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Rational Diagnosis of Squamous Cell Carcinoma of the Head and Neck Region: Comparative Evaluation of CT, MRI, and ¹⁸FDG PET

Dept. of Diagnostic Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen D-72076, Germany.

View larger version (129K): [in a new window]   Fig. 1A. —71-year-old man with squamous cell carcinoma of left lower alveolar ridge (diameter, 15 mm; stage, pT4 pN2b). Tumor was missed by CT but clearly depicted by both PET and MRI Contrast-enhanced CT scan at level of primary tumor fails to reveal lesion.

View larger version (167K): [in a new window]   Fig. 1B. —71-year-old man with squamous cell carcinoma of left lower alveolar ridge (diameter, 15 mm; stage, pT4 pN2b). Tumor was missed by CT but clearly depicted by both PET and MRI T2-weighted STIR image shows tumor (arrow) with high signal intensity.

View larger version (107K): [in a new window]   Fig. 1C. —71-year-old man with squamous cell carcinoma of left lower alveolar ridge (diameter, 15 mm; stage, pT4 pN2b). Tumor was missed by CT but clearly depicted by both PET and MRI Axial PET scan shows tumor (arrow) with average standard uptake value (SUV) of 6.46 (maximum SUV, 10.0).

View larger version (122K): [in a new window]   Fig. 2. —65-year-old man with squamous cell carcinoma (stage, pT4 pN0) in anterior mouth floor. Coronal PET scan depicts second tumor (arrow) (average standard uptake value, 4.2) in lower paracardial mediastinum, corresponding to esophageal carcinoma, which was confirmed by endoscopy.

View larger version (176K): [in a new window]   Fig. 3A. —54-year-old man SCC of lower alveolar ridge. Contrast-enhanced CT scan shows submandibular lymph nodes (arrows) of borderline size and in close relation to primary tumor interpreted as metastases.

View larger version (170K): [in a new window]   Fig. 3B. —54-year-old man SCC of lower alveolar ridge. STIR image at the same level as A shows equivocal lymph node findings (arrows).

View larger version (112K): [in a new window]   Fig. 3C. —54-year-old man SCC of lower alveolar ridge. PET scan at same level as A and B; low radiotracer uptake correctly indicates benign lymph nodes (arrows).

View larger version (14K): [in a new window]   Fig. 4. —Receiver operating characteristic analysis of findings of CT, MRI, and PET in diagnosis of lymph node spread. CT = dotted line, MRI = dashed line, and PET = solid line. Area under curve (Az) ± SD for CT = 0.909 ± 0.032, Az for MRI = 0.938 ± 0.027, and Az for PET = 0.926 ± 0.029. Differences are not significant.

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