Venous thromboembolism (VTE) can present as deep vein thrombosis (DVT) and/or acute pulmonary embolism (PE). In fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT, 18F-FDG activity along the deep veins of the lower extremities (LE) is often observed and, unless it is associated with focal intense activity, is not considered abnormal. However, anecdotally it has been associated with the placement of an inferior vena cava filter. In this short paper we intend to investigate this association. We found 10 patients who were investigated in the vascular laboratory by means of either LE or upper-extremity duplex or a chest computed tomography with PE protocol, or who had undergone the placement of an inferior vena cava filter between 27 April 2010 and 7 January 2013 and who had also undergone one or more 18F-FDG-PET scan(s) that included the LE. Seventeen patients without venous 18F-FDG uptake were added as controls. 18F-FDG uptake visualized in the LE was scored as the number of positive LE veins and the extent of the radiotracer uptake. The time intervals between the VTE event and the 18F-FDG-PET scan(s) were recorded. The time intervals between the most remote and the closest 18F-FDG-PET before a VTE event averaged 79 ± 101 and 49 ± 82 days, respectively, and the closest and the most remote 18F-FDG-PET after the VTE event averaged 58 ± 50 and 122 ± 124 days. The extent of uptake in the LE veins averaged 7 ± 2 for the patients with an acute DVT on LE duplex and 5 ± 3 for those with negative or chronic DVT on LE duplex (P=nonsignificant). Two patients (n=3 and 10) were negative for VTE events and had an extent of 0. The number of positive events correlated slightly with the extent of venous uptake (r=0.69). The 17 control patients without venous uptake on 18F-FDG-PET had no history of VTE. There was an association between LE venous uptake of 18F-FDG and risk for VTE. The association was not related to the location of the VTE, nor to the timing of the VTE.
Whole-rock and Sr–Nd–Pb isotopic composition data, zircon Hf isotopic data and zircon U–Pb ages were obtained for the Late Triassic porphyries in the Zhongdian arc, eastern Tibet. These porphyries are intermediate and metaluminous and are enriched in large ion lithophile elements and depleted in high field strength elements. Moreover, they have weak negative Eu anomalies, high Sr and Ba contents, and high Sr/Y ratios. Different mineral geothermobarometers suggest that the porphyries in the Zhongdian arc crystallized at c. 640–829 °C and pressures of 2.1–2.8 kbar at depths shallower than 8 km. The porphyries have a calculated water content of 4.47–4.94 wt % and a relatively high magmatic oxygen fugacity. These porphyries were emplaced mainly at 230–203 Ma with a peak at 218–215 Ma. The Sr–Nd–Pb–Hf isotope data suggest that the porphyries in the Zhongdian arc were derived from a mixed melt of 50–65 % asthenospheric mantle and 35–50 % eclogite from the western Yangtze lower crust that experienced low-degree partial melting of 2–10 %. Subsequent fractional crystallization resulted in the decreasing trends of the major- and trace-element contents. The high Sr/Y and La/Yb values are the result of the low degree of partial melting of the western Yangtze lower crust rather than fractional crystallization, because no linear relationship was noted between Sr/Y or La/Yb and SiO2. The mixed melts from the lower crust and asthenospheric mantle provided a fertile magma source, and subsequent fractional crystallization under the favourable magmatic conditions of high water content and high oxidation state resulted in the formation of the porphyry Cu–Au deposits.
A 48-year-old man with a newly diagnosed acute myeloid leukemia developed purpuric rash on day 6 after chemotherapy. Skin biopsy on day 8 demonstrated Grover disease. Triamcinolone treatment started on day 10 with subjective improvement on day 15. Initial FDG PET/CT on day 12 demonstrated rarely seen diffuse skin uptake that was interpreted as technical artifact and repeated on day 16. Accurately reviewing both PET and CT imaging would prevent confusion between diffuse cutaneous hypermetabolic activity and a technical artifact. Grover disease usually affects the trunk and may be related to the elimination of chemotherapy agents by sweating.
An observational finding found a large variation in the brain SUV in patients with multiple myeloma undergoing PET/CT. The first hypothesis considered a toxic effect of chemotherapeutic agents, but no correlation was found with hematological signs of toxicity. Low brain FDG uptake has been described with anesthesia, but this was not relevant in this case. An alternative is the presence of a large FDG avid mass, but that was excluded. Since there was a question of chemotherapy toxicity, the metrics used for comparison were Hemoglobin levels (Hgb, g/dl), Erythrocyte count (RBC, M/μL), Lymphocytes absolute counts (Lymph#, K/μL) and % (lymph, %), Granulocytes Neutrophils, K/μL), age and C-reactive protein levels (CRP, g/L). The liver SUV (standardized uptake value) was included to eliminate unexpected global effects on the SUV values, since FDG uptake is a competitive system with a single source (plasma FDG levels). There was in fact no correlation between brain SUV and hepatic SUV, eliminating the so-called super scan effect. Further analysis, however, revealed a strong positive correlation with hemoglobin or RBC levels, but an inverse effect with Neutrophils, C-reactive proteins and age (in years). The results suggest that brain metabolism strongly depends on oxygen supply and may be depressed by general inflammatory diseases and independently with age. If the variation of glucose metabolism correlates with cognitive deficits (CD), considering general measures of good health may be a first step for relief of age related CD.
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