Three-Dimensional Image Fusion of FDG-PET/CT and Contrast-Enhanced CT for Computer-Assisted Planning of Maxillectomy of Recurrent Maxillary Squamous Cell Carcinoma and Defects Reconstruction

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng
PurposeTo describe a new technology assisted by three-dimensional image fusion of ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸FDG-PET/CT) and contrast-enhanced CT (CECT) for computer planning of a maxillectomy of recurrent maxillary squamous cell carcinoma and defects reconstruction.MethodsTreatment of recurrent maxillary squamous cell carcinoma usually includes tumor resection and free flap reconstruction. ¹⁸FDG-PET/CT provided images of regions of abnormal glucose uptake and thus demonstrated metabolic tumor volume to guide tumor resection CECT data were used to create three-dimensional (3D) reconstructed images of vessels, to demonstrate the vascular diameters and locations, so that the most suitable vein and artery could be selected during anastomosis of the free flap. The data of preoperative maxillofacial CECT scans and ¹⁸FDG-PET/CT were imported into the navigation system (iPlan 3.0; Brainlab, Feldkirchen, Germany). Three-dimensional image fusion between FDG-PET/CT and CECT was accomplished using the Brainlab software according to the position of the two skulls simulated respectively in the CECT and PET/CT. After verification of the image fusion accuracy, the 3D reconstruction images of the metabolic tumor, vessels, and other critical structures could be visualized within the same coordinate system. These sagittal, coronal, axial, and 3D reconstruction images were used to determine the virtual osteotomy sites and reconstruction plan, which was provided to the surgeon and used for surgical navigation.ResultThe average shift of the 3D image fusion between FDG-PET/CT and CECT was <1 mm. This technique, by clearly demonstrating the metabolic tumor volume and the most suitable vessels for anastomosis, facilitated resection and reconstruction of recurrent maxillary squamous cell carcinoma.ConclusionsWe used 3D image fusion of FDG-PET/CT and CECT to successfully accomplish resection and reconstruction of recurrent maxillary squamous cell carcinoma. This method has the potential to improve the clinical outcomes of this challenging procedure.



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