Head and Neck Cancer Soft Tissue Radiation Necrosis - Diagnostic Challenge

Darko Pucar, Michael W. Groves, Paul Biddinger, Ramon Figueroa, Hadyn T. Williams

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


A 53-year-old man with T4aN2cM0 tongue base squamous cell carcinoma received definitive chemoradiation. FDG PET/CT at 6 weeks showed partial metabolic response with soft tissue air indicating radiation necrosis at primary site and complete response in the neck. At 9 weeks, contrasted CT showed worsening but nonenhancing ulceration, area biopsied demonstrating a minute carcinoma focus with treatment effect. At 12 weeks, PET/CT showed increased primary site uptake interpreted as disease progression; however, no viable tumor was found at salvage surgery. Because nonenhancing ulceration predicts pure radiation necrosis with no viable tumor, contrasted CT may guide treatment selection in challenging cases.

Original languageEnglish (US)
Pages (from-to)e110-e112
JournalClinical nuclear medicine
Issue number2
StatePublished - Feb 1 2019


  • contrasted CT
  • head and neck cancer
  • radiation necrosis
  • soft tissue

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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