PET-CT with MR Fusion: Single Comprehensive Preoperative Metastatic Workup in Head and Neck Malignancy: A Case Report

Head neck cancers (HNC) are the sixth most common cancer worldwide. In presence of the complex anatomy of this region, early diagnosis can sometimes be a challenge. At present for the TNM staging, contrast enhanced CT and MRI are the primary imaging modalities for evaluating T stage of HNSCC. Multiple studies suggest that PET/CT might be superior to conventional imaging (CT or MRI) in initial staging and may alter management and treatment especially when distant metastases are discovered. We present a case of a 35-year-old patient who presented to us with an ulcerative lesion on the left buccal mucosa, which was staged as cT2N0M0, using the conventional radiology. But on subsequent imaging by PET-CT with MR-fusion was upstaged to cT4bN0M0, thus completely changing the management of the patient. With the recent advances in technology leading to fusion of MRI images with PET-CT images have combined the benefits of all three imaging modalities and has led to increased sensitivity towards soft tissue and peri-neural invasion of tumours leading to upstaging of primary oral cavity malignancies, altering their management. Accuracy is increased when the information of multiple imaging modalities are analysed together and has the potential of changing the management plan of patients.