18F-FDG simultaneous PET/MR monitoring treatment response of a Turcot syndrome case
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18F-FDG simultaneous PET/MR monitoring treatment response of a Turcot syndrome case Haiyan Wang 1 & Qiaoyi Xue 2 & Zhiwen You 1 & Xing Chen 1 & Jianmin Yuan 2 & Jun Zhao 1 Received: 27 May 2020 / Accepted: 19 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Keywords Turcot syndrome . PET/MR . Treatment response monitoring
A 17-year-old female with Turcot syndrome (TS) presented with constipation and hematochezia for 2 weeks. Dozens of small flat polyps and a mass near the dentate line were seen during colonoscopy. Serum CA19-9 level was 41.50 IU/mL. The patient underwent whole-body 18F-FDG positron emission tomography/magnetic resonance (PET/MR) scan for preoperative staging. In addition to the colon lesions (Fig. 1b, e: a 7 cm mass, white arrow, SUVmax = 17.74; enlarged lymph nodes, red arrows, SUVmax = 2.97), lesions in the right thalamus
This article is part of the Topical Collection on Oncology-Digestive tract. Haiyan Wang and Qiaoyi Xue contributed equally to this work. * Jun Zhao [email protected] 1
Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
2
Central Research Institute, UIH Group, Shanghai, People’s Republic of China
(Fig. 1c, 1.3 × 1.1 cm, SUVmax = 4.74) and right breast (Fig. 1d, 3.1 × 1.7 cm, SUVmax = 2.24) were found with low FDG uptake. The patient underwent endoscopic mucosal resection for the polyps, and the rectal mass was partially removed. The histopathological diagnosis was rectal adenocarcinoma and breast fibroadenoma. CA 19-9 level reduced to 13.50 IU/mL after 3 courses of SHR-1210 and anti–PD-1 antibody treatment. The patient showed no gastrointestinal symptoms, but her follow-up scan (5 months later) indicated an enlarged lesion in the right thalamus (Fig. 2c, 2.0 × 1.7 cm, SUVmax = 4.19). The patient presented with no neurological complaints, so the planned thalamic surgery was postponed. TS is a rare hereditary disorder with only 150 cases reported in literature [1]. The 5-year survival rate is < 5% [2, 3]. Early diagnosis with proper intervention is essential in the management of TS. Simultaneous 18F-FDG PET/MR is of potential clinical value in identifying the malignancy, clinical staging, and treatment response monitoring of TS, because of its effectiveness in revealing involvement of multiple organs within one scan and unique advantage in detecting subtle brain lesions.
Eur J Nucl Med Mol Imaging
Fig. 1 18F-FDG PET/MR image showed: ① A 7cm long annular thickened mass was seen in the lower segment of the rectum, with significantly increased FDG uptake (1b, 1e, white arrows, SUVmax=17.74). Several enlarged lymph nodes surrounding the rectal lesion with high FDG uptake (1b, red arrows, SUVmax=2.97) were also found in PET/MR fused images. ② 18F-FDG PET/MR imaging revealed a 1.3×1.1cm abnormal signal in the right thalamus, with lower FDG
uptake than the surrounding brain tissue (1c, SUVmax=4.74). ③ PET/ MR fused images showed a 3.1×1.7cm solid nodule in
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