G. Kara Gedik

The Role of FDG-PET/CT in Ovarian Cancer Patients with High Tumor Markers or Suspicious Lesion on Contrast-Enhanced CT in Evaluation of Recurrence and/or in Determination of Intraabdominal Metastases

OBJECTIVES This retrospective study was designed to investigate the role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in determination of recurrence and/or intraabdominal metastasis in patients with ovarian cancer having increased tumor markers or suspicious lesion detected by a contrast-enhanced abdominal CT (ceCT). MATERIALS AND METHODS A total of 34 female patients who were treated for histopathologically proven ovarian cancer, underwent PET/CT examination for restaging and suspected recurrence. Patients with pathology report, tumor marker levels, ceCT and PET/CT performed within one month were included in the study. RESULTS A total of 34 patients were included in the study. 25 of 34 patients had high tumor marker (CA 125) level. The remaining 9 patients had suspected recurrence on ceCT imaging with normal tumor marker levels. Recurrence was confirmed by re-operation and biopsy (n=4), clinical and imaging follow-up (n=21) in 25 patients with elevated tumor markers. Recurrent disease was not shown in 5 of 25 patients on ceCT imaging and 1 of 25 patients on PET/CT imaging with high CA125 values. Both ceCT and PET/CT revealed recurrent disease in 19 of 25 patients. PET/CT showed more lesions in 11 of 19 patients. Sensitivity, specificity and accuracy of the PET/CT were 96.1%, 100% and 97%, respectively. CONCLUSION PET/CT is found as a beneficial method for detection of the recurrence, in patients with increased serum CA 125 level and negative CT findings or with normal CA 125 level and recurrence detected by CT which was performed due to clinical symptoms.

The value of FDG-PET/CT in the post-treatment evaluation of endometrial carcinoma: A comparison of PET/CT findings with conventional imaging and CA 125 as a tumour marker

OBJECTIVES This retrospective study was designed to assess the value of positron emission tomography/computed tomography imaging (PET/CT) in the post-treatment evaluation of the patients with endometrial carcinoma and to compare PET/CT scan with conventional imaging (CI) including computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) and CA 125 with both 20U/ml and 35U/ml cut-off values. MATERIALS AND METHODS A total of 31 patients who were treated for histopathologically proven endometrial adenocarcinoma, underwent PET/CT examination for restaging and suspected recurrence. Thirty five PET/CT studies were performed in 31 patients. Lesion status was determined on the basis of clinical follow-up including radiological imaging (follow-up CT scan) at least 6 months and response to therapy. RESULTS Of the 35 PET/CT studies, 13 (37%) studies were positive, whereas 22 (63%) of them were negative. On study-based analysis the overall sensitivity, specificity, accuracy for PET/CT imaging were 100%, 96% and 97%, respectively. The corresponding information for CI were 46%, 87% and 74%, for CA 125 (cut off=20U/ml) measurement were 45%, 88% and 74%, and for CA 125 (cut off=35U/ml) measurement were 27%, 100% and 78%, respectively. On lesion-based analysis, PET/CT revealed only one false positive case. In none of 21 patients with negative 22 PET/CT studies, no subsequent clinical or radiological recurrences were observed with a follow-up of at least 6 months. CONCLUSION FDG-PET/CT is found more useful modality than CI and CA 125 in the evaluation of post-treatment endometrial carcinoma patients, for suspected recurrence.

Primary epithelioid trophoblastic tumor with a synchronous breast carcinoma detected only with FDG-PET/CT Scan

Epithelioid trophoblastic tumor is a recently described, rare and distinctive type of gestational trophoblastic tumor. We report the case of a 31-year old patient who had a full-term pregnancy 18 months before presentation. She had a right axillary lymph node metastasis and was referred for FDG-PET/CT scan for evaluation of distant metastasis and to detect primary malignancy. The axillary lymph node biopsy revealed metastatic breast carcinoma. FDG-PET/CT revealed increased uptake of right axillary lymph node, soft tissue density lesion with a diameter of 24 mm on left cervical region with increased FDG uptake, increased uptake on cervical region and left inguinal lymph node with increased uptake. Pelvic MRI imaging and ultrasonography were negative for malignancy in cervical region. Biopsy of the lesion was consistent with epithelioid trophoblastic tumor in cervical region. Gestational trophoblastic tumor was not suspected because she had no signs such as abnormal vaginal bleeding. FDG-PET/CT demonstrated the primary lesion in cervical region. We report a rare case of primary epithelioid trophoblastic tumor detected only with FDG-PET/CT scan which synchronized with breast carcinoma.

Epitrochlear and axillary lymph node visualization on FDG-PET/CT imaging in a patient with rheumatoid arthritis.

An 38 year-old female with oral tongue cancer was referred for FDG-PET/CT scan for evaluating axillary lymph nodes and restaging malignancy. Bilateral uptake of axillary and epitrochlear lymph nodes were observed on PET/CT imaging. The uptake pattern was unexpected for the patient with this malignancy and she had a history of rheumatoid arthritis. Additionally, the wrists were included in the field of view and showed elevated FDG uptake. In this case report, we report benign axillary and epitrochlear tracer uptake on FDG-PET/CT scan in a patient with a history of rheumatoid arthritis.

Bone and peritoneal metastasis of breast carcinoma: findings on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography.

or pathological diagnosis is impossible, PET/CT is a feasible imaging method in peritoneal disease. FDG PET/CT may give additional information to other imaging methods in the staging of peritoneal carcinomatosis. A 56-year-old female patient with breast carcinoma was eferred to Nuclear Medicine Department for FDG PET/CT examiation as a part of staging before treatment. On FDG PET/CT (fig. 1), hyperdense lesion of 17 × 13 mm in size with mild FDG uptake as shown at the inner-lower quadrant of left breast. Maximum tandardized uptake value (SUVmax) was 1.22. There were also ultiple bone metastases with increased FDG uptake (SUVmax: .78). After the imaging she was treated with chemotherapy and adiotherapy.Three weeks after chemotherapy and 7 months after adiotherapy, she re-presented to our department for restaging nd she had abdominal pain for one week. Figure 2 illustrates he FDG PET/CT images after therapy. A mass of 28 mm in diamter with increased FDG uptake (SUVmax: 3.29) at the inner-lower uadrant of left breast and precarinal, subcarinal and left hilar ymphadenopaties with increased FDG uptake (SUVmax: 6.06) ere depicted. Moreover, axillary lymph node with mild increased etabolic activity (SUVmax: 2.12), a solid nodule with a diameter f 24 mm at the right anterior lobe of liver with increased metabolic ctivity (SUVmax: 6.17) and multiple mixed lytic/sclerotic bone etastases were detected. Additionally, multiple nodular masses t the omentum with increased metabolic activity (SUVmax: 6.0) ere noticed (Omental cake). A clear progression was seen in FDG ET/CT findings comparing to FDG PET/CT imaging before treatent. Peritoneal spreading of tumors can be developed by hematogeous, lymphatic or direct invasion1. Tumor cells may be seen icroscopically in ascitis in the early stage of diseases. By the later tages, spreading along parietal peritoneum and reaches to viseral peritoneum, the appearance of omental or mesenteric cake ay be imaged1. The sensitivity of FDG PET imaging in detection of eritoneal metastases varies between 30-66%. The sensitivity and ositive predictive value increases in peritoneal disease by using