Positron-emission tomography pitfalls related to oral prosthesis

This case report describes false-positive positron-emission tomography/computed tomography (PET/CT) findings related to oral prostheses and its implications in cancer surveillance. In head and neck cancer management, F18-flurodeoxyglucose (FDG) PET/CT is widely accepted for evaluating treatment response and detecting recurrence. Interpretation of FDG PET/CT images in this setting is often challenging due to various prostheses and reconstruction methods. Following surgery for squamous cell carcinoma of the maxillary alveolus, a 61-year-old female had a FDG PET/CT scan on a 7-month follow-up that showed high FDG uptake along the resection site. Clinical examination showed no signs of inflammation or recurrence. Repeat FDG PET/CT without the prosthesis was normal. The PET/CT attenuation-corrected images demonstrated high FDG uptake (standardized uptake value: 11.6) along the resection site corresponding to contrast-enhanced CT images of the lesion. PET/CT nonattenuation-corrected images also confirmed increased activity. Repeat PET/CT without the prosthesis was normal. FDG is not tumor specific; it can accumulate in inflammation, infection, and post-therapy settings. Metallic and high-density prostheses show radial artifacts on CT and falsely elevated FDG uptake on PET/ CT in adjacent areas. Salivary pooling may concentrate FDG. The presence of oral prostheses has not been described as a cause of this high level of activity. PET/CT images that demonstrate intense activity corresponding to dense structures should be viewed with caution. A detailed history and physical exam as well as knowledge of artifacts are pertinent for the managing physician. Laryngoscope, 2012.