title: Feasibility and incremental benefit of puffed-cheek 18F-FDG PET/CT on oral cancer patients.
abstract: OBJECTIVE
  The complexity of small oral cavity and intimate apposition of the oral cavity mucosal surfaces make CT identification of obvious masses difficult. Puffed-cheek CT improves the evaluation of oral cavity lesions. We used the puffed-cheek maneuver with 18F-FDG PET/CT scans to determine the feasibility and accuracy in clinical practice and to identify any benefits.
  
  
  METHODS
  Twenty-two patients with oral cancer were included. They were instructed to perform the puffed-cheek maneuver after a conventional 18F-FDG PET/CT scan. Two physicians reviewed the puffed-cheek and conventional 18F-FDG PET/CT images and achieved consensus about the cancer extent, location, and dental artifacts before classifying and grading the oral cancers. Dichotomous results of localized or extended cancer and artifact grading scores from the puffed-cheek and conventional 18F-FDG PET/CT methods were compared using McNemar test and the Wilcoxon signed-rank test. P < 0.05 was considered significant.
  
  
  RESULTS
  The puffed-cheek maneuver with 18F-FDG PET/CT was practical and had incremental benefits. The conventional 18F-FDG PET/CT classified 12 patients correctly as having localized or extended cancer, and the puffed-cheek 18F-FDG PET/CT classified 21 patients correctly. Puffed-cheek 18F-FDG PET/CT found a synchronous skip cancer and provided detailed cancer delineation. This method might reduce the effects of dental artifacts without undesirable muscular FDG uptake.
  
  
  CONCLUSIONS
  Puffed-cheek PET/CT is feasible in the current clinical setting and can improve the delineation of oral cancer extent and location, with a potential benefit of reducing dental artifacts.
authors.affiliation: From the *Department of Nuclear Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; †School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; and ‡ Department of Radiology, University of Kentucky, Lexington, KY.
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Chang
authors.forename: Bang-Hung
authors.initials: BH
authors.lastname: Yang
authors.forename: Ko-Han
authors.initials: KH
authors.lastname: Lin
authors.forename: Ren-Shyan
authors.initials: RS
authors.lastname: Liu
authors.forename: Shyh-Jen
authors.initials: SJ
authors.lastname: Wang
authors.forename: Wei-Jen
authors.initials: WJ
authors.lastname: Shih
mesh_terms: D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging; D002610:Cheek / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18