Landmark based registration of 18F FDG PET to CT in patients with head and neck cancer: Case reports

Previous studies have suggested that 18F-FDG PET can be of assistance in the monitoring of disease activity in patients with head and neck cancer undergoing radical radiotherapy treatment. Provided that an adequate period of time elapses between radiotherapy treatment and FDG-PET scanning, this metabolic imaging modality has distinct advantages over anatomical imaging modalities such as CT or MRI which rely largely on changes in size, contrast enhancement and radiodensity of residual mass. The distinction between radiation necrosis and residual tumour is particularly difficult with these modalities. Co-registration of anatomical images from CT or MRI with metabolic images from FDG-PET in this setting may help to locate residual tumour tissue more accurately than PET alone. THE PET scan was peformed on a Siemens 951/3t R PET scanner (6.5 mm in-plane resolution). Patients were positioned supine on the bed in the radiotherapy planning mask to hold the head and neck immobile. A three-bed transmission scan was peformed followed by an intravenous injection of 370 MBq of 18F-FDG. After a 45 min uptake period, a three-bed emission scan was performed to complete the study. Contrast enhanced CT was pedormed on a Picker PQ2000 helical CT scanner. Patients were scanned supine on the bed in the radiotherapy planning mask at a resolution of 21 line pairs/cm. Landmark based registration was used to co-register the PET mages to the CT images. The algorithm uses an analytic linear least-squares solution for a 12 parameter fit of at least 12 operator defined anatomical homologous landmarks in the two image volumes. Both the CT and PET scans include an area of the patient from the base of the brain to the lung apices, thus providing sufficient landmarks for the registration algorithm. We present two patients in whom FDG-PET and CT were used as tools in monitoring disease activity