Revision 3 for 'Head and neck cancer therapy response interpretation (Hopkins criteria)'

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Hopkins criteria. - Head and neck PET/CT. Therapy response interpretation criteria.

Hopkins head and Neck cancer therapy response interpretation criteria, is a qualitative system of interpretation for therapy response assessment using PET CT.


Widely used options for therapy response assessment are clinical examination, histopathology, CT  and MR imaging, however have variable diagnostic accuracy. (1,2)


18 F FDG PET/CT is useful in the  diagnosis, staging, therapy assessment, and follow-up of Head and neck squamous cell cancer (HNSCC) (3,4).

Pretreatment 18F-FDG PET/CT is useful in accurate staging and prediction of disease recurrence as well as survival (5).  

Post-treatment 18F-FDG PET/CT is useful in evaluating treatment response, detecting recurrence (6), predicting outcomes and survival (7,8).


These criteria has a  substantial interreader agreement, high negative predictive value, can predict overall survival and progression-free survival in patients with HNSCC.(9)


Squamous cell tumors of the head and neck is the most frequent.

Strongly associated risk factors (10):
- tobacco use.
- alcohol consumption.
- human papillomavirus (HPV) infection.


Five-Point Qualitative Posttherapy Assessment Scoring System (Hopkins Criteria) for Head and Neck PET/CT

  1. Response category 18 F-FDG uptake at the primary site and nodes less than IJV. Complete metabolic response.

  2. Focal 18 F-FDG uptake at the primary site and nodes greater than IJV but less than liver. Likely complete metabolic response.

  3. Diffuse 18 F-FDG uptake at the primary site or nodes is greater than IJV or liver. Likely postradiation inflammation.

  4. Focal 18 F-FDG uptake at the primary site or nodes greater than liver. Likely residual tumor.

  5. Focal and intense 18 F-FDG uptake at the primary site or nodes. Residual tumor.

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