Fig. 5.
True positive evaluation with combined PET/DWIMRI (positive concordant findings on MRI, DWI and PET). Sixty-nine-year old male with pain 4 years after radiochemotherapy for SCC of the hypopharynx. Unenhanced T1 (A): poorly defined hypointensity in both aryepiglottic folds, pre-epiglottic space and retropharyngeal space. Contrast-enhanced T1 (B): infiltrative, moderately enhancing lesion (white arrows) in the right paraglottic and pre-epiglottic space with invasion into the soft tissues of the neck (black arrow) suggesting recurrence. Note strongly enhancing retropharygeal space and left aryepiglottic fold due to inflammatory oedema. (C) ADC map: restricted diffusion on the right (arrows, ADCmean = 0.997–10-3 mm2/s) consistent with recurrence. High signal in the left paraglottic space and retropharyngeal space (ADCmean = 1.815 × 10-3 mm2/s) due to inflammatory oedema. (D) PET/MRI (PET fused with gadolinium-enhanced Dixon) consistent with recurrence (arrows, SUVmean = 4.417; SUVmax = 5.518). (E) Corresponding whole-organ axial histological section (haematoxylin-eosin, HE) confirms recurrence on the right (arrows) and inflammatory oedema on the left and in the retropharyngeal space. (F) Section from right specimen periphery (HE, original magnification 100×) depicts venous tumour thrombi. T stage on PET/DWIMRI was T4a. Pathological stage was pT4a