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CASE OF THE MONTH - Nasopharyngeal Cancer Staging 08/30/2007

Clinical:  66Y M for staging, head and neck cancer
Procedure:  Following a 5 hour fast, the patient was given 18F-fluorodeoxyglucose (FDG) intravenously. 60 minutes later, high resolution positron emission tomographic (PET) imaging was performed, using the Philips Gemini PET/CT system, extending from the level of the top of the brain to the knees. CT attenuation correction was employed. Images were reconstructed using 3D RAMLA techniques, formatted in axial, coronal and sagittal planes. Attenuation corrected, uncorrected, and cinematic projection image displays were reviewed.



Findings:  There is mucoperiosteal thickening in the left maxillary antrum, nearly complete opacification. Increased glucose utilization is localized to the region of the left pharyngeal tonsil, extending cephalad over ~4.3 cm to the level of the fossa of RosenmĂĽller, which is filled/blunted by this process. This process is further characterized by a peak standardized uptake value (SUV) of 4.6, rising to 5.6 on delayed imaging of the head and neck, concerning for residual malignancy. The right tonsillar activity is also increased, peak SUV = 3.9, rising to 4.3, probably reactive/inflammatory. There is otherwise grossly normal biodistribution of radioglucose activity, with no other/new focal or regional areas of hypermetabolism to suggest active malignant neoplasia/metastases.

Impression:

  1. Asymmetric increase in glucose uptake, with left posterior pharyngeal activity concerning for recurrent/residual malignancy.
  2. Probable reactive/inflammatory process, right tonsil and left maxillary antrum.
  3. Otherwise grossly normal whole body FDG PET/CT.

CASE OF THE MONTH - Nasopharyngeal Cancer Restaging 12/17/2007

Clinical:  66Y M for restaging, head and neck cancer/nasopharynx (171.0).
Procedure:  Following a 5 hour fast, the patient was given 18F-fluorodeoxyglucose (FDG) intravenously. 60 minutes later, high resolution positron emission tomographic (PET) imaging was performed, using the Philips Gemini PET/CT system, extending from the level of the top of the brain to the knees. CT attenuation correction was employed. Images were reconstructed using 3D RAMLA techniques, formatted in axial, coronal and sagittal planes. Attenuation corrected, uncorrected, and cinematic projection image displays were reviewed.



Findings:  The prior examination dated 08/30/2007 is reviewed. The previously demonstrated left pharyngeal tonsillar activity has resolved. A new focus of increased activity, however, is localized to a right middle jugular node, station III, ~1.2 cm, peak SUV = 4.2, rising to 5.0 on delayed imaging of the head and neck. Increased activity is also localized to a ~1.3 cm focus in the left nasopharyngeal roof, peak SUV = 3.0, 3.2 on delayed images (ns); and to a 1.2 cm focus in the right supraglottic larynx, peak SUV = 4.6, 4.5 on delayed images (ns). Increased glucose uptake is present diffusely in the thoracic esophagus, most likely inflammatory or physiologic. Mildly increased activity in the bilateral hilar nodes and the precarinal region is nonspecific, peak SUVs 1.7-2.4. There is otherwise grossly normal biodistribution of radioglucose activity, with no other/new focal or regional areas of hypermetabolism to suggest active malignant neoplasia/metastases.

Impression:

  1. Resolution of left pharyngeal tonsillar abnormality.
  2. New right middle internal jugular adenopathy, malignant metabolic features.
  3. Upper left nasopharyngeal and right supraglottic laryngeal activity, probably inflammatory, clinical correlation advised.
  4. Nonspecific hilar/mediastinal adenopathy.
  5. Diffuse esophageal uptake, likely esophagitis.

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