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CT: Anthracosis
Rev Esp Med Nucl Imagen Mol. 2017;36(1):65–66
Interesting images
A potential pitfall in the use of 68 Ga-PSMA PET/CT: Anthracosis夽 Un problema potencial en el uso del 68 Ga-PSMA PET/TC: antracosis T. Elri ∗ , M. Aras, Y.S. Salihoglu, R.U. Erdemir, M. Cabuk Department of Nuclear Medicine, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey
A 72 year-old prostate cancer patient with known bone metastases was referred to 68 Ga-PSMA PET/CT due to increased serum tumor markers [PSA = 21.36 ng/ml (normal levels = 0.04–4 ng/ml)] and newly detected liver metastases on recent abdominal CT. In addition to intense PSMA avid bone and liver metastases, PET/CT also revealed a hilar mass in the left lung and accompanying mediastinal lymphadenopathies with intense radiopharmaceutical uptake (Fig. 1). The hilar mass was bronchoscopically biopsied to exclude second primary lung malignancy. The histopathological
analyses of this mass was reported as anthracosis. The follow up 68 Ga-PSMA PET/CT performed three months after the initial scan revealed progressed lesions in the bone and abdomen. However the sizes and 68 Ga-PSMA uptakes of mediastinal lymph nodes and hilar mass were significantly regressed (Fig. 2). 68 Ga-PSMA PET/CT is a relatively new imaging modality, and there is little information about the PSMA avidity of extraprostatic malignancies and benign conditions.1,2 It was reported that 68 Ga-PSMA PET/CT alone could not gave us the opportunity to reliably discriminate primary
Fig. 1. Initial 68 Ga-PSMA PET/CT revealed intense radiopharmaceutical uptake in mediastinal and left hilar area (white arrows) in addition to multiple intense PSMA avid metastases in liver and L3 vertebrate (arrowhead) (A: maximum intensity projection (MIP) image). Axial images showed intense PSMA avid subcarinal lymphadenopathy and left hilar mass (B and C: axial PET, CT and fusion images with lung and mediastinal window settings).
夽 Presentation at a meeting: This work was presented before as a poster presentation in the 28th National Congress of Turkish Society of Nuclear Medicine, April 6–10, 2016. ∗ Corresponding author. E-mail address: [email protected] (T. Elri). http://dx.doi.org/10.1016/j.remn.2016.06.011 2253-8089 2016 Elsevier Espana, ˜ S.L.U. y SEMNIM. All rights reserved. 2253-654X/©
66
A. Niccoli-Asabella et /al. / Rev Med Nucl Imagen Mol. 2014;33(6):370–373 T. Elri et al. Rev EspEsp Med Nucl Imagen Mol. 2017;36(1):65–66
Fig. 2. Follow up 68 Ga-PSMA PET/CT showed progression of liver metastases, decreased uptake of bone metastasis in L3 vertebrate due to radiotherapy (arrowhead), and new foci of intense uptake in upper abdomen (black arrow) (A: MIP image). However, intensity of mediastinal and hilar uptakes were significantly reduced (B and C: axial PET, CT and fusion images with lung and mediastinal window settings).
lung cancer from lung metastases of prostate cancer.3 On the other hand, although chronic inflammatory processes of the lung are well known reasons for false positive 18 F-FDG PET/CT reporting, to our knowledge, 68 Ga-PSMA uptake in the benign conditions of the lung has not been reported yet.4,5 Our case showed that inflammatory conditions of the lung such as anthracosis may cause false positive reporting in 68 Ga-PSMA PET/CT. In conclusion, it should be kept in mind that benign conditions of the lung such as anthracosis may cause intense radiopharmaceutical uptake on 68 Ga-PSMA PET/CT and may lead to misdiagnosis. Histopathological analysis should be performed in the suspicion of second primary lung malignancy as this was the case in our patient. Conflicts of interests All the authors state that there were no conflicts of interests when the manuscript was written.
References 1. Law WP, Fiumara F, Fong W, Miles KA. Gallium-68 PSMA uptake in adrenal adenoma. J Med Imaging Radiat Oncol. 2015, http://dx.doi.org/10.1111/ 1754-9485.12357 [Epub ahead of print]. 2. Krohn T, Verburg FA, Pufe T, Neuhuber W, Vogg A, Heinzel A, et al. [68Ga] PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice. Eur J Nucl Med Mol Imaging. 2015;42: 210–4. 3. Pyka T, Weirich G, Einspieler I, Maurer T, Theisen J, Hatzichristodoulou G, et al. [68Ga] PSMA-HBED PET for differential diagnosis of suspicious lung lesions in patients with prostate cancer. J Nucl Med. 2015;57: 367–71. 4. Cheng NM, Yeh TW, Ho KC, Ng SH, Hsueh C, Yen TC, et al. False positive F-18 FDG PET/CT in neck and mediastinum lymph nodes due to anthracosis in a buccal cancer patient. Clin Nucl Med. 2011;36:963–4. 5. Canbaz F, Kefeli M, Sahin Z, Basoglu T. Anthracotic solitary pulmonary nodule imitating lung malignancy on F-18 FDG PET/CT imaging. Clin Nucl Med. 2011;36:955–6.
Interesting images
A potential pitfall in the use of 68 Ga-PSMA PET/CT: Anthracosis夽 Un problema potencial en el uso del 68 Ga-PSMA PET/TC: antracosis T. Elri ∗ , M. Aras, Y.S. Salihoglu, R.U. Erdemir, M. Cabuk Department of Nuclear Medicine, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey
A 72 year-old prostate cancer patient with known bone metastases was referred to 68 Ga-PSMA PET/CT due to increased serum tumor markers [PSA = 21.36 ng/ml (normal levels = 0.04–4 ng/ml)] and newly detected liver metastases on recent abdominal CT. In addition to intense PSMA avid bone and liver metastases, PET/CT also revealed a hilar mass in the left lung and accompanying mediastinal lymphadenopathies with intense radiopharmaceutical uptake (Fig. 1). The hilar mass was bronchoscopically biopsied to exclude second primary lung malignancy. The histopathological
analyses of this mass was reported as anthracosis. The follow up 68 Ga-PSMA PET/CT performed three months after the initial scan revealed progressed lesions in the bone and abdomen. However the sizes and 68 Ga-PSMA uptakes of mediastinal lymph nodes and hilar mass were significantly regressed (Fig. 2). 68 Ga-PSMA PET/CT is a relatively new imaging modality, and there is little information about the PSMA avidity of extraprostatic malignancies and benign conditions.1,2 It was reported that 68 Ga-PSMA PET/CT alone could not gave us the opportunity to reliably discriminate primary
Fig. 1. Initial 68 Ga-PSMA PET/CT revealed intense radiopharmaceutical uptake in mediastinal and left hilar area (white arrows) in addition to multiple intense PSMA avid metastases in liver and L3 vertebrate (arrowhead) (A: maximum intensity projection (MIP) image). Axial images showed intense PSMA avid subcarinal lymphadenopathy and left hilar mass (B and C: axial PET, CT and fusion images with lung and mediastinal window settings).
夽 Presentation at a meeting: This work was presented before as a poster presentation in the 28th National Congress of Turkish Society of Nuclear Medicine, April 6–10, 2016. ∗ Corresponding author. E-mail address: [email protected] (T. Elri). http://dx.doi.org/10.1016/j.remn.2016.06.011 2253-8089 2016 Elsevier Espana, ˜ S.L.U. y SEMNIM. All rights reserved. 2253-654X/©
66
A. Niccoli-Asabella et /al. / Rev Med Nucl Imagen Mol. 2014;33(6):370–373 T. Elri et al. Rev EspEsp Med Nucl Imagen Mol. 2017;36(1):65–66
Fig. 2. Follow up 68 Ga-PSMA PET/CT showed progression of liver metastases, decreased uptake of bone metastasis in L3 vertebrate due to radiotherapy (arrowhead), and new foci of intense uptake in upper abdomen (black arrow) (A: MIP image). However, intensity of mediastinal and hilar uptakes were significantly reduced (B and C: axial PET, CT and fusion images with lung and mediastinal window settings).
lung cancer from lung metastases of prostate cancer.3 On the other hand, although chronic inflammatory processes of the lung are well known reasons for false positive 18 F-FDG PET/CT reporting, to our knowledge, 68 Ga-PSMA uptake in the benign conditions of the lung has not been reported yet.4,5 Our case showed that inflammatory conditions of the lung such as anthracosis may cause false positive reporting in 68 Ga-PSMA PET/CT. In conclusion, it should be kept in mind that benign conditions of the lung such as anthracosis may cause intense radiopharmaceutical uptake on 68 Ga-PSMA PET/CT and may lead to misdiagnosis. Histopathological analysis should be performed in the suspicion of second primary lung malignancy as this was the case in our patient. Conflicts of interests All the authors state that there were no conflicts of interests when the manuscript was written.
References 1. Law WP, Fiumara F, Fong W, Miles KA. Gallium-68 PSMA uptake in adrenal adenoma. J Med Imaging Radiat Oncol. 2015, http://dx.doi.org/10.1111/ 1754-9485.12357 [Epub ahead of print]. 2. Krohn T, Verburg FA, Pufe T, Neuhuber W, Vogg A, Heinzel A, et al. [68Ga] PSMA-HBED uptake mimicking lymph node metastasis in coeliac ganglia: an important pitfall in clinical practice. Eur J Nucl Med Mol Imaging. 2015;42: 210–4. 3. Pyka T, Weirich G, Einspieler I, Maurer T, Theisen J, Hatzichristodoulou G, et al. [68Ga] PSMA-HBED PET for differential diagnosis of suspicious lung lesions in patients with prostate cancer. J Nucl Med. 2015;57: 367–71. 4. Cheng NM, Yeh TW, Ho KC, Ng SH, Hsueh C, Yen TC, et al. False positive F-18 FDG PET/CT in neck and mediastinum lymph nodes due to anthracosis in a buccal cancer patient. Clin Nucl Med. 2011;36:963–4. 5. Canbaz F, Kefeli M, Sahin Z, Basoglu T. Anthracotic solitary pulmonary nodule imitating lung malignancy on F-18 FDG PET/CT imaging. Clin Nucl Med. 2011;36:955–6.