Chronic Periaortitis – Review and Presentations

Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis andinflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case showsa classic picture ofIgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery

Abnormal Cerebral Glucose Metabolism in Patients with Narcolepsy

BACKGROUND: The purpose of this study was to investigate the differences of cerebral glucose metabolism between narcoleptic patients and normal controls. METHODS: We enrolled 24 patients with narcolepsy who underwent night polysomnography and multiple sleep latency tests to confirm the narcolepsy. 18F-fluorodeoxy glucose positron emission tomography scan was performed in all narcoleptic patients and 24 normal age-sex matched controls. To compare the cerebral glucose metabolism between the two groups, statistical parametric mapping (SPM99) was used. RESULTS: Patients with narcolepsy showed significant decreases of cerebral glucose metabolism in the bilateral rectal and subcallosal gyri, right superior frontal gyrus, right medial frontal gyrus, bilateral precuneus, right inferior parietal lobule, and left supramarginal gyrus of the parietal lobe at the uncorrected P<0.001. The bilateral posterior hypothalami and mediodorsal thalamic nuclei showed glucose hypometabolism at the level of corrected P<0.05 with small volume correction. CONCLUSIONS: This study showed cerebral glucose hypometabolism of hypothalamus-thalamus-orbitofrontal pathways in narcoleptic brains. The distribution of abnormal glucose metabolism is concordant to the cerebral pathways of the hypocretin system.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

A Case of Thyroid Cancer Detected with Pet Scan

Although the utility of FDG-PET scan is usually limited to the follow up of a recurrence follow the resection of primary malignant tumors. Its usefulness may be widen to the diagnosis in some malignant neoplasms; that use mostly glucose their energy sources. Thyroid cancers use glucose for their metabolic activities and incidental focal thyroid uptake shown on FDG-PET scans may be representative of a primary tumor. Therefore, increased focal thyroid uptake shown on whole body FDG-PET scans should not be overlooked even when it is not marked, and prompt further investigation should be done to rule out a possible cancer. We present a case of thyroid cancer, incidentally detected with a PET scan in a 60-year-old-man. We also present a review of the literatures regarding the usefulness of PET scan in thyroid cancer.

Feasibility of FDG-PET Scan before Second Look Operation in Patients with Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: This study is to investigate whether Positron Emission Tomography (PET) is useful for determining pathologic complete response in patients with ovarian carcinoma who had a clinical complete response after primary treatment. METHODS: FDG-PET scans were performed in 10 patients with advanced ovarian cancer (4 patients with stage IIC, 6 patients with IIIC), who showed complete response with cytoreductive surgery and 6 cycles of post-operative adjuvant Cisplatin-based combination chemotherapy. FDG-PET scan was obtained with GE Advance Scanner, beginning at 50 minutes after injection of 370-555 MBq (10-15 mCi) of 18F FDG. Uptakes exceeding 3.5 SUV (Standardized Uptake Value) or larger than surrounding tissue were determined as a positive findings. Second-look laparotomy was undertaken within median 4 days after FDG-PET scanning. RESULTS: The mean age of the patients was 45 years and serous cystadenocarcinoma was most common histologic type. None showed active lesion in pelvis or abdomen with FDG-PET scan (SUV: >3.5 kg/ml), however, 5 patients (50%) showed residual tumors on multiple biopsy during second look operation. One patient showed positive lesion in lung on FDG-PET scan, which was confirmed to have metastatic lesion. CONCLUSION: FDG-PET scan is not useful for detection of small ovarian cancer lesions in pelvis and abdomen and cannot substitute for second-look operation to determine pathologic complete response.