A plea for the elective inclusion of the brain in routine whole-body FDG PET

FDG-pet in paraneoplastic syndromes

Paraneoplastic syndromes are rare disorders, but recognition is important because clinical manifestations of paraneoplastic syndromes may precede those of the underlying malignancy by months or even years. As tumor therapy still is the mainstay of treatment for paraneoplastic syndromes, early diagnosis of the initial tumor or its recurrence is of utmost clinical importance. For finding the associated tumor, the combined use of FDG-PET and CT seems to have the highest sensitivity and may contribute to accurately distinguishing a true tumor or recurrence from benign lesions or physiologic or inflammatory uptake. Further, this approach helps localize the tumor for further management of the patient such as surgery or more invasive diagnostic procedures. Cerebral FDG-PET proved to confirm paraneoplastic encephalitis and may help monitor tumor therapy.

[Contribution of PET in the follow-up of cerebral metastases in non-small cell lung cancer. A clinical case valuation]

We report a clinical case of a male 44 years old with lung adenocarcinoma with a single brain metastases treated with surgery and radiotherapy. The different PET studies performed during the evolution of the disease were very useful and crucial, firstly in the detection of radiation necrosis and after that when cerebral metastases recurrent appeared twice. The radiographic technique (Brain MRI) and the histopathology after the surgical removal confirmed the PET results. PET imaging is helpful in selected patients with brain metastases in lung cancer.

Novel Imaging Techniques in Melanoma

Cutaneous melanoma is one of the most deadly malignancies. Although it accounts for approximately 4% of all cancer cases, it ac-counts for approximately 79% of skin cancer-related deaths. In the past few years, the nuclear medicine platform used in the management of melanoma has extended to biochemical and structural imaging. In clinical practice, integrated positron emission tomography/CT devices allow anatomic and metabolic characterization of meta-static disease in a single study. Similarly, more accurate localization of sentinel nodes in a 3-D space now is feasible with hybrid single photon emission CT/CT system. In translational research, [18F]fluorodeoxyglucose probes have been designed to optimize the detection of melanoma tumor sites in vivo.