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Value of CT Thallium-201 SPECT Fusion Imaging over SPECT Alone for Detection and Localization of Nasopharyngeal and Maxillary Cancers

Tadaki Nakahara1, Naoyuki Shigematsu1, Masato Fujii2, Etsuo Kunieda1, Takayuki Suzuki1, Chikako Tanaka3, Jun Hashimoto1 and Atsushi Kubo1

1 Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan 160-8582.
2 Department of Otolaryngology, Keio University School of Medicine, Tokyo, Japan.
3 Department of Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.


Figure 1
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  		Fig. 1A —Normal and abnormal findings on thallium-201 SPECT images. 20-year-old man in complete remission from T3 N2 M0 nasopharyngeal carcinoma after chemoradiotherapy. Modified brain 201Tl SPECT image shows no pathologic uptake in scan area including nasopharynx. Physiologic uptake sites in scalp, nasal cavity, salivary glands, palate, and prevertebral muscle (arrows) are noted.

 

Figure 2
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  		Fig. 1B —Normal and abnormal findings on thallium-201 SPECT images. 60-year-old man with untreated T1 N0 M0 nasopharyngeal carcinoma. CT/SPECT fusion image shows pathologic uptake in right side of nasopharynx (arrowhead). Physiologic uptake in nasal cavity, muscle, parotid gland, and scalp is helpful to confirm image registration accuracy (CT in gray-scale and thallium uptake in color).

 

Figure 3
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  		Fig. 2A —68-year-old man with local recurrence of T4 N2c M0 nasopharyngeal carcinoma 10 months after chemoradiotherapy. Contrast-enhanced CT scan shows nasopharyngeal wall thickening on left side. No remarkable change of structural abnormality is seen when compared with CT performed 6 months after therapy.

 

Figure 4
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  		Fig. 2B —68-year-old man with local recurrence of T4 N2c M0 nasopharyngeal carcinoma 10 months after chemoradiotherapy. CT/SPECT fusion image performed 10 months after chemoradiotherapy shows moderate uptake in thickened wall (CT in gray-scale and thallium uptake in color).

 

Figure 5
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  		Fig. 3A —64-year-old woman with local recurrence of T4 N1 M0 nasopharyngeal carcinoma 6 months after chemoradiotherapy. Thallium-201 SPECT scan reveals moderate uptake near right side of nasopharynx (arrow).

 

Figure 6
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  		Fig. 3B —64-year-old woman with local recurrence of T4 N1 M0 nasopharyngeal carcinoma 6 months after chemoradiotherapy. CT/SPECT fusion image shows uptake to be mainly located in clivus (CT in gray-scale and thallium uptake in color).

 

Figure 7
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  		Fig. 3C —64-year-old woman with local recurrence of T4 N1 M0 nasopharyngeal carcinoma 6 months after chemoradiotherapy. SPECT scan after stereotactic radiosurgery to clival lesion shows remarkably reduced uptake in recurrent lesion.

 

Figure 8
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  		Fig. 4A —54-year-old man with cervical spine recurrence (or metastasis) of T4 N0 M0 nasopharyngeal carcinoma 11 months after chemoradiotherapy. Thallium-201 SPECT scan shows moderate uptake near left posterior side of nasopharynx (arrow). Uptake site cannot be determined on SPECT scan alone.

 

Figure 9
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  		Fig. 4B —54-year-old man with cervical spine recurrence (or metastasis) of T4 N0 M0 nasopharyngeal carcinoma 11 months after chemoradiotherapy. CT/SPECT fusion image shows that uptake is located in left lateral mass of first cervical spine (CT in gray-scale and thallium uptake in color).

 

Figure 10
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  		Fig. 4C —54-year-old man with cervical spine recurrence (or metastasis) of T4 N0 M0 nasopharyngeal carcinoma 11 months after chemoradiotherapy. T1-weighted MR image after contrast enhancement confirms recurrence (or metastasis) in same location (arrow) as shown in B.

 

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