CT, MR, US,18F-FDG PET/CT, and their combined use for the assessment of cervical lymph node metastases in squamous cell carcinoma of the head and neck

Eur Radiol. 2009 Mar;19(3):634-42. doi: 10.1007/s00330-008-1192-6. Epub 2008 Oct 9.


The purpose of this retrospective study was to compare the diagnostic value of four different imaging methods-computed tomography (CT), magnetic resonance (MR) imaging, ultrasonography (US), and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT-and their combined use for preoperative detection of cervical nodal metastases in head and neck squamous cell carcinoma (SCC). Sixty-seven patients (58 men and 9 women; mean age, 60.1 years) with head and neck SCCs underwent CT, MR, US, and PET/CT before surgery. First, each study was reviewed separately for the presence of nodal metastases. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified, on a level-by-level basis, with histopathologic findings. Histopathologic examination revealed nodal metastases in 74 of 402 nodal levels. The sensitivity, specificity, and accuracy were 77.0%, 99.4%, and 95.3% for CT and MR; 78.4%, 98.5%, and 94.8% for US; and 81.1%, 98.2%, and 95.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (p > 0.05). The combination of CT, MR, US, and PET/CT improved sensitivity (86.5%), without loss of specificity (99.4%) and accuracy (97.0%), although the difference failed to reach statistical significance.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Female
  • Fluorodeoxyglucose F18*
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Humans
  • Lymphatic Metastasis / diagnosis*
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Positron-Emission Tomography / methods*
  • Tomography, X-Ray Computed / methods*
  • Ultrasonography / methods*


  • Fluorodeoxyglucose F18