“Hepatic Superscan” in a Patient With Hepatosplenic Alphabeta T-cell Lymphoma: 18F-FDG PET/CT Findings

"Hepatic Superscan" Revealed on 18 F-FDG PET Due to Drug-Induced Fulminant Hepatitis

ABSTRACT

"Hepatic superscan" could be caused by a variety of etiologies. Here we report a 68-year-old woman with a medication history of cefoperazone and azithromycin for pneumonia recently who underwent 18 F-FDG PET/CT to detect underlying malignancy due to unexplained liver damage and fever of unknown origin. Unexpectedly, "hepatic superscan" without morphologic changes was noted. Unfortunately, aggressive treatment did not reverse the damaged liver function, and the patient rapidly died. Drug-induced fulminant hepatitis was diagnosed clinically. Our case demonstrates that fulminant hepatitis could result in "hepatic superscan" on 18 F-FDG PET despite negative findings on the ultrasonography, CT, and MRI.

Hepatic Superscan in Methotrexate-Associated Lymphoproliferative Disorder

ABSTRACT

A 60-year-old man on methotrexate for treatment of adult-onset Still disease presented with acute onset of fever, pancytopenia, and deranged liver function. Besides FDG-avid lesions in spleen and skeleton, his 18 F-FDG PET/CT study showed diffuse and intense uptake in the liver with significantly suppressed heart and brain activity (reminiscent of a hepatic superscan). Subsequent biopsy confirmed the diagnosis of methotrexate-associated lymphoproliferative disorder.

Hepatic Angiosarcoma With Diffuse Increased 18 F-FDG Uptake on PET/CT

ABSTRACT

A 51-year-old woman was diagnosed with fulminant hepatic failure based on laboratory indexes. Contrast-enhanced CT demonstrated numerous, widespread lesions in all segments of the liver. 18 F-FDG PET/CT showed the abundant foci of increased 18 F-FDG uptake in the enlarged liver. The liver transplantation was performed due to fulminant hepatic failure. Postoperative pathology demonstrated diffused hepatic angiosarcoma, which should be included in the differential diagnosis of diffuse 18 F-FDG uptake hepatic lesions on PET/CT.

FDG-PET/CT: novel method for viability assessment of livers perfused ex vivo

PURPOSE

Ex vivo liver machine perfusion is a promising option to rescue marginal liver grafts mitigating the donated organ shortage. Recently, a novel liver perfusion machine that can keep injured liver grafts alive for 1 week ex vivo was developed and reported in Nature Biotechnology. However, liver viability assessment ex vivo is an unsolved issue and the value of 18F-fluorodeoxyglucose (FDG)-PET/CT for such purpose was explored.

MATERIALS AND METHODS

Discarded two human and six porcine liver grafts underwent FDG-PET/CT for viability assessment after 1 week of ex vivo perfusion. PET parameters [standardized uptake value (SUV)max, SUVmean, SUVpeak and total lesion glycolysis] were compared between hepatic lobes and between porcine and human livers. The prevalence of FDG-negative organ parts was recorded. The estimated effective radiation dose for PET/CT was calculated.

RESULTS

All organs were viable with essentially homogeneous FDG uptake. Of note, viability was preserved in contact areas disclosing the absence of pressure necrosis. Four porcine and two human organs had small superficial FDG-negative areas confirmed as biopsy sites. Total lesion glycolysis was significantly higher in the right hepatic lobe (P = 0.012), while there was no significant difference of SUVmax, SUVmean and SUVpeak between hepatic lobes. There was no significant difference in FDG uptake parameters between porcine and human organs. The estimated effective radiation dose was 1.99 ± 1.67 mSv per organ.

CONCLUSION

This study demonstrates the feasibility of FDG-PET/CT for viability assessment of ex vivo perfused liver grafts after 1 week.

PET/Computed Tomography in the Evaluation of Fever of Unknown Origin and Infectious/Inflammatory Disease in Pediatric Patients

Fever in children is common. If it persists and its cause cannot be identified in a reasonable time, along with laboratory and conventional imaging investigations, it is defined as fever of unknown origin (FUO). 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) is well established in the evaluation of malignancy, which is a possible cause of FUO. FDG often locates inflammatory and infectious lesions considered nonspecific or false-positive for oncology; however, these findings are beneficial in FUO evaluation because infectious and inflammatory diseases are important FUO causes. FDG-PET/CT is being increasingly used for investigation of FUO as well as infectious/inflammatory disease.

FDG Hepatic Superscan Due to Metastatic Infiltration of Prostate Cancer

A 69-year-old man with prostate cancer presented to the hospital with 2 weeks' history of fever, abdominal distension, and fatigue. Laboratory findings showed signs of acute liver failure, and marked elevation of lactate dehydrogenase and tumor marker levels. Abdominal CT showed hepatomegaly with multiple hypodense lesions in both lobes, suggesting metastases. FDG PET/CT scan shows hypermetabolism unusually in the liver with significantly suppressed heart and brain activity, reminiscent of an FDG hepatic superscan. The hypermetabolic lesions confirmed with Tru-Cut needle biopsy of the liver as metastasis of prostate cancer.

Roles of F-18-Fluoro-2-Deoxy-Glucose PET/Computed Tomography Scans in the Management of Post-Transplant Lymphoproliferative Disease in Pediatric Patient

Post-transplant lymphoproliferative disease is a well-known complication in transplant recipients. Evaluating the extent and stage of disease is important for management and follow-up. As a combination of anatomic and functional imaging, PET/CT is a sensitive and specific tool to stage and detect occult disease compared with conventional imaging. PET/CT also has a role in monitoring treatment response. Although PET/CT has been shown to be potentially useful in adults, evidence in children is insufficient. This review provides an overview of the use of PET/CT in post-transplant lymphoproliferative disease, especially in pediatric patients.

Diffuse Hepatosplenic 99mTc-Pyrophosphate Activity Caused by Amyloidosis

A 46-year-old man underwent Tc-pyrophosphate scan to evaluate possible infiltrative myocardiopathy revealed by echocardiography. The images did not show abnormal cardiac activity. However, diffuse abnormal activity in the liver and spleen was noted. Pathological examination from the specimen acquired from hepatic biopsy demonstrated amyloidosis, light chain type.

A Rare Case of Neutrophil-Rich, ALK-Negative Anaplastic Large Cell Lymphoma in the Lung Mimicking a Pulmonary Abscess on 18F-FDG PET/CT

A 21-year-old man complained of cough, fever, and hemoptysis for 15 days. Peripheral neutrophil cell (33.8 × 10/L) was markedly increased, and a mass in the left lung was detected by chest radiography. F-FDG PET/CT was referred for characterizing the lesion and found a large mass with multiple cavities in the left lung, which had markedly high uptake of F-FDG, mimicking pulmonary abscess. Surprisingly, the lesion was eventually proved to be neutrophil-rich anaplastic large cell lymphoma. After 4 cycles' chemotherapy, the lesion shrank significantly.