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Cancer Imaging

Open Access

Can we save our resources with half-body-18F-FDG-PET-CT rather than whole-body, in the management of head & neck cancers?

Cancer Imaging201414(Suppl 1):P2

Published: 9 October 2014


18F-FDG PET-CT plays a significant role in the management of head and neck (H&N) malignancies. There have been recent suggestions that half-body (above diaphragm) PET-CT may be sufficient for the management of H&N cancer patients. This study aims to determine if half-body PET-CT is a safe practice option, or should we stick to whole-body PET-CT.


A 6-year-period retrospective analysis of 729 consecutive PET-CT scans of H&N cancer patients was performed in order to record the incidence of below-diaphragm metastases and below-diaphragm synchronous primary malignancies. The four main indications of PET-CT in H&N cancers are; pre-treatment staging of high-risk of disseminated disease, metastatic cervical lymphadenopathy with unknown primary, assessment of therapeutic response and detection of recurrence/relapse.


A total of 664 squamous cell carcinoma (SCC) and 65 nasopharyngeal carcinoma (NPC) cases were studied. 35/729 (4.8%) of cases showed below-diaphragm metastases (liver, renal, adrenal, retroperitoneal and lumbar vertebral metastases), 24/664 (3.3%) by SCC and 11/65 (16.9%) by NPC.

52/729 (7.1%) cases showed synchronous primary malignancies, of which 32 (4.4%) were below-diaphragm (colonic, pancreatic, bladder cancers and retroperitoneal lymphoma).

In total, 84/729 (11.5%) H&N cases had either below-diaphragm metastases or below-diaphragm synchronous primary malignancies.


A significant proportion of H&N patients, over 10%, have either below-diaphragm metastases or below-diaphragm synchronous primary malignancies. Half-body (above diaphragm) PET-CT would have missed these lesions, leading to mis-staging of disease and mis-management of patients. It is important to keep whole-body PET-CT in practice in the management of H&N cancers. This is more so in the management of NPC compared to SCC.

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.