A Comparative Study of Fused FDG PET/MRI, PET/CT, MRI, and CT Imaging for Assessing Surrounding Tissue Invasion of Advanced Buccal Squamous Cell Carcinoma

• Published in: Clinical nuclear medicine 2011-07, Vol.36 (7), p.518-525
• Main Authors: Huang, Shu-Hua, Chien, Chi-Yen, Lin, Wei-Che, Fang, Fu-Min, Wang, Pei-Wen, Lui, Chun-Chung, Huang, Yung-Cheng, Hung, Bor-Tau, Tu, Min-Chien, Chang, Chiung-Chih
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - pathology; Demography; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mouth Neoplasms - diagnostic imaging; Mouth Neoplasms - epidemiology; Mouth Neoplasms - pathology; Neoplasm Invasiveness; Neoplasm Staging; Observer Variation; Positron-Emission Tomography; Predictive Value of Tests; Sensitivity and Specificity; Tomography, X-Ray Computed
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0b013e318217566f

PURPOSE:This study aimed to evaluate the diagnostic value of fused fluorodeoxyglucose positron emission tomography and magnetic resonance imaging (PET/MRI) compared with PET/computed tomography (CT), MRI, and CT in assessing surrounding tissue invasion of advanced buccal squamous cell carcinoma (BSCC). MATERIALS AND METHODS:PET/CT and MRI were performed in 17 consecutive patients with suspected masticator space invasion of BSCC from CT images. Attenuation-corrected PET and head and neck MRI datasets were registered. For pathologic correlation, 4 regions of interest were examined, including the maxilla, mandible, pterygoid, and masseter muscle. The tumor maximal diameter, measured by different imaging modalities, was correlated with pathology results. RESULTS:All PET/MRI fusions were verified as well matched using specific anatomic criteria. For pathology results, 1 patient had inflammation only, 1 had spindle cell cancer, and 15 had squamous cell cancer. Of 64 regions of interest, 20 (31.3%) harbored tumor invasion. The likelihood ratio was highest in fused PET/MRI (42.56) compared with PET/CT (25.02), MRI (22.94), and CT (8.6; all P < 0.05). The sensitivity and specificity of fused PET/MRI were also highest among the 4 modalities (90.0%/90.9%, 80.0%/84.1%, 80.0%/79.5%, and 55.0%/81.8%, respectively). The level of confidence was higher in fused PET/MRI or MRI than in PET/CT or CT (85.9%, 85.9%, 70.3%, 73.4%, respectively). The maximal lesion size was 3.0 to 6.0 cm in the pathology specimen. Regression analysis showed better agreement between fused PET/MRI and pathology results. CONCLUSIONS:Fused PET/MRI is more reliable for focal invasion assessment and tumor size delineation in advanced BSCC compared with PET/CT, MRI, and CT. PET/CT has the lowest confidence level, which may limit its use in the clinical setting.