Infrequently Performed Nuclear Medicine Studies of the Head and Neck

Introduction: • Discuss the clinical role of lymphoscintigraphy with 99mTc-sulfur colloid for presurgical lymph node mapping of oral cancers.

• Discuss imaging characteristics of carotid body tumors (paragangliomas) with DOTATATE PET/CT and MIBG scintigraphy.

• Examine Gallium-67 scintigraphy in the setting of mastoiditis of the temporal bones.

• Examine the role of 99mTc-pertechnetate in evaluating sialadenitis and lacrimal duct obstruction.

• Discuss the clinical utility of 99mTc-sulfur colloid for aspiration.

• Elucidate the role of 99mTc-MDP bone scintigraphy for evaluation of temporomandibular joint (TMJ) disease.

• Elucidate the clinical utility of 111In and 99mTc DTPA in cerebrospinal fluid (CSF) imaging to evaluate for hydrocephalus and ventriculoperitoneal (VP) shunt patency.

• Review clinical PET and radionuclide scintigraphy cases involving carotid body tumors, lymph node mapping, mastoiditis, sialadenitis/parotiditis, lacrimal duct obstruction, aspiration, TMJ disease, VP shunt patency and hydrocephalus.

Methods: • Review of the current literature regarding PET and radionuclide scintigraphy for assessing head and neck pathologies.

• Comparison of the diagnostic utility of nuclear medicine imaging with conventional radiology modalities (radiography, CT, and MR) in the characterization of head and neck pathologies.

• Presentation of high yield clinical cases of PET and radionuclide scintigraphy performed for carotid body tumors, lymph node mapping, mastoiditis, sialadenitis/parotiditis, lacrimal duct obstruction, aspiration, TMJ disease, VP shunt patency and hydrocephalus.

Results: • Lymphoscintigraphy with 99mTc-sulfur colloid assists with surgical planning by localizing sentinel lymph nodes for excision.

• Gallium-67 scintigraphy can help differentiate active mastoiditis from benign mastoid effusions or treated infection.

• DOTATATE PET/CT and MIBG scintigraphy improve characterization, localization, and assessment of disease burden of carotid body tumors.

• 99mTc radionuclide-based imaging including MDP, sulfur colloid and pertechnetate scintigraphy are clinically useful tools for confirming TMJ disease, aspiration, sialadenitis and lacrimal duct obstruction.

• Utilization of 111-In and 99mTc-DTPA is an excellent, noninvasive approach to assess cerebrospinal flow within the ventricular system in the setting of VP shunt patency and normal pressure hydrocephalus.

Conclusions: Nuclear medicine imaging is an excellent modality with high clinical utility for diagnosing and characterizing varying diseases and pathologies involving the head and neck.