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Hussain M, Ghani H, Ali Y, Clement C, Nawgiri R. Fine needle aspiration diagnosis of benign oncocytic lesions of the head and neck associated with false positive 18F-fluorodeoxyglucose uptake on positron emission tomography scan. Diagn Cytopathol 2024. [PMID: 38712593 DOI: 10.1002/dc.25331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/28/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has become the mainstay for staging and post-therapy surveillance of cancer as malignant neoplasms generally demonstrate higher FDG uptake that benign entities. However, there are certain benign lesions, most notably oncocytic tumors, that can display very high uptake and fine needle aspiration (FNA) is usually done to confirm malignancy. Therefore, it is important to recognize that benign oncocytic lesions of the head and neck may also present as FDG-avid lesions to avoid a diagnostic pitfall. METHODS Electronic search of institutional surgical and cytopathology archives was conducted to identify cases of benign oncocytic lesions involving the head and neck region diagnosed by FNA from January 2012 to April 2022. Chart review was used to assess whether lesions were initially discovered via PET scanning. RESULTS One hundred and twenty-five cases of oncocytic lesions were identified; 12 (9%) PET positive lesions were identified in the head and neck region from patients being evaluated for metastasis or for suspicion of malignancy. Cytopathology of all 12 cases demonstrated benign oncocytic lesions; eight (67%) of these cases were consistent with Warthin tumor, one (8.3%) was a benign oncocytic lesion, and one (8.3%) was consistent wit a parathyroid adenoma. Most (58%) of the PET-positive lesions were in parotid region, two from thyroid gland (17%), one from submandibular gland (8%), one from paratracheal area (8%). The PET scan SUVs ranged from 3.3 to 19.5 g mL-1. CONCLUSIONS Oncocytic lesions including Warthin tumors can result in false-positive FDG uptake on PET scans. Clinicians and cytopathologists should be aware of PET-positive benign oncocytic head and neck lesions.
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Affiliation(s)
- Mahreen Hussain
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Hafiz Ghani
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Yasir Ali
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cecilia Clement
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ranjana Nawgiri
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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Nam IC, Baek HJ, Ryu KH, Moon JI, Cho E, An HJ, Yoon S, Baik J. Prevalence and Clinical Implications of Incidentally Detected Parotid Lesions as Blind Spot on Brain MRI: A Single-Center Experience. ACTA ACUST UNITED AC 2021; 57:medicina57080836. [PMID: 34441042 PMCID: PMC8398632 DOI: 10.3390/medicina57080836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Background and objective: This study was conducted to assess the prevalence and clinical implications of parotid lesions detected incidentally during brain magnetic resonance imaging (MRI) examination. Materials and Methods: Between February 2016 and February 2021, we identified 86 lesions in the brain MRI reports of 84 patients that contained the words “parotid gland” or “PG”. Of these, we finally included 49 lesions involving 45 patients following histopathological confirmation. Results: Based on the laboratory, radiological or histopathological findings, the prevalence of incidental parotid lesions was low (1.2%). Among the 45 study patients, 41 (91.1%) had unilateral lesions, and the majority of the lesions were located in the superficial lobe (40/49, 81.6%). The mean size of the parotid lesions was 1.3 cm ± 0.4 cm (range, 0.5 cm–2.8 cm). Of these, 46 parotid lesions (93.9%) were benign, whereas the remaining three lesions were malignant (6.1%). Conclusions: Despite the low prevalence and incidence of malignancy associated with incidental parotid lesions detected on brain MRI, the clinical implications are potentially significant. Therefore, clinical awareness and appropriate imaging work-up of these lesions are important for accurate diagnosis and timely management.
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Affiliation(s)
- In-Chul Nam
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.-C.N.); (K.-H.R.); (J.-I.M.); (E.C.)
| | - Hye-Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.-C.N.); (K.-H.R.); (J.-I.M.); (E.C.)
- Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea
- Correspondence:
| | - Kyeong-Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.-C.N.); (K.-H.R.); (J.-I.M.); (E.C.)
| | - Jin-Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.-C.N.); (K.-H.R.); (J.-I.M.); (E.C.)
| | - Eun Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea; (I.-C.N.); (K.-H.R.); (J.-I.M.); (E.C.)
| | - Hyo-Jung An
- Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea;
| | - Seokho Yoon
- Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Korea;
| | - Jiyeon Baik
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Korea;
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Derebaşinlioğlu H, Yilmaz S. Coincidence of Malignant Melanoma and an Incidently Discovered Parotid Mass Presenting a Diagnostic Challenge. Plast Reconstr Surg Glob Open 2018; 6:e1897. [PMID: 30324074 DOI: 10.1097/GOX.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/15/2022]
Abstract
Parotid masses coincided with skin tumors in head and neck region may represent a serious diagnostic challenge. Conventional imaging modalities such as computed tomography, magnetic resonance imaging may help to determine nature of the masses. Positron emission tomography - computed tomography imaging is reported to be useful for the detection of malignancy in the parotid gland. But in some situations all of them become insufficient. We present a case of cheek malignant melanoma with an incidentally discovered parotid mass during the investigation. We describe the problems experienced in the course of differential diagnosis and decision making in terms of surgical management. As a result, the most reliable diagnosis of suspicious parotid lesions accompanying head and neck melanomas comes from frozen section analyses. The other diagnostic tools are not reliable enough to allow a safe surgical plan in terms of regional treatment; however, the significance of positron emission tomography - computed tomography in distant metastasis investigation should always be kept in mind.
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Treglia G, Bertagna F, Sadeghi R, Muoio B, Giovanella L. Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 272:3617-26. [PMID: 25262193 DOI: 10.1007/s00405-014-3308-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/23/2014] [Indexed: 12/14/2022]
Abstract
This study aimed at performing a meta-analysis on the prevalence and risk of malignancy of focal parotid incidental uptake (FPIU) detected by hybrid fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) or (18)F-FDG PET alone. A comprehensive literature search of studies published up to July 2014 was performed. Records reporting at least 5 FPIUs were selected. Pooled prevalence and malignancy risk of FPIU were calculated including 95 % confidence intervals (95 % CI). Twelve records were selected for our meta-analysis. Pooled prevalence of FPIU detected by (18)F-FDG PET or PET/CT was 0.6 % (95 % CI 0.4-0.7 %), collecting data of 220 patients with FPIU. Overall, 181 FPIUs underwent further evaluation and 165 FPIUs were pathologically proven. Pooled risk of malignancy was 9.6 % (95 % CI 5.4-14.8 %), 10.9 % (95 % CI 5.8-17.3 %) and 20.4 % (95 % CI 12.3-30 %), considering all FPIUs detected, only those which underwent further evaluation and only those pathologically proven, respectively. Selection bias in the included studies, the heterogeneity among studies and the publication bias are limitations of our meta-analysis. Overall FPIUs are observed in about 1 % of (18)F-FDG PET or PET/CT scans and they are benign in most of the cases. Nevertheless, further evaluation is needed whenever FPIUs are detected by (18)F-FDG-PET or PET/CT to exclude malignant lesions or with possible malignant degeneration. Prospective studies are needed to confirm the findings reported by our meta-analysis.
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Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, via Ospedale, 12, 6500, Bellinzona, Switzerland.
| | - Francesco Bertagna
- Department of Nuclear Medicine, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Barbara Muoio
- School of Medicine, Catholic University, Rome, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, via Ospedale, 12, 6500, Bellinzona, Switzerland
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Kim JY, Lee SW, Kim JS, Kim SY, Nam SY, Choi SH, Roh JL, Choi EK, Kim JH, Song SY, Yoon SM, Kim YS, Kim SS, Park JH, Shin HS, Chang SK, Ahn SD. Diagnostic value of neck node status using 18F-FDG PET for salivary duct carcinoma of the major salivary glands. J Nucl Med 2012; 53:881-6. [PMID: 22573820 DOI: 10.2967/jnumed.111.098384] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED (18)F-FDG PET and PET/CT have shown clinical usefulness in the initial staging and follow-up of patients with salivary malignancy. Therefore, we evaluated the utility of (18)F-FDG PET in preoperative staging, determining the extent of neck node involvement, and surgical planning for patients with salivary duct carcinoma (SDC) of the major salivary gland. METHODS We evaluated 18 patients with SDC who were assessed by (18)F-FDG PET and CT before surgery. The sensitivity, specificity, accuracy, and predictive values of CT and PET/CT for predicting the primary tumor site and determining the extent of neck node involvement at each dissected neck level were evaluated by comparing imaging findings with pathologic nodal stage. RESULTS The median maximum standardized uptake value of the primary lesions and cervical nodes were 4.7 (range, 1.8-12.1) and 5.8 (range, 1.7-13.0), respectively. The sensitivities of (18)F-FDG PET and CT for predicting the primary tumor site were 100% (18/18) and 94.4% (17/18), respectively. In analyzing cervical lymph nodes at 73 dissected neck levels, (18)F-FDG PET had a sensitivity of 76.1%, a specificity of 96.3%, a positive predictive value of 97.2%, and a negative predictive value of 70.3%; the corresponding values for CT were 39.1%, 92.6%, 90.0%, and 47.2%, respectively. The sensitivity and negative predictive value were significantly higher for (18)F-FDG PET than for CT (P < 0.001 and P = 0.03, respectively).(18)F-FDG PET determination of the extent of neck node involvement changed the neck dissection regimen in 5 patients (27.8%). CONCLUSION SDC of the major salivary gland is a highly metabolic tumor with high (18)F-FDG uptake. (18)F-FDG PET is useful for evaluating neck node status and for determining surgical planning in patients with major salivary gland SDC.
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Affiliation(s)
- Ja Young Kim
- Bundang CHA Hospital, School of Medicine, CHA University, Seongnam, Korea; CHA University, Seoul, Korea
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Abstract
More than 70 benign and malignant sinonasal tumours and tumour-like conditions have been described. However, sinonasal tumours are rare, and sinonasal cancers comprise only 3% of all head and neck cancers and 1% of all malignancies, with a peak incidence in the 5th to 7th decades and with a male preponderance. The early symptoms and imaging findings of sinonasal tumours are similar to rhinosinusitis with runny and stuffy nose, lacrimation and epistaxis and therefore neglected both by the patients and doctors. When late symptoms such as anosmia, visual disturbances, cranial neuropathy (Cn II, IV, V, VI) or facial swelling appear, the patient is referred to sinonasal endoscopy or imaging. At the time of correct diagnosis more than half of the tumours have reached an advanced stage with a poor prognostic outcome. Even if imaging is performed in the early stages, a radiologist inexperienced with sinonasal anatomy and tumour features may easily interpret early signs of a malignant tumour as rhinosinusitis or a lesion that does not require follow-up. This article presents the imaging findings in some of the most common benign and malignant sinonasal tumours, and the TNM classification and staging of sinonasal carcinomas.
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Park SB, Choi JY, Lee EJ, Yoo J, Cheon M, Cho SK, Choe YS, Lee KH, Kim BT. Diagnostic Criteria on (18)F-FDG PET/CT for Differentiating Benign from Malignant Focal Hypermetabolic Lesions of Parotid Gland. Nucl Med Mol Imaging 2012; 46:95-101. [PMID: 24900041 DOI: 10.1007/s13139-012-0135-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 03/18/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We investigated PET/CT diagnostic criteria for differentiating benign from malignant parotid lesions with focal (18)F-FDG uptake. METHODS The subjects of the study were 272 patients who exhibited focal (18)F-FDG uptake of the parotid gland. Sixty-eight pathologically confirmed parotid lesions from 67 patients were included. The maximum SUV (SUVmax), uptake patterns (homogeneous vs. heterogeneous), size measured by CT, maximum Hounsfield units (HUmax) and margins on CT (well vs. ill defined) of each parotid lesion on PET/CT images were compared with final diagnoses. RESULTS Thirty-two parotid lesions were histologically proven to be malignant. There were significant differences in uptake patterns (cancer incidence, heterogeneous:homogeneous = 79.2%:29.5%, p < 0.0001) and margins on CT (cancer incidence, ill:well defined = 84.4%:13.3%, p < 0.0001) between benign and malignant lesions. The cancer risks of parotid lesions were 89.5% with heterogeneous uptake and ill-defined margins, 70.6% with heterogeneous uptake or ill-defined margins (no overlap in subjects) and 9.3% with homogeneous uptake and well-defined margins (p < 0.0001). When any lesion with heterogeneous uptake or ill-defined margins was regarded as malignant, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.6% (29/32), 80.6% (29/36), 80.6% (29/36), 90.6% (29/32) and 85.6% (58/68), respectively. For predicting malignancy, combined PET/CT criteria showed better sensitivity, NPV and accuracy than PET-only criteria, and had a tendency to have more accurate results than CT-only criteria. There were no significant differences in SUVmax, size or HUmax between benign and malignant lesions. CONCLUSION Uptake patterns and margins on CT are useful PET/CT diagnostic criteria for differentiating benign from malignant lesions.
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Abstract
OBJECTIVE It has been suggested that (18)F-FDG uptake determined by PET can differentiate squamous cell carcinoma from benign sinonasal papilloma. We wish to present our experience with sinonasal papillomas and PET/CT to determine if the degree of FDG uptake is indicative of benign or malignant disease. CONCLUSION Benign sinonasal papilloma may be associated with intense FDG uptake on PET/CT. FDG PET/CT does not appear to reliably differentiate benign from malignant sinonasal papilloma.
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Lee SK, Rho BH, Won KS. Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy. Eur Radiol 2009; 19:2268-74. [PMID: 19396445 DOI: 10.1007/s00330-009-1407-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 02/17/2009] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
Abstract
Twelve parotid incidentalomas in 10 consecutive subjects (nine with a known malignancy elsewhere and one presumptively healthy subject) identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography (18F-FDG PET/CT) were investigated, with the aim of calculating maximum standardized uptake value (SUV(max)) of each FDG-avid focus, and identifying corresponding sonographic and pathologic findings. The results of ultrasound-guided fine-needle aspiration biopsy (FNAB) (n = 9) and core-needle biopsy (CNB) (n = 3) were Warthin tumor in 10 cases, and pleomorphic adenoma and chronic inflammation in one each. SUV(max) was 7.0-21.0 g/mL (average 13.7 g/mL) for Warthin tumor, 6.8 g/mL for pleomorphic adenoma, and 7.3 g/mL for chronic inflammation. Each FDG-avid focus corresponded to ovoid (n = 11) or lobulated (n = 1) hypoechoic mass on grayscale ultrasonography (US) and hypervascular mass, except one with chronic inflammation, on power Doppler (PD) US. Parotid incidentaloma identified by 18F-FDG PET/CT during workup of various malignancies elsewhere does not necessarily signify primary or metastatic malignancy, but indicates a high likelihood of benign lesions, particularly Warthin tumor. Such lesions should be evaluated thoroughly by US and ultrasound-guided FNAB or CNB if parotid disease would change the patient's treatment plan.
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Affiliation(s)
- Sang Kwon Lee
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea.
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Yabuuchi H, Matsuo Y, Kamitani T, Setoguchi T, Okafuji T, Soeda H, Sakai S, Hatakenaka M, Nakashima T, Oda Y, Honda H. Parotid Gland Tumors: Can Addition of Diffusion-weighted MR Imaging to Dynamic Contrast-enhanced MR Imaging Improve Diagnostic Accuracy in Characterization? Radiology 2008; 249:909-16. [DOI: 10.1148/radiol.2493072045] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Singh NK, Cook GJR, Lewington VJ, Chua SC. PET/CT assessment of clinically unsuspected, incidental FDG-avid lesions in oncological patients. Imaging 2008. [DOI: 10.1259/imaging/30631072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hamada K, Ueda T, Tomita Y, Yoshikawa H, Hatazawa J. Myoepithelioma of Soft Tissue Originating from the Hand: 18F-FDG PET Features. AJR Am J Roentgenol 2006; 186:270-1. [PMID: 16357423 DOI: 10.2214/ajr.05.0191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kenichiro Hamada
- Osaka University Graduate School of Medicine, Osaka, Japan 565-0871
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Abstract
Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG) has been effective for the diagnosis, staging, and restaging of malignancies of the head and neck region. However, lack of anatomic landmarks, variable physiologic uptake, and asymmetric FDG distribution in several altered physiologic states can confound image interpretation. In addition, many benign causes and several artifacts can simulate physiologic or pathologic FDG uptake in the head and neck. Combined PET-computed tomography (CT) is a unique imaging modality that permits anatomic and functional imaging on a single scanner with nearly perfect coregistration. Combined PET-CT provides information that cannot be obtained with PET or CT alone. In particular, PET-CT facilitates the interpretation of FDG uptake in the head and neck, an area that is characterized by dense and complex anatomic structures. An atlas of FDG uptake in this anatomic region was compiled on the basis of combined PET-CT findings in 11,000 patients. In general, patterns of FDG uptake were variable and often reflected patient activity during or immediately preceding the uptake phase. With the growing interest in PET-CT, interpreting radiologists and nuclear medicine physicians must be familiar with the patterns of FDG uptake in the head and neck to avoid misinterpretation or mis-diagnosis.
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Affiliation(s)
- Todd M Blodgett
- Department of Radiology, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA.
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Goerres GW, Von Schulthess GK, Hany TF. Positron emission tomography and PET CT of the head and neck: FDG uptake in normal anatomy, in benign lesions, and in changes resulting from treatment. AJR Am J Roentgenol 2002; 179:1337-43. [PMID: 12388526 DOI: 10.2214/ajr.179.5.1791337] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Gerhard W Goerres
- Division of Nuclear Medicine, University Hospital Zurich, Raemistr. 100, CH-8091 Zurich, Switzerland
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