Hybrid Imaging of Head and Neck Malignancies

  • Arie Gordin
  • Marcelo Daitzchman
  • Ora Israel


Head and neck cancer represents approximately 2–4% of all malignancies in the United States, with an annual incidence of 38,000 new cases.1 The majority of these malignancies (over 90%) are squamous cell carcinoma (SCC) of the larynx, oropharynx, and oral cavity. Early detection and accurate staging of head and neck tumors are critical for selecting the appropriate treatment and therefore are of prognostic significance. After therapy, early detection of recurrence has been shown to improve patient outcome.2


Positron Emission Tomography National Comprehensive Cancer Network Cervical Lymph Node Metastasis Conventional Imaging Modality Right Lower Lobe 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Jemal A, Tiwari R, Murray T, Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ. Cancer statistics, 2004. Cancer J Clin 2004;54:8–29.CrossRefGoogle Scholar
  2. 2.
    Quon A, Fischbein NJ, McDougall IR, Le Q-T, Loo Jr BW, Pinto H, Kaplan MJ. Clinical role of 18F-FDG PET/CT in the management of squamous cell carcinoma of the head and neck and thyroid carcinoma. J Nuc Med 2007;48(Supp 1):58–67.Google Scholar
  3. 3.
    Curtin H, Ishwararn H, Mancuso H, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MRI imaging in staging of neck metastases. Radiology 1998;207:123–130.PubMedGoogle Scholar
  4. 4.
    Lowe VJ, Dunphy FR, Varvares M, Kim H, Wittry M, Dunphy CH, Dunleavy T, McDonough E, Minster J, Fletcher JW, Boyd JH. Evaluation of chemotherapy response in patients with head and neck cancer using FDG PET. Head Neck 1997;19:666–674.CrossRefPubMedGoogle Scholar
  5. 5.
    Adams S, Baum RP, Stuckensen T, Bitter K, Hör G. Prospective comparison of FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 1998;25:1255–1260.CrossRefPubMedGoogle Scholar
  6. 6.
    Anzai Y, Caroll WR, Quint DJ, Bradford CR, Minoshima S, Wolf GT, Wahl RL. Recurrence of head and neck cancer after surgery or irradiation: prospective comparison of FDG PET and MR imaging diagnoses. Radiology 1996;200:135–141.PubMedGoogle Scholar
  7. 7.
    McGuirt WF, Greven K, Williams Dr, Keyes JW, Watson N, Watson N, Cappellari JO, Geisinger KR.PET scanning in head and neck oncology: A review. Head and Neck 1998;20:208–215.CrossRefPubMedGoogle Scholar
  8. 8.
    Kresnik K, Mikosch P, Gallowitsch HJ, Kogler D, Wieser A, Heinisch M, Unterweger O, Raunik W, Kumnig G, Gomez I, Grünbacher G, Lind P. Evaluation of head and neck cancer with 18 F-FDG PET: a comparison with conventional methods. Eur J Nucl Med 2001;28:816–821.CrossRefPubMedGoogle Scholar
  9. 9.
    Lowe VJ, Boyd JH, Dunphy FR, Kim H, Dunleavy T, Collins BT, Martin D, Stack Jr BC, Hollenbeak C, Fletcher JW. Surveillance for recurrent head and neck cancer using PET. J Clin Oncol 2000;18:651–658.PubMedGoogle Scholar
  10. 10.
    Blodgett TM, Fukui MB, Snyderman CH, Branstetter IV BF, McCook BM, Townsend D, Meltzer CC. Combined PET-CT in the head and neck: part 1. Physiologic, altered physiologic, and artefactual FDG uptake. Radiographics 2005;25:897–912.CrossRefPubMedGoogle Scholar
  11. 11.
    Uchida Y, Minoshima S, Kawata T, Motoori K, Nakano K, Kazama T, Uno T, Okamoto Y, Ito H.Diagnostic value of FDG PET and salivary gland scintigraphy for parotid tumors. Clin Nucl Med 2005;30:170–176.CrossRefPubMedGoogle Scholar
  12. 12.
    Fukui MB, Blodgett TD, Meltzer CC. PET/CT imaging in recurrent head and neck cancer. Semin US, CT & MRI 2003;24:157–163.CrossRefGoogle Scholar
  13. 13.
    Gordin, A, Golz, A, Keidar Z, Daitzchman M, Bar-Shalom R, Israel O. The role of FDG-PET/CT imaging in head and neck malignancies -impact on diagnostic accuracy and patient care. Otolaryngol Head Neck Surg 2007;137:130–137.CrossRefPubMedGoogle Scholar
  14. 14.
    Ha PK, Hdeib A, Goldenberg D, Jacene H, Patel P, Koch W, Califano J, Cummings CW, Flint PW, Wahl R, Tufano RP. The role of positron emission tomography and computed tomography fusion in the management of early-stage and advanced stage primary head and neck squamous cell carcinoma. Arch Otolaryngol 2006;132:11–16.Google Scholar
  15. 15.
    Alberico RA, Husain SH, Sirotkin I. Imaging in head and neck oncology. Surg Oncol Clin N Am 2004;13:13–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Shah J. Cervical lymph node metastases: diagnostic, therapeutic and prognostic implications. Oncology 1990;4:61–69.PubMedGoogle Scholar
  17. 17.
    Schwartz DL, Ford E, Rajendran J, Yueh B, Coltrera M, Virgin J, Anzai Y, Haynor D, Lewellyn B, Mattes D. FDG-PET/CT imaging for preradiotherapy staging of head and neck squamous cell carcinoma. Int J Radiat Oncol 2005;61:129–136.CrossRefGoogle Scholar
  18. 18.
    Schoder H, Yeung HW. Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 2004;34:180–197.CrossRefGoogle Scholar
  19. 19.
    Stoeckli SJ, Steinert H, Pfaltz M, Schmid S. Is there a role for PET with FDG in the initial staging of nodal negative oral and oropharyngeal SCC. Head Neck 2002;24:345–349.CrossRefPubMedGoogle Scholar
  20. 20.
    Schoder H, Carlson DL, Kraus DH, Stambuk HE, Gönen M, Erdi YE, Yeung HWD, Huvos AG, Shah JP, Larson SM, Wong RJ. FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med 2006;47:755–762.PubMedGoogle Scholar
  21. 21.
    Tenkos T, Rosenthal E, Lee D, Taylor R, Marn CS. Positron emission tomography in evaluation of stage III and IV head and neck cancer. Head Neck 2001;23:1056–1060.CrossRefGoogle Scholar
  22. 22.
    Fleming AJ, Smith SP, Paul CM. Impact of PET/CT on previously untreated head and neck cancer patients. Laryngoscope 2007;117:1173–1179.CrossRefPubMedGoogle Scholar
  23. 23.
    Muir C. Cancer of an unknown primary site. Cancer 1995;75:353–356.CrossRefPubMedGoogle Scholar
  24. 24.
    Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from unknown primary. Cancer Treat Rev 2004;30:153–164.CrossRefPubMedGoogle Scholar
  25. 25.
    Johansen J, Eigtved A, Buchwald C, Theilgaard SA. Implication of 18F-Fluoro-2-Deoxy-D-Glucose positron emission tomography on management of carcinoma of unknown primary in the head and neck: A Danish cohort study. Laryngoscope 2002;112:2009–2014.CrossRefPubMedGoogle Scholar
  26. 26.
    Greven KM, Keyes Jr JW, Williams 3rd, McGuirt WF, Joyce MT. Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with FDG. Cancer 1999;86:114–118.CrossRefPubMedGoogle Scholar
  27. 27.
    Assar OS, Fischbein NJ, Caputo GR, Kaplan MJ, Price DC, Singer MI, Dillon WP, Hawkins RA.Metastatic head and neck cancer: Role and usefulness of FDG PET in locating occult primary tumors. Radiology 1999;210:177–181.Google Scholar
  28. 28.
    Wartski M, Le Stanc E, Gontier E, Vilain D, Banal A, Tainturier C, Pecking A, Paul A, Alberini JL. In search of unknown primary tumor presenting with cervical metastases: performance of hybrid FDG-PET-CT. Nucl Med Comm 2007;28:365–371.CrossRefGoogle Scholar
  29. 29.
    Zimmer LA, Branstetter BF, Nayak JV, Johnson JT. Current use of 18f-Fluorodeoxyglucose positron emission tomography and computed tomography in squamous cell carcinoma of the head and neck. Laryngoscope 2005;115:2029–2034.CrossRefPubMedGoogle Scholar
  30. 30.
    Kitagawa Y, Nishizawa S, Sano K, Ogasawara T, Nakamura M, Sadato N, Yoshida M, Yonekura Y.Prospective comparison of 18F-FDG-PET with conventional imaging modalities (MRI, CT and 67 Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med 2003;44:198–206.Google Scholar
  31. 31.
    Wong VJ, Lin DT, Schoder H, Patel SG, Gonen M, Wolden S, Pfister DG, Shah GP, Larson SM, Kraus DH. Diagnostic and prognostic value of 18-FDG PET for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2002;20:4199–4208.CrossRefPubMedGoogle Scholar
  32. 32.
    Kunkel M, Forster GJ, Reichert TE, Jeong J-H, Benz P, Bartenstein P, Wagner W, Whiteside TL.Detection of oral squamous cell carcinoma by 18-FDG PET: implications for prognosis and patient management radiation treatment planning with an integrated positron emission and computer tomography: A feasibility study. Cancer 2003;98:2257–2265.CrossRefPubMedGoogle Scholar
  33. 33.
    Schoder H, Yeung HWD, Gonen M, Kraus D, Larson SM. Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 2004;231:65–72.CrossRefPubMedGoogle Scholar
  34. 34.
    Brouwer J, Bodar EJ, De Bree R, Lankendijk JA, Castelijns JA, Hoekstra OS, Leemans CR. Detecting recurrent laryngeal carcinoma after radiotherapy: room for improvement. Eur Arch Otorhin 2004;261:417–422.CrossRefGoogle Scholar
  35. 35.
    Gordin A, Daitzchman M, Doweck I, Yefremov N, Golz A, Keidar Z, Bar-Shalom R, Kuten A, Israel O. FDG PET/CT imaging in patients with carcinoma of the larynx: diagnostic accuracy and impact on clinical management. Laryngoscope 2006;116:273–278.CrossRefPubMedGoogle Scholar
  36. 36.
    Geets X, Daisne JF, Tomsej M, Duprez T, Lonneux M, Grégoire V. Impact of the type of imaging modality on target volumes delineation and dose distribution in pharyngo-laryngeal squamous cell carcinoma: Comparison between pre and per-treatment studies. Radiother Oncol 2006;78:291–297.CrossRefPubMedGoogle Scholar
  37. 37.
    Podoloff DA, Advani RH, Allred C, Benson AB, Brown E, Burstein HJ, Carlson RW, Coleman RE, Czuczman MS, Delbeke D, Edge SB, Ettinger DS, Grannis FW, Hillner BE, Hoffman JM, Keil K, Komaki R, Larson SM, Mankoff DA, Rozenzweig KE, Skibber JM, Yahalom J, Yu JM, Zelenetz AD.NCCN task force report: Positron Emission Tomography (PET/Computed tomography (CT) scanning in cancer. J Natl Compr Canc Netw 2007;5(Suppl 1):S1–S22. PubMedGoogle Scholar
  38. 38.
    Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, Coleman E, Wahl R, Paschold JC, Avril N , Einhorn LH, Suh WW, Samson D, Delbeke D, Gorman M, Shields AF. Recommendations for the use of FDG( fluorine-18, (2-[18F] Fluoro-2-deoxy-D-glucose) positron emission tomography in oncology. J Nucl Med 2008;49:480–508.CrossRefPubMedGoogle Scholar
  39. 39.
    Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules: Detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol 2007;188:57–68.CrossRefPubMedGoogle Scholar
  40. 40.
    Joo HY, Yoo IR, Kim SH. Clinical significance of small pulmonary nodules with little or no FDG uptake on PET/CT images of patients with nonthoracic malignancies. J Nucl Med 2007;48:15–21Google Scholar
  41. 41.
    Lin K, Patel SG, Chu PY, Matsuo JMS, Singh B, Wong RJ, Kraus DH, Shaha AR, Shah JP, Boyle JO.Second primary malignancy of the aerodigestive tract in patients treated for cancer of the oral cavity and larynx. Head and Neck 2005;27:1042–1048.CrossRefPubMedGoogle Scholar
  42. 42.
    Stokkel MP, Moons KG, Ten Broek FW, van Rijk PP, Hordijk GJ. 18F-fluorodeoxyglucose dual-head positron emission tomography as procedure for detecting simultaneous primary tumors in cases of head and neck cancer. Cancer 1999;86:2370–2377.CrossRefPubMedGoogle Scholar
  43. 43.
    Ward PH, Calcaterra TC, Kagan AR. The enigma of post-irradiation edema and recurrent or residual carcinoma of the larynx. Laryngoscope 1975;85:522–529.CrossRefPubMedGoogle Scholar
  44. 44.
    Vermeersch H, Loose D, Ham H, Otte A, Van de Wiele C. Nuclear medicine imaging for the assessment of primary and recurrent head and neck carcinoma using routinely available traces. Eur J Nucl Med Mol Imaging 2003;30:1689–1700.CrossRefPubMedGoogle Scholar
  45. 45.
    Basu S, Houseni M, Alavi A. Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 2008;29:367–373.CrossRefPubMedGoogle Scholar
  46. 46.
    Ozawa N, Okamura T, Koyama K,  Nakayama K, Kawabe JK, Shiomi S, Yamane H, Inoue Y.Retrospective review: Usefulness of a number of imaging modalities including CT, MRI, technetium-99m pertechnetate scintigraphy, gallium-67 scintigraphy and F-18-FDG PET in the differentiation of benign from malignant parotid masses. Radiat Med 2006;24:41–49.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of OtolaryngologyHead and Neck Surgery, The Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Diagnostic ImagingRambam Health Care CampusHaifaIsrael
  3. 3.Rambam Health Care Campus, B. and R. Rappaport School of Medicine, TechnionIsrael Institute of TechnologyHaifaIsrael

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