{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:00:13Z","timestamp":1792699213314,"version":"4.5.0"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objective: The aim of the present study is to compare diagnostic accuracies of MRI, PET\/CT and fused PET\/MRI in the assessment of cervical lymph nodes in patients with head and neck cancer (HNC). Methods: Imaging data of 37 patients who underwent MRI, PET\/CT, and surgery at our center were retrospectively merged into PET\/MR images. Histopathological results of neck dissections and lymph node resections served as the gold standard. Results: MRI and PET\/CT were performed on the same day. The mean interval between imaging and surgery was 20 (\u00b119.5) days. All three imaging modalities identified the same number of true positive and false negative cases, resulting in identical sensitivity estimates of 66.7%. Specificities were 90.9% for MRI, 95.5% for PET\/CT, and 100% for PET\/MRI. The corresponding positive predictive values (PPVs) were 83.3%, 80.7%, and 81.5%, while the negative predictive values (NPVs) were 80.0%, 90.9%, and 100%, respectively. Ten false results are further analyzed regarding side and level of the affected lymph node, and intersections of the three modalities are displayed. In 12 (32.4%) cases, additional findings are depicted in PET\/CT, 5 (13.5%) of which are histologically confirmed to be further malignancies. Conclusions: Software-based PET\/MRI is an easy-to-perform procedure and provides valuable clinical information in select clinical questions. Furthermore, whole-body acquisition by PET\/CT leads to a notable number of additional malignant diagnoses, which especially favors its use in high-risk patients.<\/jats:p>","DOI":"10.3390\/diagnostics16020252","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T11:42:58Z","timestamp":1768304578000},"page":"252","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["MRI, PET\/CT and PET\/MRI Fusion in the Assessment of Lymph Node Metastases in Head and Neck Cancer"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4790-0498","authenticated-orcid":false,"given":"Nikolaus","family":"Poier-Fabian","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Asel","sequence":"additional","affiliation":[{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"},{"name":"Department of Radiology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Cristurean","sequence":"additional","affiliation":[{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mayrhofer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Moser","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Maximilian","family":"Janssen","sequence":"additional","affiliation":[{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"},{"name":"Institute of Anatomy and Cell Biology, Medical Faculty, Johannes Kepler University Linz, Krankenhausstrasse 5, 4020 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ziegler","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"},{"name":"Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7740-3623","authenticated-orcid":false,"given":"Nina","family":"Rubicz","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Martin","family":"Zwittag","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021 Linz, Austria"},{"name":"Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1053\/j.semnuclmed.2020.07.005","article-title":"Imaging of Head and Neck Cancer with CT, MRI, and US","volume":"51","author":"Junn","year":"2021","journal-title":"Semin. Nucl. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"de Koekkoek-Doll, P.K., Roberti, S., Smit, L., Vogel, W.V., Beets-Tan, R., van den Brekel, M.W., and Castelijns, J. (2022). ADC Values of Cytologically Benign and Cytologically Malignant 18 F-FDG PET-Positive Lymph Nodes of Head and Neck Squamous Cell Carcinoma. Cancers, 14.","DOI":"10.3390\/cancers14164019"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1053\/j.sult.2017.05.003","article-title":"Chapter 2 Squamous Cell Carcinoma of the Head and Neck\u2014Imaging Evaluation of Regional Lymph Nodes and Implications for Management","volume":"38","author":"Kelly","year":"2017","journal-title":"Semin. Ultrasound CT MR"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gilyoma, J.M., Rambau, P.F., Masalu, N., Kayange, N.M., and Chalya, P.L. (2015). Head and Neck Cancers: A Clinico-Pathological Profile and Management Challenges in a Resource-Limited Setting. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1773-9"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20764","DOI":"10.1038\/s41598-020-77740-5","article-title":"Assessment of Metastatic Lymph Nodes in Head and Neck Squamous Cell Carcinomas Using Simultaneous 18F-FDG-PET and MRI","volume":"10","author":"Chen","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19347","DOI":"10.1038\/s41598-023-46845-y","article-title":"MRI and PET\/CT in the Assessment of Lymph Node Metastases in Head and Neck Cancer","volume":"13","author":"Zwittag","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"873","DOI":"10.6004\/jnccn.2020.0031","article-title":"Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology","volume":"18","author":"Pfister","year":"2020","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_8","first-page":"122","article-title":"Head and Neck Cancers\u2014Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual","volume":"67","author":"Lydiatt","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ejrad.2007.02.037","article-title":"Detection of Lymph Node Metastases in Head and Neck Cancer: A Meta-Analysis Comparing US, USgFNAC, CT and MR Imaging","volume":"64","author":"Nelemans","year":"2007","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1038\/nrc1739","article-title":"Biomarkers in Cancer Staging, Prognosis and Treatment Selection","volume":"5","author":"Ludwig","year":"2005","journal-title":"Nat. Rev. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s00259-015-3145-z","article-title":"Locoregional Tumour Evaluation of Squamous Cell Carcinoma in the Head and Neck Area: A Comparison between MRI, PET\/CT and Integrated PET\/MRI","volume":"43","author":"Schaarschmidt","year":"2016","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"248","DOI":"10.2214\/AJR.16.16265","article-title":"Potential Role of PET\/MRI for Imaging Metastatic Lymph Nodes in Head and Neck Cancer","volume":"207","author":"Kim","year":"2016","journal-title":"Am. J. Roentgenol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1177\/0194599819839946","article-title":"Risk Factors for Blood Transfusion with Neck Dissection","volume":"161","author":"Azmy","year":"2019","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_14","first-page":"1627","article-title":"Discrimination of Metastatic Cervical Lymph Nodes with Diffusion-Weighted MR Imaging in Patients with Head and Neck Cancer","volume":"24","author":"Sumi","year":"2003","journal-title":"Am. J. Neuroradiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1002\/jmri.21480","article-title":"Feasibility of Diffusion-Weighted Imaging in the Differentiation of Metastatic from Nonmetastatic Lymph Nodes: Early Experience","volume":"28","author":"Kim","year":"2008","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00330-012-2575-2","article-title":"ADC Maps in the Prediction of Pelvic Lymph Nodal Metastatic Regions in Endometrial Cancer","volume":"23","author":"Rechichi","year":"2013","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/jnci\/djp514","article-title":"Detection of Lymph Node Metastases by Gadolinium-Enhanced Magnetic Resonance Imaging: Systematic Review and Meta-Analysis","volume":"102","author":"Klerkx","year":"2010","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Loeffelbein, D.J., Souvatzoglou, M., Wankerl, V., Dinges, J., Ritschl, L.M., M\u00fccke, T., Pickhard, A., Eiber, M., Schwaiger, M., and Beer, A.J. (2014). Diagnostic Value of Retrospective PET-MRI Fusion in Head-and-Neck Cancer. BMC Cancer, 14.","DOI":"10.1186\/1471-2407-14-846"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1017\/S002221511600058X","article-title":"Management of Neck Metastases in Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines","volume":"130","author":"Paleri","year":"2016","journal-title":"J. Laryngol. Otol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/jnci\/djn125","article-title":"18F-Fluorodeoxyglucose Positron Emission Tomography to Evaluate Cervical Node Metastases in Patients with Head and Neck Squamous Cell Carcinoma: A Meta-Analysis","volume":"100","author":"Kyzas","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.mric.2016.12.008","article-title":"PET-MR Imaging in Head and Neck","volume":"25","author":"Lee","year":"2017","journal-title":"Magn. Reson. Imaging Clin. N. Am."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Van den Wyngaert, T., De Schepper, S., and Carp, L. (2020). Quality Assessment in FDG-PET\/CT Imaging of Head-and-Neck Cancer: One Home Run Is Better Than Two Doubles. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.01458"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1001\/archotol.128.7.751","article-title":"Others Neck Dissection Classification Update: Revisions Proposed by the American Head and Neck Society and the American Academy of Otolaryngology--Head and Neck Surgery","volume":"128","author":"Robbins","year":"2002","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2","DOI":"10.6004\/jnccn.2025.0007","article-title":"NCCN Guidelines\u00ae Insights: Head and Neck Cancers, Version 2.2025: Featured Updates to the NCCN Guidelines","volume":"23","author":"Colevas","year":"2025","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bourhis, J., Aup\u00e9rin, A., Borel, C., Lefebvre, G., Racadot, S., Geoffrois, L., Sun, X.S., Saada, E., Cirauqui, B.C., and Rutkowski, T. (2025). Nivolumab Added to Cisplatin-Radiotherapy versus Cisplatin-Radiotherapy Alone after Surgery for Patients with Squamous Cell Carcinoma of the Head and Neck at High-Risk of Relapse (GORTEC 2018-01 NIVOPOST-OP): A Randomised, Open-Label, Phase 3 Trial. Lancet, Online ahead of print.","DOI":"10.2139\/ssrn.5317671"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"726","DOI":"10.2967\/jnumed.106.037473","article-title":"18F-FLT PET Does Not Discriminate between Reactive and Metastatic Lymph Nodes in Primary Head and Neck Cancer Patients","volume":"48","author":"Troost","year":"2007","journal-title":"J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.ijrobp.2006.12.044","article-title":"What Does PET Imaging Add to Conventional Staging of Head and Neck Cancer Patients?","volume":"68","author":"Pohar","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1097\/00005537-199906000-00007","article-title":"Uses and Limitations of FDG Positron Emission Tomography in Patients with Head and Neck Cancer","volume":"109","author":"Hanasono","year":"1999","journal-title":"Laryngoscope"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.oraloncology.2006.09.004","article-title":"Clinical Significance of Intrathoracic Lesions Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients with Head and Neck Cancer","volume":"43","author":"Roh","year":"2007","journal-title":"Oral Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1007\/s00330-008-1192-6","article-title":"CT, MR, US, 18F-FDG PET\/CT, and Their Combined Use for the Assessment of Cervical Lymph Node Metastases in Squamous Cell Carcinoma of the Head and Neck","volume":"19","author":"Yoon","year":"2009","journal-title":"Eur. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Liao, L.-J., Lo, W.-C., Hsu, W.-L., Wang, C.-T., and Lai, M.-S. (2012). Detection of Cervical Lymph Node Metastasis in Head and Neck Cancer Patients with Clinically N0 Neck\u2014A Meta-Analysis Comparing Different Imaging Modalities. BMC Cancer, 12.","DOI":"10.1186\/1471-2407-12-236"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s12149-007-0097-9","article-title":"Assessment of Cervical Lymph Node Metastases Using FDG-PET in Patients with Head and Neck Cancer","volume":"22","author":"Yamazaki","year":"2008","journal-title":"Ann. Nucl. Med."},{"key":"ref_33","first-page":"755","article-title":"18F-FDG PET\/CT for Detecting Nodal Metastases in Patients with Oral Cancer Staged N0 by Clinical Examination and CT\/MRI","volume":"47","author":"Carlson","year":"2006","journal-title":"J. Nucl. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1056\/NEJMoa2415434","article-title":"Neoadjuvant and Adjuvant Pembrolizumab in Locally Advanced Head and Neck Cancer","volume":"393","author":"Uppaluri","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Lang, D., Wahl, G., Poier, N., Graf, S., Kiesl, D., Lamprecht, B., and Gabriel, M. (2020). Impact of PET\/CT for Assessing Response to Immunotherapy\u2014A Clinical Perspective. J. Clin. Med. Res., 9.","DOI":"10.3390\/jcm9113483"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/252\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T11:50:07Z","timestamp":1768305007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020252"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020252","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]}}}