Tsuyoshi Komori

Leptomeningeal carcinomatosis and intramedullary spinal cord metastases from lung cancer: detection with FDG positron emission tomography.

A 64-year-old man with a history of large-cell lung carcinoma and recent resection of a brain metastasis was examined because of a general decline in his ability to function. Whole-body positron emission tomography with fluorine-18 fluorodeoxyglucose (FDG PET) showed metastases along the spinal cord that were confirmed with MRI. Intramedullary spinal cord metastasis occurs rarely, and the prognosis is extremely poor. Whole-body FDG PET allows the entire spinal cord to be examined noninvasively compared with magnetic resonance imaging, computed tomography, and myelography.

Cerebral Lesions Incidentally Detected on 2-Deoxy-2-[18F]Fluoro-D-Glucose Positron Emission Tomography Images of Patients Evaluated for Body Malignancies

OBJECTIVESnThe purpose of this work was done to evaluate the value of including the brain in the field of view of a whole-body 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography (FDG-PET) study of patients referred for the evaluation of body malignancies.nnnMETHODSnA total of 1026 consecutive patients were included in this work. The primary diagnoses were the following: lung (n = 253), colorectal (n = 148), head and neck (n = 61), lymphoma (n = 249), melanoma (n = 84), and others (n = 231). Whole-body FDG images including the brain were acquired with a dedicated PET tomograph (GE advance, General Electronic Medical Systems, Milwaukee, WI) one hour after the intravenous administration of 10 mCi of FDG. Two experienced nuclear medicine physicians interpreted the images. Positive findings in the brain or the skull were correlated with other imaging studies and clinical follow-up.nnnRESULTSnAbnormal findings were detected in 3.9% (40/1026) of the patients. Among the 40 abnormal focal lesions, 29 patients had a known history of cerebral disease, cerebrovascular or metastatic disease in most patients. Of the 11 patients without a prior history of cerebral disease, four patients had increased focal FDG uptake suggestive of metastases. Among these, two were proven clinically, one was proven to be a skull base metastasis on MRI, and the other had negative clinical follow-up, but only of two months duration. The other seven patients had a decreased focal FDG uptake most consistent with infarct, one was proven clinically, and the other six had a negative clinical follow-up (mean of 6.3 months, range 1-10), but had multiple risk factors for cerebrovascular disease.nnnCONCLUSIONSnWe conclude that FDG-PET screening for cerebral lesions in patients with body malignancy has little clinical impact. Unsuspected cerebral or skull metastases were detected in 0.4% (4/1026) of the patients.

Serendipitous Detection of Cushing’s Disease by Fdg Positron Emission Tomography and a Review of the Literature

A 70-year-old woman was referred for F-18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging of the brain to evaluate progressive dementia and neuropsychiatric symptoms. Although she had a history of hypertension and diabetes mellitus, she did not exhibit phenotypic features of Cushing’s disease. The FDG-PET images revealed marked FDG uptake in the pituitary gland but no evidence of degenerative dementia. Two macroadenomas were confirmed by magnetic resonance imaging. Endocrinologic evaluation revealed Cushing’s disease. After surgical resection of the tumors, the patient’s symptoms decreased markedly.

Central Nervous System Involvement of Intravascular Large B-cell Lymphoma on 18f-fdg Pet/ct

Intravascular large B-cell lymphoma is a rare subtype of extranodal diffuse large B-cell lymphoma. We present a case of intravascular large B-cell lymphoma with central nervous system involvement that can be detected on F-FDG PET and may be useful for applications in biopsy and diagnosis.