Application of fluorodeoxyglucose positron emission tomography in the management of head and neck cancers

Figure 6 A patient with nasopharyngeal cancer. A: Initial stage was T1N0 when the patient was referred to our institution after conventional workup (arrow in axial image); B: Fluorodeoxyglucose positron emission tomography revealed hypermetabolic foci in the primary tumor in the nasopharynx and in bilateral level II lymph nodes which were small and were not called as lymphadenophy in her computed tomography and magnetic resonance imaging. Fine needle biopsies of these lymph nodes were obtained. The right level II node (arrows) was confirmed to contain metastatic disease, while the left level II lymph node was not diagnostic; C: Intensity modulated radiotherapy plan for this patient. The right level II node was treated to a high dose of radiation. The lower neck was treated with an anterior-posterior field (From Woods C, Sohn J, Machtay M, Yao M. Radiation treatment planning for head and neck cancer with PET. PET Clinics 2012; 7: 396; with permission).