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Review
. 2024 May 16;16(10):1905.
doi: 10.3390/cancers16101905.

Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications

Carmelo Caldarella  1 , Marina De Risi  1 , Mariangela Massaccesi  2 , Francesco Miccichè  3 , Francesco Bussu  4   5 , Jacopo Galli  6   7 , Vittoria Rufini  1   8 , Lucia Leccisotti  1   8
Affiliations
Review

Role of 18F-FDG PET/CT in Head and Neck Squamous Cell Carcinoma: Current Evidence and Innovative Applications

Carmelo Caldarella et al. Cancers (Basel). .

Abstract

This article provides an overview of the use of 18F-FDG PET/CT in various clinical scenarios of head-neck squamous cell carcinoma, ranging from initial staging to treatment-response assessment, and post-therapy follow-up, with a focus on the current evidence, debated issues, and innovative applications. Methodological aspects and the most frequent pitfalls in head-neck imaging interpretation are described. In the initial work-up, 18F-FDG PET/CT is recommended in patients with metastatic cervical lymphadenectomy and occult primary tumor; moreover, it is a well-established imaging tool for detecting cervical nodal involvement, distant metastases, and synchronous primary tumors. Various 18F-FDG pre-treatment parameters show prognostic value in terms of disease progression and overall survival. In this scenario, an emerging role is played by radiomics and machine learning. For radiation-treatment planning, 18F-FDG PET/CT provides an accurate delineation of target volumes and treatment adaptation. Due to its high negative predictive value, 18F-FDG PET/CT, performed at least 12 weeks after the completion of chemoradiotherapy, can prevent unnecessary neck dissections. In addition to radiomics and machine learning, emerging applications include PET/MRI, which combines the high soft-tissue contrast of MRI with the metabolic information of PET, and the use of PET radiopharmaceuticals other than 18F-FDG, which can answer specific clinical needs.

Keywords: 18F-FDG; PET; PET/CT; PET/MRI; head and neck; radiomics; squamous cell carcinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Example of recommended PET acquisition protocol for head-and-neck tumors. Skull base to proximal thighs scan with arms raised (A) followed by head–neck study with the patient’s arm placed down (B). The focal uptake in the right parotid gland (arrow) is a reactive lymph node.
Figure 2
Figure 2
Axial PET, CT, and PET/CT images of a patient with cervical lymph node metastases of undifferentiated carcinoma, and no clinical evidence of primary lesion in the head–neck district. High 18F-FDG uptake is seen in enlarged cervical lymph nodes bilaterally (A,B), although more evident on the left side (red circles in (A,C)), and in the 7th dorsal vertebra (yellow arrow in (D,F)) without structural alterations at low-dose CT (E). PET/CT scan revealed the otherwise unknown primary nasopharyngeal tumor, on the left side (long arrow in (G,I)), not apparent on low-dose CT (H).
Figure 3
Figure 3
PET/CT images showing intense 18F-FDG uptake in a large hypopharyngeal cancer and an enlarged lymph node on the right cervical side; another sub-centimetric cervical lymph node with a mild increase in 18F-FDG uptake is seen contralaterally (arrows).
Figure 4
Figure 4
PET/CT images showing an enlarged and hypodense left cervical lymph node metastasis with no significant increase in 18F-FDG uptake due to necrotic changes (arrow).
Figure 5
Figure 5
Axial 18F-FDG PET (A,C,E), CT (G), and fused PET/CT images (B,D,F) for staging in a patient with oropharyngeal carcinoma. Increased 18F-FDG uptake is seen in the primary tumor (A,B) with bilateral pharyngeal involvement (>on the left), as well as in bilateral cervical lymph nodes (yellow and green arrows in (C,D,E,F)). The focal 18F-FDG uptake in the esophagus (red arrow in (H)) was confirmed as a synchronous primary. Slight uptake by a pseudo-nodular left lung consolidation (white triangle in (H)) was due to inflammatory changes.
Figure 6
Figure 6
Baseline (A,B) and post-chemotherapy (C,D) 18F-FDG PET/CT in a patient with bilateral cervical lymph node metastases from nasopharyngeal carcinoma. Marked reduction in entity and extent of 18F-FDG, as well as in size, was observed in all the involved lymph nodes, with a persistent inhomogeneous uptake and no evidence of new active lesions (partial response).
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