Yaeko Takagi

Serum ferritin levels in patients with cervical cancer.

Serum ferritin levels were determined by a radioimmunoassay (a 2-site solid-phase method). The mean ferritin level for 52 control women was 35 ng/ml, and the 2nd to 98th percentile reference intervals were 3.9 to 108 ng/ml. The upper limit of ferritin level for controls was determined to be 108 ng/ml, and the sera from cervical cancer patients were screened. In 98 patients with untreated cervical cancer, 50 (51%) had elevated levels of serum ferritin. Among 36 patients who were surgically treated and whose resected specimens were pathologically examined, 12 of 16 patients (75%) with ferritin levels above normal and 3 of 20 patients (15%) with levels below 108 ng/ml had parametrial invasion and/or lymph node metastasis. Serum ferritin levels were measured at 2− to 4-week intervals and 6 months after treatment on 21 patients with levels elevated before therapy. Ferritin levels decreased to the normal range 4 weeks after treatment in many patients, but the development of elevated levels thereafter was closely associated with a poor prognosis. Measurement of serum ferritin may be useful in predicting the extent of cancer beyond the cervix and the prognosis for cervical cancer patients.

Dose-related fluorodeoxyglucose uptake in acute radiation-induced hepatitis

Therapeutic assessment with fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is sometimes problematic after radiation therapy. Herein we describe a patient with acute radiation-induced hepatitis in which PET showed dose-dependent FDG uptake. A 50-year-old man underwent FDG PET for staging of esophageal cancer. Chemoradiotherapy was delivered concurrently with a radiation field that expanded from the esophagus into the upper stomach to cover metastasis of the gastric wall. The patient also underwent FDG PET 26 days and 4 months after chemoradiotherapy to evaluate the therapeutic effect. Twenty-eight days after chemoradiotherapy, hematochemistry revealed elevated hepatic enzymes and postcontrast computed tomography showed band-like hypoattenuation in the liver with parenchymal swelling corresponding to the radiation field. FDG PET performed 26 days after chemoradiotherapy showed a wedge-shaped hypermetabolic area in which the degree of FDG uptake correlated with the prescribed radiation dose. Follow-up PET 4 months after therapy showed no abnormal uptake in the liver. Acute radiation-induced hepatitis can be a potential cause of false-positve findings of malignancy on FDG PET scans, and PET images should carefully be compared with the distribution of prescribed dose. Threshold dose might be higher for metabolic changes than for morphologic changes.

Hypermetabolic change as a possible predictive sign of a relapsed central nervous system lymphoma.

Purpose: A patient with abdominal lymphoma who had been in complete remission for 6 years presented with a 1-month history of dysarthria. The aim of our report is to discuss the discordance of the patients results between magnetic resonance (MR) imaging and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). Materials and Methods: After the onset, FDG PET and brain MR imaging were performed. The FDG PET study included whole-body and brain scan. The MR study included pre- and postcontrast T1, T2, fluid-attenuated inversion recovery and diffusion-weighted sequences. Results: Brain MR imaging showed a localized abnormal signal around the left Sylvian fissure in any sequence, although a postcontrast study exhibited poor enhancement in the lesion. Brain PET showed a widespread area of slightly increased uptake in the brain on the left side, which was quite inconsistent with the MR results. After 4 months, follow-up MR imaging revealed a widespread abnormal signal, with enhancing masses, in the hypermetabolic region. Conclusions: Hypermetabolic changes on FDG PET preceded signal changes on MR imaging, potentially suggesting that hypermetabolism occurred in the microscopic infiltration of lymphoma cells.