Fluorine-18 FDG positron emission tomography in advanced nasopharyngeal carcinoma

Because patients with advanced nasopharyngeal carcinoma can benefit from adjuvant chemotherapy in addition to chemoradiation, precise staging is important. The extent of disease can be evaluated in a single examination involving a whole-body fluorine-18 fluorodeoxyglucose positron emission tomographic (F-18 FDG PET) scan. A 43-year-old man with nasopharyngeal carcinoma, who had been treated with chemoradiation therapy and then bilateral neck dissection of cervical lymph node metastases, was referred for an F-18 FDG PET scan for staging purposes. In a single study, the whole-body PET scan showed multiple sites of metastases, which were unknown until then. The PET scan findings were confirmed subsequently by a CT scan of the chest, abdomen, and pelvis and by a bone scan. However, two mediastinal adenopathic lesions were not reported on the CT scan. Furthermore, a vertebral metastasis was not revealed on the CT scan. The patient is responding well to chemotherapy.