UTERUSTA DIAGNOSTIK KÜRETAJA SEKONDER ARTMIŞ F-18 FDG TUTULUMU OLGUSU

Endometrial cancer is one of the most common malignant tumors of the women, and if it can be detected in the earlier stages, the curability and the prognosis of the endometrial cancers can be better. A 52 year-old female patient, as part of ongoing research project in our clinic on endometrial carcinoma, was referred to our clinic with a suspicion of endometrial carcinoma with increased serum CA-125 measurement. Increased F-18 FDG uptake in uterine cavity that was secondary to the diagnostic curettage was demonstrated on F 18 FDG PET images. This uptake might be secondary to benign inflammatory changes or hemorrhage arising from diagnostic curettage that patient underwent ten days ago. According to our knowledge, this is the first case demonstrating increased F-18 FDG uptake secondary to diagnostic curettage Endometrium kanseri kadınlarda en çok görülen malign tümörlerden birisidir. Erken teşhis edildiğinde tam tedavi şansı yüksektir ve prognozu çok iyi seyirlidir. Bölümümüzde endometrium kanseri ile ilgili olarak devam eden bir proje kapsamında, serum CA-125 yüksekliği ile endometrium kanseri şüphesi olan 53 yaşında kadın hasta bölümümüze refere edildi. PET görüntülerinde uterusda artmış F-18 FDG tutulumu izlenmiştir. Bu bulgunun hastanın öyküsünde 10 gün önce geçirilmiş diagnostik küretaja bağlı benign inflamatuar değişiklikler veya hemoraji ile ilgili olduğu düşünülmüştür. Bu olgu sunumunda diagnostik küretaja sekonder olduğu düşünülen F-18 FDG tutulumu muhtemelen literatürde ilk kez gösterilmektedi

Validity of F-18 FDG PET/CT for preoperative evaluation of endometrial cancer

Amaç: Endometrium kanseri tanısı almış hastalara operasyon öncesi evrelendirme amacıyla yapılan dual faz F-18 FDG PET-BT'nin SUV değerlerininæ serum CA125 düzeyi, patoloji ve MR ile korelasyonun ve myometrial invazyonu öngörmede yerinin belirlenmesi amaçlanmıştır. Yöntem: Aralık 2008- Eylül 2009 tarihleri arasında DEÜTF Nükleer Tıp Anabilim dalında preoperatif evreleme amacıyla dual faz F-18 FDG PET-BT incelemesi uygulanan 30 hastanın dosya bilgileri ve görüntüleri retrospektif olarak değerlendirilmiştir. SUV değerleri (erken ve geç SUVmax-mean-min, ROI1.2SUVmax-mean-min ve SUVToplam) ve retansiyon indeksleri hesaplanmıştır. F-18 FDG PET-BT ile elde edilen myometrial invazyon, evre, lenf nodu metastazı bulguları, patoloji ve MR sonuçları ve CA125 değerleriyle karşılaştırılmıştır. Bulgular: Otuz hastanın yaş ortalaması 59±9(43-76) idi. Cerrahi 2002 FIGO evrelemesine göre, dokuz hasta evre 1A, 10 hasta evre 1B, iki hasta evre 1C, altı hasta evre 3C, birer hasta evre 2B, 3A ve 4B'dir. Hastaların ortalama SUVmax değerleri 13.3±7olarak hesaplanmıştır. PET-BTæ evre, myometrial invazyon derinliği ve lenf nodu metastazı ile korele bulunmuştur. ROC analizine göreæ myometrial invazyon var-yok ayrımında SUV1max 8.6 kesme noktası için %90 duyarlılık, %89 özgüllük bulunmuştur. Yüzeyel ve derin invazyon ayrımında SUV1Toplam için 1282 kesme noktasında %86 duyarlılık ve %77 özgüllük saptanmıştır. PET-BT'nin lenf nodu metastazı saptamadaki duyarlılığı %85, özgüllüğü %100, PPV %100, NPV %95, doğruluğu %96 olarak hesaplanmıştır. MR'ın lenf nodu metastazı saptamada duyarlılığı %57, özgüllüğü %100, PPV %100, NPV %88, doğruluk %90 olarak hesaplanmıştır. Sonuç: F-18 FDG PET-BT, endometrium kanserli hastalarda prognostik faktörler ile korelasyonu olması, lenf nodu metastazı ve myometrial invazyon değerlendirmede başarılı olması, tüm vücut incelemesi olduğu için tek bir çalışmada klinisyene hastalık izleminde ve tedavisinde yardımcı bilgi sağlayabilecek bir yöntemdir. Retansiyon indeksi, geç çekim, SUVmin ve ROI12.cm SUV değerlerinin endometrium kanser değerlendirmede ek katısı olmadığı saptanmıştır. Objective: The purpose is to compare SUVvalues of dual phase F-18 FDG PET/CT in preoperative staging of endometrial cancer patients with CA125 values, pathology, MR and to evaluate accuracy of F-18 FDG PET in myometrial invasion. Methods: We retrospectively reviewed medical records and images of 30 postmenopausal women with endometrial carcinoma who underwent preoperative dual phase FDG PET-CT between December 2008 and September 2009 in DEUTF Department of Nuclear Medicine. Different SUV values (early and late SUVmax-mean-min, ROI1.2SUVmax-mean-min ve SUVTotal) and retention index were calculated. We compared F-18 FDG PET/CT results in staging, detecting myometrial invasion and lymph node metastasis with pathology, MR and CA125 values. Results: Mean age of 30 postmenopausal patients with endometrial carcinoma was 59±9(43-76). Based on the surgical 2002 FIGO staging system, nine patients were stage 1A, 10 patients were stage 1B, two patients were stage 1C, six patients were stage 3C, one patient was stage 2B, 3A and 4B each. Mean SUVmax of primary lesions was 13.3±7. We found correlation of PET-CT with stage, myometrial invasion and lymph node metastasis. Using 8.6 as a cut-off value for SUVmax to determine the presence or absence of myometrial invasion, PET/CT had 90% sensitivity, 89% specificity. Using 1282 as a cut-off value for SUV1Total to determine the superficial or deep invasion, PET/CT had 90% sensitivity, 89% specificity. Sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting lmyph node metastasis were 85%, 100%, 100%, 95% and 96%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of MR for detecting lmyph node metastasis were 57%, 100%, 100%, 88% and 90%, respectively. Conclusion: F-18 FDG PET-CT can be useful for the management of patients with endometrium carcinoma because of presence of correlations with prognostic factors, accuracy in detecting lymph node metastasis and myometrial invasion and the ability of scanning the whole body. Retention index, late images, SUVmin and ROI1.2cmSUV values were found not useful in evaluating endometrial carcinoma

The diagnostic role of dual-phase F-18-FDG PET/CT in the characterization of solitary pulmonary nodules

ObjectiveOur objective was to evaluate the diagnostic role of dual-phase F-18-fluorodeoxyglucose (F-18-FDG) PET/computed tomography (CT) in the characterization of solitary pulmonary nodules (SPNs).Patients and methodsA total of 48 SPNs in 48 patients were included in this retrospective study. The final diagnosis was confirmed histopathologically or by follow-up CT. Two PET/CT scans were performed: the first (early scan) was performed 1 h after injection and the second (delayed scan) was performed 2 h later. Standardized uptake values (SUVs) [early and delayed SUVmax and SUVmean adjusted to body weight, body surface area (BSA), lean body mass (LBM) and blood glucose level (Glc)], retention index and nodule-to-mediastinum (nodule activity/subcarinal region of interest activity) ratios were calculated, along with the receiver operating characteristic curve. Intraobserver and interobserver variabilities among nuclear medicine physicians were analysed for the two phases.ResultsEighteen patients had malignant tumour, whereas 30 had benign lesions. The median (min-max) SUVmax was 1.5 (0.5-4.1) in the benign group and 3.6 (1.3-38) in the malignant group. With the threshold value of early SUVmax as 2.5 and 2.75 using the receiver operating characteristic curve, a sensitivity of 94-75%, specificity of 75-80% and an accuracy of 83-78% were calculated. With the same threshold values for delayed images, 94-100% sensitivity, 77-80% specificity and 83-88% accuracy were obtained. BSA-SUVmax, LBM-SUVmax and Glc-SUVmax did not show any advantage over other quantitative parameters in the SPN characterization. There was no variability in the results obtained between the two nuclear medicine physicians.ConclusionDual-phase PET/CT may increase the diagnostic potential of PET/CT in the characterization of SPNs. In this particular study group, a threshold value could not be determined for the retention index, but higher retention indices may show higher malignant potential in SPNs. (C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins