Interpretability of PET/CT imaging in head and neck cancer patients following composite mandibular resection and osteocutaneous free flap reconstruction

Abstract

We investigated positron emission tomography (PET)/CT scanning following segmental resections and osteocutaneous free-flap reconstruction. The interpretability of PET/CT imaging with healing osteotomies and reconstruction hardware was analyzed. Patient scans within 18 months of surgery were interpreted for malignancy. Interpretations were compared with clinical data to determine sensitivity/specificity. Standardized uptake values (SUVs) were determined for bony controls, osteotomies, and tumors and were analyzed using paired t test. Fifteen scans were visually interpreted, 13 underwent SUV analysis. Reconstruction hardware did not interfere with interpretability. Sensitivity and specificity were 88% and 86%, respectively. Osteotomy sites averaged 25% higher SUVs compared with bony controls (vs sternum p = .003, vs mandible p = .008). Tumor SUVs were higher than osteotomies (p = .023) and controls (vs sternum p = .013, vs mandible p = .025). Although osteotomies were characterized by an increased fluorodeoxyglucose signal, scan interpretability was unimpaired. Our study suggests that PET/CT imaging can be utilized to survey free-flap patients at acceptable levels of sensitivity/specificity.