• Minerva Becker, Arthur D Varoquaux, Christophe Combescure, Olivier Rager, Marc Pusztaszeri, Karim Burkhardt, Bénédicte M A Delattre, Pavel Dulguerov, Nicolas Dulguerov, Eirini Katirtzidou, Francesca Caparrotti, Osman Ratib, Habib Zaidi, and Christoph D Becker.
• Department of Imaging, Divisions of Radiology and Nuclear Medicine, Geneva University Hospitals, University of Geneva, Rue, Gabrielle Perret Gentil 4, CH-1211, Geneva 14, Switzerland. Minerva.Becker@hcuge.ch.
• Eur Radiol. 2018 Feb 1; 28 (2): 651-663.

PurposeTo determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy.Materials And MethodsThis was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering.ResultsThe proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001).ConclusionFDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy.Key Points• FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence. • Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage. • 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence. • 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions. • Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.

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