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¹⁸F-FET PET Compared with ¹⁸F-FDG PET and CT in Patients with Head and Neck Cancer

¹ Institute of Medicine and Brain Imaging Center West, Research Center Jülich, Jülich, Germany; ² GP Nuclear Medicine and Radiology, Bad Honnef, Germany; ³ Department of Cranio- and Maxillofacial Surgery, Heinrich-Heine University, Düsseldorf, Germany; ⁴ Institute of Radiology, Heinrich-Heine University, Düsseldorf, Germany; and ⁵ Institute of Nuclear Chemistry, Research Center Jülich, Jülich, Germany

Correspondence: For correspondence or reprints contact: Dirk Pauleit, MD, Institute of Medicine, Research Center Jülich, P.O. Box 1913; 52425 Jülich, Germany. E-mail: pauleit{at}web.de

Recent studies suggest a somewhat selective uptake of O-(2-[¹⁸F]fluoroethyl)-L-tyrosine (FET) in cerebral gliomas and in squamous cell carcinoma (SCC) and a good distinction between tumor and inflammation. The aim of this study was to investigate the diagnostic potential of ¹⁸F-FET PET in patients with SCC of the head and neck region by comparing that tracer with ¹⁸F-FDG PET and CT. Methods: Twenty-one patients with suspected head and neck tumors underwent ¹⁸F-FET PET, ¹⁸F-FDG PET, and CT within 1 wk before operation. After coregistration, the images were evaluated by 3 independent observers and an ROC analysis was performed, with the histopathologic result used as a reference. Furthermore, the maximum standardized uptake values (SUVs) in the lesions were determined. Results: In 18 of 21 patients, histologic examination revealed SCC, and in 2 of these patients, a second SCC tumor was found at a different anatomic site. In 3 of 21 patients, inflammatory tissue and no tumor were identified. Eighteen of 20 SCC tumors were positive for both ¹⁸F-FDG uptake and ¹⁸F-FET uptake, one 0.3-cm SCC tumor was detected neither with ¹⁸F-FDG PET nor with ¹⁸F-FET PET, and one 0.7-cm SCC tumor in a 4.3-cm ulcer was overestimated as a 4-cm tumor on ¹⁸F-FDG PET and missed on ¹⁸F-FET PET. Inflammatory tissue was positive for ¹⁸F-FDG uptake (SUV, 3.7–4.7) but negative for ¹⁸F-FET uptake (SUV, 1.3–1.6). The SUVs of ¹⁸F-FDG in SCC were significantly higher (13.0 ± 9.3) than those of ¹⁸F-FET (4.4 ± 2.2). The ROC analysis showed significantly superior detection of SCC with ¹⁸F-FET PET or ¹⁸F-FDG PET than with CT. No significant difference (P = 0.71) was found between ¹⁸F-FDG PET and ¹⁸F-FET PET. The sensitivity of ¹⁸F-FDG PET was 93%, specificity was 79%, and accuracy was 83%. ¹⁸F-FET PET yielded a lower sensitivity of 75% but a substantially higher specificity of 95% (accuracy, 90%). Conclusion: ¹⁸F-FET may not replace ¹⁸F-FDG in the PET diagnostics of head and neck cancer but may be a helpful additional tool in selected patients, because ¹⁸F-FET PET might better differentiate tumor tissue from inflammatory tissue. The sensitivity of ¹⁸F-FET PET in SCC, however, was inferior to that of ¹⁸F-FDG PET because of lower SUVs.

Key Words: ¹⁸F-FET • ¹⁸F-FDG • head and neck cancer • squamous cell carcinoma • amino acids • PET

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