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Why Most PET of Lung and Head-and-Neck Cancer Will Be PET/CT

Nuclear Medicine, Department of Medical Radiology, University Hospital, Zurich, Switzerland

View larger version (26K): [in a new window]   FIGURE 1. Lung carcinoma in upper right lung with ipsilateral mediastinal lymph-node metastasis. (A) Transverse PET. (B) Transverse CT. (C) Integrated transverse PET/CT image of upper thorax. Integrated PET/CT imaging ruled out tumor invasion of thoracic wall.

View larger version (22K): [in a new window]   FIGURE 2. Lung carcinoma (not shown) in right lung with focal increased 18F-FDG accumulation in left lower neck. (A) Transverse PET. (B) Transverse CT. (C) Integrated transverse PET/CT image of lower neck. Integrated PET/CT imaging ruled out N3 stage. PET/CT revealed that increased 18F-FDG accumulation in neck was localized in the intrinsic laryngeal muscles. Finding was result of compensatory laryngeal muscle activation caused by contralateral recurrent laryngeal nerve palsy from direct nerve invasion by lung cancer.

View larger version (43K): [in a new window]   FIGURE 3. Transverse and sagittal PET, noncontrast-enhanced CT, and PET/CT images of 65-y-old patient who underwent staging for a squamous cell carcinoma of the tongue. (A) Primary extends from right lateral border of tongue inferiorly to floor of mouth, posteriorly to base of tongue, and laterally to pharyngeal wall. There were no signs of osteolysis at adjacent mandibula (bone window not shown), which was also confirmed in helical contrast-enhanced CT acquired with 3-mm slices (not shown). In addition, second primary with osseous maxillary infiltration at posterior alveolar part was found. Bilateral lymph-node involvement easily identified with PET, CT, and PET/CT. Note that FDG uptake in cerebellum is visible on consecutive CT slice and projects into bone as a result of partial-volume effect and leveling intensity of PET image. (B) In sagittal view, intense uptake of 18F-FDG is seen posteriorly to bladder on maximum intensity projection image (MIP) (* = injection site) and on sagittal slices of PET, CT, and PET/CT. This was a tubulovillous adenoma without histologic signs of cancer.