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RESUMEN La captación de 18 FDG en PET-TC por un adenoma hepatocelular (HCA) es poco frecuente. Esta situación genera dudas en cuanto a los diagnósticos diferenciales y tratamiento. El objetivo de este artículo fue realizar una mini revisión de los últimos 37 años de HCA con avidez por el 18FDG y presentar un nuevo caso. Sobre la base de un estudio realizado por otros autores entre 1984 y 2014, se amplía la búsqueda utilizando las mismas palabras clave hasta el año 2021. Se analizan los datos relevantes. Entre 1984 y 2021 detectamos 38 casos en 37 años. Fue más frecuente en mujeres en edad reproductiva. Los subtipos H-HCA e I-HCA fueron los más frecuentes. El tratamiento quirúrgico fue el más empleado. La diferenciación celular y los trastornos metabólicos de la glucosa y de los lípidos favorecerían la captación de 18FDG. La resección hepática ofrecería mayores garantías permitiendo el estudio completo de la lesión.
ABSTRACT Hepatocellular adenoma (HCA) uptake of 18FDG uptake on PET-CT is rare. This situation poses doubts about the differential diagnoses and treatment. The aim of this article is to perform a mini review of 18FDG avid HCA over the past 37 years and to describe a new case presentation. Based on a study conducted by other authors between 1984 and 2014, we extended the search until 2021 using the same keywords. The relevant data were analyzed. Between 1984 and 2021 we detected 38 cases in 37 years. HCAs were more common in women of childbearing age. The most common types were H-HCA an I-HCA. Surgical resection was the treatment most used. Cell differentiation and glucose and lipid metabolic diseases would favor 18FDG uptake. Liver resection provides better outcomes, allowing for a complete examination of the lesion.
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F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy.
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Metastatic sex cord stromal tumor (SCST) is rare and contributing <1% of ovarian tumors. A 42-year-old female presented with lower abdominal pain for 2 months. Ultrasonography revealed masses in the abdominal and pelvic. USG guided biopsy from the pelvic mass revealed SCST. For staging, whole body F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed and revealed heterogenous mildly FDG avid retroperitoneal and bilateral pelvic masses with lung nodules. To confirm the nature of the lung nodule; PET-CT guided biopsy performed and revealed metastatic SCST. After three cycle of chemotherapy, clinical, biochemical and imaging show partial response to treatment.
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@#Primitive neuroectodermal tumours (PNETs) occurring directly from the lung parenchyma without involvement of the chest wall or pleura are particularly unusual. We describe a 16-year-old male who presented with severe chest and back pain following a fall during high jump competition. Incidental finding of an opacity at the right lung upper lobe was seen on his chest radiograph. Computed tomography of the thorax demonstrated a lobulated hypodense lesion in the anterior segment of right upper lobe and subsequent biopsy confirmed the diagnosis of Ewing Sarcoma/ PNET following histologic and immunohistochemical examination. Whole-body positron emission computed tomography/computed tomography (PET/CT) revealed mild, homogenous F18-fluorodeoxyglucose (FDG) uptake in the lung lesion with no evidence of metastasis. He eventually underwent right thoracotomy and right upper lobectomy. Indeed, F18-FDG PET/CT is a valuable imaging method in demonstrating active focus of glucose metabolism in lung parenchymal lesion, for preoperative evaluation and as baseline scan for patient’s monitoring.
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Tuberculous scar tumour is difficult to diagnose as it does not present with any respiratory symptoms and has a negative chest X-ray. This is a case report on the use of dual tracer 11C-acetate and 18F-fluorodeoxyglucose (18FDG) whole body positron emission tomography-computerised tomography (PET-CT) for detection of tuberculous scar tumour. A 44-year-old Chinese female was incidentally found to have a raised serum Ca 19.9. Magnetic resonance imaging of the whole abdomen, upper endoscopy, and colonoscopy were all unremarkable. A low-dose computed tomography (CT) of the thorax showed bilateral upper lobe fibrosis. Bronchoalveolar lavage for culture and cytology was negative. A dual tracer 11C-acetate and 18FDG whole body PET-CT showed that the left upper lobe fibrosis was hypermetabolic in nature. It was more avid for 11C-acetate than for 18FDG. The left upper lobe lesion was subsequently confirmed on open lung biopsy to be a moderately differentiated adenocarcinoma. Therefore, in a tuberculous endemic region, dual tracer whole body PET-CT with 11C-acetate and 18FDG may have a role in the early detection of tuberculous scar tumour in the lung.
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Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The tumour arises from the mesothelial cells lining the pleura and peritoneum or, rarely, in the pericardium or tunica vaginalis. This neoplasm is characterized by being difficult to diagnose, having a rapid evolution and a poor response to therapy. Mesothelioma is very glucose avid, and malignant pleural mesothelioma has been reported concerning the utility of F-18 FDG PET or PET/CT. But little has been known about the imaging finding of malignant peritoneal mesothelioma on F-18 FDG PET/CT. We report a case of malignant peritoneal mesothelioma mimicking peritoneal carcinomatosis of F-18 FDG PET/CT.
Subject(s)
Carcinoma , Glucose , Mesothelioma , Pericardium , Peritoneum , PleuraABSTRACT
We present a patient with high 18F-fluorodeoxyglucose (FDG) uptake detected in a neurofibroma that was confused with sarcomatous transformation on a positron emission tomography/computed tomography (PET/CT) scan. A 39-year-old male patient with a 20-year history of neurofibromatosis-1 (NF-1) performed FDG PET/CT scan for the evaluation of lesions with sarcomatous transformation. The FDG PET/CT images demonstrated varying degrees of increased FDG uptake in the multiple nodules throughout whole body. The left pelvic mass with the highest FDG uptake had a maximum standardized uptake values (maxSUV) 5.0 and surgical resection was performed. Histological analysis confirmed the presence of a benign neurofibroma infiltrated with inflammatory cells.
Subject(s)
Adult , Humans , Male , Electrons , Neurofibroma , NeurofibromatosesABSTRACT
A 60-year-old woman, who had non-small-cell lung cancer (NSCLC) in left lower lobe underwent brain F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for evaluation of cerebral metastasis. On follow-up FDG-PET/CT, only hypometaolic lesion was detected and progressed in right frontal lobe at 6 months and 10 months, later. Hypermetabolic metastasis was not detected even at last scan time of FDG-PET/CT. Brain MRI showed brain metastasis in right frontal lobe. As might be expected, the physician should take cerebral metastasis into consideration even though there is only hypometabolic change on subsequent FDG-PET/CT in patients with NSCLC.
Subject(s)
Female , Humans , Middle Aged , Brain , Electrons , Follow-Up Studies , Frontal Lobe , Lung , Lung Neoplasms , Neoplasm MetastasisABSTRACT
Imaging approach for early diagnosis, accurate staging, and the evaluation of treatment response has been consisted of anatomical and functional imaging methods. The anatomical image usually depends on high spatial resolution to distinguish morphological difference from normal anatomy, but altered anatomy is not a specific finding for malignancy. Moreover, it frequently needs other imaging modalities for systemic evaluation of disease. The functional image has been used for research and clinical purpose to overcome these shortcomings of the anatomical image, and the importance of functional evaluation of tumors is widely accepted by the introduction of Positron Emission Tomography (PET). Most of the PET systems at present are supplied as PET/CT combining functional and anatomical images, altogether. Especially for hepatobiliary tumors, showing a low sensitivity by PET alone, PET/CT will play an important role in determining TNM stage, deciding treatment modality, and evaluating treatment response. In addition, PET/CT as the most advanced molecular image technique has further growing potentials such as the development of a faster PET system, various new PET tracers, etc, which will contribute to improving patient survival and the quality of life.
Subject(s)
Humans , Bile Duct Neoplasms , Carcinoma, Hepatocellular , Early Diagnosis , Electrons , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Quality of LifeABSTRACT
PURPOSE: This study was designed to investigate the cellular uptake of various tumor imaging radiopharmaceuticals in human breast cancer cells before and after paclitaxel exposure considering viable cell number. MATERIALS AND METHODS: F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin were used to evaluate the cellular uptake in MCF-7 cells. MCF-7 cells were cultured in multi-well plates. Wells were divided into DMSO exposure control group, and paclitaxel exposure group. The exposure durations of paclitaxel with 10 nM or 100 nM were 2 h, 6 h, 12 h, 24 h, and 48 h. RESULTS: Viable cell fraction was reduced as the concentration and exposure time of paclitaxel increased. After 10 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was not reduced significantly, irrespective of exposure time and viable cell fraction. After 100 nM paclitaxel exposure, the cellular uptake of all 5 radiopharmaceuticals was enhanced significantly irrespective of viable cell fraction. The peak uptake was observed in experimental groups with paclitaxel exposure for 6 to 48 h according the type of radiopharmaceutical. When the cellular uptake was adjusted for the viable cell fraction and cell count, the peak cellular uptake was observed in experimental groups with paclitaxel exposure for 48 h, irrespective of the type of radiopharmaceutical. CONCLUSION: The cellular uptake of F-18-fluorodeoxyglucose, C-11-methionine, Tl-201, Tc-99m-MIBI, and Tc-99m-tetrofosmin did not reflect viable cell number in MCF-7 cells after paclitaxel exposure for up to 48 h.
Subject(s)
Humans , Breast Neoplasms , Breast , Cell Count , Cell Line , Cell Survival , Dimethyl Sulfoxide , MCF-7 Cells , Paclitaxel , RadiopharmaceuticalsABSTRACT
Whole body positron emission tomography (PET) using F-18 Fluorodeoxyglucose (FDG) has been used for characterizing focal lesions, initial staging, monitoring recurrence, and post-therapeutic follow-up in various malignant tumors. A recently developed integrated PET/computed tomography (CT) scanner is able to perform hardware-based image fusion of functional PET and anatomical CT images with ease and high registration accuracy. F-18 FDG PET/CT is more useful than conventional PET due to the shorter scan time and easy differential diagnosis between physiological and pathological uptake, allowing for accurate anatomical localization, improved diagnostic confidence and accuracy, and better radiation therapy planning. The application of F-18 FDG PET/CT in oncology practice is on its sharp rise in Korea due to the recent change of the reimbursement system to allow insurance coverage along with its wide range of clinical utilities. Whole body PET/CT deserves a particular attention as a useful diagnostic imaging modality in oncology practice.
Subject(s)
Diagnosis, Differential , Diagnostic Imaging , Electrons , Follow-Up Studies , Insurance Coverage , Korea , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , RecurrenceABSTRACT
PURPOSE: Accurate evaluation of cervical lymph node (LN) metastasis of head and neck squamous cell cancer (SCC) is important to treatment planning. We evaluated the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of cervical LN metastasis of head and neck SCC and performed a retrospective comparison with CT/MRI findings. MATERIALS AND METHODS: Seventeen patients with pathologically proven head and neck SCC underwent F-18 FDG PET/CT and CT/MRI within 4 week before surgery. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. F-18 FDG PET/CT images were analyzed visually for assessment of regional tracer uptake in LN. We analyzed the differences in sensitivity and specificity between F-18 FDG PET/CT and CT/MRI using the Chi-square test. RESULTS: Among the 17 patients, a total of 123 LN levels were dissected, 29 of which showed metastatic involvement. The sensitivity and specificity of F-18 FDG PET/CT for detecting cervical LN metastasis on a level-by-level basis were 69% (20/29) and 99% (93/94). The sensitivity and specificity of CT/MRI were 62% (18/29) and 96% (90/94). There was no significant difference in diagnostic accuracy between F-18 FDG PET/CT and CT/MRI. Interestingly, F-18 FDG PET/CT detected double primary tumor (hepatocellular carcinoma) and rib metastasis, respectively. CONCLUSION: There was not statistically significant difference of diagnostic accuracy between F-18 FDG PET/CT and CT/MRI for the detection of cervical LN metastasis of head and neck SCC. The low sensitivity of F-18 FDG PET/CT was due to limited resolution for small metastatic deposits.
Subject(s)
Humans , Classification , Electrons , Head and Neck Neoplasms , Head , Lymph Nodes , Neck , Neoplasm Metastasis , Neoplasms, Squamous Cell , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography , Retrospective Studies , Ribs , Sensitivity and SpecificityABSTRACT
PURPOSE: FDG uptake on positron emission tomography (PET) has been considered a prognostic indicator in non-small cell lung cancer (NSCLC). The aim of this study was to assess the clinical significance of maximum value of SUV (maxSUV) in recurrence prediction in patients with surgically resected NSCLC. MATERIALS AND METHODS: NSCLC patients (n=42, F:M=14:28, age 62.3+/-12.3 y) who underwent curative resection after FDG-PET were enrolled. Twenty-nine patients had pathologic stage I, and 13 had pathologic stage II. Thirty-one patients were additionally treated with adjuvant oral chemotherapy. MaxSUVs of primary tumors were analyzed for correlation with tumor recurrence and compared with pathologic or clinical prognostic indicators. The median follow-up duration was 16 mo (range, 3-26 mo). RESULTS: Ten (23.8%) of the 42 patients experienced recurrence during a median follow-up of 7.5 mo (range, 3-13 mo). Univariate analysis revealed that disease-free survival (DFS) was significantly correlated with maxSUV ( or =7, p=0.006), tumor size ( or =3 cm, p=0.024), and tumor cell differentiation (well/moderate vs. poor, p=0.044). However, multivariate Cox proportional analysis identified maxSUV as the single determinant for DFS (p=0.014). Patients with a maxSUV of > or =7 (n=10) had a significantly lower 1-year DFS rate (50.0%) than those with a maxSUV of <7 (n=32, 87.5%). CONCLUSION: MaxSUV is a significant independent predictor for recurrence in surgically resected NSCLC. FDG uptake can be added to other well-known factors in prognosis prediction of NSCLC.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Cell Differentiation , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lung Neoplasms , Lung , Positron-Emission Tomography , Prognosis , RecurrenceABSTRACT
Lung cancer has become a leading cause of cancer death in Korea. Accurate staging of non-small cell lung cancer (NSCLC) is essential to the ability to offer a patient the most effective available treatment and the best estimate of prognosis. PET with F-18 fluorodeoxyglucose (FDG) is indicated for the nodal staging of NSCLC and detection of distant metastases. Use of PET for mediastinal staging should not be relied on as a sole staging modality, and positive findings should be confirmed by mediastinoscopy. FDG PET avoids futile surgery by a more accurate selection of patients, especially by the detection of unexpected distant metastases.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Korea , Lung Neoplasms , Mediastinoscopy , Neoplasm Metastasis , PrognosisABSTRACT
PURPOSE: In uterine cervical cancer, it is clinically important to predict prognosis on initial staging. We investigated whether abnormally increased FDG uptake of lymph nodes and peak SUV of primary tumor on initial FDG PET can predict prognosis after treatment in cervical cancer patients. MATERIALS AND METHODS: Subjects were 74 newly diagnosed cervical cancer patients (50+/-12yr). Whole body PET was performed after an injection of F-18 FDG. Peak SUV was measured in the primary cervical tumor. Images were interpreted by two nuclear medicine physicians. Follow-up for the disease-free survival was done in all patients. Survival analysis was done by using the Kaplan-Meier method, and a Logrank test was used to compare survival. Cox regression analysis was followed to find independent predictive factors. RESULTS: Recurrence occurred in 13 patients. In univariate analysis, advanced FIGO stage, large size of primary tumor, positive lymph node on MRI or CT, and positive lymph node on PET were significant prognostic factors to predict recurrence. Peak SUV and cell type of tumor failed to show any significant correlation with disease-free survival. In multivariate analysis, positive lymph node on PET (Exp (beta) =6.416, p=0.002) and on CT or MRI (Exp (beta) =5.711, p=0.026) were independent prognostic factors for predicting recurrence. CONCLUSION: In uterine cervical cancer, lymph node metastasis of pretreatment FDG PET is the best independent prognostic factor for predicting recurrence. But, peak SUV was not significant prognostic factor.
Subject(s)
Humans , Disease-Free Survival , Follow-Up Studies , Lymph Nodes , Magnetic Resonance Imaging , Multivariate Analysis , Neoplasm Metastasis , Nuclear Medicine , Positron-Emission Tomography , Prognosis , Recurrence , Uterine Cervical NeoplasmsABSTRACT
PURPOSE: To assess the quantitative accuracy and the clinical utility of 3D volumetric PET imaging with FDG in brain studies, 24 patients with various neurological disorders were studied. MATERIALS AND METHODS: Each patient was injected with 370 MBq of 2-[18F]fluoro-2-deoxy-D-glucose. After a 30 min uptake period, the patients were imaged for 30 min in 2 dimensional acquisition (2D) and subsequently for 10 min in 3 dimensional acquisition imaging (3D) using a GE AdvanceTM PET system. The scatter corrected 3D (3D SC) and non scatter-corrected 3D images were compared with 2D images by applying ROIs on gray and white matter, lesion and contralateral normal areas. Measured and calculated attenuation correction methods for emission images were compared to get the maximum advantage of high sensitivity of 3D acquisition. RESULTS: When normalized to the contrast of 2D images, the contrasts of gray to white matter were 0.75+/-0.13 (3D) and 0.95+/-0.12 (3D SC). The contrasts of normal area to lesion were 0.83+/-0.05 (3D) and 0.96+/-0.05 (3D SC). Three nuclear medicine physicians judged 3D SC images to be superior to the 2D with regards to resolution and noise. Regional counts of calculated attenuation correction was not significantly different to that of measured attenuation correction. CONCLUSION:: 3D PET images with the scatter correction in FDG brain studies provide quantitatively and qualitatively similar images to 2D and can be utilized in a routine clinical setting to reduce scanning time and patient motion artifacts.