Fluorine-18-fluorodeoxyglucose PET/CT rare finding of a unique multiorgan involvement of Wegener's granulomatosis

Wegener's granulomatosis (WG) is an uncommon autoimmune disorder, which mainly involves the blood vessels, kidneys and respiratory tract. We report an interesting case of WG with unusual multiorgan involvement in a young male who presented with a short history of right-sided otalgia, nasal obstruction and a right parotid mass. His initial CT and MRI scans showed a large parotid mass with features suggestive of malignancy with bilateral cavitating pulmonary nodules suggesting metastatic disease. The imaging-based differential diagnosis was squamous cell carcinoma or adenoid cystic carcinoma. The microscopic findings on ultrasound-guided biopsy of the parotid mass were, surprisingly, those of acute necrotising granulomatous inflammation with some features suggestive of a vasculitic process. A multidisciplinary team discussion and further investigation resulted in the additional findings of haematuria, raised erythrocyte sedimentation rate and positive serum cytoplasmic anti-neutrophil cytoplasmic antibody test, which led to the diagnosis of WG. Subsequently, the patient developed acute urinary retention owing to gross prostatic enlargement related to further disease involvement, which was confirmed with a positive biopsy. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT scan showed disease distribution at the right maxillary sinus/nasal cavity, right parotid, mediastinum, lungs and prostate. To our knowledge, this is the first reported 18F-FDG PET/CT case with multiorgan involvement in a single WG patient. The patient has improved both clinically and on imaging after appropriate treatment with immunosuppressive therapy and steroids. Although 18F-FDG PET/CT imaging did not actually alter the management of this patient, it can help to establish the disease distribution and guide the biopsy.

The use of radioisotopes for palliation of metastatic bone pain

Bone pain associated with advanced prostate and other cancers is a frequent and significant complication. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the armamentarium for the treatment of multiple osseous metastases. The 3 radioisotopes currently approved for treatment of pain (strontium-89/(89)Sr, samarium-153/(153)Sm and rhenium-186/(186)Re) are discussed in this review including the approved dose, method of administration and indications for use.

Is there a role of whole body bone scan in early stages of non small cell lung cancer patients

PURPOSE

The aim of our study was to re-evaluate the role of whole-body bone scanning (WBBS) in detecting bone metastases in apparently operable stages of non small cell lung cancer (NSCLC) patients.

PATIENTS AND METHODS

We made a retrospective analysis of 60 patients (53 males, 7 females, aged 47-87 years, mean 68+/-4) between 2004-2006. All patients had a full series of imaging staging procedures including WBBS. Their medical records were reviewed with respect to how often bone metastases were detected and whether or not the patients showed any symptoms or laboratory abnormalities indicating bone involvement.

RESULTS

Skeletal metastases (confirmed afterwards by x-ray, computed tomography or biopsy) were found in 11 (18.3%) patients. All of them had normal serum alkaline phosphatase and calcium concentrations. Eleven patients had symptoms suggesting bone metastases and 49 were asymptomatic. Bone metastases were detected in 3 (27.2%) of 11 clinically symptom-positive patients and in 8 (16.3%) of 49 clinically symptom-negative patients.

CONCLUSION

The present study indicates that if bones scans were done only in patients reporting skeletal symptoms an important number of patients (16.3%) would have been misstaged due to asymptomatic bone metastases. We conclude that in patients with apparently operable NSCLC preoperative staging using WBBS is useful to avoid under-staging and futile surgery.