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Usefulness of nonattenuation-corrected positron emission tomography image in a patient with hepatocarcinoma treated with chemoembolization
Rev Esp Med Nucl. 2010;29(3):144-145
Interesting images
Usefulness of nonattenuation-corrected positron emission tomography image in a patient with hepatocarcinoma treated with chemoembolization Utilidad de la imagen de la tomografía por emisión de positrones no corregida por atenuación en paciente con hepatocarcinoma tratado con quimioembolización J. Orcajo Rincón a,*, J.C. Alonso Farto a, A. Rotger Regi a, D. Zamudio Rodríguez a and V. Pérez Aradas b Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Immunology, Hospital 12 de Octubre, Madrid, Spain
a
b
information on the article
History of the article: Received 26 October 2009 Accepted 28 January 2010 Available online 15 April 2010
It has been estimated that approximately one million people die annually worldwide because of hepatocarcinoma.1 Transarterial chemoembolization is a therapeutic alternative in a subgroup of these patients, being based on achieving greater concentrations of local chemotherapy and obtaining ischemic necrosis by arterial occlusion with chemoembolising material.2 With the use of materials such as lipiodol, hyperdense CT images are obtained2 which may induce the appearance of false areas of hyperuptake because of their use to correct attenuation in PET.2,3 CT
Attenuation-corrected PET
CT
Nonattenuation-corrected PET
PET-CT fusion
PET-CT fusion
Figure 2. CT image, nonattenuation-corrected PET and PET-CT fusion demonstrating the absence of the focal deposit of FDG in the liver observed in the attenuationcorrected PET expressing an absence of local recurrence.
Figure 1. CT image, attenuation-corrected PET and PET-CT fusion demonstrating intense metabolic activity in segment vii coinciding with hyperdense lesion in the CT scan. The remaining hepatic lesions observed in the CT (cysts in both lobes, transjugular intraheptic port-systemic shunt andperihepatic ascites) did not show hyperuptake of FDG.
* Correspondence author. E-mail: [email protected] (J. Orcajo Rincón). 0212-6982/$ - see front matter © 2009 Elsevier España, S.L. and SEMNIM. All rights reserved.
Figure 3. Comparative PET image with and without attenuation correction.
J. Orcajo Rincón et al / Rev Esp Med Nucl. 2010;29(3):144-145
Our images demonstrate the importance of evaluating PET-FDG with or without attenuation correction separately (figs. 1, 2 and 3). A 65-year-old cirrhotic male diagnosed with hepatocarcinoma in segment vii treated with transarterial chemoembolization (lipiodoladriamycin-spongostan) was attended. Attentuation-corrected PETFDG showed an area of hypermetabolism (max. SUV: 7.1) in liver segment vii not observed in nonattuenuation-corrected images. Hyperuptake of FDG in the other CT findings described (cystic lesions in both lobes, transjugular intrahepatic porto-systemic shunt and perihepatic ascites) was not observed.
145
References 1. Marin HL, Furth EE, Olthoff K, Shaked A, Soulen MC. Histopathologic outcome of neoadjuvant image-guided therapy of hepatocellular carcinoma. J Gastrointestin Liver Dis. 2009;18:169-76. 2. Heusner TA, Fronz U, Jentzen W, Verhagen R, Forsting M, Bockisch A, et al. The effect of different chemoembolization materials on CT-based attenuation correction in PET/CT. Rofo. 2007;179:1159-65. 3. Joshi U, Raijmakers PG, Riphagen II, Teule GJ, Van Lingen A, Hoekstra OS. Attenuation-corrected vs nonattenuation-corrected 2-deoxy-2-[F-18]fluoro-Dglucose-positron emission tomography in oncology: A systematic review. Mol Imaging Biol. 2007;9:99-105.
Interesting images
Usefulness of nonattenuation-corrected positron emission tomography image in a patient with hepatocarcinoma treated with chemoembolization Utilidad de la imagen de la tomografía por emisión de positrones no corregida por atenuación en paciente con hepatocarcinoma tratado con quimioembolización J. Orcajo Rincón a,*, J.C. Alonso Farto a, A. Rotger Regi a, D. Zamudio Rodríguez a and V. Pérez Aradas b Department of Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain Department of Immunology, Hospital 12 de Octubre, Madrid, Spain
a
b
information on the article
History of the article: Received 26 October 2009 Accepted 28 January 2010 Available online 15 April 2010
It has been estimated that approximately one million people die annually worldwide because of hepatocarcinoma.1 Transarterial chemoembolization is a therapeutic alternative in a subgroup of these patients, being based on achieving greater concentrations of local chemotherapy and obtaining ischemic necrosis by arterial occlusion with chemoembolising material.2 With the use of materials such as lipiodol, hyperdense CT images are obtained2 which may induce the appearance of false areas of hyperuptake because of their use to correct attenuation in PET.2,3 CT
Attenuation-corrected PET
CT
Nonattenuation-corrected PET
PET-CT fusion
PET-CT fusion
Figure 2. CT image, nonattenuation-corrected PET and PET-CT fusion demonstrating the absence of the focal deposit of FDG in the liver observed in the attenuationcorrected PET expressing an absence of local recurrence.
Figure 1. CT image, attenuation-corrected PET and PET-CT fusion demonstrating intense metabolic activity in segment vii coinciding with hyperdense lesion in the CT scan. The remaining hepatic lesions observed in the CT (cysts in both lobes, transjugular intraheptic port-systemic shunt andperihepatic ascites) did not show hyperuptake of FDG.
* Correspondence author. E-mail: [email protected] (J. Orcajo Rincón). 0212-6982/$ - see front matter © 2009 Elsevier España, S.L. and SEMNIM. All rights reserved.
Figure 3. Comparative PET image with and without attenuation correction.
J. Orcajo Rincón et al / Rev Esp Med Nucl. 2010;29(3):144-145
Our images demonstrate the importance of evaluating PET-FDG with or without attenuation correction separately (figs. 1, 2 and 3). A 65-year-old cirrhotic male diagnosed with hepatocarcinoma in segment vii treated with transarterial chemoembolization (lipiodoladriamycin-spongostan) was attended. Attentuation-corrected PETFDG showed an area of hypermetabolism (max. SUV: 7.1) in liver segment vii not observed in nonattuenuation-corrected images. Hyperuptake of FDG in the other CT findings described (cystic lesions in both lobes, transjugular intrahepatic porto-systemic shunt and perihepatic ascites) was not observed.
145
References 1. Marin HL, Furth EE, Olthoff K, Shaked A, Soulen MC. Histopathologic outcome of neoadjuvant image-guided therapy of hepatocellular carcinoma. J Gastrointestin Liver Dis. 2009;18:169-76. 2. Heusner TA, Fronz U, Jentzen W, Verhagen R, Forsting M, Bockisch A, et al. The effect of different chemoembolization materials on CT-based attenuation correction in PET/CT. Rofo. 2007;179:1159-65. 3. Joshi U, Raijmakers PG, Riphagen II, Teule GJ, Van Lingen A, Hoekstra OS. Attenuation-corrected vs nonattenuation-corrected 2-deoxy-2-[F-18]fluoro-Dglucose-positron emission tomography in oncology: A systematic review. Mol Imaging Biol. 2007;9:99-105.