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FDG PET/CT case report early detection of ovarian cancer

FDG PET/CT case report early detection of ovarian cancer. NM case conference, 2008-01-18 chairman: Nan-Jing Peng, MD. 46 y/o female SLE under regular medication uterine myoma S/P hysterectomy 7-8 years ago family history of lung cancer (father) Patient’s sister is a GYN doctor

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FDG PET/CT case report early detection of ovarian cancer

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  1. FDG PET/CT case reportearly detection of ovarian cancer NM case conference, 2008-01-18 chairman: Nan-Jing Peng, MD

  2. 46 y/o female • SLE under regular medication • uterine myoma S/P hysterectomy 7-8 years ago • family history of lung cancer (father) • Patient’s sister is a GYN doctor • Tumor marker checked every year: normal • Elevating CA-199 level in 2 months, CA-19-9: 209.6 U/ml on 2007-12-24 • Contrast-enhanced abdominal CT: negative • GYN echo: negative • Colonscopy: negative • FDG PET/CT on 2007-12-24

  3. FDG PET/CT on 2007-12-24 “Small” focal FDG uptake at left adnexa (SUVmax: early 3.7 and delayed 5.2) Highly suspicious malignany

  4. Debulking surgery on 2008-01-14 left adnexa adjacent bowel adhesion Pathology: mucinous adenocarcinoma of left ovary, stage Ia

  5. DDx: benign v.s. malignant ovarian lesion: • Increased ovarian 18F-FDG uptake: (1) postmenopausal patients: indicated malignancy (2) premenopausal patients: could be either malignant or functional • SUV 7.9 separated benign from malignant ovarian uptake • Many malignant and functional ovarian lesions had overlapping SUVs • Detecting a dominant functional ovarian cyst on CT and discussing the menstrual cycle phase with the patient may assist in differentiating physiologic from malignant 18F-FDG ovarian uptake. J Nucl Med 2004; 45:266–271

  6. Physiologic Ovarian Uptake • long diameters: 2.0±0.3 cm • early SUVmax: 4.4±1.5 g/ml • delayed SUVmax: 5.0±1.62 g/ml • FDG can accumulate in thenormal ovarian follicle or corpus luteum. • The typical spherical or discoidFDG accumulation in the ovary during the early luteal phase or ovulatory phase represents normal physiological uptake. • In premenopausal womenit is preferable to schedule pelvic FDG PET scans within a few days after the start of menstruation. Eur J Nucl Med Mol Imaging (2005) 32:757–763

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