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Figure 3c. Asymmetric muscle uptake in a 62-year-old woman with squamous cell carcinoma of the tongue who had undergone neck dissection. (a) Axial FDG PET scans demonstrate multiple hypermetabolic foci in the right anterolateral cervical region. Asymmetric and superficial uptake in the right anterior portion of the neck (arrowheads) suggests tense sternocleidomastoid muscle uptake. An additional asymmetric focus of uptake is noted posterior to the right sternocleidomastoid muscle (long arrow) and suggests cervical lymph node metastasis, although unilateral cervical muscle uptake cannot be excluded (cf Fig 4). Symmetric foci seen within the larynx (short arrows) probably represent the intrinsic laryngeal muscles. (b, c) Axial CT (b) and PET-CT fusion (c) images help confirm that the superficial asymmetric FDG uptake in the anterior cervical region corresponds to the right sternocleidomastoid muscle (arrowhead). The absence of contralateral muscle uptake is due to prior neck dissection. The unilateral focus of uptake posterior to the right sternocleidomastoid muscle (long arrow) corresponds to a cervical lymph node, and symmetric foci within the larynx (short arrows) correspond to the intrinsic laryngeal muscles and cricoarytenoid muscles posteriorly. The results of simultaneous evaluation with PET and CT confirmed the diagnosis of (advanced) metastatic disease in the neck and had a significant impact on clinical management. The patient was started on therapy on the basis of the PET-CT findings.
