Easy interpretation of heterotopic ossification demonstrated on bone SPECT/CT.

A 29-year-old male patient suffered from paraplegia 6 months after brain injury. Heterotopic ossification was diagnosed based on clinical characteristics such as decreased range of motion at the bilateral hips without infective signs. A planar bone scintigraphy using Tc-MDP showed intensive radiotracer accumulation in the proximal portion of the bilateral femurs and the right acetabulum. The SPECT/CT images showed increased radiotracer accumulation in the adjacent soft tissues of the bilateral hips but not in the bone. The conservative treatment rather than surgical intervention was given according to the findings in bone SPECT/CT images.

Opportunities for 2-[(18)F] fluoro-2-deoxy-D-glucose PET/CT in cervical-vaginal neuroendocrine carcinoma: case series and literature review.

OBJECTIVE: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[(18)F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) scan for the detection of this rare malignancy. MATERIALS AND METHODS: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). RESULTS: Two cases (cases 1 and 4) were restaged after (18)F-FDG PET/CT scan in the initial staging process. Post-treatment (18)F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. CONCLUSION: (18)F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the (18)F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the (18)F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.

Positive correlation between serum liver enzyme levels and standard uptake values of liver on FDG-PET.

PURPOSE: The aim of the study is to assess the relationship between serum liver enzyme level, hepatic virus infectious state, and standard uptake value of liver on 2-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET). MATERIAL AND METHODS: It is the retrospective review study from September 2005 to September 2007. A total of 354 healthy subjects referred from the Department of Community Medicine and Health Examination Center of our hospital for health screening were reviewed retrospectively and recruited for analysis. Whole-body FDG-PET, serum liver enzyme levels [aspartate aminotransferase (AST) or SGOT and alanine aminotransferase (ALT) or SGPT], and hepatic B (HBV)/hepatic C virus (HCV) infectious states by checking serum antibodies were performed in all subjects. The mean and maximal values of standard uptake values (SUV) of liver were calculated. The relationships between serum liver enzyme levels, hepatic virus infectious states, and standard uptake values of liver on FDG-PET were evaluated. RESULT: There is statistically significant positive correlation between SGOT/SGPT and SUV of liver on FDG-PET. However, there are no significant differences in the SUV of liver on FDG-PET between HBV/HCV infection and nonhepatic virus infection subjects. CONCLUSION: High FDG uptake in the liver because of high level of SGOT/SGPT may lower the diagnostic sensitivity of hepatic malignant or infectious lesions on FDG-PET. For avoiding false-negative findings, careful evaluation of liver on FDG-PET and correlation with other clinical manifestations should be recommended in patients with high level of SGOT/SGPT. Nevertheless, neither HBV/HCV infectious states significantly influences on the SUV of liver on FDG-PET.

Detection of recurrent nasopharyngeal carcinomas after radiotherapy with technetium-99m tetrofosmin single photon emission computed tomography in patients with indeterminate magnetic resonance imaging findings.

The aim of this study is to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of head and neck for detecting suspected recurrence of nasopharyngeal carcinomas (NPCs) when magnetic resonance imaging (MRI) findings are indeterminate. MRI was performed 4 months after radiotherapy and 26 NPC patients with indeterminate MRI findings were included. MRI, Tc-99m TF SPECT, and biopsy were performed within 1 week. The final results were based on histopathologic findings and clinical follow-up for at least 6 months. For detecting recurrent NPC in indeterminate MRI findings, the sensitivity, specificity, and accuracy of Tc-99m TF SPECT were 92.3%, 100.0%, and 96.2%, respectively. Based on this result, we can suggest Tc-99m TF SPECT is effective to detect recurrent NPC when MRI findings are indeterminate. However, further studies including a larger NPC patient population are warranted to determine the exact role and clinical usefulness of Tc-99m TF SPECT to differentiate benign lesions and recurrent NPC when MRI findings are indeterminate.

Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings.

OBJECTIVE: In advanced cervical cancer, it has been reported that progression-free survival is significantly related to para-aortic lymph node metastasis. Computed tomography (CT) has been widely used for clinical staging, but its sensitivity for lymph nodal metastasis is low. Therefore, this prospective study was undertaken to evaluate (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting para-aortic lymph nodal metastasis in patients with locally advanced cervical carcinoma when CT findings were negative. METHODS: Fifty women with advanced cervical cancer confined to the pelvis with negative abdominal CT findings were included in this study. After 10 mCi of FDG was administered intravenously, the abdomens were scanned by PET. Para-aortic lymph node metastases were diagnosed as present or absent according to a standardized staging procedure. RESULTS: Retroperitoneal surgical exploration revealed 14 patients with para-aortic lymph nodal metastasis. Two patients had false-negative FDG-PET findings and the other two patients had false-positive FDG-PET findings. CONCLUSION: Overall, FDG-PET imaging had a sensitivity of 85.7%, a specificity of 94.4%, and an accuracy of 92%. When abdominal CT findings are negative, the use of FDG-PET can accurately detect para-aortic lymph nodal metastatis in patients with advanced cervical cancer.

Usefulness of thallium-201 SPECT scintimammography to differentiate benign from malignant breast masses in mammographically dense breasts.

The purpose of this study was to assess the usefulness of thallium-201 (Tl-201) single-photon emission-computed tomography (SPECT) scintimammography to differentiate benign from malignant breast masses in 32 female Taiwanese patients with indeterminate mammographic probability of malignancy because of mammographically dense breasts. All breast masses were removed, and final histopathological diagnoses were obtained in all cases. The results showed that thallium-201 SPECT scintimammography findings were true-positive in 22 cases, false-positive in 1 case, true-negative in 7 cases, and false-negative in 2 cases. The diagnostic sensitivity, specificity, and accuracy were 91.7%, 87.5%, and 90.6%, respectively, for detecting breast cancer in mammographically dense breasts. In conclusion, thallium-201 SPECT scintimammography is a useful tool for differentiating benign from malignant breast masses in patients with indeterminate mammograms because of mammographically dense breasts.