The Angry Torus: Osteoradionecrosis Resulting in a Potential Positron-Emission Tomography/CT Pitfall

Authors: Mayo, Ray C.; Ginsberg, Lawrence E.

Source: Neurographics, Volume 1, Number 3, December 2011 , pp. 105-107(3)

Publisher: American Society of Neuroradiology

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Abstract:

A 59-year-old woman, status post resection of a sinonasal carcinoma, underwent staging PET/CR, which showed increased FDG uptake in multiple areas, including the hard palate. Histologic results from several biopsy sites confirmed metastatic tumor, but only acute-on-chronic inflammation in the palate. One percent of the population has a bony overgrowth at the palatine suture, a torus palatinus. A combination of oral trauma and radiation therapy may predispose the torus palatinus to become inflamed, with resultant increased FDG uptake on PET/CT. This, in turn, may lead to a false-positive interpretation. Given the morbidity associated with osteoradionecrosis, unnecessary biopsy is contraindicated, and radiologists should be aware of an inflamed (angry) torus palatinus to avoid a potential imaging pitfall.

Keywords: FDG = fluorodeoxyglucose (18F); PET = positron-emission tomography

Document Type: Research article

DOI: http://dx.doi.org/10.3174/ng.3110017

Publication date: 2011-12-01

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Neurographics is the peer-reviewed, quarterly educational journal of the American Society of Neuroradiology. The journal comprises mainly articles created from select scientific exhibits at the ASNR Annual Meeting. Neurographics will also publish other high-quality submissions that are primarily educational and have a high emphasis on a pictorial approach. Articles are available free online, and a print-on-demand edition can be ordered from the Neurographics site.
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