Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion

Radiology. 2004 Apr;231(1):65-72. doi: 10.1148/radiol.2311030271. Epub 2004 Feb 27.


Purpose: To compare diagnostic accuracy of attenuation-corrected positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with head and neck cancer and to evaluate the effect of PET/CT findings on patient care.

Materials and methods: Studies of 68 patients were reviewed by two physicians in consensus. Focal fluorodeoxyglucose (FDG) uptake in the head and neck on attenuation-corrected PET images was graded as benign, equivocal, or malignant. CT and PET/CT images were then reviewed, and initial findings were amended if necessary. Comparison was performed on a lesion-by-lesion basis. Accuracy was evaluated on the basis of follow-up and histopathologic findings. Potential effects on patient care were assessed by a head and neck surgeon. PET and PET/CT accuracy was compared with a McNemar test adjusted for clustering.

Results: A total of 157 foci with abnormal FDG uptake were noted, two of which were seen only on PET/CT images. PET/CT images were essential in determining the exact anatomic location for 100 lesions (74% better localization in regions previously treated surgically or with irradiation vs 58% in untreated areas; P =.06). On the basis of PET findings alone, 45 lesions were considered benign; 39, equivocal; and 71, malignant. With PET/CT, the fraction of equivocal lesions decreased by 53%, from 39 of 155 to 18 of 157 (P <.01). PET/CT had a higher accuracy of depicting cancer than did PET (96% vs 90%, P =.03). Six proved malignancies were missed with PET, but only one was missed with PET/CT. PET/CT findings altered the care for 12 (18%) of 68 patients.

Conclusion: PET/CT is more accurate than PET alone in the detection and anatomic localization of head and neck cancer and has the clear potential to affect patient care.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / classification
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / therapy
  • False Positive Reactions
  • Female
  • Fluorodeoxyglucose F18 / metabolism
  • Follow-Up Studies
  • Head and Neck Neoplasms / classification
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Image Interpretation, Computer-Assisted
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / metabolism
  • Male
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Muscle, Skeletal / metabolism
  • Patient Care
  • Radiopharmaceuticals / metabolism
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, Emission-Computed
  • Tomography, X-Ray Computed


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18