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A pediatric malignant paraganglioma and brief review of the literature.
Zi, J, Ma, C, Xu, C, Bai, Y
Hellenic journal of nuclear medicine. 2016;(3):281-284
Abstract
UNLABELLED A 10 years old boy presented to our hospital complaining of belly pain. He had a retroperitoneal mass diagnosed by ultrasound 3 days before. During that time he was found to have slight hypertension. Computed tomography (CT) showed a left retroperitoneal mass with edge enhancement and central necrosis indicating pheochromocytoma (PCC). Vanillymandelic acid (VMA) in the 24 hours urine sample was not elevated. Pheochromocytoma was suspected given his hypertension and the ultrasound and CT findings. Fluorine-18- fluorodeoxy glucose positron emission tomography (18F-FDG PET) showed intense uptake in the left adrenal area (SUVmax 32.9) with a central 18F-FDG uptake defect. Subsequently, left adrenalectomy was successfully performed. Histological examination showed that the tumor was a paraganglioma (PGL) with low-grade malignancy. CONCLUSION Fluorine-18-FDG PET is a highly sensitive method to detect PGL, but could not make a differential diagnosis between PGL and PCC although high uptake of 18F-FDG may indicate malignancy. As our case clearly demonstrates, rare cases of PCC or PGL should be considered in the setting of secondary hypertension.
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2.
Causes of (18)F-FDG uptake on white adipose tissue.
Hwang, DY, Lee, JW, Lee, SM, Kim, S
Hellenic journal of nuclear medicine. 2016;(1):7-9
Abstract
White adipose tissue usually shows negligible fluorine-18-fluorodeoxyglucose ((18)F-FDG) uptake. In certain clinical conditions this (18)F-FDG uptake has been reported to be increased like in HIV patients under treatment, in exogenous Cushing's syndrome, in cases related to premedication and other cases.
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3.
(18)F-FDG PET/CT imaging in systemic lupus erythematosus related autoimmune haemolytic anaemia and lymphadenopathy.
Zhang, X, Xu, C, Wang, X
Hellenic journal of nuclear medicine. 2016;(1):42-5
Abstract
OBJECTIVE We present a case of systemic lupus erythematosus (SLE) related autoimmune haemolytic anaemia (AIHA) and lymphadenopathy. AIHA as a serious complication of SLE, requiring urgent appropriate management. The timely differential diagnosis between SLE with lymphadenopathy and lymphoma, primary and SLE-related AIHA often looms as practical challenge under clinical scenario. Fluorine-18 fluorodeoxyglucose position emission tomography/computed tomography ((18)F-FDG PET/CT) performed for fever of a known origin and for possible malignancy, showed increased (18)F-FDG uptake in lymph nodes, as well as increased spleen uptake, which was probably due to lymphoma. CONCLUSIONS A symmetrically increased (18)F-FDG uptake in small lymph nodes with multiple serous cavity effusion helped the differential diagnosis between SLE related AIHA and lymphoma. In addition, PET/CT can visualize not only the degree of disease activity or the "burden of inflammation" but also the distribution of the disease in the entire body.
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Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography Hypermetabolism of Vertebral Arteries Revealing Giant Cell Arteritis.
Daumas, A, Scafi, M, Jean, E, Andrianasolo, M, Cammilleri, S, Benyamine, A, Granel, B
The American journal of medicine. 2015;(7):e1-2
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Fluorodeoxyglucose-positron-emission tomography/computed tomography imaging for adrenal masses in patients with lung cancer: review and diagnostic algorithm.
Stone, WZ, Wymer, DC, Canales, BK
Journal of endourology. 2014;(1):104-11
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Abstract
BACKGROUND AND PURPOSE Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. PATIENTS AND METHODS Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. RESULTS Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. CONCLUSIONS Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ≥10 mm with high PET maximum SUV (≥3.1) and SUV ratios (>2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.
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Acute toxoplasmosis mimicking melanoma metastases: review of conditions causing false-positive results on (18)F-FDG PET/CT.
Ivanova, K, Glatz, K, Zippelius, A, Nicolas, G, Itin, P
Dermatology (Basel, Switzerland). 2012;(4):349-53
Abstract
Invasive malignant melanoma is the most common fatal form of skin cancer. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography demonstrates a very high sensitivity and specificity for the detection of melanoma metastases. Here, we report an unusual case of toxoplasma lymphadenitis in a male adult patient mimicking a malignant cervical lymphadenopathy. Toxoplasmosis is a zoonosis caused by the intracellular parasite Toxoplasma gondii, which is usually asymptomatic in immunocompetent hosts.
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Imaging of hypoxic lesions in patients with gliomas by using positron emission tomography with 1-(2-[18F] fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole, a new 18F-labeled 2-nitroimidazole analog.
Shibahara, I, Kumabe, T, Kanamori, M, Saito, R, Sonoda, Y, Watanabe, M, Iwata, R, Higano, S, Takanami, K, Takai, Y, et al
Journal of neurosurgery. 2010;(2):358-68
Abstract
OBJECT Assessment of hypoxic conditions in brain tumors is important for predicting tumor aggressiveness and treatment response. A new hypoxia imaging agent, 1-(2-[(18)F]fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole (FRP-170), with higher image contrast and faster clearance than preexisting hypoxia tracers for PET, was used to visualize hypoxic tissues in 8 patients with glioma. METHODS The FRP-170 was injected and PET imaging was performed 2 hours later in 8 patients, including 3 with glioblastoma multiforme, 2 with oligodendroglioma, and 1 each with diffuse astrocytoma, anaplastic ganglioglioma, and recurrent anaplastic astrocytoma. All 8 patients also underwent MR imaging, and some patients underwent [(11)C]methionine or [(18)F]fluorodeoxyglucose PET, and proton MR spectroscopy for comparison. Tissues obtained at biopsy or radical resection were immunostained with hypoxia-inducible factor-1alpha (HIF-1alpha) antibody for the confirmation of hypoxia, except in the patient with recurrent anaplastic astrocytoma who was treated using Gamma Knife surgery. RESULTS The FRP-170 PET images showed marked uptake with upregulation of HIF-1alpha in the 3 glioblastomas multiforme, and moderate uptake in the recurrent anaplastic astrocytoma and one oligodendroglioma, but no uptake in the other tumors. The FRP-170 PET images showed positive correlation with HIF-1alpha immunoreactivity and some correlation with FDG PET and MR imaging enhancement, but no correlation with [(11)C]methionine PET. Imaging with FRP-170 PET seemed to be more sensitive for detecting hypoxia than identifying the lactate peak on proton MR spectroscopy. CONCLUSIONS Imaging with FRP-170 PET can visualize hypoxic lesions in patients with glioma, as confirmed by histological examination. This new method can assess tumor hypoxia preoperatively and noninvasively.
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[Adrenal incidentaloma and nuclear medicine examination].
Tenenbaum, F
Journal de radiologie. 2009;(3 Pt 2):444-8
Abstract
In the setting of adrenal incidentaloma, nuclear medicine evaluation is only indicated after biological and imaging work-up has been completed. MIBG scintigraphy is helpful to characterize pheochromocytomas. In lesions without MIBG uptake, 18F FDG or 18F DOPA PET can be considered to characterize chromaffin cell tumours. To characterize lesions of the adrenal cortex, iodocholesterol scintigraphy is performed to confirm the origin of the adenoma and the benign or malignant nature of the lesion since benign adenomas show tracer uptake and malignant lesions show no tracer uptake. 18F FDG PET only characterizes the lesion as benign or malignant.
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Zolpidem-induced sleepwalking, sleep related eating disorder, and sleep-driving: fluorine-18-flourodeoxyglucose positron emission tomography analysis, and a literature review of other unexpected clinical effects of zolpidem.
Hoque, R, Chesson, AL
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2009;(5):471-6
Abstract
Zolpidem is a hypnotic which acts at the GABAA receptor and is indicated for short-term insomnia. Sleep related disorders including somnambulism, sleep related eating and sleep-driving have been reported with zolpidem. A 51-year-old insomniac who used zolpidem 10 mg nightly starting at 44 years of age is described. A few weeks after starting zolpidem she began walking, eating, and had one episode of driving while asleep. Episodes of sleep related eating, sleepwalking, and sleeptalking occurred 3 nights per week, 1 to 2 h after sleep onset. After her evaluation, the patient's zolpidem was gradually discontinued, and all sleep related activities immediately ceased. An 18F-FDG-PET was obtained 2 months after discontinuation of zolpidem. The following day, FDG was administered 1 h after oral administration of 10 mg zolpidem, and then a second PET was performed. We report the results and a review of the literature regarding other unintended effects seen with zolpidem use.
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FDG-PET/CT for the evaluation of response to therapy of cutaneous T-cell lymphoma to vorinostat (suberoylanilide hydroxamic acid, SAHA) in a phase II trial.
Kuo, PH, Carlson, KR, Christensen, I, Girardi, M, Heald, PW
Molecular imaging and biology. 2008;(6):306-14
Abstract
INTRODUCTION Harnessing the power of molecular imaging in particular positron emission tomography (PET) to assess response to therapy in early clinical trials has the potential to yield crucial data on efficacy and streamline drug development. Vorinostat (also known as SAHA, suberoylanilide hydroxamic acid) is a histone deacetylase (HDAC) inhibitor which alters gene transcription to inhibit proliferation and promote apoptosis. METHODS In a phase II trial of vorinostat for cutaneous T cell lymphoma (CTCL), 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-PET/computed tomography (CT) was performed on patients with both cutaneous and nodal disease. FDG-PET/CT fuses the power of metabolic imaging from FDG-PET with the anatomic detail of CT. Scans were conducted on subjects pre-therapy and during therapy. RESULTS Changes in the values of FDG uptake and measurements of nodal dimensions and thickness of cutaneous lesions were tabulated. FDG-PET/CT provided an objective measure of the response (or lack thereof) of both cutaneous and nodal disease to therapy with vorinostat. The results of this study are encouraging for the potential utility of FDG-PET/CT in future trials with HDAC inhibitors for other diseases and for CTCL with other therapies. CONCLUSION Further study will be required to determine the prognostic value of the initial PET/CT scan and response on follow-up scans.