Recurrent Laryngeal Nerve Palsy in Patients with Lung Cancer: Detection with PET-CT Image Fusion—Report of Six Cases

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) was performed for preoperative staging of lung cancer. In six of 184 patients, there was an intense FDG accumulation in the lower anterior neck. Fusion of PET and computed tomographic images revealed that the focal FDG uptake was localized in the internal laryngeal muscles. This finding was a result of compensatory laryngeal muscle activation caused by contralateral recurrent laryngeal nerve palsy due to direct nerve invasion by lung cancer of the left mediastinum or lung apices. The knowledge of this pitfall is important to avoid false-positive PET results.

© RSNA, 2002


  • 1 Steinert HC, Hauser M, Allemann F, et al. Non–small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology 1997; 202:441-446. LinkGoogle Scholar
  • 2 Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg 1998; 66:886-893. Crossref, MedlineGoogle Scholar
  • 3 Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non–small-cell lung cancer with positron-emission tomography. N Engl J Med 2000; 343:254-261. Crossref, MedlineGoogle Scholar
  • 4 Kalff VV, Hicks RJ, MacManus MP, et al. Clinical impact of (18)F fluorodeoxyglucose positron emission tomography in patients with non–small-cell lung cancer: a prospective study. J Clin Oncol 2001; 19:111-118. Crossref, MedlineGoogle Scholar
  • 5 Engel H, Steinert H, Buck A, Berthold T, Huch Böni RA, von Schulthess GK. Whole-body PET: physiological and artifactual fluorodeoxyglucose accumulations. J Nucl Med 1996; 37:441-446. MedlineGoogle Scholar
  • 6 Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996; 23:1409-1415. Crossref, MedlineGoogle Scholar
  • 7 Cook GJ, Maisey MN, Fogelman I. Normal variants, artefacts and interpretative pitfalls in PET imaging with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med 1999; 26:1363-1378. Crossref, MedlineGoogle Scholar
  • 8 Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. RadioGraphics 1999; 19:61-77. LinkGoogle Scholar
  • 9 Hamacher K, Coenen HH, Stöcklin G. Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986; 27:235-238. MedlineGoogle Scholar
  • 10 Mikolajczyk K, Szabatin M, Rudnicki P, Grodzki M, Burger C. A JAVA environment for medical image data analysis: initial application for brain PET quantitation. Med Inform 1998; 23:207-214. Crossref, MedlineGoogle Scholar
  • 11 Fujimoto T, Itoh M, Tashiro M, Yamaguchi K, Kubota K, Ohmori H. Glucose uptake by individual skeletal muscles during running using whole-body positron emission tomography. Eur J Appl Physiol 2000; 83:297-302. Crossref, MedlineGoogle Scholar
  • 12 Barrington SF, Maisey MN. Skeletal muscle uptake of fluorine-18-FDG: effect of oral diazepam. J Nucl Med 1996; 37:1127-1129. MedlineGoogle Scholar
  • 13 Kostakoglu L, Wong JC, Barrington SF, Cronin BF, Dynes AM, Maisey MN. Speech-related visualization of laryngeal muscles with fluorine-18-FDG. J Nucl Med 1996; 37:1771-1773. MedlineGoogle Scholar
  • 14 Tucker HM, Laverty P. Paralysis and paresis of the vocal folds. In: Blitzer A, Brin MF, Sasaki CT, Fahn S, Harris KS, eds. Neurologic disorders of the larynx. 5th ed. New York, NY: Thieme, 1992; 182-189. Google Scholar
  • 15 Kraus DH, Ali MK, Ginsberg RJ, et al. Vocal cord medialization for unilateral paralysis associated with intrathoracic malignancies. J Thorac Cardiovasc Surg 1996; 111:334-341. Crossref, MedlineGoogle Scholar
  • 16 Hong KH, Jung KS. Arytenoid appearance and vertical level difference between the paralyzed and innervated vocal cords. Laryngoscope 2001; 111:227-232. Crossref, MedlineGoogle Scholar
  • 17 Howard D. Neurological affections of the pharynx and larynx In: Kerr AG, Groves J. Scott-Brown’s otolaryngology. 5th ed. London, England: Butterworths, 1987; 169-185. Google Scholar

Article History

Published in print: July 2002