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Molnar O, Straciuc OM, Mihuțiu S, Lazăr L. Impact of PET/CT Imaging with FDG in Locally Advanced Cervical Carcinoma-A Literature Review. Curr Oncol 2024; 31:2508-2526. [PMID: 38785469 PMCID: PMC11119194 DOI: 10.3390/curroncol31050188] [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] [Received: 03/30/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Positron emission tomography (PET) and computed tomography (CT) have evolved as a pivotal diagnostic modality in the field of oncology. With its increasing application in staging and ready availability, it becomes imperative for committed radiation oncologists to possess a complete analysis and understanding of integration of molecular imaging, which can be helpful for radiation planning, while also acknowledging its possible limitations and challenges. A significant obstacle lies in the synthesis and design of tumor-specific bmolecules for diagnosing and treating cancer. The utilization of radiation in medical biochemistry and biotechnology, encompassing diagnosis, therapy, and control of biological systems, is encapsulated under the umbrella term "nuclear medicine". Notably, the application of various radioisotopes in pharmaceutics has garnered significant attention, particularly in the realm of delivery systems for drugs, DNA, and imaging agents. The present article provides a comprehensive review of use of novel techniques PET and CT with major positron-emitting radiopharmaceuticals currently in progress or utilized in clinical practice with their integration into imaging and radiation therapy.
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Affiliation(s)
- Ottó Molnar
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
| | - Oreste Mihai Straciuc
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
- Centrul PET/CT Pozitron Diagnosztika, 410035 Oradea, Romania
| | - Simona Mihuțiu
- Department of Medicine-Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, 410073 Oradea, Romania
- Oncology Department, Pelican Hospital, 410469 Oradea, Romania
| | - Liviu Lazăr
- Doctoral Studies Department, Biomedical Science, 410087 Oradea, Romania
- Department of Medicine-Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, 410073 Oradea, Romania
- Băile Felix Medical Rehabilitation Hospital, 417500 Băile Felix, Romania
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Abstract
Leiomyomas are prevalent benign smooth muscle tumors in the uterus, displaying variable degrees of FDG uptake on PET/CT. The glucose metabolism intensity of those lesions relies on biologic features and markedly increased FDG accumulation is more typically related to malignant diseases, as in the case of leiomyosarcomas. Notwithstanding that uterine fibroids typically exhibit mild to moderate FDG uptake, in this article we report a case of unexpectedly intense hypermetabolism of a benign uterine leiomyoma on a PET/CT scan performed for initial staging of a breast cancer patient.
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Kusunoki S, Terao Y, Ujihira T, Fujino K, Kaneda H, Kimura M, Ota T, Takeda S. Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI. Taiwan J Obstet Gynecol 2018; 56:508-513. [PMID: 28805609 DOI: 10.1016/j.tjog.2017.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To analyze the efficacy of positron emission tomography/computed tomography (PET/CT) for the diagnosis of uterine sarcoma. MATERIALS AND METHODS Thirty-four patients evaluated between January 2010 and March 2015 were retrospectively enrolled. All patients in whom uterine sarcoma was suspected based on contrast-enhanced magnetic resonance imaging (MRI) findings (heterogeneous, high signal intensity on T2-weighted images and/or high intensity on T1-weighted images) underwent PET/CT for further assessment. Patients were divided into 2 groups based on postoperative pathological findings: uterine sarcoma (n = 15) and leiomyoma (n = 19). The maximum standardized uptake value (SUVmax) of all lesions was measured using PET/CT; we calculated the optimal cutoff value for diagnosing sarcoma. RESULTS The median SUVmax for uterine sarcoma and leiomyoma was 12 and 4.1, respectively; these values were significantly different. An SUVmax of greater than 7.5 was able to exclude leiomyoma with 80.8% sensitivity and 100% specificity (area under the curve, 95.3%). A cutoff SUVmax of 7.5 yields 100% specificity, and a cutoff SUVmax of 4.4 yields a 100% negative predictive value (NPV). The combination of PET/CT and lactate dehydrogenase (LDH) levels had a sensitivity of 86.6%, specificity of 100%, positive predictive value of 100%, and an NPV of 90.4%. No relation between histopathology or International Federation of Gynecology and Obstetrics (FIGO) stage and 18-fluoro-2-deoxy-d-glucose uptake value on PET/CT was seen. The surgical outcome trended toward a correlation with the SUVmax, although this was not statistically significant. CONCLUSIONS In patients with MRI findings consistent with either uterine sarcoma or leiomyoma, PET/CT can decrease the false-positive rate by setting an optimal cutoff SUVmax of 7.5. Using this cutoff can avoid unnecessary surgery.
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Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Takafumi Ujihira
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Kazunari Fujino
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Hiroshi Kaneda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Miki Kimura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Tsuyoshi Ota
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, 113-8431, Japan.
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Sawai Y, Shimizu T, Yamanaka Y, Niki M, Nomura S. Benign metastasizing leiomyoma and 18-FDG-PET/CT: A case report and literature review. Oncol Lett 2017; 14:3641-3646. [PMID: 28927125 DOI: 10.3892/ol.2017.6609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/10/2017] [Indexed: 12/16/2022] Open
Abstract
Pulmonary benign metastasizing leiomyoma (PBML) is a rare disease entity that usually occurs in females of reproductive age with a previous history of uterine myoma. It is typically characterized by multiple pulmonary tumors consisting of benign leiomyoma cells. In the present study, two cases of PBML are discussed. The patient in each case underwent 2-deoxy-2-(fluorine-18)-fluoro-D-glucose positron emission tomography/computed tomography (18-FDG-PET/CT) scans. One patient demonstrated a lack of 18-FDG uptake and a quiescent clinical course. However, the second patient exhibited a markedly high uptake of 18-FDG and aggressive cell proliferation. The two tumors revealed significant differences in metabolic behavior and in clinical course; however, they were similar with regard to cellular appearance. A review of previous studies concerning the findings of 18-FDG-PET/CT in published cases of PBML was also conducted and is presented here.
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Affiliation(s)
- Yusuke Sawai
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - Toshiki Shimizu
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - Yuta Yamanaka
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - Maiko Niki
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
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5
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Sato M, Kawana K, Adachi K, Fujimoto A, Taguchi A, Fujikawa T, Yoshida M, Nakamura H, Nishida H, Inoue T, Ogishima J, Eguchi S, Yamashita A, Tomio K, Arimoto T, Wada-Hiraike O, Oda K, Nagamatsu T, Osuga Y, Fujii T. Low uptake of fluorodeoxyglucose in positron emission tomography/computed tomography in ovarian clear cell carcinoma may reflect glutaminolysis of its cancer stem cell-like properties. Oncol Rep 2017; 37:1883-1888. [PMID: 28112360 DOI: 10.3892/or.2017.5398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/16/2017] [Indexed: 01/01/2023] Open
Abstract
The characteristics of ovarian cancers that showed low activation of glycolysis were investigated. Using medical records of patients with ovarian cancers who had undergone fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) prior to their primary surgery at the University of Tokyo Hospital between 2010 and 2015, we identified cases with a low uptake of FDG in PET/CT. We considered the maximum standardized uptake value (SUVmax) as the degree of glucose uptake. We investigated the properties which may account for the low activation of glycolysis in vitro. The expression level of alanine, serine, cysteine-preferring transporter 2 (ASCT2, a glutamine influx transporter), system L-type amino acid transporter 1 (LAT1, a glutamine efflux transporter) and glucose transporter 1 (GLUT1, a glucose influx transporter) were investigated by western blotting. The phosphorylation level of AMP-activated protein kinase (AMPK), which is one of the metabolic sensors, was also investigated. Most of the cases with a low uptake SUVmax were limited to patients with ovarian clear cell carcinoma (CCC). We obtained cancer stem cell (CSC)-like properties from CCC cell lines, and compared the expression levels of transporters between non-CSCs and CSCs. Whereas the expression level of ASCT2 was nearly unchanged between non-CSCs and CSCs, the expression levels of LAT1 and GLUT1 were decreased in CSCs compared to non-CSCs. The phosphorylation level of AMPK was reduced in CSCs compared to non-CSCs. In conclusion, we suggested that ovarian CCC showed low activation of glycolysis, and this may reflect glutaminolysis of its CSC-like properties.
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Affiliation(s)
- Masakazu Sato
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsuyuki Adachi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Asaha Fujimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomona Fujikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mitsuyo Yoshida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroe Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Haruka Nishida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomoko Inoue
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Juri Ogishima
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Satoko Eguchi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Aki Yamashita
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kensuke Tomio
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takahide Arimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsutoshi Oda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan
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FDG-PET/CT findings of atypical (bizarre/symplastic) uterine leiomyoma in a patient with abdominal leiomyosarcoma. Radiol Case Rep 2015; 7:670. [PMID: 27326292 PMCID: PMC4899701 DOI: 10.2484/rcr.v7i3.670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Atypical (bizarre) leiomyoma is a benign uterine smooth-muscle tumor characterized by a) a significant number of cells with dense eosinophilic cytoplasm and enlarged, bizarre single/multiple hyperchromatic or multiple nuclei without tumor necrosis and b) poor mitotic activity. We report the case of an atypical (bizarre) leiomyoma revealed by focal fluoro-deoxyglucose (FDG) uptake during a PET-CT in a patient with relapsing abdominal and retroperitoneal leiomyosarcoma.
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7
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High 18F-FDG Uptake For Uterine Smooth Muscle Tumor of Uncertain Malignant Potential. Clin Nucl Med 2015; 40:349-51. [DOI: 10.1097/rlu.0000000000000727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Hirose Y, Kaida H, Ishibashi M, Kawahara A, Kobayashi M, Hayabuchi N. Glucose transporter expression of intraductal papilloma of the breast detected by fluorodeoxyglucose positron emission tomography. Jpn J Radiol 2011; 29:217-21. [PMID: 21519997 DOI: 10.1007/s11604-010-0531-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/11/2010] [Indexed: 12/12/2022]
Abstract
A 40-year-old woman discovered through palpation a tumor in the upper lateral quadrant of the left mammary gland. Mammography, ultrasonography (US), and magnetic resonance imaging (MRI) showed a 10 mm diameter tumor. Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) showed abnormal accumulation in the detected tumor, and the maximum standardized uptake value was 2.2. The patient underwent tumor resection. The postoperative histopathological finding was intraductal papilloma. The intraductal papilloma showed strong expression of glucose transporter (GLUT)-4 on membrane and/or cytoplasm, and weak expression of GLUT-1 and GLUT-3 by immunohistochemistry. This case suggests that other glucose transporters (e.g., GLUT-4), other pathological factors, and cytokines may have a close relation with (18)F-FDG accumulation in intraductal papilloma more than GLUT-1 or GLUT-3 expression.
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Affiliation(s)
- Yasumitsu Hirose
- Division of Nuclear Medicine, PET Center and Department of Radiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume 830-0011, Japan
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9
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Seddon BM, Davda R. Uterine sarcomas--recent progress and future challenges. Eur J Radiol 2011; 78:30-40. [PMID: 21247711 DOI: 10.1016/j.ejrad.2010.12.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
Uterine sarcomas are a group of rare tumours that provide considerable challenges in their treatment. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made post-operatively. Current staging systems have been unsatisfactory, although a new FIGO staging system specifically for uterine sarcomas has now been introduced, and may allow better grouping of patients according to expected prognosis. While the mainstay of treatment of early disease is a total abdominal hysterectomy, it is less clear whether routine oophorectomy or lymphadenectomy is necessary. Adjuvant pelvic radiotherapy may improve local tumour control in high risk patients, but is not associated with an overall survival benefit. Similarly there is no good evidence for the routine use of adjuvant chemotherapy. For advanced leiomyosarcoma, newer chemotherapy agents including gemcitabine and docetaxel, and trabectedin, offer some promise, while hormonal therapies appear to be more useful in endometrial stromal sarcoma. Novel targeted agents are now being introduced for sarcomas, and uterine sarcomas, and show some indications of activity. Non-pharmacological treatments, including surgical metastatectomy, radiofrequency ablation, and CyberKnife(®) radiotherapy, are important additions to systemic therapy for advanced metastatic disease.
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Affiliation(s)
- Beatrice M Seddon
- London Sarcoma Service, Department of Oncology, University College Hospital, 1st Floor Central, 250 Euston Road, London, NW1 2PG, United Kingdom.
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Park JH, Han JY, Hyun IY, Lee BI, Moon YS. Case of uterine leiomyoma showing fludeoxyglucose uptake on F-18 fludeoxyglucose positron emission tomography/computed tomography. J Obstet Gynaecol Res 2010; 36:1261-4. [PMID: 21083837 DOI: 10.1111/j.1447-0756.2010.01307.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In order not to over treat uterine leiomyoma and to avoid overlooking uterine leiomyosarcoma, a highly reliable diagnostic method has been thought. Occasionally, it is difficult to discriminate uterine leiomyoma from uterine leiomyosarcoma. Recently positron emission tomography/computed tomography (PET/CT) has been proved useful in assessing pelvic malignancies. We experienced a case of uterine leiomyoma showing increased F-18 fludeoxyglucose uptake on PET/CT in a postmenopausal woman. However, histological analysis demonstrated benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed negative in leiomyoma. Our case indicates that uterine leiomyoma in a postmenopausal woman may show false positive result of PET/CT.
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Affiliation(s)
- Jee Hyun Park
- Department of Obstetrics and Gynecology, Laboratory Medicine, College of Medicine, Inha University, Incheon, Korea
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11
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Sohaib SA, Verma H, Attygalle AD, Ind TE. Imaging of Uterine Malignancies. Semin Ultrasound CT MR 2010; 31:377-87. [DOI: 10.1053/j.sult.2010.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Assessment of Fluorodeoxyglucose Uptake by Leiomyomas in Relation to Histopathologic Subtype and the Menstrual State. J Comput Assist Tomogr 2009; 33:877-81. [DOI: 10.1097/rct.0b013e31819f1bb2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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18F-Fluorodeoxyglucose uptake in uterine leiomyomas in healthy women. Clin Imaging 2009; 33:462-7. [DOI: 10.1016/j.clinimag.2009.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 02/10/2009] [Indexed: 11/18/2022]
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14
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Suppression of F-18 fluorodeoxyglucose uptake in benign uterine leiomyomas with danazol. Clin Nucl Med 2009; 34:452-5. [PMID: 19542955 DOI: 10.1097/rlu.0b013e3181a7d02a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Abstract
We report the case of pulmonary benign metastasizing leiomyoma in an asymptomatic 64-year-old woman who underwent hysterectomy for a uterine leiomyoma 26 years earlier. Routine chest radiograph revealed bilateral diffuse nodular opacities within the pulmonary lobes. Thoracic computed tomography (CT) scan showed peripheral lung nodules that do not display contrast enhancement. Positron emission tomography (PET)-CT with 18F-fluorodeoxyglucose (18F-FDG PET-CT) demonstrated no significant metabolic activity of the nodules. The lesions were diagnosed as benign metastasizing leiomyoma by histopathologic examination. To our best knowledge, this is the first case studied combining CT and FDG PET-CT technique.
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Liu Y. Benign ovarian and endometrial uptake on FDG PET-CT: patterns and pitfalls. Ann Nucl Med 2009; 23:107-12. [PMID: 19225932 DOI: 10.1007/s12149-008-0227-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 11/27/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Service, Department of Radiology, New Jersey Medical School, Newark, New Jersey, USA.
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17
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Incidence and characteristics of uterine leiomyomas with FDG uptake. Ann Nucl Med 2008; 22:803-10. [PMID: 19039559 DOI: 10.1007/s12149-008-0184-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 06/13/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Uterine leiomyomas sometimes show focal 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) images that may result in a false-positive diagnosis for malignant lesions. This study was conducted to investigate the incidence and characteristics of uterine leiomyomas that showed FDG uptake. METHODS We reviewed FDG-PET and pelvic magnetic resonance (MR) images of 477 pre-menopausal (pre-MP, age 42.1 +/- 7.3 years) and 880 post-MP (age 59.9 +/- 6.8 years) healthy women who underwent these tests as parts of cancer screening. Of 1357, 323 underwent annual cancer screening four times, 97 did three times, 191 did twice, and the rest were screened once. Focal FDG uptake (maximal standardized uptake value > 3.0) in the pelvis was localized and characterized on co-registered PET/MR images. RESULTS Uterine leiomyomas were found in 164 pre-MP and 338 post-MP women. FDG uptake was observed in 18 leiomyomas of 17 of the 164 (10.4%) pre-MP women and in 4 leiomyomas of 4 of the 338 (1.2%) post-MP women. The incidence was significantly higher in pre-MP women than in post-MP women (chi-square, P < 0.001). Of the 22, 13 showed signal intensity equal to or higher than that of the myometrium on T2-weighted MR images, which suggested abundant cellularity, whereas the majority of leiomyomas without FDG uptake showed low signal intensity. Of the 13 women, 12 examined more than twice showed substantial changes in the level of FDG uptake in leiomyomas each year with FDG uptake disappearing or newly appearing. These changes were observed frequently in relation with menopause or menstrual phases. CONCLUSIONS Leiomyomas with focal FDG uptake were seen in both pre-and post-MP women with a higher incidence in pre-MP women. Abundant cellularity and hormonal dependency may explain a part of the mechanisms of FDG uptake in leiomyomas. It is important to know that the level of FDG uptake in leiomyomas can change and newly appearing FDG uptake does not necessarily mean malignant transformation.
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Quirce Pisano R, Banzo Marraco I, Jiménez-Bonilla JF, Martínez-Rodríguez I, Sainz Esteban A, Carril Carril JM. [Potential sources of diagnostic pitfall and variants in FDG-PET/CT]. ACTA ACUST UNITED AC 2008; 27:130-59. [PMID: 18367053 DOI: 10.1157/13117196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Oncological FDG PET show variants and findings that may lead to a diagnostic error and that may be clarified by the morfofunctional imaging from PET/CT. In this article we show the experience acquired since a Siemens PET/CT Biograph LSO Pico3D was applied in our centre. We describe some representative examples of FDG distribution patterns which may lead to erroneous interpretations of the clinical studies when they refer to specific clinical situations. The examples included are classified into two main groups according to the cause: Technical and biological, and the latter into physiological and non-physiological (pathophysiological). Patterns are described within the biological group showing changes of the FDG biodistribution that may reduce the uptake in tumoural lesions, the physiological variants that may be interpreted as pathology, the effects of previous treatment and uptakes related to benign diseases. CONCLUSION We consider that knowledge of these variants and findings to be crucial in order to obtain optimal performance of PET/CT and to overcome the PET limitations.
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Affiliation(s)
- R Quirce Pisano
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España.
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19
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Kitajima K, Murakami K, Yamasaki E, Kaji Y, Sugimura K. Standardized uptake values of uterine leiomyoma with 18F-FDG PET/CT: variation with age, size, degeneration, and contrast enhancement on MRI. Ann Nucl Med 2008; 22:505-12. [PMID: 18670857 DOI: 10.1007/s12149-008-0135-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 02/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the effect of age, size, the degree of degeneration, and contrast enhancement on magnetic resonance imaging (MRI) on 18F-fluoro-2-deoxyglucose (18F-FDG) uptake in uterine leiomyomas using quantitative standardized uptake values (SUVs). METHODS A total of 61 leiomyomas of 41 patients, who underwent combined positron emission tomography/computed tomography (PET/CT) using 18F-FDG and contrast-enhanced MRI were included in this study. Sixty-one leiomyomas were divided into two groups: "non-degenerated" leiomyomas showing distinct low signal intensity on T2-weighted images and intermediate signal intensity on T1-weighted images, and "degenerated" leiomyomas showing other types of signal intensity. Sixty-one leiomyomas were also divided into two groups of "strongly enhancing" leiomyomas and "weakly enhancing" leiomyomas in terms of their degree of contrast enhancement on MRI. RESULTS The mean values of the maximum and average SUVs for the total of 61 leiomyomas were 2.34 +/- 0.75 (range 1.59-5.15) and 1.74 +/- 0.50 (0.66-3.95), respectively. There was a moderate negative correlation between the maximum and average SUVs and age (r = -0.43 and P = 0.00016, r = -0.31 and P = 0.029, respectively). Although there was a mild positive correlation between maximum SUV and size (r = 0.35 and P = 0.011), there was no significant difference between average SUV and size. Although there was no significant difference in average SUV between "degenerated" and "non-degenerated" leiomyomas, the maximum SUV of "degenerated" leiomyomas was significantly higher than that of "non-degenerated" leiomyomas (P = 0.0012). The degree of contrast enhancement on MRI was not significantly correlated with 18F-FDG uptake. CONCLUSIONS Mild or moderate uptake of 18F-FDG is often observed in uterine leiomyoma and declines with age, and should not be confused with malignant accumulation.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Dokkyo Medical University School of Medicine, 880 Kita-kobayashi, Mibu, Shimotsuga-gun, Tochigi, Japan.
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