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Role of ^(18)F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma

World Journal of Radiology 2014年第5期6卷 177-191页

作者： bundhit tantiwongkosi Fang Yu Anand Kanard Frank R Miller Division of Neuroradiology Department of Radiology and Otolaryngology Head Neck SurgeryUniversity of Texas Health Science Center at San Antonio San Antonio TX 78229 United States Imaging Service South Texas Veterans Health Care System San Antonio TX 78229 United States Department of Radiology University of Texas Health Science Center at San Antonio San Antonio TX 78229 United States Department of Medical Oncology University of Texas Health Science Center at San Antonio San Antonio TX 78229 United States Department of Otolaryngology Head Neck Surgery University of Texas Health Science Center at San AntonioSan Antonio TX 78229 United States

Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced disease(typically stage Ⅲ and Ⅳ) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Somepatients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography(CT) or magnetic resonance imaging(MRI). 18F-2-fluoro-2-deoxyD-glucose positron emission tomography/CT(18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.

关键词： Head and neck cancer Positron emission tomography Computed tomography Staging Post treatment Recurrence

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Positron-emission tomography/computed tomography imaging in head and neck oncology:An update

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World Journal of Otorhinolaryngology 2016年第2期6卷 23-32页

作者： Viet D Nguyen bundhit tantiwongkosi Wyatt J Weinheimer Frank R Miller Department of Radiology University of TexasHealth Science Center at San Antonio Division of Neuroradiology Department of Radiology and Otolaryngology Head Neck SurgeryUniversity of Texas Health Science Center at San Antonio Department of Otolaryn-gology Head Neck Surgery University of Texas Health Science Center at San Antonio

Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.

关键词： Positron emission tomography Staging Diagnosis Computed tomography Head and neck cancer Management of squamous cell carcinoma Carcinoma of unknown primary Second primary malignancy Surveillance Recurrence Prognosis

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Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism

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Open Journal of Radiology 2019年第1期9卷 82-91页

作者： bundhit tantiwongkosi Frank R. Miller Viet D. Nguyen Kathleen E. Hands Boyce B. Oliver Alfredo A. Santillan Wilson B. Altmeyer Achint K. Singh Fang Yu Radiology Department University of Texas Health San Antonio San Antonio TX USA Otolaryngology Head Neck Surgery Department University of Texas Health San Antonio San Antonio TX USA Thyroid and Endocrine Center of South Texas San Antonio TX USA Surgical Oncology Department University of Texas Health San Antonio San Antonio TX USA Surgical Oncology Department Texas Oncology San Antonio TX USA Radiology Department University of Texas Southwestern Dallas TX USA

Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85%, 97%, 96%, 87% and 91% for lateralization and 76%, 96%, 85%, 92% and 90% for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88%, 100%, 100%, 50% and 90% for lateralization and 71%, 100%, 100%, 60% and 80% for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.

关键词： Computed Tomography Parathyroid 4-Dimensional Hyperparathyroidism

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