Hiroko Kurooka

Distinguishing benign from malignant gallbladder wall thickening using FDG-PET.

ObjectiveBecause thickening of the gallbladder wall is observed not only in patients with gallbladder cancer but also in those with benign diseases such as chronic cholecystitis and gallbladder adenomyosis, it is difficult to distinguish between benign and malignant gallbladder wall thickening by conventional techniques of diagnostic imaging such as computed tomography (CT), magnetic resonance imaging (MRI), and abdominal ultrasonography (US). In the present study, we attempted to distinguish between benign and malignant gallbladder wall thickening by means of fluorine- 18-fluorodeoxyglucose (FDG)- Positron emission tomography (PET).MethodsFDG-PET was performed in 12 patients with gallbladder wall thickening detected by CT or US, to determine whether it was benign or malignant. Emission scans were taken, beginning 45 minutes after intravenous administration of FDG, and SUV was calculated as an indicator of glucose metabolism.ResultsOf the 12 patients, 4 showed positive uptake of FDG in the gallbladder wall. Of these 4 patients, 3 had gallbladder cancer. The remaining one, who had chronic cholecystitis, had false-positive findings. The other 8 patients had negative uptake of FDG in the gallbladder wall. Two of these 8 underwent surgical resection, which yielded a diagnosis of chronic cholecystitis. The other 6 patients exhibited no sign of gallbladder malignancy and have been followed without active treatment.ConclusionsFDG-PET appears able to distinguish between benign and malignant gallbladder wall thickening.

Effectiveness of preoperative PET examination of huge angiosarcoma of the heart.

Abstract: We report a 60-year-old-woman with a huge intracardiac angiosarcoma in whom preoperative F-18 fluorodeoxyglucose (FDG) PET was useful for confirming malignancy of the tumor and determining whether surgery was indicated for it. Her chief complaint was dyspnea. Because she was suspected to have a huge intracardiac tumor on the basis of transthoracic echocardiographic and computed tomography (CT) findings, FDG PET was performed, and the maximum standardized uptake value (SUV) of the tumor was found to be 5.6. Because other tests and SUV level suggested a malignant cardiac tumor, surgical resection of it was attempted. On histopathological examination, the tumor was found to be an angiosarcoma. Our experience with this case indicates that, when dealing with patients suspected to have very large tumors, FDG PET is useful in examination for malignant potential and is indispensable in exploration for distant metastases.

Lamivudine therapy for hepatitis B virus reactivation in a patient receiving intra-arterial chemotherapy for advanced hepatocellular carcinoma.

We describe a case of hepatitis B virus (HBV) reactivation that responded to lamivudine therapy in a 58-year-old man with advanced hepatocellular carcinoma (HCC). After seroconversion of hepatitis B e antigen to e antibodies by interferon therapy, the patient was found to have HCC with a portal tumor thrombus. A transarterial port was placed in the right femoral artery to permit infusion of epirubicin and cisplatin. After 3 months of arterial chemotherapy, the serum alpha-fetoprotein level had decreased and tumor staining diminished. Laboratory examinations suggested a flare-up of hepatitis B. Lamivudine was given to manage HBV reactivation. After 1 month, the serum HBV DNA level fell below the detection limit, and the alanine aminotransferase activity decreased to the normal range. With further arterial chemotherapy for HCC, no tumor staining was detected on computed tomography. Administration of lamivudine decreased serum HBV DNA levels for 7 months. Our findings suggest that HBV may be reactivated during chemotherapy for HCC, similar to other types of malignancies, and that lamivudine is effective for the management of HBV reactivation.

Cyclical etidronate for treatment of osteopenia in patients with cirrhosis of the liver

Osteoporosis is associated with cirrhosis of the liver. We evaluated the effects of cyclical etidronate on osteopenia in women with cirrhosis of the liver. The subjects were 50 women with cirrhosis who had underlying hepatitis viral infection. Half of the patients were randomly assigned to receive cyclical etidronate (200 mg). The bone mineral density (BMD) of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at entry and at 1 year intervals for at least 2 years. After 1 year of treatment, the median BMD was +0.7% in the treated group and minus sign2.0% in the control group. After 2 years of treatment, the median BMD was +0.1% in the treated group and minus sign3.4% in the control group. After 3 years of treatment, the median BMD was minus sign0.6% in the treated group and minus sign5.2% in the control group. These differences between the groups were significant. No adverse effects of cyclical etidronate were noted. These results suggest that cyclical etidronate can prevent bone loss and may therefore be useful in the management of bone disease in women with cirrhosis of the liver.

Two cases of focal nodular hyperplasia of the liver : Value of scintigraphy with Tc-99m GSA and positron emission tomography with FDG

Focal nodular hyperplasia (FNH) of the liver is relatively rare, and can be difficult to differentiate from other benign tumors arising in the liver. We describe a 23-year-old woman and a 25-year-old man with FNH. They were hospitalized for further evaluation of a space-occupying lesion in the liver. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) revealed increased radioactivity in the tumor in one patient and radioactivity similar to that in the normal part of liver in the other. F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed uptake similar to that of the normal liver in both patients. FNH was diagnosed on the basis of angiographic findings and histological findings in liver biopsy specimens. Our results show that scintigraphy with Tc-99m GSA and FDG-PET may provide information helpful in the diagnosis of FNH.

A case of glucagonoma with high uptake on F-18 fluorodeoxyglucose positron emission tomography

Glucagonomas are relatively rare, and can be difficult to differentiate from other pancreatic tumors. A 62-year-old woman who had suffered from diabetes mellitus was hospitalized for further evaluation of a space-occupying lesion in the head of the pancreas and tumors in the liver. F-18 fluorodeoxyglucose positron emission tomography revealed accumulation of isotope corresponding to a tumor of the pancreas with a standardized uptake value of 4.3, and tumors in the liver with standardized uptake values of 2.4 and 2.8. The serum glucagon level was high (1,170 pg/ml) and the secretin tolerance test was negative. She was diagnosed with glucagonoma with a high serum glucagon level and clinical findings. It is suggested that glucagonoma may be one of the tumors which show high uptake of F-18 fluorodeoxyglucose.

Evaluation of diagnostic abilities of Ga-SPECT for head and neck lesions.

ObjectiveSingle-photon emission computed tomography (SPECT) using gallium (Ga) has been frequently used for diagnosing head and neck tumors in patients. Although the usefulness of Ga-SPECT is well known, the degree of the increase in diagnostic ability with Ga-SPECT for head and neck tumors has not been reported. We compared the ability of the planar images of Ga scintigraphy, SPECT images of Ga scintigraphy, and CT images to diagnose head and neck primary tumors and neck metastases.MethodsThe subjects of this study were 167 patients with malignant head/neck lesions. For Ga scintigraphy, Ga-67-citrate (74 MBq) was injected via a cubital vein. Planar and SPECT images were taken 72 h after the Ga-67-citrate injection. The rate of detection of the primary lesions was compared first between SPECT and planar images then between SPECT and CT images. The rate of detection for each stage of disease according to the TNM classification was also analyzed.ResultsThe rate of detection of primary lesions was 50% with planar imaging and 69% with SPECT. And similarly, regarding the rate of detection of lymph node metastases, there was a significant difference between planar imaging and SPECT. The rate of detection of primary lesions was 70% for both CT and SPECT. At T stage, the rates of detection of primary lesions with each imaging technique were 11% with planar imaging and 39% with SPECT, and 22% with CT for stage T1.ConclusionsThis study revealed the marked superiority of SPECT images over planar images in terms of the ability to detect primary tumors and tumor metastasis to cervical lymph nodes. Furthermore, the primary T1 tumor detection rate of SPECT images was higher than that of CT images. On the basis of these results, the concomitant use of SPECT is highly recommended when Ga scintigraphy is performed to check for malignant head/neck tumors.

A case of cavernous hemangioma in which malignancy was preoperatively excluded by FDG-PET

A contrast-enhanced mass was revealed by computed tomography and magnetic resonance imaging in the left pelvic cavity of a 71-year-old man. Although the mass appeared to be a cavernous hemangioma, malignancy could not be ruled out. Abdominal angiography was performed but failed to rule out malignancy because it revealed vascular dislocation and encasement. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was then performed, and suggested a benign tumor, with a standardized uptake value (SUV) of 1.7. Following this finding, because the tumor was large and rupture could not be ruled out, we decided to perform surgery. The resected tumor was a benign cavernous hemangioma, consistent with the result obtained by FDG-PET.

Detection of local residual tumor after laryngeal cancer treatment using FDG-PET

Objective: Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is sometimes used as a means of follow-up after diagnosis and treatment of cancers of the head and neck region. The present study was undertaken to evaluate the ability of FDG-PET to detect local residual tumor after treatment of laryngeal cancer.Methods: Thirty-six patients with laryngeal cancer underwent FDG-PET before and after initial treatment. Of these patients, 20 received FDG-PET before treatment and 28 received it after treatment. The relationship between standardized uptake values (SUV) and the presence or absence of local residual tumor was investigated by setting the cut-off value of the SUV using the receiver operating characteristics (ROC) curve.Results: When the pre-treatment SUV threshold for laryngeal cancer was set at 7.20, the detection of local residual tumor after treatment using FDG-PET had a sensitivity of 77.78%, specificity of 81.82%, false positive rate of 18.18%, false negative rate of 22.22%, accuracy of 80% and a p value of 0.02. When the post-treatment SUV threshold for the larynx was set at 3.35, the test had a sensitivity of 93.75%, specificity of 91.67%, false positive rate of 8.33%, false negative rate of 6.25%, accuracy of 92.86% and a p value of 0.0001.Conclusions: FDG-PET was found to be useful for determining the presence of local residual tumor after treatment of laryngeal cancer.

Randomized trial assessing gastric emptying in patients with chronic hepatitis C during interferon-α or -β therapy and effect of cisapride

We examined the effects of interferon-α or -β therapy on gastric emptying and digestive symptoms. The effects of cisapride on gastric emptying and digestive symptoms were also evaluated. The subjects were 48 patients with chronic hepatitis C. All patients were randomly assigned to one of four groups (A, interferon-α group; B, interferon-α and cisapride group; C, interferon-β group; D, interferon-β and cisapride group). Gastric emptying was measured before initiation of interferon therapy and two weeks after initiation of therapy. The half-time of gastric emptying (T1/2) was calculated. The T1/2 ratio was calculated by dividing the T1/2 after interferon therapy by the T1/2 before interferon therapy. Digestive symptom scores were determined at the time of the gastric emptying tests. The T1/2 after interferon therapy was higher than that before therapy in groups A and C (P = 0.002 and 0.059, respectively). The digestive symptom score after interferon therapy was higher than that before therapy in groups A and C (P = 0.012 and 0.093, respectively). The T1/2 ratio in group B was significantly lower than that in group A (P = 0.021), and the T1/2 ratio in group D was lower than that in group C, but the difference did not reach statistical significance (P = 0.057). Interferon-α is associated with a greater delay in gastric emptying and a higher symptom score than is interferon-β. Administration of cisapride corrects the delayed gastric emptying and relieves associated digestive symptoms.