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Post-treatment appearances, pitfalls, and patterns of failure in head and neck cancer on FDG PET/CT imaging.

Purandare NC, Puranik AD, Shah S, Agrawal A, Rangarajan V - Indian J Nucl Med (2014)

Bottom Line: Majority of patients with head and neck cancer are treated with combined treatment regimes such as surgery, radiation therapy, and chemotherapy.The loss of structural symmetry and imaging landmarks as a result of therapy makes post-treatment imaging a daunting task on conventional modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) as well as on 18 Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET/CT).Combined multimodality treatment approach causes various tissue changes that give rise to a spectrum of findings on FDG PET/CT imaging, which are depicted in this atlas along with a few commonly encountered imaging pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Majority of patients with head and neck cancer are treated with combined treatment regimes such as surgery, radiation therapy, and chemotherapy. The loss of structural symmetry and imaging landmarks as a result of therapy makes post-treatment imaging a daunting task on conventional modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) as well as on 18 Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET/CT). Combined multimodality treatment approach causes various tissue changes that give rise to a spectrum of findings on FDG PET/CT imaging, which are depicted in this atlas along with a few commonly encountered imaging pitfalls. The incremental value of FDG PET/CT in detecting locoregional recurrences in the neck as well as distant failures has also been demonstrated.

No MeSH data available.


Related in: MedlinePlus

Pitfalls due to treatment related complications (surgery). Pectoralis major myocutaneous (PMMC) flap reconstruction for buccal cancer. Coronal MIP image shows an intense focus of FDG uptake in the left hemithorax (arrow in a) which appears to be metastatic disease. Fused PET/CT shows focal uptake in the anterior chest wall (arrow in c) which was the site for the PMMC flap. FDG uptake was seen due to flap donor site inflammation. Note the absent pectoralis major in the left chest wall. arrowhead in b)
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Figure 10: Pitfalls due to treatment related complications (surgery). Pectoralis major myocutaneous (PMMC) flap reconstruction for buccal cancer. Coronal MIP image shows an intense focus of FDG uptake in the left hemithorax (arrow in a) which appears to be metastatic disease. Fused PET/CT shows focal uptake in the anterior chest wall (arrow in c) which was the site for the PMMC flap. FDG uptake was seen due to flap donor site inflammation. Note the absent pectoralis major in the left chest wall. arrowhead in b)

Mentions: Complications can arise after both surgery and radiation therapy. Surgical complications occur early and include serous collections, infections, abscess and fistula formation, flap necrosis. Benign serous collections are self-limiting and should be distinguished from infected abscesses that might need a drainage procedure. Benign serous collections also called seromas usually do not show any FDG avidity unless they get infected. On FDG PET/CT abscesses show a rim of tracer uptake in the periphery with a photopenic center which corresponds to a hypodense collection on CT with air pockets seen occasionally. Linear FDG uptake is seen along the fistulous communications associated with abscesses [Figure 9]. These complications occur at the site of surgical resection and reconstructed flaps in the head–neck region. Rarely, one can come across infections/inflammations at the site of the donor flap in the chest or the abdominal wall and focal tracer uptake in this region can potentially mimic metastatic disease [Figure 10].


Post-treatment appearances, pitfalls, and patterns of failure in head and neck cancer on FDG PET/CT imaging.

Purandare NC, Puranik AD, Shah S, Agrawal A, Rangarajan V - Indian J Nucl Med (2014)

Pitfalls due to treatment related complications (surgery). Pectoralis major myocutaneous (PMMC) flap reconstruction for buccal cancer. Coronal MIP image shows an intense focus of FDG uptake in the left hemithorax (arrow in a) which appears to be metastatic disease. Fused PET/CT shows focal uptake in the anterior chest wall (arrow in c) which was the site for the PMMC flap. FDG uptake was seen due to flap donor site inflammation. Note the absent pectoralis major in the left chest wall. arrowhead in b)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4157188&req=5

Figure 10: Pitfalls due to treatment related complications (surgery). Pectoralis major myocutaneous (PMMC) flap reconstruction for buccal cancer. Coronal MIP image shows an intense focus of FDG uptake in the left hemithorax (arrow in a) which appears to be metastatic disease. Fused PET/CT shows focal uptake in the anterior chest wall (arrow in c) which was the site for the PMMC flap. FDG uptake was seen due to flap donor site inflammation. Note the absent pectoralis major in the left chest wall. arrowhead in b)
Mentions: Complications can arise after both surgery and radiation therapy. Surgical complications occur early and include serous collections, infections, abscess and fistula formation, flap necrosis. Benign serous collections are self-limiting and should be distinguished from infected abscesses that might need a drainage procedure. Benign serous collections also called seromas usually do not show any FDG avidity unless they get infected. On FDG PET/CT abscesses show a rim of tracer uptake in the periphery with a photopenic center which corresponds to a hypodense collection on CT with air pockets seen occasionally. Linear FDG uptake is seen along the fistulous communications associated with abscesses [Figure 9]. These complications occur at the site of surgical resection and reconstructed flaps in the head–neck region. Rarely, one can come across infections/inflammations at the site of the donor flap in the chest or the abdominal wall and focal tracer uptake in this region can potentially mimic metastatic disease [Figure 10].

Bottom Line: Majority of patients with head and neck cancer are treated with combined treatment regimes such as surgery, radiation therapy, and chemotherapy.The loss of structural symmetry and imaging landmarks as a result of therapy makes post-treatment imaging a daunting task on conventional modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) as well as on 18 Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET/CT).Combined multimodality treatment approach causes various tissue changes that give rise to a spectrum of findings on FDG PET/CT imaging, which are depicted in this atlas along with a few commonly encountered imaging pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Majority of patients with head and neck cancer are treated with combined treatment regimes such as surgery, radiation therapy, and chemotherapy. The loss of structural symmetry and imaging landmarks as a result of therapy makes post-treatment imaging a daunting task on conventional modalities like computed tomography (CT) scan and magnetic resonance imaging (MRI) as well as on 18 Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F FDG PET/CT). Combined multimodality treatment approach causes various tissue changes that give rise to a spectrum of findings on FDG PET/CT imaging, which are depicted in this atlas along with a few commonly encountered imaging pitfalls. The incremental value of FDG PET/CT in detecting locoregional recurrences in the neck as well as distant failures has also been demonstrated.

No MeSH data available.


Related in: MedlinePlus