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Cancer Imaging

Open Access

How accurate is 18F-FDG-PET-CT in determining local cartilaginous/bony involvement by head & neck malignancy?

Cancer Imaging201414(Suppl 1):P1

Published: 9 October 2014


18F-FDG-PET-CT plays an important role in the management of head and neck cancers (HNC). In particular, presence/absence of local osseous invasion is an important factor in T-staging and determining treatment options. This study aimed to determine the accuracy of PET-CT in prediction of local osseous invasion by head and neck cancers.


A 6-year-period retrospective analysis of 771 PET-CT scans of HNC (oral/nasal cavity, pharynx, larynx) was performed. Final diagnosis of osseous involvement was determined by histopathology, clinical and imaging follow-up.


PET-CT scans demonstrated increased abnormal osseous uptake in 63 cases, of which 52 were true osseous invasion, but 11 were false-positive (4 due to osteoradionecrosis, 4 benign dental infection/inflammation, 3 over-staging due to intense FDG-uptake nearby the bone). 708 cases were reported as ‘no osseous uptake’, of which 704 were true-negative, but 4 were false-negative (2 due to intrinsically low FDG-avid primary disease and bony lesions were not significantly FDG-avid, 2 due to bony necrosis of tumour with no significant FDG-uptake).

Sensitivity, specificity, PPV, NPV and accuracy of PET-CT in detecting local osseous invasion are 93, 98, 83, 99 and 98% respectively.


18F-FDG-PET-CT plays an important role in detecting local osseous invasion by HNC, with an accuracy of 98%. Important false-positives are due to benign causes such as infection and osteoradionecrosis, and due to intense FDG-uptake nearby the bone. If there is clinical doubt further investigations including MRI and biopsy should be performed.

Authors’ Affiliations

Paul Strickland Scanner Centre, Mount Vernon Hospital, London, UK


© Sonoda et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.