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Clinical Usefulness of ¹⁸F-FDG PET in Nasopharyngeal Carcinoma Patients with Questionable MRI Findings for Recurrence

¹ Department of Diagnostic Radiology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
² Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
³ Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
⁴ Department of Medical Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
⁵ Department of Otorhinolaryngology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
⁶ Institute of Nuclear Energy Research, Taoyuan, Taiwan

View larger version (90K): [in a new window]   FIGURE 1. A 53-y-old man with NPC 14 mo after intensity-modulated radiation therapy and intracavity brachytherapy. (A) Axial T1-weighted MR image shows an irregular mass (arrow) in the left nasopharynx. (B) 18F-FDG PET image shows a false-positive finding. Histopathologic findings showed acute and chronic inflammation, and follow-up MRI 4 mo later showed regression of the lesion.

View larger version (85K): [in a new window]   FIGURE 2. A 59-y-old man with NPC 16 mo after concurrent chemoradiation therapy. (A) Axial T2-weighted MR image shows an irregular mass (arrow) in the left nasopharynx. (B) 18F-FDG PET finding is true negative, with the image showing no uptake in the corresponding area. Subsequent biopsy showed this was an inflammatory mass.

View larger version (67K): [in a new window]   FIGURE 3. A 44-y-old woman with NPC 9 mo after intensity-modulated radiation therapy. (A) Coronal contrast-enhanced T1-weighted MR image shows an asymmetric mucosal thickening (arrow) in the left nasopharynx. (B) However, the negative 18F-FDG PET findings are false, for histopathologic examination showed a recurrent NPC.

View larger version (75K): [in a new window]   FIGURE 4. A 45-y-old woman with NPC 12 mo after intensity-modulated radiation therapy. (A) Axial T2-weighted MR image shows a questionable left-sided high jugular adenopathy (arrow). (B) 18F-FDG PET scan reveals an additional metastatic node (arrow) in the right supraclavicular fossa in addition to the left-sided high jugular metastatic node.

View larger version (82K): [in a new window]   FIGURE 5. A 45-y-old woman with NPC 12 mo after concurrent chemoradiation therapy. (A) 18F-FDG PET scan shows an area of uptake (arrow) in the left hilar region. (B) Chest CT scan shows a small pulmonary nodule (arrow, top) in the left upper lobe and discloses another tiny nodule (arrow, bottom) in the right lower lobe. A follow-up CT scan 2 mo later showed definite enlargement at these 2 lung nodules, consistent with lung metastases.