Local resectability assessment of head and neck cancer: Positron emission tomography/MRI versus positron emission tomography/CT

Abstract

Both contrast-enhanced PET/MRI and contrast-enhanced PET/CT can serve as reliable examinations for defining local resectability of head and neck cancer.

Use of MRI and FDG‐PET/CT to predict fixation of advanced hypopharyngeal squamous cell carcinoma to prevertebral space

“…In addition, the following quantitative PET‐based parameters of the primary tumor were assessed: maximum standardized uptake value (SUV max ) and metabolic tumor volume (MTV). Our selection of parameters is based on previously published literature and several decades of experience in a tertiary‐care hospital serving as a national reference center for head and neck cancer …”

“…With the recent introduction of FDG‐PET/MR, some CT‐related problems in the oropharynx that also exist in FDG‐PET/CT, for example, dental artifacts, could be improved. For assessing the resectability of the primary tumor, several studies showed that both hybrid imaging modalities—FDG‐PET/CT and FDG‐PET/MR—are reliable tools . The clinical assessment of HNSCC usually relies on triple endoscopy, which incorporates an examination of the upper aerodigestive tract with rigid or flexible instruments under general anesthesia and a systematic digital palpation of the pivotal subsites.…”

“…Triple endoscopy may also detect superficial carcinomas or precancerous lesions of the mucosal surface, which cannot be seen on FDG‐PET/CT, CT, or MR imaging . Several factors render a tumor unresectable, with the most common ones found in laryngeal and hypopharyngeal carcinoma patients being carotid artery encasement and infiltration of the prevertebral space (PVS) . Although artery encasement and cartilage invasion are more reliably diagnosed with cross‐sectional imaging than with triple endoscopy, the standard of reference for PVS infiltration remains explorative cervicotomy.…”

“…For assessing the resectability of the primary tumor, several studies showed that both hybrid imaging modalities-FDG-PET/CT and FDG-PET/MRare reliable tools. [5][6][7] The clinical assessment of HNSCC usually relies on triple endoscopy, which incorporates an examination of the upper aerodigestive tract with rigid or flexible instruments under general anesthesia and a systematic digital palpation of the pivotal subsites. Thereby, the location and extent of the primary tumor is assessed, and synchronous second malignancies are found in 6.4%-12% of patients.…”

“…8,9 Several factors render a tumor unresectable, with the most common ones found in laryngeal and hypopharyngeal carcinoma patients being carotid artery encasement and infiltration of the prevertebral space (PVS). 4,5,11 Although artery encasement and cartilage invasion are more reliably diagnosed with cross-sectional imaging than with triple endoscopy, the standard of reference for PVS infiltration remains explorative cervicotomy. As the latter is an invasive procedure, digital palpation under general anesthesia and relaxation is usually considered as the second best clinical assessment.…”