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Chan KL, Lord M, McNamara D, Désilets É, Bergeron E. Spilled gallstone mimicking metastasis from cervix cancer on positron emission tomography – computed tomography. World J Obstet Gynecol 2023; 12:11-16. [DOI: 10.5317/wjog.v12.i2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 02/17/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Spilled gallstones from previous cholecystectomy is not an uncommon situation. It may further mimic neoplastic disease and can be misled by fluorine 18 fluorodeoxyglucose position emission tomography with computed tomography ([18F]FDG PET/CT).
CASE SUMMARY A 63 year-old patient was diagnosed with a cancer of the cervix. Pretreatment [18F]FDG PET/CT showed a peritoneal lesion suspicious for metastasis. Surgical exploration and histologic examination revealed the lesion to be a spilled gallstone from a previous cholecystectomy.
CONCLUSION [18F]FDG PET/CT carries pitfalls since benign conditions such as intraperitoneal gallstones may be confused as malignant lesions. This case highlights the importance to be aware of the possible implications of dropped gallstones for the future, minimize its occurrence, and make all efforts to properly evaluate cancer staging, particularly for the cervix cancer.
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Affiliation(s)
- Kenneth L Chan
- Department of Gynecology, Charles-LeMoyne Hospital, Greenfield Park J4V2H1, Quebec, Canada
| | - Martin Lord
- Department of Medical Imaging, Charles-LeMoyne Hospital, Greenfield Park J4V2H1, Quebec, Canada
| | - Daniel McNamara
- Department of Medical Imaging, Charles-LeMoyne Hospital, Greenfield Park J4V2H1, Quebec, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park J4V2H1, Quebec, Canada
| | - Eric Bergeron
- Department of Surgery, Charles-LeMoyne Hospital, Greenfield Park J4V2H1, Quebec, Canada
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Mendoza H, Nosov A, Pandit-Taskar N. Molecular imaging of sarcomas with FDG PET. Skeletal Radiol 2023; 52:461-475. [PMID: 36173459 DOI: 10.1007/s00256-022-04182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 02/02/2023]
Abstract
Sarcoma comprises a heterogenous entity of musculoskeletal malignancies arising from a mesenchymal origin. The diagnosis and management of pediatric sarcoma requires a multidisciplinary approach and the use of various imaging modalities including CT, MRI and FDG PET scans. FDG PET/CT (FDG PET), as a metabolic imaging, complements and provides superior diagnostic information as against other imaging modalities alone. Advantages of FDG PET in differentiating malignant sarcomatous lesions from benign lesions, and value in staging and restaging have been noted in several studies. The use of FDG PET in clinical management has increased over the years. The data on prognostication of outcomes or predicting responders to therapy with FDG PET in patients with sarcoma is somewhat limited. This review will focus on the pearls and pitfalls of FDG PET and role of FDG PET in initial extent of disease assessment, treatment response, and surveillance imaging pertaining to osteosarcoma, chondrosarcoma, Ewing's sarcoma, and rhabdomyosarcoma. We also discuss the limitations and unmet needs of FDG PET in the management of patients with sarcoma.
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Affiliation(s)
- Humberto Mendoza
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Anton Nosov
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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Kose S. Role of Computed Tomography in the Evaluation of Peritoneal Carcinomatosis. J Belg Soc Radiol 2023; 107:27. [PMID: 37064170 PMCID: PMC10103720 DOI: 10.5334/jbsr.2921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2023] [Indexed: 04/18/2023] Open
Abstract
Peritoneal carcinomatosis (PC) refers to metastatic spread of tumor into the peritoneal cavity. Earlier, PC was thought to be associated with grave clinical outcome. However, various advances in treatment options including cytoreductive surgery and heated intraperitoneal chemotherapy or early post-operative chemotherapy can prolong survival of patients with peritoneal carcinomatosis. These treatment options are associated with high morbidity and mortality. The purpose of this article is to acquaint the radiologist about various appearances of peritoneal carcinomatosis in order to help clinicians in selecting candidates for surgery and avoid unnecessary potentially debilitating surgeries in patients with unresectable PC.
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Affiliation(s)
- Snehal Kose
- All India Institute of Medical Sciences, New Delhi, IN
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Gallium-68-labeled fibroblast activation protein inhibitor PET in gastrointestinal cancer: insights into diagnosis and management. Eur J Nucl Med Mol Imaging 2022; 49:4228-4240. [PMID: 35657428 DOI: 10.1007/s00259-022-05847-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Gallium-68-labeled fibroblast activation protein inhibitor (68Ga-FAPI) is an emerging promising tumor tracer. This study aims to evaluate the diagnostic efficiency of 68Ga-FAPI PET in gastrointestinal cancer, and to determine its potential impact on clinical management. METHODS Patients with malignancies were prospectively enrolled in a clinical trial to evaluate the diagnostic value of 68Ga-FAPI PET. One hundred twenty patients with gastrointestinal malignancies (121 68Ga-FAPI PET scans) between June 2020 and May 2021 were retrospectively analyzed. Initial staging of untreated patients and restaging of treated patients were evaluated. The treatment scheme promoted by imaging was determined according to NCCN guidelines. Final diagnosis and treatment reference standards were determined by a dedicated multidisciplinary team. The diagnostic performance and treatment guidance of 68Ga-FAPI PET were compared with those of conventional imaging (CI) and 18F-FDG PET. RESULTS The diagnostic accuracy of 68Ga-FAPI PET was much higher than that of CI and 18F-FDG PET (95.0% vs. 65.1% and 69.0%, respectively, both p < 0.001). 68Ga-FAPI PET revised diagnosis in 30.3% and 26.2% of patients compared with CI and 18F-FDG PET. The accordance rate of 68Ga-FAPI PET-guided treatment in comparison with the reference standard was significantly higher than that of CI and 18F-FDG PET (96.7% vs. 75.2% and 76.2%, respectively, both p < 0.001). 68Ga-FAPI PET changed treatment in 22.9% and 23.8% of patients compared with CI and 18F-FDG PET. CONCLUSIONS 68Ga-FAPI PET showed remarkable diagnostic performance in gastrointestinal cancer, resulting in more accurate staging and guidance for timely treatment revision, thereby having a critical impact on clinical management. TRIAL REGISTRATION NCT04554719. Registered September 8, 2020-retrospectively registered, http://clinicaltrails.gov/show/NCT04554719.
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Yeh R, Amer A, Johnson JM, Ginat DT. Pearls and Pitfalls of 18FDG-PET Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:287-298. [DOI: 10.1016/j.nic.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Indirect comparison of the diagnostic performance of 18F-FDG PET/CT and MRI in differentiating benign and malignant ovarian or adnexal tumors: a systematic review and meta-analysis. BMC Cancer 2021; 21:1080. [PMID: 34615498 PMCID: PMC8495994 DOI: 10.1186/s12885-021-08815-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/27/2021] [Indexed: 01/23/2023] Open
Abstract
Objective To compare the value of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI) in differentiating benign and malignant ovarian or adnexal tumors. Materials and methods English articles reporting on the diagnostic performance of MRI or 18F-FDG PET/CT in identifying benign and malignant ovarian or adnexal tumors published in PubMed and Embase between January 2000 and January 2021 were included in the meta-analysis. Two authors independently extracted the data. If the data presented in the study report could be used to construct a 2 × 2 contingency table comparing 18F-FDG PET/CT and MRI, the studies were selected for the analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the included studies. Forest plots were generated according to the sensitivity and specificity of 18F-FDG PET/CT and MRI. Results A total of 27 articles, including 1118F-FDG PET/CT studies and 17 MRI studies on the differentiation of benign and malignant ovarian or adnexal tumors, were included in this meta-analysis. The pooled sensitivity and specificity for 18F-FDG PET/CT in differentiating benign and malignant ovarian or adnexal tumors were 0.94 (95% CI, 0.87–0.97) and 0.86 (95% CI, 0.79–0.91), respectively, and the pooled sensitivity and specificity for MRI were 0.92 (95% CI: 0.89–0.95) and 0.85 (95% CI: 0.79–0.89), respectively. Conclusion While MRI and 18F-FDG PET/CT both showed to have high and similar diagnostic performance in the differential diagnosis of benign and malignant ovarian or adnexal tumors, MRI, a promising non-radiation imaging technology, may be a more suitable choice for patients with ovarian or accessory tumors. Nonetheless, prospective studies directly comparing MRI and 18F-FDG PET/CT diagnostic performance in the differentiation of benign and malignant ovarian or adnexal tumors are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08815-3.
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Aggarwal R, Indiran V, Maduraimuthu P. Different etiologies of an unusual disease: Colouterine fistula - Report of two cases. Indian J Radiol Imaging 2021; 28:37-40. [PMID: 29692524 PMCID: PMC5894316 DOI: 10.4103/ijri.ijri_172_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Colouterine fistula is an extremely rare condition, as the uterus is a thick, muscular organ. Here, we present two different etiologies for this rare condition—diverticulitis and malignancy. A 77-year-old female with colouterine fistula due to diverticulitis presented with complaints of lower abdominal pain localized particularly in the left iliac fossa and fever. Another case was of 73-year-old female with colouterine fistula due to malignancy who presented with abdominal pain, blood in stools, and whitish discharge from vagina. Both cases were evaluated with contrast-enhanced computed tomography (CECT). The presence of air and fluid within the uterus on ultrasound or CT scan, prompts the possibility of colouterine fistula with CECT providing accurate preoperative assessment.
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Affiliation(s)
- Rohit Aggarwal
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
| | - Prabakaran Maduraimuthu
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
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Lee HY, Oh YL, Park SY. Hyperattenuating adrenal lesions in lung cancer: biphasic CT with unenhanced and 1-min enhanced images reliably predicts benign lesions. Eur Radiol 2021; 31:5948-5958. [PMID: 33459853 DOI: 10.1007/s00330-020-07648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate usefulness of biphasic computed tomography (CT) in characterizing hyperattenuating adrenal lesions in lung cancer. METHODS This retrospective study included 239 patients with lung cancer who underwent adrenal CT for hyperattenuating (> 10 Hounsfield unit) adrenal lesions. Adrenal CT comprised unenhanced and 1-min and 15-min enhanced images. We dichotomized adrenal lesions depending on benign or metastatic lesions. Reference standard for benignity was histologic confirmation or ≥ 6-month stability on follow-up CT. Two independent readers analyzed absolute (APW) or relative percentage wash-out (RPW) using triphasic CT, and enhancement ratio (ER) or percentage wash-in (PWI) using biphasic CT (i.e., unenhanced and 1-min enhanced CT). Criteria for benignity were as follows: criteria 1, (a) APW ≥ 60% or (b) RPW ≥ 40%, and criteria 2, (a) ER > 3 and (b) PWI > 200%. We analyzed area under the curve (AUC) and accuracy for benignity, and inter-reader agreement. RESULTS Proportion of benign adrenal lesion was 71.1% (170/239). For criteria 1 and 2, AUCs were 0.872 (95% confidence interval [CI], 0.822-0.911) and 0.886 (95% CI, 0.838-0.923), respectively, for reader 1 (p = 0.566) and 0.816 (95% CI, 0.761-0.863) and 0.814 (95% CI, 0.759-0.862), respectively, for reader 2 (p = 0.955), and accuracies were 87.9% (210/239) and 86.2% (206/239), respectively, for reader 1 (p = 0.479) and 81.2% (194/239) and 80.3% (192/239), respectively, for reader 2 (p = 0.763). Weighted kappa was 0.725 (95% CI, 0.634-0.816) for criteria 1 and 0.736 (95% CI, 0.649-0.824) for criteria 2. CONCLUSION Biphasic CT can reliably characterize hyperattenuating adrenal lesions in patients with lung cancer. KEY POINTS • Criteria from biphasic computed tomography (CT) for diagnosing benign adrenal lesions were enhancement ratio of > 3 and percentage wash-in of > 200%. • In the analysis by two independent readers, area under the curve between criteria 1 and 2 was not significantly different (0.872 and 0.886 for reader 1; 0.816 and 0.814, for reader 2; p > 0.05 for each comparison). • Wash-in characteristics from biphasic CT are helpful to predict benign adrenal lesions in lung cancer.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Pandey S, Maheshwari S, Rajesh U, Grewal DS, Maria V. A case report of colouterine fistula due to colonic diverticulitis: a rare complication. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Colouterine fistula is a very rare entity because of the sturdy and muscular nature of the uterus. Due to the rarity of this condition and nonspecific clinical findings, it poses a diagnostic challenge to treating physicians.
Case presentation
Here, we report a case of a 64-year-old female, who presented with lower abdominal pain. Clinically, there was suspicion of a recto-vaginal fistula. However, on imaging, she was found to have a colouterine fistula secondary to sigmoid diverticulitis.
Conclusion
It is essential to be aware of this rare complication of sigmoid diverticulitis. The imaging plays a cardinal role in the diagnosis and guiding the management of this disease.
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Sena Y, Matsumoto S, Silman C, Otsuka K, Kiyota T. Physiological 18F-FDG uptake in the normal adult anal canal: evaluation by PET/CT. Ann Nucl Med 2020; 34:538-544. [PMID: 32430619 DOI: 10.1007/s12149-020-01480-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography-computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. METHODS We conducted a retrospective study of-PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn's disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. RESULTS In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00-6.30), and delayed phase: 2.52 (range 1.00-8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24-2.25), and delayed: 0.81 (range 0.23-2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30-1.89), and delayed: 0.90 (range 0.30-1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40-17.73) and 14.23 (range 6.70-22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. CONCLUSIONS PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.
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Affiliation(s)
- Yankel Sena
- Faculty of Medicine, Oita University, Yufu, Oita, Japan
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Ozaki K, Harada K, Terayama N, Kosaka N, Kimura H, Gabata T. FDG-PET/CT imaging findings of hepatic tumors and tumor-like lesions based on molecular background. Jpn J Radiol 2020; 38:697-718. [PMID: 32246350 DOI: 10.1007/s11604-020-00961-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The usefulness of whole-body 18-fluoro-2-deoxyglucose (FDG)-fluorodeoxyglucose positron emission (PET)/computed tomography (CT) is established for assessment of disease staging, detection of early disease recurrence, therapeutic evaluation, and predicting prognosis in various malignancies; and for evaluating the spread of inflammation. However, the role of FDG-PET/CT for the liver is limited because CT and magnetic resonance imaging (MRI) can provide an accurate diagnosis of most tumors. In addition, in other potentially useful roles there are several pitfalls in the interpretation of FDG uptake in PET/CT imaging. Accurate evaluation demands knowledge of the FDG uptake of each lesion, including potential negative and positive uptakes, and requires an understanding of the underlying background of the molecular mechanisms. The degree of FDG uptake is dependent on cellular metabolic rate and the expression of glucose transporter, hexokinase, and glucose-6-phosphatase, which in turn are closely affected by biological characteristics such as pathological category (e.g., adenocarcinoma, squamous cell carcinoma, small cell cancer, transitional cell cancer, neuroendocrine tumor, sarcoma, lymphoma), tumor differentiation, histological behavior (e.g., solid, cystic, mucinous), and intratumoral alterations (e.g., necrosis, degeneration, hemorrhage). Correlation with the CT and MRI findings, which also precisely depict the pathological findings, is important to avoid misdiagnosis.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan.
| | - Kenichi Harada
- Department of Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Noboru Terayama
- Department of Radiology, Takaoka City Hospital, Takaoka, Japan
| | - Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Reinert CP, Wanek L, Bösmüller H, Federmann B, Fritz J, Sökler M, Horger M. Computed tomography texture analysis for assessment of chemotherapy response of Hodgkin lymphoma. Medicine (Baltimore) 2020; 99:e19146. [PMID: 32049838 PMCID: PMC7035051 DOI: 10.1097/md.0000000000019146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to test the hypothesis that computed tomography texture analysis (CTTA) is accurate for response assessment of Hodgkin lymphoma (HL).A total of 100 patients with HL were identified. CTTA in baseline and interim staging was performed generating volume of interests in lymphoma tissue from which CTTA features including 1st, 2nd, and higher order textural features were extracted. Baseline and interim 2-deoxy-fluor-glucose positron emission tomography results were used to determine therapy response and compared to CTTA in terms of patient outcome.At interim, 1st-order features yielded a significant drop (e.g., entropy of heterogeneity, P = .01) or a significant rise (deviation, P < .001), whereas 2nd and higher order features decreased (e.g., entropy of co-occurrence matrix, P < .001). Patients achieving complete remission at end of treatment had a significantly lower entropy of heterogeneity at baseline and interim compared to patients achieving partial remission (P < .05).CT textural features change in parallel to metabolic therapy response, and are therefore a feasible diagnostic tool for a more accurate response assessment of HL.
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Affiliation(s)
| | - Larissa Wanek
- Department of Diagnostic and Interventional Radiology
| | - Hans Bösmüller
- Institute of Pathology, University Hospital of Tübingen, Tübingen, Germany
| | - Birgit Federmann
- Institute of Pathology, University Hospital of Tübingen, Tübingen, Germany
| | - Jan Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Martin Sökler
- Department of Internal Medicine II, University Hospital of Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology
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Frankl J, Sherwood A, Clegg DJ, Scherer PE, Öz OK. Imaging Metabolically Active Fat: A Literature Review and Mechanistic Insights. Int J Mol Sci 2019; 20:ijms20215509. [PMID: 31694216 PMCID: PMC6862590 DOI: 10.3390/ijms20215509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 02/07/2023] Open
Abstract
Currently, obesity is one of the leading causes death in the world. Shortly before 2000, researchers began describing metabolically active adipose tissue on cancer-surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in adult humans. This tissue generates heat through mitochondrial uncoupling and functions similar to classical brown and beige adipose tissue in mice. Despite extensive research, human brown/beige fat's role in resistance to obesity in humans has not yet been fully delineated. FDG uptake is the de facto gold standard imaging technique when studying brown adipose tissue, although it has not been rigorously compared to other techniques. We, therefore, present a concise review of established and emerging methods to image brown adipose tissue activity in humans. Reviewed modalities include anatomic imaging with CT and magnetic resonance imaging (MRI); molecular imaging with FDG, fatty acids, and acetate; and emerging techniques. FDG-PET/CT is the most commonly used modality because of its widespread use in cancer imaging, but there are mechanistic reasons to believe other radiotracers may be more sensitive and accurate at detecting brown adipose tissue activity. Radiation-free modalities may help the longitudinal study of brown adipose tissue activity in the future.
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Affiliation(s)
- Joseph Frankl
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (J.F.); (A.S.)
| | - Amber Sherwood
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (J.F.); (A.S.)
| | - Deborah J. Clegg
- College of Nursing and Health Professions, Drexel University, 10th Floor, Room 1092, 1601 Cherry Street, Mail Stop 10501, Philadelphia, PA 19102, USA;
| | - Philipp E. Scherer
- Department of Internal Medicine, Touchstone Diabetes Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA;
| | - Orhan K. Öz
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (J.F.); (A.S.)
- Correspondence:
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Abstract
Fluorodeoxyglucose positron emission tomography computed tomography (FDG-PET/CT) provides a comprehensive whole body evaluation in patients with endometrial and vulvar cancer. Here, we discuss the role of FDG-PET/CT in defining the disease extent in patients presenting with these cancers. Detection of lymph node and distant metastases has implications for staging, treatment planning, and patient prognosis. Procedures for image acquisition and interpretation for optimum accuracy and essential elements that should be included in the PET-CT report are described. Common imaging pitfalls are presented and illustrated with examples.
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Affiliation(s)
- Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - David Z Chow
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Abstract
The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus. The staging procedure is purely clinical (i.e. gynecologic examination under general anesthesia) according to the International Federation of Gynaecology and Obstetrics classification. Earlier, with the nonavailability of sophisticated medical equipment and imaging specialists, oncologists relied heavily on clinical examination. However, anatomical and functional imaging has been proven to be considerably superior in understanding parametrial involvement and nodal/distant metastases in the cancer cervix than clinical examination alone. Data are evolving on the usage of F-FDG PET/CT in initial staging, treatment planning, and monitoring therapy response for gynecological malignancies. Prognostic information derived from the primary lesion such as the maximum standardized uptake value, metabolic tumor volume, and extent of para-aortic nodal metastatic disease plays a critical role in tailoring therapy on the basis of patient tumor-specific factors rather than on International Federation of Gynaecology and Obstetrics stage alone. Thus, F-FDG PET/CT needs to be listed not only under the panel of pretherapy investigations for Ca cervix but also for recurrence and therapy response assessments. It allows a more confident approach to patient management at initial staging, especially in terms of the decision to choose surgical versus palliation measures.
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Catalano O, Kilcoyne A, Signore A, Mahmood U, Rosen B. Lower Gastrointestinal Tract Applications of PET/Computed Tomography and PET/MR Imaging. Radiol Clin North Am 2018; 56:821-834. [PMID: 30119776 DOI: 10.1016/j.rcl.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article discusses the role of PET/CT and PET/MR imaging in the evaluation of inflammatory and malignant disorders of the lower gastrointestinal tract. This includes a review of the current literature and a discussion of new and emerging research.
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Won SY, Kim HS, Park SY. Transrectal or transvaginal ultrasoundguided biopsy for pelvic masses: external validation and usefulness in oncologic patients. Ultrasonography 2018; 38:149-155. [PMID: 30153726 PMCID: PMC6443595 DOI: 10.14366/usg.18028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to externally validate the diagnostic usefulness of transrectal ultrasound (TRUS) or transvaginal ultrasound (TVUS)-guided biopsy for pelvic masses, and to analyze the diagnostic performance of these methods in oncologic patients. Methods A consecutive series of 30 patients who underwent TRUS- or TVUS-guided biopsy for pelvic masses was included. Tissue samples were obtained using an 18-gauge core biopsy needle under local anesthesia for lesions detected on computed tomography or magnetic resonance imaging. We analyzed the rates of diagnostic biopsies upon pathologic examination and biopsy-related major complications requiring treatment. In diagnostic biopsy cases, the performance was also investigated for all patients and patients with underlying malignancy. Results The diagnostic biopsy rate was 93.3% (28 of 30) for all patients and 95.0% (19 of 20) for oncologic patients. No patients had major complications. In diagnostic biopsies, the sensitivity, specificity, positive and negative predictive value, and accuracy for identifying malignancy were 100% (17 of 17), 72.7% (8 of 11), 85.0% (17 of 20), 100% (8 of 8), and 89.3% (25 of 28) for all patients and 100% (14 of 14), 60.0% (3 of 5), 87.5% (14 of 16), 100% (3 of 3), and 89.5% (17 of 19) for oncologic patients, respectively. Conclusion This study externally validated the feasibility and safety of TRUS- or TVUS-guided biopsy. In addition, these techniques appear to enable accurate pathologic diagnoses of pelvic masses in oncologic patients to be made safely and relatively noninvasively.
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Affiliation(s)
- So Yeon Won
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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Servente L, Gigirey V, García Fontes M, Alonso O. Incidental focal colonic uptake in studies 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2017; 37:15-19. [PMID: 28750749 DOI: 10.1016/j.remn.2017.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the frequency of focal colonic uptake as an incidental observation in 18F-FDG PET/CT studies, and to correlate this finding with histopathological results. MATERIAL AND METHODS Out of a total of 3,176 PET/CT studies with 18F-FDG systematic analysis was carried out on 30 studies in which colonic focal uptake was observed. Patients with known colorectal neoplasia were excluded. The maximum standardised uptake values (SUVm) and the morphological findings provided by the CT were recorded. The studies were reported by a radiologist and a nuclear medicine doctor. The findings were compared with endoscopy and pathology findings. RESULTS Of the 30 patients with focal hypermetabolic lesions of the colon (0.94%), 15 were men and 15 were women with ages between 27 and 73 (mean 55 years). The reasons for PET/CT were bronchopulmonary cancer (4), breast cancer (4), tumour of unknown origin (4), melanoma (3), renal carcinoma (3), cervical neoplasia (2), adenocarcinoma of ovary (2), and others (8). Of the 23 colonoscopies performed, 10 patients (43.4%) had malignant lesions, 6 (26.1%) had pre-malignant lesions, and in 7 patients (30.4%) no lesion was identified or was benign. No endoscopy was performed on 7 patients for various reasons (patient refusal to perform the study, advanced oncological disease). An analysis was performed with the SUVm, with no statistically significant differences being found between malignant-premalignant lesions and benign lesions. CONCLUSIONS Focal uptake in the colon of 18F-FDG has clinical relevance, and is mainly associated with morphological lesions in CT. It should be evaluated, as it may be a second tumour or a pre-malignant lesion. It is recommended that all focal uptakes of the colon be evaluated with endoscopy.
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Affiliation(s)
- L Servente
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay.
| | - V Gigirey
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - M García Fontes
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - O Alonso
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
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Guideline for PET/CT imaging of neuroendocrine neoplasms with 68Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F–DOPA. Eur J Nucl Med Mol Imaging 2017; 44:1588-1601. [DOI: 10.1007/s00259-017-3728-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022]
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Lakhani A, Khan SR, Bharwani N, Stewart V, Rockall AG, Khan S, Barwick TD. FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging. Radiographics 2017; 37:577-594. [DOI: 10.1148/rg.2017160059] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Amish Lakhani
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Sairah R. Khan
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Nishat Bharwani
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Victoria Stewart
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Andrea G. Rockall
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Sameer Khan
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
| | - Tara D. Barwick
- From the Department of Radiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England (A.L., S.R.K., N.B., V.S., S.K., T.D.B.); Faculty of Medicine, Department of Surgery and Cancer (A.L., N.B., T.D.B.), and Department of Surgery and Cancer (A.G.R.), Imperial College London, London, England; and Department of Radiology, the Royal Marsden NHS Foundation Trust, London, England (A.G.R.)
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Bonde AA, Korngold EK, Foster BR, Fung AW, Sohaey R, Pettersson DR, Guimaraes AR, Coakley FV. Radiological appearances of corpus luteum cysts and their imaging mimics. Abdom Radiol (NY) 2016; 41:2270-2282. [PMID: 27472937 DOI: 10.1007/s00261-016-0780-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To review the radiological appearances of corpus luteum cysts and their imaging mimics. CONCLUSION Corpus luteum cysts are normal post-ovulatory structures seen in the ovaries through the second half of the menstrual cycle and the first trimester of pregnancy. The typical appearance, across all modalities, is of a 1- to 3-cm cyst with a thick crenulated vascularized wall. Occasionally, similar imaging findings may be seen with endometrioma, ectopic pregnancy, tuboovarian abscess, red degeneration of a fibroid, and ovarian neoplasia. In most cases, imaging findings are distinctive and allow for a confident and accurate diagnosis that provides reassurance for patients and referring physicians and avoids costly unnecessary follow-up.
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Prabhakar HB, Kraeft JJ, Schorge JO, Scott JA, Lee SI. FDG PET-CT of gynecologic cancers: pearls and pitfalls. ACTA ACUST UNITED AC 2016; 40:2472-85. [PMID: 25680500 DOI: 10.1007/s00261-015-0362-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
FDG PET-CT plays an important role in treatment planning and in prognosis assessment of gynecologic cancer patients. Detection of hypermetabolic tissue with FDG PET, when combined with the high spatial resolution of CT, results in improved cancer detection and localization not afforded by either modality independently. This article is a primer for a radiologist performing PET-CT on gynecologic cancer patients and includes the imaging protocol, normal pattern of FDG distribution in the female pelvis and the lymph node drainage pathways from the gynecologic organs. Clinically relevant imaging findings that should be included in the report are discussed. Case examples illustrate how potential errors in exam interpretation can be avoided by concurrently performing a high-quality diagnostic CT with the FDG PET scan and by analyzing both the stand-alone and the fusion images.
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Affiliation(s)
- Hima B Prabhakar
- Department of Radiology, Pennsylvania Hospital, University of Pennsylvania Health System, University of Pennsylvania, 800 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Jessica J Kraeft
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - John O Schorge
- Gillette Center for Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James A Scott
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lakhman Y, Nougaret S, Miccò M, Scelzo C, Vargas HA, Sosa RE, Sutton EJ, Chi DS, Hricak H, Sala E. Role of MR Imaging and FDG PET/CT in Selection and Follow-up of Patients Treated with Pelvic Exenteration for Gynecologic Malignancies. Radiographics 2016; 35:1295-313. [PMID: 26172364 DOI: 10.1148/rg.2015140313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Pelvic exenteration (PE) is a radical surgical procedure used for the past 6 decades to treat locally advanced malignant diseases confined to the pelvis, particularly persistent or recurrent gynecologic cancers in the irradiated pelvis. The traditional surgical technique known as total PE consists of resection of all pelvic viscera followed by reconstruction. Depending on the tumor extent, the procedure can be tailored to remove only anterior or posterior structures, including the bladder (anterior exenteration) or rectum (posterior exenteration). Conversely, more extended pelvic resection can be performed if the pelvic sidewall is invaded by cancer. Preoperative imaging evaluation with magnetic resonance (MR) imaging and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is central to establishing tumor resectability and therefore patient eligibility for the procedure. These imaging modalities complement each other in diagnosis of tumor recurrence and differentiation of persistent disease from posttreatment changes. MR imaging can accurately demonstrate local tumor extent and show adjacent organ invasion. FDG PET/CT is useful in excluding nodal and distant metastases. In addition, FDG PET/CT metrics may serve as predictive biomarkers for overall and disease-free survival. This pictorial review describes different types of exenterative surgical procedures and illustrates the central role of imaging in accurate patient selection, treatment planning, and postsurgical surveillance.
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Affiliation(s)
- Yulia Lakhman
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Stephanie Nougaret
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Maura Miccò
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Chiara Scelzo
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hebert A Vargas
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Ramon E Sosa
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Elizabeth J Sutton
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Dennis S Chi
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Hedvig Hricak
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
| | - Evis Sala
- From the Department of Radiology (Y.L., S.N., H.A.V., R.E.S., E.J.S., H.H., E.S.) and Department of Surgery, Gynecology Service (D.S.C.), Memorial Sloan Kettering Cancer Center, 300 E 66th St, Room 703, New York, NY 10065; Department of Bioimaging and Radiological Science, Catholic University A. Gemelli Hospital, Rome, Italy (M.M.); and Department of Surgery, Gynecology and Obstetrics Section, Tor Vergata University, Rome, Italy (C.S.)
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Cayvarlı H, Bekiş R, Akman T, Altun D. The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence. Mol Imaging Radionucl Ther 2015; 23:76-83. [PMID: 25541930 PMCID: PMC4288227 DOI: 10.4274/mirt.83803] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision. Methods: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT. Results: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients’ management in 20 (15%) cases. Conclusions: 18F-FDG PET/CT can provide useful information in discriminating true recurrence in patients with suspected gastric cancer recurrence and may have significant impact on clinical decisions/patient management in a considerable percentage of patients.
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Affiliation(s)
- Hakan Cayvarlı
- Ordu State Hospital, Clinic of Nuclear Medicine, Ordu, Turkey. E-ma-il:
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Hybrid imaging for pancreatic malignancy: clinical applications, merits, limitations, and pitfalls. Clin Nucl Med 2015; 40:206-13. [PMID: 25608151 DOI: 10.1097/rlu.0000000000000677] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The role of PET/CT in pancreatic malignancy is evolving with new scientific evidence emerging continuously. PET/CT applications in imaging the pancreas and its organ-specific merits, limitations, and potential pitfalls are still evolving. This article provides an overview of the state-of-the-art applications of PET/CT imaging in evaluating pancreatic malignancy, comparing with conventional imaging modalities, such as contrast-enhanced CT and MRI. Current PET/MRI is also reviewed, along with brief discussion on cost-benefit analysis.
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Abstract
FDG-PET/CT has been evaluated in a variety of gynecologic malignancies in a variety of settings and is approved by the Centers for Medicare & Medicaid Services for the initial and subsequent treatment strategies of these malignancies. Cervical cancer is typically very FDG avid, and FDG-PET/CT appears to be most valuable for initial staging, radiation therapy planning, and detection of recurrent disease. For ovarian cancer, the most value of FDG-PET/CT appears to be for detecting recurrent disease in the setting of rising CA-125 level and negative or equivocal anatomical imaging studies. Initial studies evaluating response to therapy are promising and further work in this area is needed. FDG uptake in both nonmalignant and physiological processes in the pelvis can make interpretation of FDG-PET/CT in this region challenging and knowledge of these entities and patterns can avoid misinterpretation. Some of the most common findings relate to the cyclic changes that occur as part of the menstrual cycle in premenopausal women. Mucinous tumors and low-volume or peritoneal carcinomatosis are causes of false-negative results on FDG-PET/CT studies. As new tracers are developed, comparisons with patient outcomes and standards of care (eg, FDG-PET/CT) will be needed.
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Affiliation(s)
- Paul Grant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
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Tan GJS, Berlangieri SU, Lee ST, Scott AM. FDG PET/CT in the liver: lesions mimicking malignancies. ACTA ACUST UNITED AC 2015; 39:187-95. [PMID: 24233161 DOI: 10.1007/s00261-013-0043-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) PET/CT is invaluable in managing liver lesions, in particular in the evaluation of suspected liver metastases. It is both sensitive and specific in detecting liver metastases from a wide range of primary cancers, and may change clinical management, most commonly by detecting additional lesions and decreasing the number of futile surgeries. However, some benign lesions may also show increased metabolic activity which can lead to false positive PET findings. We describe some of these lesions and their imaging characteristics that may help in differentiating them from malignant metastases. METHODS e reviewed all whole body FDG PET/CT studies performed over a 5-year period in our institution, and identified those with focal liver lesions showing increased FDG uptake for which histological results were available. RESULTS majority of lesions showing increased metabolic activity were due to malignant disease, such as metastases or primary liver tumours. However, we also found increased FDG uptake in non-neoplastic lesions such as Cryptococcosis, abscesses, and secondary inflammation from cholecystitis. Increased metabolic activity was also seen in some benign neoplasms such as hepatic adenomas and hemangioendotheliomas. CONCLUSION DG PET/CT is currently the most sensitive non-invasive imaging modality for the detection of hepatic metastases, particularly from the gastrointestinal tract. False positive results are rare, and have been described mainly in abscesses. However, other lesions can also show increased metabolic activity, and failure to differentiate these from metastases may result in inappropriate treatment.
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Human cytomegalovirus and Epstein-Barr virus infection impact on (18)F-FDG PET/CT SUVmax, CT volumetric and KRAS-based parameters of patients with locally advanced rectal cancer treated with neoadjuvant therapy. Eur J Nucl Med Mol Imaging 2014; 42:186-96. [PMID: 25269837 DOI: 10.1007/s00259-014-2910-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/02/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE It has long been debated whether human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) are associated with rectal cancer. The gene products of HCMV and EBV contribute to cell-cycle progression, mutagenesis, angiogenesis and immune evasion. The aim of this prospective study was to analyse the association between infection of a tumour by HCMV and EBV and clinical, histological, metabolic ((18)F-FDG uptake), volumetric (from CT) and molecular (KRAS status) features and long-term outcomes in a homogeneously treated group of patients with locally advanced rectal cancer. METHODS HCMV and EBV were detected in pretreatment biopsies using polymerase chain reaction (PCR). The Cox proportional hazards regression model was used to explore associations between viral infection and disease-free survival (DFS) and overall survival (OS). RESULTS We analysed 37 patients with a median follow-up of 74 months (range 5-173 months). Locoregional control, OS and DFS at 5 years were 93%, 74% and 71%, respectively. Patients with HCMV/EBV coinfection had a significantly higher maximum standardized uptake value than patients without viral coinfection (p = 0.02). Significant differences were also observed in staging and percentage relative reduction in tumour volume between patients with and without HCMV infection (p < 0.01) and EBV infection (p < 0.01). KRAS wildtype status was significantly more frequently observed in patients with EBV infection (p <0.01) and HCMV/EBV co-infection (p = 0.04). No significant differences were observed in OS or DFS between patients with and without EBV infection (p = 0.88 and 0.73), HCMV infection (p = 0.84 and 0.79), and EBV/CMV coinfection (p = 0.24 and 0.39). CONCLUSION This pilot study showed that viral infections were associated with metabolic staging differences, and differences in the evolution of metabolic and volumetric parameters and KRAS mutations. Further findings of specific features will help determine the best candidates for metabolic and volumetric staging and restaging. Further toxicity profile findings will help to determine the best candidates for specific supportive treatment during pelvic chemoradiotherapy in patients with locally advanced rectal cancer.
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Abstract
Dihydroxyphenylalanine (DOPA) is a neutral amino acid that resembles natural l-dopa (dopamine precursor). It enters the catecholamine metabolic pathway of endogenous l-DOPA in the brain and peripheral tissues. It is amenable to labeling with fluorine-18 (18F) for PET imaging and was originally used in patients with Parkinson’s disease to assess the integrity of the striatal dopaminergic system. The recent introduction and use of hybrid PET/CT scanners has contributed significantly to the management of a series of other pathologies including neuroendocrine tumors, brain tumors, and pancreatic cell hyperplasia. These pathologic entities present an increased activity of l-DOPA decarboxylase and therefore demonstrate high uptake of 18F-DOPA. Despite these potentially promising applications in several clinical fields, the role of 18F-DOPA has not been elucidated completely yet because of associated difficulties in synthesis and availability. Unfortunately, the available literature does not provide recommendations for procedures or administered activity, acquisition timing, and premedication with carbidopa. The aim of this paper is to outline the physiological biodistribution and normal variants, including possible pitfalls that may lead to misinterpretations of the scans in various clinical settings.
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Abstract
18F-DOPA is a radiopharmaceutical with interesting clinical applications and promising performances in the evaluation of the integrity of dopaminergic pathways, brain tumors, NETs (especially MTCs, paragangliomas, and pheochromocytomas), and congenital hyperinsulinism. 18F-DOPA traces a very specific metabolic pathway and has a very precise biodistribution pattern. As for any radiopharmaceutical, the knowledge of the normal distribution of 18F-DOPA, its physiologic variants, and its possible pitfalls is essential for the correct interpretation of PET scans. Moreover, it is important to be aware of the potential false-positive and false-negative episodes that can occur in the various clinical settings.
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Affiliation(s)
- Sotirios Chondrogiannis
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy
| | - Maria Cristina Marzola
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy
| | - Domenico Rubello
- Department of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, Rovigo 45100, Italy.
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Randall E, Loeber S, Kraft S. PHYSIOLOGIC VARIANTS, BENIGN PROCESSES, AND ARTIFACTS FROM 106 CANINE AND FELINE FDG-PET/COMPUTED TOMOGRAPHY SCANS. Vet Radiol Ultrasound 2014; 55:213-26. [DOI: 10.1111/vru.12138] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/20/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Elissa Randall
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
| | - Samantha Loeber
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
| | - Susan Kraft
- Department of Environmental and Radiological Health Sciences (ERHS); Colorado State University; CO 80523
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PET and PET–CT imaging findings of peritoneal and omental involvement in patients with lymphoma. Clin Imaging 2013; 37:1089-93. [DOI: 10.1016/j.clinimag.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 07/05/2013] [Indexed: 12/13/2022]
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Imaging-guided biopsy of (18)F-FDG-avid extrapulmonary lesions: do lesion location and morphologic features on CT affect the positive predictive value for malignancy? AJR Am J Roentgenol 2013; 201:433-8. [PMID: 23883226 DOI: 10.2214/ajr.12.9166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to analyze the effect of lesion location and morphologic appearance on CT on the positive predictive value (PPV) for malignancy of all extrapulmonary lesions that were (18)F-FDG avid on PET/CT and that were biopsied under imaging guidance. MATERIALS AND METHODS Between January 2004 and December 2010, 227 patients underwent imaging-guided biopsy of 231 PET-positive extrapulmonary lesions with diagnostic pathologic results. The PET PPV for malignancy was retrospectively calculated and stratified according to lesion location and morphologic appearance. RESULTS The overall PET PPV for malignancy was 72%. Inflammatory processes accounted for the majority of benign biopsy results. Lesion location significantly affected the PPV (p < 0.001). Bone (96%) and liver (90%) lesions had significantly higher PPVs for malignancy compared with other locations, whereas lymph nodes (60%) had a significantly lower PPV for malignancy. Lesions that were morphologically suspicious and morphologically benign according to CT findings alone were associated with PPVs of 74% and 57%, respectively (p = 0.05). FDG-avid subcentimeter lymph nodes (n = 8) had a PPV for malignancy of 38%. CONCLUSION Over half of PET-avid morphologically benign-appearing lesions and one third of PET-avid subcentimeter lymph nodes were found to be malignant at biopsy, suggesting that benign morphologic appearance alone should not preclude further workup of a PET-positive lesion. Biopsies of FDG-avid lesions in liver and bone yielded high rates of true malignancy, whereas biopsies of lymph nodes yielded a lower rate of malignancy compared with other lesion locations.
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Xu HN, Nioka S, Li LZ. Imaging heterogeneity in the mitochondrial redox state of premalignant pancreas in the pancreas-specific PTEN-null transgenic mouse model. Biomark Res 2013; 1:6. [PMID: 24252270 PMCID: PMC3776248 DOI: 10.1186/2050-7771-1-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/18/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Metabolic alteration is one of the hallmarks of carcinogenesis. We aimed to identify certain metabolic biomarkers for the early detection of pancreatic cancer (PC) using the transgenic PTEN-null mouse model. Pancreas-specific deletion of PTEN in mouse caused progressive premalignant lesions such as highly proliferative ductal metaplasia. We imaged the mitochondrial redox state of the pancreases of the transgenic mice approximately eight months old using the redox scanner, i.e., the nicotinamide adenine dinucleotide/oxidized flavoproteins (NADH/Fp) fluorescence imager at low temperature. Two different approaches, the global averaging of the redox indices without considering tissue heterogeneity along tissue depth and the univariate analysis of multi-section data using tissue depth as a covariate were adopted for the statistical analysis of the multi-section imaging data. The standard deviations of the redox indices and the histogram analysis with Gaussian fit were used to determine the tissue heterogeneity. RESULTS All methods show consistently that the PTEN deficient pancreases (Pdx1-Cre;PTENlox/lox) were significantly more heterogeneous in their mitochondrial redox state compared to the controls (PTENlox/lox). Statistical analysis taking into account the variations of the redox state with tissue depth further shows that PTEN deletion significantly shifted the pancreatic tissue to an overall more oxidized state. Oxidization of the PTEN-null group was not seen when the imaging data were analyzed by global averaging without considering the variation of the redox indices along tissue depth, indicating the importance of taking tissue heterogeneity into account for the statistical analysis of the multi-section imaging data. CONCLUSIONS This study reveals a possible link between the mitochondrial redox state alteration of the pancreas and its malignant transformation and may be further developed for establishing potential metabolic biomarkers for the early diagnosis of pancreatic cancer.
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Affiliation(s)
- He N Xu
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Britton Chance Laboratory of Redox Imaging, Johnson Research Foundation, Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shoko Nioka
- Britton Chance Laboratory of Redox Imaging, Johnson Research Foundation, Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lin Z Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Britton Chance Laboratory of Redox Imaging, Johnson Research Foundation, Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sahani DV, Bonaffini PA, Catalano OA, Guimaraes AR, Blake MA. State-of-the-art PET/CT of the pancreas: current role and emerging indications. Radiographics 2012; 32:1133-58; discussion 1158-60. [PMID: 22786999 DOI: 10.1148/rg.324115143] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fused positron emission tomography (PET)/computed tomography (CT) is a recently developed technology that couples the functional information of PET with the anatomic details of CT. Integrated PET/CT scanners produce both PET and contrast material-enhanced CT images of the entire body in one setting. Typically, the amount of fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake in normal pancreatic parenchyma is insignificant compared with that of the liver. However, both malignant (eg, adenocarcinoma) and benign (eg, acute pancreatitis) pancreatic conditions may demonstrate intense FDG uptake. PET/CT provides an opportunity to depict pancreatic tumors and distant metastases, perform preoperative staging, and monitor response to treatment, and it has proved useful in distinguishing postoperative fibrosis from recurrence. In selected cases, PET/CT findings may be used to help diagnose autoimmune pancreatitis mimicking a mass by depicting systemic involvement. PET/CT may also be used to direct biopsy to sites more likely to yield representative tumor tissue. Novel radiolabeled molecules, such as sigma-receptor ligands and 18F-3'-fluoro-3'-deoxy-l-thymidine (FLT), may play an even greater role in distinguishing tumor recurrence from postoperative fibrosis or inflammation.
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Affiliation(s)
- Dushyant V Sahani
- Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Role of combined DWIBS/3D-CE-T1w whole-body MRI in tumor staging: Comparison with PET-CT. Eur J Radiol 2012; 81:1917-25. [DOI: 10.1016/j.ejrad.2011.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/07/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022]
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40
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Cronin CG, Prakash P, Daniels GH, Boland GW, Kalra MK, Halpern EF, Palmer EL, Blake MA. Brown Fat at PET/CT: Correlation with Patient Characteristics. Radiology 2012; 263:836-42. [DOI: 10.1148/radiol.12100683] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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F-18 FDG PET/CT imaging of solitary liver Langerhans cell histiocytosis: preliminary findings. Ann Nucl Med 2012; 26:436-9. [DOI: 10.1007/s12149-012-0587-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 02/14/2012] [Indexed: 11/26/2022]
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42
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Gorospe L, Jover-Díaz R, Vicente-Bártulos A. Spectrum of PET–CT pelvic pitfalls in patients with gynecologic malignancies. ACTA ACUST UNITED AC 2012; 37:1041-65. [DOI: 10.1007/s00261-012-9867-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Imaging plays a vital role in the evaluation of patients with suspected or proven peritoneal malignancy. Nevertheless, despite significant advances in imaging technology and protocols, assessment of peritoneal pathology remains challenging. The combination of complex peritoneal anatomy, an extensive surface area that may host tumour deposits and the considerable overlap of imaging appearances of various peritoneal diseases often makes interpretation difficult. Contrast-enhanced multidetector computed tomography (MDCT) remains the most versatile tool in the imaging of peritoneal malignancy. However, conventional and emerging magnetic resonance imaging (MRI) and positron emission tomography (PET)/CT techniques offer significant advantages over MDCT in detection and surveillance. This article reviews established and new techniques in CT, MRI and PET imaging in both primary and secondary peritoneal malignancies and provides an overview of peritoneal anatomy, function and modes of disease dissemination with illustration of common sites and imaging features of peritoneal malignancy.
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Affiliation(s)
- Chirag M Patel
- Department of Diagnostic Imaging, Barts and the London NHS Trust, Bart's Cancer Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
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44
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D'souza MM, D'souza PV, Jaimini A, Sharma R, Tripathi M, Singh D, Mondal A. A rare case of pemphigus vegetans mimicking malignancy on F-18 FDG PET/CT. Clin Nucl Med 2011; 36:248-51. [PMID: 21285693 DOI: 10.1097/rlu.0b013e318208f746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 42-year-old man with a history of chronic smoking and alcoholism was suspected to harbor a malignancy involving the perioral region and the scalp. He underwent an F-18 FDG PET/CT scan which revealed abnormal F-18 FDG accumulation in the oral mucosa and lips, extending to the nose, scalp, and bilateral cervical lymph nodes. Further work-up ultimately revealed the lesions to be secondary to pemphigus vegetans. Pemphigus vegetans is a rare variant of pemphigus vulgaris, an autoimmune bullous cutaneous disorder and involves mainly the flexural regions of the body. Unlike pemphigus vulgaris, lesions of pemphigus vegetans present as heaped up, eroded, and ulcerative plaques in the intertriginous regions of the body. Occasional lesions may be present on scalp and elsewhere in the Hallopeau variant of the disease. The use of F-18 FDG PET in the field of oncology is rapidly evolving; however, it is not tumor specific. The integration of CT into PET has increased the specificity of this modality. Nevertheless, there are many physiologic and benign conditions that may result in high accumulation of FDG, and may mimic malignancy. Familiarity with F-18 FDG-avid nonmalignant lesions may extend the use of F-18 FDG PET imaging beyond the field of oncology. To the best of our knowledge, this is the first description of PET/CT findings in pemphigus vegetans.
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Affiliation(s)
- Maria M D'souza
- Department of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
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45
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Incidental Detection of Temporary Focal FDG Retention in the Spleen. Nucl Med Mol Imaging 2011; 45:158-60. [PMID: 24899998 DOI: 10.1007/s13139-011-0078-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/20/2011] [Indexed: 10/18/2022] Open
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46
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Culverwell AD, Scarsbrook AF, Chowdhury FU. False-positive uptake on 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging. Clin Radiol 2011; 66:366-82. [PMID: 21356398 DOI: 10.1016/j.crad.2010.12.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/14/2010] [Accepted: 12/21/2010] [Indexed: 01/29/2023]
Abstract
With the increasing utilization of integrated positron-emission tomography/computed tomography (PET/CT) using the glucose analogue 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (FDG) in oncological imaging, it is important for radiologists and nuclear medicine physicians to be aware that FDG uptake is not specific for malignancy, as many different physiological variants and benign pathological conditions can also exhibit increased glucose metabolism. Such false-positive FDG uptake often arises outside the area of primary interest and may mimic malignant disease, thereby confounding accurate interpretation of PET/CT studies. With the use of illustrative clinical cases, this article will provide a systematic overview of potential interpretative pitfalls and illustrate how such unexpected findings can be appropriately evaluated.
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Affiliation(s)
- A D Culverwell
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, UK
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47
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Schubert T, Pansini M, Bongartz G, Niemann T. Critical pitfall: varices in cancer patients mimicking lymphadenopathy; differentiation of varicose veins and enlarged lymph nodes in routine staging. J Radiol Case Rep 2011; 5:23-9. [PMID: 22470814 DOI: 10.3941/jrcr.v5i9.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two patients, each with a history of multiple cancers, were referred to our institution for routine cancer staging. Contrast enhanced multislice-CT showed round and oval shaped inguinal and retroperitoneal masses in one patient and inguinal mass lesions in the other patient. The mass lesions were suspicious of lymphadenopathy related to cancer recurrence. Additional MR-Imaging, however, showed tortuous varicose veins as well as suspicious lymph nodes in one patient and solely venous convolutes in the other patient. Regarding the routine contrast enhanced CT-scan in the portovenous phase, varices showed no significant difference in radiodensity compared to enlarged lymph nodes.
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Affiliation(s)
- Tilman Schubert
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
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48
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Liu Y, Ghesani NV, Zuckier LS. Physiology and pathophysiology of incidental findings detected on FDG-PET scintigraphy. Semin Nucl Med 2010; 40:294-315. [PMID: 20513451 DOI: 10.1053/j.semnuclmed.2010.02.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A routine feature of positron emission tomography/computed tomography (PET/CT) imaging is whole-body acquisition that results in many unexpected findings identified outside of the primary region of abnormality. Furthermore, (18)F-fluorodeoxyglucose (FDG) is a marker of glycolysis and does not specifically accumulate in malignancy. Understanding the physiology and pathophysiology of normal FDG distribution and common incidental findings is therefore essential to the physician interpreting whole-body FDG-PET/CT studies. Whereas many incidental findings are benign and of limited clinical significance, others represent uncommon manifestations of the primary malignancy, second malignancies, or various clinically significant pathologic processes. Patients with a single malignancy are at greater risk of developing synchronous or metachronous second malignancies, possibly related to exposure to shared carcinogenic agents or presence of prooncogenic mutations. The decision of how to pursue an intervention on the basis of an incidental finding is generally left to clinical judgment.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Section, Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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49
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Son H, Kositwattanarerk A, Hayes MP, Chuang L, Rahaman J, Heiba S, Machac J, Zakashansky K, Kostakoglu L. PET/CT Evaluation of Cervical Cancer: Spectrum of Disease. Radiographics 2010; 30:1251-68. [DOI: 10.1148/rg.305105703] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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50
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Abstract
Data on the use of PET in women with genetic or familial high-risk for breast or ovarian cancer are scarce. Open issues include the complementary use of dedicated breast-PET scanners in patients at high-risk for breast cancer, the relation between pathological characteristics of cancer diagnosed in BRCA carriers and (18)F-fluorodeoxyglucose ((18)F-FDG)-avidity, and the predictive value of PET in patients at high-risk for ovarian cancer presenting with a pelvic mass or potential chemical markers. Therefore, the use of PET in high-risk patients with unproven malignant disease needs to be investigated in well designed clinical trials. Once breast or ovarian cancer is diagnosed, indications for (18)F-FDG-PET or PET-CT imaging are similar for high-risk patients and patients with sporadic cancer. However, PET can provide data that are beyond tumour detection per se. Future directions of PET in high-risk patients might include monitoring the response of BRCA carriers to new treatments such as poly-ADP ribose polymerase (PARP) inhibitors, personalisation of treatment, and the use of new PET tracers to investigate the tissue changes related to increased risk for breast and ovarian cancer.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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