Thallium-201 Single-Photon Emission CT versus CT for the Detection of Recurrent Squamous Cell Carcinoma of the Head and Neck
Suresh K. Mukherji
,a,
Markus Gapanya,
Doug Phillipsa,
Brian Neelona,
Sean O' O'Briena,
William McCartneya,
Steve Buejenovicha,
Jayashree S. Parekha,
Jacob P. Noordzija and
Mauricio Castilloa
a From the Departments of Radiology (S.K.M., W.M., S.B., M.C.) and Surgery (S.K.M.), University of North Carolina School of Medicine, and the Lineberger Cancer Center (S.K.M., B.N., S.O.), Chapel Hill, NC; the Department of Otolaryngology Head Neck Surgery (M.G.), University of Minnesota School of Medicine, Minneapolis, MN; and the Department of Radiology (D.P., J.S.P.) and Otolaryngology (D.P.), University of Virginia School of Medicine, Charlottesville, VA.
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FIG 1. Correct identification of recurrent squamous cell carcinoma by Tl-201 SPECT.
A, Axial contrast-enhanced CT performed in a patient with a floor-of-mouth carcinoma 6 months after completion of combination radio- and chemotherapy. The study shows a heterogeneously enhancing mass that has soft-tissue (large straight arrows) and low-attenuation components (asterisk). Note erosion along the lingual cortex of the mandible (small straight arrows) and presence of gas (curved arrow). These findings were suspicious for recurrent tumor.
B, Axial thallium-201 SPECT obtained at the floor of mouth in the same patient illustrated in 1A. This study shows abnormal radiotracer uptake (arrow) in the region of the abnormality shown in 1A. Biopsy of this area revealed squamous cell carcinoma.
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FIG 2. Correct exclusion of recurrent squamous cell carcinoma by Tl-201 SPECT.
A, Contrast-enhanced CT in a patient with a right-tonsil carcinoma previously treated with surgery and radiation therapy 14 months prior to this study. The patient presented with a right-sided nodal recurrence. This patient was a candidate for salvage surgery if no recurrent tumor was present at the primary site. Pretreatment studies were unavailable for comparison. CT shows an asymmetric soft-tissue mass involving the right tonsil (arrows). This is associated with asymmetry of the right glossotonsillar sulcus (arrowhead). Compare this to the normal appearance of the normal contralateral side.
B, Axial thallium-201 SPECT through the low oropharynx obtained in same patient illustrated in 2A shows no abnomal radiotracer uptake in the right tonsil. This patient has been followed up for over 2 years after completion of treatment and has no evidence of recurrent tumor at the primary site.
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