1. INTERNATIONAL CONFERENCE ON SURGERY ACCSESS IN TROPICAL AREAS & UPDATES IN ONCOLOGY APPILATIONS OF PET/CT IN ORAL & MAXILLOFACIAL CANCER Hải Phòng, November, 8-9,2017 Dr. Trần Cao Bính NATIONAL HOSPITAL OF ODONTO- STOMATOLOGY, HANOI

2. OVERVIEW OUTLINE PRINCIPLES 18FDG INDICATIONS & CONTRAINDICATIONS
CLINICAL CASES
CONCLUSIONS

3. I. OUTLINE

4. The combined PET/CT scans provide images that pinpoint the anatomic location of abnormal metabolic activity within the body.
The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

6. II. PRINCILES BASIC

7. Annihilation coincidence detection (ACD)
Annihilation coincidence detection (ACD). When a positron is emitted by a nuclear transformation, it scatters through matter
losing energy and annihilates with an electron, resulting in two 511-keV photons that are emitted in nearly opposite directions ...

11. The value of PEC / CT in cancers Sensitivity Specificity Accuracy
The value of PEC / CT in cancers
Sensitivity
Specificity
Accuracy
Recur 88
100 92
Lympho node 95 67 91
Bone cancer 83 93
Lung cancer 85
Liver Cancer 87
Total
96%
84.4%
93%
   
Source: Center for Oncology and Nuclear Medicine of Bach Mai Hospital

12. III. 18FDG

18. IV. Indications & Contraindications

20. Detect cancer.
Determine whether a cancer has spread in the body.
Assess the effectiveness of a treatment plan, such as cancer therapy.
Determine if a cancer has returned after treatment.
Determine blood flow to the heart muscle.
Determine the effects of a heart attack, or myocardial infarction, on areas of the heart.

21. Identify areas of the heart muscle that would benefit from a procedure such as angioplasty or coronary artery bypass surgery.
Evaluate brain abnormalities, such as tumors, memory disorders, seizures and other central nervous system disorders. …

22. 4. 2. CONTRAINDICATIONS - Pregnant
4.2. CONTRAINDICATIONS - Pregnant. - Women who are breastfeeding (stop breastfeeding 24 hours after the shot). - History of allergy to contrast medium, kidney failure. In these cases PET / CT without contrast medium.

23. Application in oral Maxillofacial pathology 1. Early stage cancers 2
Application in oral Maxillofacial pathology 1. Early stage cancers 2. Tongue & oral floor cancer 3. Salivary gland cancer 4. Examination of nodal metastasis after radiation therapy or chemotherapy. 5. Biopsy

24. V. CASES

25. A 64-year-old man with T4 squamous cell carcinoma (SCC) of the lingual gingiva of the left posterior mandible.
Axial plain computed tomography (CT) image shows bone destruction of the left posterior mandible (arrow).
Axial PET/CT scan shows intense ...

26. A 56-year-old man diagnosed with SCC of the lateral border of the tongue (left side).
(A, B) Axial CT and PET/CT images reveal increased FDG uptake in the lateral border of the tongue (arrow).
(C, D) Axial CT and PET/CT images at a lower level show increased ...

27. A 57-year-old man diagnosed with Hodgkin's lymphoma
A 57-year-old man diagnosed with Hodgkin's lymphoma. (A) Non-enhanced CT scan showed normal study.
The lymph nodes are normal according to radiographic criteria. However, the fused PET/CT images (B) show many ...

28. Metastatic head and neck SCC (HNSCC).
A 61-year-old male with T3 SCC of the right tosillar fossa.
Whole-body PET shows a focus of increased uptake (arrow) in the sternum, which proved to be a distant metastasis.
The CT component is still needed to adequately ...

29. Unknown primary tumor. A 54-year-old patient presented with an enlarging left neck mass.
CT shows a level IIA lymph node (arrow);
fine-needle aspiration biopsy showed metastatic squamous cell carcinoma.

30. Synchronous tumor.
A 65-year-old man recently diagnosed with SCC of the right mandibular retromolar trigon.
(A, B) Axial CT and PET/CT images show intense FDG uptake in the retromolar trigon;
another focal area of increased uptake can be seen in the right ...

31. Metachronous tumors. A 64-year-old woman diagnosed with SCC of the right tonsillar fossa.
(A, B) Axial PET/CT images show increased FDG uptake in the right tonsillar fossa and ipsilateral level IIA level nodal metastasis.
(C, D) Surveillance PET/CT scan ...

32. Monitoring therapy response
Monitoring therapy response. Nasopharyngeal carcinoma with ipsilateral level IIB nodal metastasis.
(A, C) Axial PET/CT images show increased FDG uptake in the right nasopharynx and ipsilateral level IIB lymph nodes.
(B, D) Six months after initiation ...

33. Surgical planning and metabolic staging
Surgical planning and metabolic staging. A 50-year-old man with T4N2bM0 SCC of the right tonsil and base of the tongue. he patient underwent resection with pectoralis flap reconstruction and concurrent chemoradiation. A and B, Contrast-enhanced CT of PET/CT. C−E, Fused PET/CT images. FDG uptake provides the primary tumor and metastatic lymph node metabolism (yellow arrows).

34. Detection of unknown primary tumor
Detection of unknown primary tumor. A 58-year-old man who presented with a right neck mass. A neck CT shows multiple enlarged necrotic right level II, III, and IV lymph nodes. FNA of the right level III node showed a metastatic poorly differentiated carcinoma with extensive necrosis. PET/CT showed a 1.0 × 1.2 cm hypermetabolic (gold arrow) and enhancing (red arrow) lesion at the right base of the tongue, large nodes in the right levels II/III, an 8-mm node at level IV, and no left-sided nodes or distant metastases. Direct laryngoscopy with biopsy and cervical esophagoscopy showed no lesions, but palpation showed a 1-cm firm right base of tongue lesion not crossing the midline, which was pathologically proved to be SCC. PET/CT is useful in identifying the unknown primary tumor in approximately one-third of patients after physical examination, anatomic cross-sectional imaging, and endoscopy. A−C, Fused PET/CT images. D−F, Contrast-enhanced CT of the PET/CT.

35. Failure to detect an unknown primary tumor
Failure to detect an unknown primary tumor. A 50-year-old man who underwent a dental extraction in which the oral surgeon incidentally identified a right-sided neck mass that was tender to touch. FNA revealed moderate to poorly differentiated SCC. PET/DCT demonstrates FDG hypermetabolic (gold arrow) and enhancing (red arrow) lymphadenopathy in the right levels I-III and fails to reveal a primary lesion. Same-day rigid esophagoscopy, direct laryngoscopy, nasal endoscopy with biopsy of the base of the tongue bilaterally, and tonsillectomy showed no tumor. The patient was treated in all potential mucosal primary sites and the bilateral neck with IMRT to a dose of Gy in 33 fractions with concurrent cisplatin. A, C, and D, Fused PET/CT images. B, Contrast-enhanced CT of the PET/CT.

36. Perineural spread. A 65-year-old woman diagnosed with T4N0M0 SCC of the skin of the left upper lip and perineural spread along infraorbital nerve and VI to the skull base. PET/DCT demonstrates a hypermetabolic and enhancing mass in the left upper lip extending along the infraorbital nerve and at the skull base (gold arrows). MR imaging demonstrates these findings (red arrows) with higher resolution. The perineural spread is better depicted on the MR imaging than PET/CT due to higher resolution and small-volume disease along the nerve. A, B, and D, PET/DCT fused images. C, Contrast-enhanced coronal CT scan. E and G, Coronal T1 pregadolinium images. F and H, Postgadolinium coronal T1 images.

37. Staging. A 62-year-old man with a stage IVa (T2 N2cM0) SCC of the tongue with a central necrotic right IB (red arrow) and right IIA (yellow arrow) FDG hypermetabolic lymphadenopathy. The left IIA lymph node (<10 mm) demonstrates FDG hypermetabolism, proved pathologically to be metastatic. Even smaller lymph nodes with apparent mild FDG uptake due to partial volume may harbor metastatic deposits.

38. Radiation therapy planning. A, Planning CT GTV in red and PTV in blue
Radiation therapy planning. A, Planning CT GTV in red and PTV in blue. Green and aqua contours represent elective nodal volumes. B, PET. C, Rigid fusion of planning CT and PET for radiation planning. The PET/CT scan was obtained in the treatment position with rigid immobilization in a thermoplastic head and neck mask.

39. Therapy assessment, complete response
Therapy assessment, complete response. A 39-year-old male patient with a stage IVa (T4N3M0) SCC of the right tonsil who underwent induction chemotherapy. A postinduction therapy PET/DCT demonstrates complete metabolic resolution of the primary tumor and nodal metastases. A and E, Maximum intensity projection views. B−D and F−H, Fused PET/CT images.

40. Therapy assessment, partial response
Therapy assessment, partial response. A 67-year-old male patient with a history of recurrent SCC of the oral tongue, SCC of the midesophagus, and SCC of the left soft palate (T2N0M0) status postresection with negative margins, who presented with a recurrent left neck mass. The pretherapy PET/CT demonstrates FDG hypermetabolic left level I nodal recurrence (red arrow), and the patient completed chemoradiotherapy to the recurrent tumor in his left neck with IMRT to a dose of 70 Gy. A 12-week posttherapy PET/DCT scan demonstrates residual activity (gold arrow) in the periphery and central necrosis of the left neck nodal mass, representing partial response and a new recurrence of the esophageal malignancy (green arrow).

41. VI. CONCLUSIONS Early diagnosis of Oncology
High sensitivity and accuracy
Assessment and monitoring of treatment outcomes
Application in oral maxillofacial pathology:
- Early diagnosis of oral - maxillofacial cancer
- Evaluate and monitor the results of treatment for
oral - maxillofacial cancer

42. THANK YOU