Dr. KEN-LIAO LIU 劉耿僚 Pitfalls & Modifications of FDG PET-CT in Head & Neck Oncology

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

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

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  • 1. Pitfalls & Modifications of 18F-FDG PET/CT in Head & Neck Oncology Dr. KEN-LIAO LIUOtolaryngology Head & Neck Surgery台中市 光田綜合醫院 耳鼻喉頭頸科 劉耿僚 醫師
  • 2. Case 1: Tongue carcinoma
  • 3. Clean Neck
  • 4. Post OP F/U
  • 5. Post OP 3 months
  • 6. Case 2: R’t supra-clavicular masses
  • 7. FNA cytology: atypia ?
  • 8. Case 3: NPC
  • 9. Post R/T 2 years
  • 10. F/U: negative !
  • 11. Case 4: Epiglottis ca.
  • 12. Case 5: Right buccal ca.
  • 13. Pre-op
  • 14. Post-OP (PMMCF) & R/T
  • 15. Post-op & R/T 3 months
  • 16. Post-op F/U
  • 17. Case 6: Right Retromolar ca.
  • 18. Winter
  • 19. Summer
  • 20. Summer
  • 21. Case 7-1: NPC (CT: cT1N1)
  • 22. Post R/T 1.5 years
  • 23. Case 7-2: R’t Glottic CA ??
  • 24. Case 8: Thyroid papillary ca post op< 1 cm LAP, low SUV !! Patho: Metastatic papillary carcinoma Partial Volume Averaging Effect !!
  • 25. ConclusionCommon Pitfalls :★ Inflammation & Infection • Post-Tx effect: Post-op & R/T ORN, C/T(thymus, bone marrow) • Granulation, Necrosis • Salivary glands • TB, Granulomatous disease, Abscess, Autoimmune disease • Smokers’ mediastinal Lymphadenitis...etc.★ Waldeyer’s ring★ Brown fat★ Muscle activity★ Partial volume averaging effect ( Inadequate scanner resolution)
  • 26. Prerequisites before PET/CT• Fasting – 4-6 h• No strenuous exercise 24 h before PET• Check blood glucose ( >200 ?)• After FDG injection, rest in bed !• P’t should void before scanning• Remove any metallic objects• Make P’t comfortable under the scanner
  • 27. Modifications to Avoid Pitfalls• Neck collar• Keep quiet• Keep warm• Massage salivary glands• Anti-tussives• Benzodiazepines (Valium)• NSAIDs , Antibiotics• Tongue depressor/mold• Visual interpretation rather than SUV
  • 28. Bone invasion ?
  • 29. Tongue depressor
  • 30. Tongue depressor
  • 31. Tongue depressor
  • 32. NSAIDs(Hypopharyngeal ca post total laryngectomy)
  • 33. Mapping of the Tumor & Interpretation of PET/CT by Head & Neck Surgeons Is Absolutely Necessary !!
  • 34. Take Home Message:1. Proper P’t Preparation before PET/CT2. Common Pitfalls in Your Mind Thank You !• Dr. KEN-LIAO LIU• Otolaryngology Head & Neck Surgery , KTGH , Taichung, Taiwan• 光田綜合醫院 耳鼻喉頭頸科 劉耿僚 醫師