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Utility of ¹⁸F-FDG PET/CT Uptake Patterns in Waldeyer's Ring for Differentiating Benign from Malignant Lesions in Lateral Pharyngeal Recess of Nasopharynx

¹ Department of Nuclear Medicine, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, Taipei Medical University and Fu Jen Catholic University, Taipei, Taiwan; ² Department of Medical Imaging, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; ³ Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; ⁴ Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Taiwan

View larger version (108K): [in this window] [in a new window]   FIGURE 1.  CT (left), PET (middle), and fused PET/CT (right) images of nasopharynx in 3 asymptomatic subjects (A–C) and 1 symptomatic subject (D): nasopharyngeal adenoid hypertrophy with 18F-FDG uptake (A), longus capitis muscle with 18F-FDG uptake (B), symmetric 18F-FDG uptake in LPR of nasopharynx (C), and symmetric 18F-FDG uptake and wall thickening in LPR of nasopharynx (D).

View larger version (71K): [in this window] [in a new window]   FIGURE 2.  Maximum-intensity-projection PET image reveals symmetrically intense 18F-FDG uptake in LPR (thick long arrow), palatine tonsil (thin long arrow), and lingual tonsil (arrowhead) in 39-y-old man with upper respiratory airway infection. Mild 18F-FDG uptake in right high jugular lymph nodes (short arrow) is also seen.

View larger version (39K): [in this window] [in a new window]   FIGURE 3.  A 49-y-old man with newly diagnosed NPC who underwent PET/CT for staging. (A) CT image shows wall thickening (arrow) of right LPR. (B and C) Only mild 18F-FDG uptake (thick arrows) in right LPR is demonstrated in transaxial (B) and maximum-intensity-projection (C) PET views. In addition, maximum-intensity-projection PET view shows 18F-FDG uptake in palatine tonsil (thin arrow) and neck lymph nodes (short arrows).

View larger version (6K): [in this window] [in a new window]   FIGURE 4.  Distribution of SUVs in LPR region of healthy, asymptomatic, and symptomatic subjects and patients with NPC.

View larger version (9K): [in this window] [in a new window]   FIGURE 5.  Receiver-operating-characteristic curve and AUC for differentiating benign from malignant lesions in LPR of nasopharynx. When combination of SUV, LPR of N/P ratio, symmetric uptake of LPR, cervical lymph node uptake, and wall thickening of LPR was considered, AUC improved to 0.932 ± 0.042 (95% CI, 0.86–0.98), with 90.4% sensitivity and 93.8% specificity.