Zoledronate-related osteonecrosis of the mandible.

We report the PET-CT appearance of Zoledronate-related osteonecrosis of the mandible in a 54-year-old woman with right breast cancer with osseous and pulmonary metastases. Her treatment included surgery, chemotherapy and Zoledronate, and external beam radiation treatment. During the course of treatment, the patient developed osteonecrosis of the jaw secondary to Zoledronate, which was biopsy-proven, for which Zoledronate was discontinued shortly after. Hybrid PET-CT was performed approximately 1 year after the discontinuation of Zoledronate. PET-CT images demonstrated diffuse, intense hypermetabolism in the mandible, consistent with documented osteonecrosis.

Bilateral ovarian metastases from breast carcinoma on FDG PET-CT.

We report the PET-CT appearance of bilateral ovarian metastases in a 51-year-old woman with a history of right breast carcinoma with osseous metastasis diagnosed 14 years earlier. The colon and stomach are the most common primary tumor sites in ovarian metastasis, followed by the breast, lung, and contralateral ovary. It is important to consider this form of neoplasm in the differential diagnosis because the treatment and prognosis will be different from a dyssynchronous primary tumor.

High-grade urothelial carcinoma of the prostate on FDG PET-CT.

We report the PET-CT appearance of a high-grade prostatic urothelial carcinoma in a 68-year-old man with a long history of urothelial carcinoma. The patient was initially diagnosed with urothelial carcinoma in the left ureter, status postleft nephrourethrectomy. He was subsequently, 11 years later, diagnosed with low-grade urothelial carcinoma involving the bladder for which he received monthly Bacillus Calmette-Guerin treatment. Three months after the diagnosis of the bladder tumor, he was found to have biopsy-proven high-grade urothelial carcinoma of the prostate for which he was referred to have a PET-CT scan to evaluate for distant metastasis.

[F-18]-Fluorodeoxyglucose PET and PET-CT in diagnostic imaging evaluation of locally recurrent and metastatic bladder transitional cell carcinoma.

BACKGROUND: Little data is available on the utility of positron emission tomography (PET) and positron emission tomography-computed tomography (PET-CT) with [F-18]-fluorodeoxyglucose (FDG) in patients with bladder cancer. We retrospectively assessed the diagnostic utility of dedicated PET and hybrid PET-CT scans with [F-18]-FDG in the imaging evaluation of recurrent and metastatic bladder transitional cell carcinoma. METHODS: The study group included 35 patients who were previously treated for the primary disease. We performed PET in 17 patients and 23 PET-CT scans in 18 patients. Diagnostic validation was by biopsy in 1 patient and clinical and radiological follow-up for up to 5 years in the remaining patients. RESULTS: PET and CT were true negative (TN) in 12 patients and true positive (TP) in 19 patients. In 4 patients in this group, both locally recurrent pelvic mass and distant metastases were demonstrated, while in 3 of these patients, unsuspected skeletal and/or nodal metastases were detected by PET-CT and these patients received additional courses of chemotherapy. PET was discordant with CT in 4 patients. PET was negative in 2 of these patients, while post-chemotherapy CT showed enlarged nodes that were determined to represent successfully treated disease. In another patient, a hypometabolic soft-tissue mass was considered to represent a scar, and a wait-and-watch strategy was pursued. In the remaining patient, PET showed random hypermetabolic osseous lesions that represented early marrow metastatic infiltration. The combined diagnostic information provided by PET-CT affected the clinical management in 17% of patients. CONCLUSION: FDG PET and PET-CT scanning may improve the imaging evaluation of patients with recurrent and metastatic bladder cancer.