Pitfalls & Modifications of    18F-FDG PET/CT in Head & Neck Oncology         Dr. KEN-LIAO LIUOtolaryngology Head & Neck S...
Case 1: Tongue carcinoma
Clean Neck
Post OP F/U
Post OP 3 months
Case 2: R’t supra-clavicular masses
FNA cytology: atypia ?
Case 3: NPC
Post R/T 2 years
F/U: negative !
Case 4: Epiglottis ca.
Case 5: Right buccal ca.
Pre-op
Post-OP (PMMCF) & R/T
Post-op & R/T 3 months
Post-op F/U
Case 6: Right Retromolar ca.
Winter
Summer
Summer
Case 7-1: NPC (CT: cT1N1)
Post R/T 1.5 years
Case 7-2: R’t Glottic CA ??
Case 8: Thyroid papillary ca post op< 1 cm LAP, low SUV !!                         Patho: Metastatic papillary carcinoma  ...
ConclusionCommon Pitfalls :★ Inflammation & Infection •   Post-Tx effect: Post-op & R/T ORN, C/T(thymus, bone marrow) •   ...
Prerequisites before PET/CT• Fasting – 4-6 h• No strenuous exercise 24 h before PET• Check blood glucose ( >200 ?)• After ...
Modifications to Avoid Pitfalls• Neck  collar• Keep quiet• Keep warm• Massage salivary glands• Anti-tussives• Benzodiazepi...
Bone invasion ?
Tongue depressor
Tongue depressor
Tongue depressor
NSAIDs(Hypopharyngeal ca post total laryngectomy)
Mapping of the Tumor & Interpretation of  PET/CT by Head & Neck Surgeons Is        Absolutely Necessary !!
Take Home Message:1. Proper P’t Preparation before PET/CT2. Common Pitfalls in Your Mind           Thank You !• Dr.   KEN-...
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
Dr. KEN-LIAO LIU 劉耿僚  Pitfalls & Modifications of  FDG PET-CT  in Head & Neck Oncology
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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.

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

  1. 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. 2. Case 1: Tongue carcinoma
  3. 3. Clean Neck
  4. 4. Post OP F/U
  5. 5. Post OP 3 months
  6. 6. Case 2: R’t supra-clavicular masses
  7. 7. FNA cytology: atypia ?
  8. 8. Case 3: NPC
  9. 9. Post R/T 2 years
  10. 10. F/U: negative !
  11. 11. Case 4: Epiglottis ca.
  12. 12. Case 5: Right buccal ca.
  13. 13. Pre-op
  14. 14. Post-OP (PMMCF) & R/T
  15. 15. Post-op & R/T 3 months
  16. 16. Post-op F/U
  17. 17. Case 6: Right Retromolar ca.
  18. 18. Winter
  19. 19. Summer
  20. 20. Summer
  21. 21. Case 7-1: NPC (CT: cT1N1)
  22. 22. Post R/T 1.5 years
  23. 23. Case 7-2: R’t Glottic CA ??
  24. 24. Case 8: Thyroid papillary ca post op< 1 cm LAP, low SUV !! Patho: Metastatic papillary carcinoma Partial Volume Averaging Effect !!
  25. 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. 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. 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. 28. Bone invasion ?
  29. 29. Tongue depressor
  30. 30. Tongue depressor
  31. 31. Tongue depressor
  32. 32. NSAIDs(Hypopharyngeal ca post total laryngectomy)
  33. 33. Mapping of the Tumor & Interpretation of PET/CT by Head & Neck Surgeons Is Absolutely Necessary !!
  34. 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

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