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Clinical Challenges
Aug 2012

A Head and Neck Radiologist’s Perspective on Best Practices for the Usage of PET/CT Scans for the Diagnosis and Treatment of Head and Neck Cancers

Author Affiliations

Author Affiliations: Departments of Radiology (Drs Zollinger and Wiggins) and Otolaryngology–Head and Neck Surgery and BioMedical Informatics (Dr Wiggins), University of Utah Health Sciences Center, Salt Lake City.

Arch Otolaryngol Head Neck Surg. 2012;138(8):754-758. doi:10.1001/archoto.2012.1408

Hypothesis: Although positron emission tomography–computed tomography (PET/CT) is frequently overused, there are certain clinical scenarios for which PET/CT is indicated and clinically useful in patients with head and neck cancer.

Cancer of the head and neck accounts for 3% of all the malignant diseases within the United States; however, there is an estimated societal cost of $3.1 billion spent annually for treatment.1-3 These neoplasms can be much more debilitating than other carcinomas, especially with the involvement of exposed physical attributes. Most head and neck cancer is secondary to squamous cell carcinoma. There are over 40 000 new head and neck squamous cell carcinoma (HNSCC) cancers reported each year in the United States.1 Multiple available imaging modalities play a significant role in the evaluation and staging of patients with HNSCC. Because of wide availability, many sites primarily use cross-sectional imaging with CT and magnetic resonance imaging (MRI) in these patients. Contrast-enhanced CT (CECT) is the most commonly used modality to evaluate infrahyoid neck disease, and contrast-enhanced MRI has proven to be the mainstay in many institutions for the evaluation of the suprahyoid neck and skull base.2 Fluorodeoxyglucose F 18 PET (FDG PET) in isolation has been proven to be a more sensitive and specific method of diagnosing head and neck cancers.2,3 The combination of PET imaging with dedicated high-resolution, head and neck CECT improves the value of information FDG-PET provides alone by allowing precise localization of metabolic activity in a region of complex anatomy.