Utility of TL-201 SPECT in clarifying false-positive FDG-PET findings due to osteoradionecrosis in head and neck cancer.

BACKGROUND

This study aimed to determine whether Tl-201 single photon emission CT (SPECT) is potentially useful in differentiating false-positive fluorodeoxyglucose positron emission tomography (FDG-PET) findings caused by osteoradionecrosis (ORN) from recurrent head and neck cancer after radiotherapy.

METHODS

Five patients were recruited. Dual-phase FDG-PET and dual-phase Tl-201 SPECT were performed for each patient.

RESULTS

All 5 patients proved to have ORN without recurrent cancer. By visual interpretation, the results were 4 positive versus 1 negative for PET, and 4 negative versus 1 positive for Tl-201 SPECT. The Tl-201 SPECT clarified 3 of the 4 false-positive PETs to be ORN. Dual-phase semiquantitative studies showed decreased standardized uptake value (SUV) over time in 3 of the 4 false-positive PETs and decreased lesion/background ratio over time in the false-positive Tl-201 SPECT.

CONCLUSION

The Tl-201 SPECT may help clarify suspected false-positive FDG uptake caused by ORN. Dual-phase FDG-PET and dual-phase Tl-201 SPECT may also have some value.