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Metastatic Head and Neck Cancer: Role and Usefulness of FDG PET in Locating Occult Primary Tumors

¹ Departments of Radiology (O.S.A., N.J.F., G.R.C., D.C.P., W.P.D., R.A.H.)
² Otolaryngology (M.J.K., M.I.S.), University of California Medical Center, 505 Parnassus Ave, San Francisco, CA 94143.

View larger version (182K): [in a new window]   Figure 1a. True-positive MR image and true-positive FDG PET image. (a) Gadolinium-enhanced axial T1-weighted MR image (repetition time msec/echo time msec = 700/26) shows an enhancing mass (arrow). (b) Axial FDG PET image shows increased uptake (arrow). A diagnosis of primary squamous carcinoma of the left base of the tongue was established with biopsy.

View larger version (133K): [in a new window]   Figure 1b. True-positive MR image and true-positive FDG PET image. (a) Gadolinium-enhanced axial T1-weighted MR image (repetition time msec/echo time msec = 700/26) shows an enhancing mass (arrow). (b) Axial FDG PET image shows increased uptake (arrow). A diagnosis of primary squamous carcinoma of the left base of the tongue was established with biopsy.

View larger version (188K): [in a new window]   Figure 2a. False-negative CT scan and true-positive FDG PET image. (a) Contrast material–enhanced axial CT scan shows right-sided necrotic lymph nodes (arrow) and minimal tonsillar asymmetry but no definite primary site of disease. Direct laryngoscopy performed 3 weeks before FDG PET did not demonstrate a primary site of disease. (b) Subsequently obtained axial FDG PET image shows prominent right tonsillar uptake (arrow), which led to the biopsy-proved diagnosis of primary squamous carcinoma.

View larger version (125K): [in a new window]   Figure 2b. False-negative CT scan and true-positive FDG PET image. (a) Contrast material–enhanced axial CT scan shows right-sided necrotic lymph nodes (arrow) and minimal tonsillar asymmetry but no definite primary site of disease. Direct laryngoscopy performed 3 weeks before FDG PET did not demonstrate a primary site of disease. (b) Subsequently obtained axial FDG PET image shows prominent right tonsillar uptake (arrow), which led to the biopsy-proved diagnosis of primary squamous carcinoma.

View larger version (131K): [in a new window]   Figure 3. Two concurrent primary carcinomas located with FDG PET. CT performed 1 month before PET did not show a primary carcinoma. Sagittal FDG PET image shows focal uptake in the base of the tongue (straight arrow) and esophagus (curved arrow). Biopsy of these sites demonstrated two separate primary carcinomas. The base-of-tongue carcinoma was only 4 mm in diameter at surgical histopathologic analysis.