This review article discusses the utility of 18F-FDG PET/CT in diagnosis and management of vascular disease. We stress usefulness of this method in large vessel inflammation and infection.In our work we based on the literature analysis and clinical cases diagnosed in our institution by use of 18F-FDG PET/CT. The literature exploration was focusing on vascular inflammation and infections and 18-FDG PET. The search was performed on PubMed database and cross referencing.We present the practical review with several images of vascular diseases like: Takayasu arteritis, giant cell arteritis, vascular graft infections, abdominal aortic aneurysm infections and cases of aortitis and periaortitis. From this work inflammation associated with atheromatic process and vulnerable atherosclerotic plaque we excluded.18F-FGD PET/CT is a sensitive metabolic, reliable, non-invasive imaging modality suitable for diagnosis and follow-up of inflammation and infections in vascular system.
BACKGROUND: 18F-FDG PET/CT has become an important tool in diagnosis of prosthetic vascular graft infections (PVGI). The aim of the study was to identify the patterns of vascular graft infection in 18F-FDG PET/CT.
MATERIAL AND METHODS:The study was performed in 24 patients with vascular graft infection, in 17 patients implanted in an open surgery mode and in 7 patients by endovascular aortic repair (EVAR). Vascular prostheses were evaluated by two visual scales and semi-quantitative analysis with maximum standardized uptake values (SUV max).
RESULTS:In the 3-point scale: 23 patients were in grade 1 and one patient was in grade 2. In the 5-point scale: 19 patients were in grade 5 with the highest activity in the focal area, 4 patients were in grade 4 and one patient in grade 3. The visual evaluation of 18F-FDG PET/CT study revealed that peri-graft high metabolic activity was associated with occurrence of morphological abnormalities (n = 21) like gas bubbles and peri-graft fluid retention or without abnormal CT findings (n = 3). The presence of the gas bubbles was linked to higher uptake of 18F-FDG (p < 0.01, SUVmax 11.81 ± 4.35 vs 7.36 ± 2.80, 15 vs 9 pts). In EVAR procedure, the highest metabolic activity was greater than in classical prosthesis (SUVmax 21.5 vs 13).CONCLUSIONS: 18F-FDG PET/CT is a very useful tool for assessment of vascular graft infections. CT findings like gas bubbles, or peri-graft fluid retention were associated with significantly higher glucose metabolism; however, in some cases without anatomic alterations, increased metabolic activity was the only sign of infection.
Within a rather large series of LCNEC, the primary tumor showed an uptake of Tc-TOC in all cases, whereas some metastases did show Tc-TOC uptake and some others did not.
A 51-year-old man with primary hyperparathyroidism was referred for radionuclide localization of hyperfunctioning parathyroid glands. He was complaining of weakness, nausea, excessive urination, and occasional heart palpitations. Laboratory values were the following: elevated parathyroid hormone level 184 pg/ml (normal range, 14-72 pg/ml), hypercalcemia-a calcium level of 11.1 mg/dl (normal range, 8.7-10.4 mg/dl) and normal renal parameters. Cervical ultrasonography and contrast enhanced computed tomography (CT) of the neck were negative. Early Tc-99m-methoxyisobutylisonitrile (MIBI) images, Tc-99m-MIBI/Tc-99m-sodium pertechnetate subtraction and Tc-99m-MIBI single photon emission computed tomography (SPECT)/CT failed to identify a focal area of increased uptake. F-18-Deoxyglucose positron emission tomography (PET)/ /CT was also negative. F-18-Choline PET/CT demonstrated two foci of increased radiotracer uptake localized behind the lower poles of the thyroid gland consistent with hyperfunctioning parathyroid glands. The patient underwent excision of these two bilateral lesions and the subsequent pathology examination confirmed the presence of parathyroid hyperplasia. The parathyroid hormone and calcium level normalized after the surgery. In the presented
Somatostatin receptor scintigraphy (SRS) is useful in diagnosing tumours with increased expression of somatostatin receptors. Lymphoma cells are known to express somatostatin receptors; however, the application of indium-labelled analogues in children is limited. The aim of this study was to investigate whether the technetium-labelled somatostatin analogue, depreotide, may be useful in diagnosing and staging malignant lymphoma in children. Fifteen children (mean age 13.8 years) with malignant lymphoma were studied (eight with Hodgkin's lymphoma and seven with non-Hodgkin's lymphoma). All children were investigated for verification of staging established by other modalities. Imaging was performed 3-5 h after administration of 300-550 MBq (99m)Tc-depreotide. All patients underwent whole-body scan and single-photon emission tomography of the chest and/or abdomen. Images were assessed visually. In all patients, foci of increased tracer uptake were found. The neck and thorax were the most frequent lesion localisations. Abdominal lesions were found in four patients, and bone lesions in three. In two patients, diffusely increased uptake was observed throughout the skeleton (verified as representing bone marrow involvement). In 11 patients, the number of abnormal sites detected by SRS was greater than that detected by CT. Based on radionuclide examination, three children were upstaged and none were downstaged. It is concluded that (99m)Tc-depreotide shows increased accumulation in pathological sites in malignant lymphoma in children. SRS with (99m)Tc-depreotide provides a single-day imaging method with high sensitivity in lymphoma and with all the advantages of a technetium-labelled compound. Further studies are required on the specificity and the possible value of (99m)Tc-depreotide in the follow-up of these patients.
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