Dr. KEN-LIAO LIU 劉耿僚: PITFALLS & MODIFICATION S of FDG PET-CT IN HEAD & NECK ONCOLOGY

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Nov. 12 2011, presented in the 3rd Chinese Otorhinolaryngology Head & Neck Surgery Conference. by Dr. KEN-LIAO LIU.

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  • 3 months, R ’ t noted other mass
  • Dr. KEN-LIAO LIU 劉耿僚: PITFALLS & MODIFICATION S of FDG PET-CT IN HEAD & NECK ONCOLOGY

    1. 1. Pitfalls & Modifications of PET/CT in Head & Neck Oncology <ul><li>D. KEN-LIAO LIU </li></ul><ul><li>KTGH, TAICHUNG, TAIWN </li></ul><ul><li>台中市 光田綜合醫院 耳鼻喉頭頸科 </li></ul><ul><li>劉耿僚 醫師 </li></ul>
    2. 2. Case 1: Tongue carcinoma
    3. 3. Clean Neck
    4. 5. Post OP F/U
    5. 9. Post OP 3 months
    6. 10. Case 2: R ’ t supra-clavicular masses
    7. 14. Case 3: NPC s/p R/T
    8. 15. Post R/T 2 years
    9. 18. F/U: negative !
    10. 19. Case 4: Epiglottis ca.
    11. 20. Case 4: Epiglottis ca.
    12. 24. Case 5: Right buccal ca.
    13. 25. Pre-op
    14. 27. Post-OP (PMMCF) & R/T
    15. 28. Post-op & R/T 3 months
    16. 30. Post-op F/U
    17. 31. Case 6: Right Retromolar ca.
    18. 32. Winter
    19. 33. Summer
    20. 34. Summer
    21. 35. Case 7-1: NPC (CT: c T 1 N 1 )
    22. 36. Post R/T 1.5 years
    23. 39. Case 7-2: L ’ t Vocal Cord Paralysis with Unknown Cause.
    24. 42. Conclusion <ul><li>Common Pitfalls : </li></ul><ul><li>★ Inflammation & Infection </li></ul><ul><ul><li>Post-Tx effect: Post-op & R/T ORN, C/T(thymus, bone marrow) </li></ul></ul><ul><ul><li>Granulation, Necrosis </li></ul></ul><ul><ul><li>Salivary glands </li></ul></ul><ul><ul><li>TB, Abscess </li></ul></ul><ul><ul><li>Smokers’ mediastinal Lymphadenitis...etc. </li></ul></ul><ul><li>★ Waldeyer’s ring </li></ul><ul><li>★ Brown fat </li></ul><ul><li>★ Muscle activity </li></ul>
    25. 43. Prerequisites before PET/CT <ul><li>Fasting – 4-6 h </li></ul><ul><li>No strenuous exercise 24 h before PET </li></ul><ul><li>Check blood glucose </li></ul><ul><li>After FDG injection, P’t should rest on a cart or recliner </li></ul><ul><li>P’t should void before scanning </li></ul><ul><li>Remove any metallic objects </li></ul><ul><li>Make P ’ t comfortable under the scanner </li></ul>
    26. 44. Modifications to Avoid Pitfalls <ul><li>Neck collar </li></ul><ul><li>Keep quiet </li></ul><ul><li>Keep warm </li></ul><ul><li>Massage salivary glands </li></ul><ul><li>Anti-tussives </li></ul><ul><li>Benzodiazepines (Valium) </li></ul><ul><li>NSAIDs , Antibiotics </li></ul><ul><li>Tongue depressor </li></ul>
    27. 45. Bone invasion ?
    28. 46. Tongue depressor
    29. 47. Tongue depressor
    30. 48. Tongue depressor
    31. 49. NSAIDs (Hypopharyngeal ca post total laryngectomy)
    32. 50. Mapping of the Tumor by Surgeons is absolutely necessary !!
    33. 51. Thank You ! <ul><li>OTOLARYNGOLOGY HEAD & NECK SURGERY, </li></ul><ul><li>KTGH, TAICHUNG, TAIWAN. </li></ul><ul><li>光田綜合醫院 耳鼻喉頭頸科 劉耿僚 醫師 </li></ul>

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