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Usefulness of positron emission tomography in the differentiation between tumor and infectious lesions in pediatric oncology: a case report.

Tibúrcio FR, de Sá Rodrigues KE, Vasconcelos HM, Miranda DM, Simões e Silva AC - BMC Pediatr (2015)

Bottom Line: Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [(18)F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis.Patient was then treated with systemic antifungal agent.Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Oncology Service, Clinics Hospital, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. fernandatiburcio@yahoo.com.br.

ABSTRACT

Background: Sometimes, in pediatric oncology, it is difficult to differentiate the relapse of primary tumor from other diagnoses such as post-ischemic lesions or fungal abscess, without performing an organ biopsy. In addition, patients frequently are not under clinical conditions to be biopsied, mainly due to febrile neutropenia. A growing number of studies has focused on the use of Positron emission tomography/computed tomography with 18 Fluorodeoxyglucose ([(18)F]FDG-PET/CT) to distinguish tumor relapse from infectious lesions in patients with febrile neutropenia.

Case presentation: This case report describes a 6 years-old girl with febrile neutropenia during the treatment of neuroblastoma. Blood culture showed Candida sp. Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [(18)F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis. Patient was then treated with systemic antifungal agent. After the recovery from febrile neutropenia, a spleen biopsy was performed, confirming the diagnosis of fungal abscess. Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.

Conclusion: This case provides an excellent example in which the use of [(18)F]FDG-PET/CT is valuable in helping to localize potential sites of disseminated fungal infection to be diagnosed within clinical context. [(18)F]FDG-PET /CT seems to have a role in the evaluation of pediatric patients with febrile neutropenia.

No MeSH data available.


Related in: MedlinePlus

Panels (a) and (b) showed fused images of [18F]FDG-PET/CT (see white arrows) corresponding to focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), previously visualized as hypointense images on computed tomography. Scanning was performed with 90 kV, 10–120 mAs (smart mA) and 3.75 mm section thickness. Acquisition time was 2 min per table position with 10-slice overlap at the FOV borders. PET image data sets were reconstructed iteratively (4 iterations and 24 subsets) by applying the CT data for attenuation correction. Fused images were displayed on a workstation using dedicated software
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Fig1: Panels (a) and (b) showed fused images of [18F]FDG-PET/CT (see white arrows) corresponding to focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), previously visualized as hypointense images on computed tomography. Scanning was performed with 90 kV, 10–120 mAs (smart mA) and 3.75 mm section thickness. Acquisition time was 2 min per table position with 10-slice overlap at the FOV borders. PET image data sets were reconstructed iteratively (4 iterations and 24 subsets) by applying the CT data for attenuation correction. Fused images were displayed on a workstation using dedicated software

Mentions: The reconstructed PET images showed focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), corresponding to the hypointense images previously detected in CT, suggesting the presence of inflammatory processes (Fig. 1). Although unlikely, we could not exclude the possibility of tumor lesions, due to previous diagnoses. Other PET findings were mild/moderate hypermetabolism in nostril and right maxillary sinus, indicating nasopharyngeal inflammatory process (Fig. 1). The images also showed the absence of the kidney and adrenal gland at left side, which were previously removed.


Usefulness of positron emission tomography in the differentiation between tumor and infectious lesions in pediatric oncology: a case report.

Tibúrcio FR, de Sá Rodrigues KE, Vasconcelos HM, Miranda DM, Simões e Silva AC - BMC Pediatr (2015)

Panels (a) and (b) showed fused images of [18F]FDG-PET/CT (see white arrows) corresponding to focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), previously visualized as hypointense images on computed tomography. Scanning was performed with 90 kV, 10–120 mAs (smart mA) and 3.75 mm section thickness. Acquisition time was 2 min per table position with 10-slice overlap at the FOV borders. PET image data sets were reconstructed iteratively (4 iterations and 24 subsets) by applying the CT data for attenuation correction. Fused images were displayed on a workstation using dedicated software
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4559925&req=5

Fig1: Panels (a) and (b) showed fused images of [18F]FDG-PET/CT (see white arrows) corresponding to focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), previously visualized as hypointense images on computed tomography. Scanning was performed with 90 kV, 10–120 mAs (smart mA) and 3.75 mm section thickness. Acquisition time was 2 min per table position with 10-slice overlap at the FOV borders. PET image data sets were reconstructed iteratively (4 iterations and 24 subsets) by applying the CT data for attenuation correction. Fused images were displayed on a workstation using dedicated software
Mentions: The reconstructed PET images showed focal hypermetabolic areas in spleen (highest was SUVmax = 3.2), corresponding to the hypointense images previously detected in CT, suggesting the presence of inflammatory processes (Fig. 1). Although unlikely, we could not exclude the possibility of tumor lesions, due to previous diagnoses. Other PET findings were mild/moderate hypermetabolism in nostril and right maxillary sinus, indicating nasopharyngeal inflammatory process (Fig. 1). The images also showed the absence of the kidney and adrenal gland at left side, which were previously removed.

Bottom Line: Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [(18)F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis.Patient was then treated with systemic antifungal agent.Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Oncology Service, Clinics Hospital, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. fernandatiburcio@yahoo.com.br.

ABSTRACT

Background: Sometimes, in pediatric oncology, it is difficult to differentiate the relapse of primary tumor from other diagnoses such as post-ischemic lesions or fungal abscess, without performing an organ biopsy. In addition, patients frequently are not under clinical conditions to be biopsied, mainly due to febrile neutropenia. A growing number of studies has focused on the use of Positron emission tomography/computed tomography with 18 Fluorodeoxyglucose ([(18)F]FDG-PET/CT) to distinguish tumor relapse from infectious lesions in patients with febrile neutropenia.

Case presentation: This case report describes a 6 years-old girl with febrile neutropenia during the treatment of neuroblastoma. Blood culture showed Candida sp. Abdominal ultrasonography revealed multiple unspecific hypoechoic areas of variable sizes in spleen, which might be either tumor or Candida-induced abscesses. [(18)F]FDG-PET/CT was performed to help the diagnosis and revealed small splenic lesions highly suggestive of disseminated candidiasis. Patient was then treated with systemic antifungal agent. After the recovery from febrile neutropenia, a spleen biopsy was performed, confirming the diagnosis of fungal abscess. Due to the small size of lesions, modalities such as ultrasonography, CT and magnetic nuclear resonance were not able in distinguishing tumor relapse from infectious lesions.

Conclusion: This case provides an excellent example in which the use of [(18)F]FDG-PET/CT is valuable in helping to localize potential sites of disseminated fungal infection to be diagnosed within clinical context. [(18)F]FDG-PET /CT seems to have a role in the evaluation of pediatric patients with febrile neutropenia.

No MeSH data available.


Related in: MedlinePlus