44 year old male, with Ca left buccal mucosa. Post left cheek commando with left RND. Post RT/CT. PET/MRI was done as a follow-up investigation.
PET / MR fused image (A) and Axial STIR image (B) reveals a nodular thickening along the anterior margin of a flap with increased FDG uptake suggesting possible recurrence. HPE: recurrent SCC. The note is also made of FDG uptake along the right medial pterygoid muscle which does not show any lesion on the corresponding MR image and is physiological. Simultaneous PET /MRI allows better appreciation due to high soft-tissue contrast with MR and accurate co-registration of PET uptake.
1. PET/MRI brings a better delineation of the lesion owing to the better soft-tissue resolution.
2. PET and MRI are sensitive and delineates any recurrence better amidst distorted planes due to surgery and radiotherapy.
3. MRI is sensitive to identify perineural intracranial extension which is common with nasopharyngeal carcinomas and adenoid cystic carcinomas.
4. Physiological uptake in a post-radiotherapy/operated head and neck cancer is not uncommon. High soft-tissue resolution on MRI brings better anatomical delineation of the anatomical planes and rules out abnormality underlying these areas of physiological FDG uptake.
This short PET-MRI Scan case was compiled by Dr. Sangeeta Taneja and Dr. Amarnath Jena (Nuclear Medicine Physician at PET-Suite @ Indraprastha Apollo Hospital, Sarita Vihar).
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The Simultaneous PET-MRI Scan is currently offered at PET-Suite at Apollo Hospital, Sarita Vihar.