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Combined (18)F-FDG and (11)C-Methionine PET/CT scans in a case of metastatic hepatocellular carcinoma.

D'souza MM, Sharma R, Jaimini A, Saw SK, Singh D, Mondal A - Indian J Nucl Med (2014)

Bottom Line: The (11)C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites.Further, dural metastasis with high tracer uptake was noted in the frontal region.To the best of our knowledge, this is the first case documented in the literature, wherein (11)C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT
A 37-year-old male who underwent a central hepatectomy of the liver for hepatocellular carcinoma (HCC) was referred for an (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) study to rule out tumor recurrence or metastases. The scan showed a recurrent hepatic mass at the operative site, along with low-grade uptake in bilateral pulmonary metastases, mediastinal and hilar lymph nodes, and few skeletal sites. A non-FDG avid intracranial extradural mass was visualized in the right frontal lobe. The (11)C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites. Further, dural metastasis with high tracer uptake was noted in the frontal region. To the best of our knowledge, this is the first case documented in the literature, wherein (11)C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC. This report highlights the potential value of (11)C-methionine PET/CT in assessing the hepatic and extrahepatic tumor burden in cases of HCC, especially in clinically unexpected locations.

No MeSH data available.


Related in: MedlinePlus

Transaxial CT in lung window (a) shows metastatic pulmonary nodules, which show low-grade FDG avidity but significant 11C-methionine uptake on the transaxial PET (thin arrows in b and e) and fused PET/CT image (thin arrows in c and f), respectively. Transaxial CT (d) shows right hilar, subcarinal, and left internal mammary nodes (mediastinal window). Significant 11C-methionine uptake also noted on the PET (e) and PET/CT fusion image (f) at these sites (thick arrows). The corresponding FDG PET and PET/CT fusion images (b and c) show low-grade uptake (thick arrows). CT = Computed tomography, FDG = Fluorodeoxyglucose, PET = Positron emission tomography.
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Figure 2: Transaxial CT in lung window (a) shows metastatic pulmonary nodules, which show low-grade FDG avidity but significant 11C-methionine uptake on the transaxial PET (thin arrows in b and e) and fused PET/CT image (thin arrows in c and f), respectively. Transaxial CT (d) shows right hilar, subcarinal, and left internal mammary nodes (mediastinal window). Significant 11C-methionine uptake also noted on the PET (e) and PET/CT fusion image (f) at these sites (thick arrows). The corresponding FDG PET and PET/CT fusion images (b and c) show low-grade uptake (thick arrows). CT = Computed tomography, FDG = Fluorodeoxyglucose, PET = Positron emission tomography.

Mentions: A 37-year-old male who underwent a central hepatectomy of the liver for HCC presented 2 years later with progressive headache, gait unsteadiness, and altered behavior. Magnetic resonance imaging (MRI) revealed a dural-based mass lesion causing pressure effect on the right frontal lobe, which was suspected to be dural metastasis. He then underwent an 18F-FDG PET/CT scan on a whole-body Full Ring PET camera (Discovery STE16-GE) after administration of 370 Mbq (10 mci) 18F-FDG intravenously followed by a 60-min rest period, subsequent to a 6-h fast. After the CT scan, an emission scan was performed from head to thigh for 2 min per frame. Images were reconstructed by three-dimensional (3D) VUE algorithm (GE Healthcare) and viewed on a Xeleris workstation (GE Healthcare) using the volumetric protocol. An 11C-methionine PET/CT scan was performed the next day on the same scanner 20 min after intravenous injection of 760 Mbq (20.5 mci) of 11C-methionine. Both studies revealed a hypermetabolic recurrent hepatic mass at the operative site [Figure 1]. Although the tumor to background ratio was higher on the FDG scan, the 11C-methionine scan could define a larger area of involvement at the operative site. Further, the 11C-methionine study revealed hypermetabolic lymph nodes in the paraaortic, precaval, portal, peripancreatic, and mesenteric region, none of which showed significantly increased FDG avidity. Additionally, metastatic nodules were noted in both lung fields, showing low-grade FDG avidity, but significant 11C-methionine uptake [Figure 2]. High 11C-methionine uptake was also noted in the paratracheal, hilar, subcarinal, and left internal mammary nodes, with no significant hypermetabolism noted at any of these sites on the corresponding FDG PET images.


Combined (18)F-FDG and (11)C-Methionine PET/CT scans in a case of metastatic hepatocellular carcinoma.

D'souza MM, Sharma R, Jaimini A, Saw SK, Singh D, Mondal A - Indian J Nucl Med (2014)

Transaxial CT in lung window (a) shows metastatic pulmonary nodules, which show low-grade FDG avidity but significant 11C-methionine uptake on the transaxial PET (thin arrows in b and e) and fused PET/CT image (thin arrows in c and f), respectively. Transaxial CT (d) shows right hilar, subcarinal, and left internal mammary nodes (mediastinal window). Significant 11C-methionine uptake also noted on the PET (e) and PET/CT fusion image (f) at these sites (thick arrows). The corresponding FDG PET and PET/CT fusion images (b and c) show low-grade uptake (thick arrows). CT = Computed tomography, FDG = Fluorodeoxyglucose, PET = Positron emission tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4157194&req=5

Figure 2: Transaxial CT in lung window (a) shows metastatic pulmonary nodules, which show low-grade FDG avidity but significant 11C-methionine uptake on the transaxial PET (thin arrows in b and e) and fused PET/CT image (thin arrows in c and f), respectively. Transaxial CT (d) shows right hilar, subcarinal, and left internal mammary nodes (mediastinal window). Significant 11C-methionine uptake also noted on the PET (e) and PET/CT fusion image (f) at these sites (thick arrows). The corresponding FDG PET and PET/CT fusion images (b and c) show low-grade uptake (thick arrows). CT = Computed tomography, FDG = Fluorodeoxyglucose, PET = Positron emission tomography.
Mentions: A 37-year-old male who underwent a central hepatectomy of the liver for HCC presented 2 years later with progressive headache, gait unsteadiness, and altered behavior. Magnetic resonance imaging (MRI) revealed a dural-based mass lesion causing pressure effect on the right frontal lobe, which was suspected to be dural metastasis. He then underwent an 18F-FDG PET/CT scan on a whole-body Full Ring PET camera (Discovery STE16-GE) after administration of 370 Mbq (10 mci) 18F-FDG intravenously followed by a 60-min rest period, subsequent to a 6-h fast. After the CT scan, an emission scan was performed from head to thigh for 2 min per frame. Images were reconstructed by three-dimensional (3D) VUE algorithm (GE Healthcare) and viewed on a Xeleris workstation (GE Healthcare) using the volumetric protocol. An 11C-methionine PET/CT scan was performed the next day on the same scanner 20 min after intravenous injection of 760 Mbq (20.5 mci) of 11C-methionine. Both studies revealed a hypermetabolic recurrent hepatic mass at the operative site [Figure 1]. Although the tumor to background ratio was higher on the FDG scan, the 11C-methionine scan could define a larger area of involvement at the operative site. Further, the 11C-methionine study revealed hypermetabolic lymph nodes in the paraaortic, precaval, portal, peripancreatic, and mesenteric region, none of which showed significantly increased FDG avidity. Additionally, metastatic nodules were noted in both lung fields, showing low-grade FDG avidity, but significant 11C-methionine uptake [Figure 2]. High 11C-methionine uptake was also noted in the paratracheal, hilar, subcarinal, and left internal mammary nodes, with no significant hypermetabolism noted at any of these sites on the corresponding FDG PET images.

Bottom Line: The (11)C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites.Further, dural metastasis with high tracer uptake was noted in the frontal region.To the best of our knowledge, this is the first case documented in the literature, wherein (11)C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Positron Emission Tomography Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT
A 37-year-old male who underwent a central hepatectomy of the liver for hepatocellular carcinoma (HCC) was referred for an (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) study to rule out tumor recurrence or metastases. The scan showed a recurrent hepatic mass at the operative site, along with low-grade uptake in bilateral pulmonary metastases, mediastinal and hilar lymph nodes, and few skeletal sites. A non-FDG avid intracranial extradural mass was visualized in the right frontal lobe. The (11)C-methionine PET/CT scan performed subsequently revealed a larger area of involvement at the primary site, along with widespread metastases to the lungs, mediastinal, hilar, and abdominal lymph nodes, and multiple skeletal sites. Further, dural metastasis with high tracer uptake was noted in the frontal region. To the best of our knowledge, this is the first case documented in the literature, wherein (11)C-methionine PET/CT played a significant role in delineating the widespread dissemination, including the extremely rare dural involvement in a case of HCC. This report highlights the potential value of (11)C-methionine PET/CT in assessing the hepatic and extrahepatic tumor burden in cases of HCC, especially in clinically unexpected locations.

No MeSH data available.


Related in: MedlinePlus