Usefulness of 18F-FDG PET/CT for evaluating response of ocular adnexal lymphoma to treatment.

The purpose of this study was to investigate the efficacy of F-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for evaluating the ocular adnexal lymphoma treatment responses.We retrospectively reviewed data for 9 histologically confirmed cases of malignant lymphoma. All patients had at least one ocular adnexal tumor site and underwent FDG PET/CT before and after treatment. Patients' histological disease subtypes included diffuse large B-cell lymphoma (n = 3), mucosa-associated lymphoid tissue lymphoma (n = 2), follicular lymphoma (n = 1), NK/T-cell lymphoma (n = 1), lymphoplasmacytic lymphoma (n = 1), and Hodgkin lymphoma (n = 1). The highest FDG uptake by the ocular adnexal lesions was calculated as the maximum standardized uptake value (SUVmax). FDG uptake at ocular adnexal sites and sites of systemic disease after treatment were also assessed using the 5-point Deauville scale.In 1 of the 9 patients, a conjunctival lesion could not be detected by either pre- or posttreatment PET/CT. For 8 of the 9 patients, the SUVmax value at the ocular adnexal site significantly decreased after treatment (7.1 ±â€Š5.1 vs 1.6 ±â€Š0.58; P = .0196). For 7 of the 9 patients, the first posttreatment FDG uptake at the ocular adnexal site was considered a complete metabolic response, and these patients showed an improved clinical ophthalmic presentation with no relapse at ocular adnexal sites during follow-up.FDG PET/CT is useful for evaluation of the response of ocular adnexal lymphoma to treatment, although its usefulness may depend on the histological subtype and site of the lesion.

18F-FDG PET/CT imaging of atypical subacute thyroiditis in thyrotoxicosis: A case report.

BACKGROUND: In addition to its established role in oncologic imaging, F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) is useful for the assessment of inflammatory activity. However, subacute thyroiditis (SAT) in thyrotoxicosis is rarely detected during these scans. CASE: A 66-year-old man with SAT in thyrotoxicosis demonstrated symptoms of transient fatigue, headache, and fever, without typical neck pain. Using F-FDG PET/CT, we found increased F-FDG uptake in the thyroid gland, predominantly in the right side due to SAT. We also observed a coexisting decrease in F-FDG uptake in the liver and increased F-FDG uptake in skeletal muscle due to thyrotoxicosis. CONCLUSION: Using F-FDG PET/CT, the combined observations of increased F-FDG uptake in the thyroid and skeletal muscle, and decreased F-FDG uptake in the liver, even when the typical symptom of neck pain is subtle or absent, may be helpful for the differential diagnosis of SAT in thyrotoxicosis.

Residual FDG uptake of primary thyroid lymphoma after treatment may overestimate residual lymphoma.

OBJECTIVE: To assess 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images in primary thyroid lymphoma (PTL) patients before and after treatment. METHODS: We conducted a retrospective review of data for ten patients (four men, six women) of mean age 65 (range 48-88) years, with histopathologically confirmed malignant thyroid lymphoma who underwent pre-treatment and post-treatment 18F-FDG PET between January 2005 and December 2014. Thyroid uptake was assessed by the 5-point scale score based on maximum intensity projection images. RESULTS: Four of the ten patients were judged to have a complete metabolic response (scores 1-3) and four to have a partial metabolic response (PMR; scores 4-5). Three of the four PMR patients had a good outcome with a treatment-free interval and overall survival of at least 53.0 months, although two of these three patients showed residual FDG uptake in the thyroid for more than 2 years after completion of treatment. Two of the ten patients were considered to have progressive metabolic disease. CONCLUSIONS: In patients with PTL, residual FDG uptake in the thyroid after treatment that corresponds to a PMR may not always indicate a poor outcome.

(18)F-FDG uptake of the spinal cord was decreased after conventional dose radiotherapy in esophageal cancer patients.

OBJECTIVE: We retrospectively investigated changes of (18)F-fluorodeocyglucose ((18)F-FDG) uptake in the spinal cord, inside and outside the radiation fields, in patients with esophageal cancer before and after conventional dose radiotherapy. METHODS: A total of 17 consecutive patients with esophageal cancer (16 males, one female; age 50-83 years, mean 67.0 years), who underwent conventional dose radiotherapy and (18)F-FDG PET/CT before and 5.1 months (range 1.6-8.6 months) after the radiotherapy, were retrospectively evaluated. Sixteen patients had esophageal cancer and one patient had esophageal metastasis from thyroid cancer. Mean standardized uptake values (SUVmean) of the cervical, thoracic (inside and outside the radiation fields) and lumbar spinal cord were measured. RESULTS: SUVmean of the thoracic spinal cord inside the radiation field was decreased significantly after radiotherapy compared to those before radiotherapy (p < 0.001). SUVmean of the cervical spinal cord showed the same trend but it was not statistically significant (p = 0.051). SUVmean of the thoracic spinal cord outside the radiation field and the lumbar spinal cord did not differ significantly before and after the radiotherapy (p = 0.146 and p = 0.701, respectively). CONCLUSIONS: The results suggest that glucose metabolism of the spinal cord is decreased in esophageal cancer patients after conventional dose radiotherapy.

A familial case of mitochondrial disease resembling Alport syndrome.

A 38-year-old man with mild sensorineural hearing loss, diabetes mellitus, proteinuria, and slight renal dysfunction was admitted to our hospital for a renal biopsy to determine the cause of kidney disease. His elder sister and mother also had sensorineural hearing loss and renal failure, suggesting the existence of a common genetic disease in this family. Although the clinical features of the patient were similar to features of Alport syndrome, renal biopsy revealed no sign of Alport syndrome. We next considered a possibility of a mitochondrial kidney disease described by Jansen in 1997. Indeed, genetic analysis of mitochondrial DNA clarified the existence of A3243G mutation in the patient and his sister. This syndrome should be recognized by nephrologists as a differential diagnosis of Alport syndrome, diabetic nephropathy, and primary glomerular diseases.