic Radiology; Diagnostic systems; Fluorine isotopes; Head & neck cancer; Head and neck tumors; Histology; Human health and pathology; Imaging; Internal Medicine; Interventional Radiology; Life Sciences; Magnetic resonance imaging; Medicine; Medicine & Public Health; Metastases; Metastasis; Neuroradiology; Original; Original Article; Patients; PET/CT; PET/MRI; Positron emission; Radiology; Second primary cancer; Squamous cell carcinoma; Statistical analysis; Tomography; Ultrasound; Head and neck tumors; PET/MRI; Second primary cancer; PET/CT; Metastases
• ISSN: 1869-4101; 1869-4101
• DOI: 10.1186/s13244-022-01261-0

Purpose
This prospective study aimed to compare the diagnostic performance of [
18
]FDG PET/MRI and PET/CT for the detection of distant metastases and distant second primary cancers in patients with head and neck squamous cell carcinoma (HNSCC).
Methods
A total of 103 [
18
F]FDG PET/MRI examinations immediately followed by PET/CT were obtained in 82 consecutive patients for staging of primary HNSCC (
n
 = 38), suspected loco-regional recurrence/follow-up (
n
 = 41) or unknown primary HNSCC (
n
 = 3). Histology and follow-up > 2 years formed the standard of reference. Blinded readers evaluated the anonymized PET/MRI and PET/CT examinations separately using a 5-point Likert score. Statistical analysis included: receiver operating characteristic (ROC) analysis, jackknife alternative free-response ROC (JAFROC) and region-of-interest (ROI)-based ROC to account for data clustering and sensitivity/specificity/accuracy comparisons for a score ≥ 3.
Results
Distant metastases and distant second primary cancers were present in 23/103 (22%) examinations in 16/82 (19.5%) patients, and they were more common in the post-treatment group (11/41, 27%) than in the primary HNSCC group (3/38, 8%),
p
 = 0.039. The area under the curve (AUC) per patient/examination/lesion was 0.947 [0.927–1]/0.965 [0.917–1]/0.957 [0.928–0.987] for PET/MRI and 0.975 [0.950–1]/0.968 [0.920–1]/0.944 [0.910–0.979] for PET/CT, respectively (
p
 > 0.05). The diagnostic performance of PET/MRI and PET/CT was similar according to JAFROC (
p
 = 0.919) and ROI-based ROC analysis (
p
 = 0.574). Sensitivity/specificity/accuracy for PET/MRI and PET/CT for a score ≥ 3 was 94%/88%/89% and 94%/91%/91% per patient, 96%/90%/91% and 96%/93%/93% per examination and 95%/85%/90% and 90%/86%/88% per lesion, respectively,
p
 > 0.05.
Conclusions
In HNSCC patients, PET/MRI and PET/CT had a high and similar diagnostic performance for detecting distant metastases and distant second primary cancers.