Positron-emission tomography pitfalls related to oral prosthesis.
This case report describes false-positive positron-emission tomography/computed tomography (PET/CT) findings related to oral prostheses and its implications in cancer surveillance. In head and neck cancer management, F18-flurodeoxyglucose (FDG) PET/CT is widely accepted for evaluating treatment response and detecting recurrence. Interpretation of FDG PET/CT images in this setting is often challenging due to various prostheses and reconstruction methods. Following surgery for squamous cell carcinoma of the maxillary alveolus, a 61-year-old female had a FDG PET/CT scan on a 7-month follow-up that showed high FDG uptake along the resection site. Clinical examination showed no signs of inflammation or recurrence. Repeat FDG PET/CT without the prosthesis was normal. The PET/CT attenuation-corrected images demonstrated high FDG uptake (standardized uptake value: 11.6) along the resection site corresponding to contrast-enhanced CT images of the lesion. PET/CT nonattenuation-corrected images also confirmed increased activity. Repeat PET/CT without the prosthesis was normal. FDG is not tumor specific; it can accumulate in inflammation, infection, and post-therapy settings. Metallic and high-density prostheses show radial artifacts on CT and falsely elevated FDG uptake on PET/ CT in adjacent areas. Salivary pooling may concentrate FDG. The presence of oral prostheses has not been described as a cause of this high level of activity. PET/CT images that demonstrate intense activity corresponding to dense structures should be viewed with caution. A detailed history and physical exam as well as knowledge of artifacts are pertinent for the managing physician. Laryngoscope, 2012.
Department of Otolaryngology, Kansas University Medical Center, Kansas City, Kansas, U.S.A.. dryogeshmore@gmail.com.
Yogesh
Y
More
Reginald
R
Dusing
Shaheen
S
Counts
Justin
J
Bond
Terrance
T
Tsue
Douglas
D
Girod
D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000534:rehabilitation / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008441:Maxillary Neoplasms / Q000000981:diagnostic imaging* / Q000534:rehabilitation / Q000601:surgery; D008875:Middle Aged; D064847:Multimodal Imaging; D010158:Palatal Obturators; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18