Interesting image
Bilateral multiple pulmonary 18F-FDG microembolisms demonstrated on PET/CT
Múltiples microembolismos pulmonares bilaterales en 18F-FDG PET/TAC
a Department of Nuclear Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
b Department of Radiology, Agrı State Hospital, Agrı, Turkey
c Department of Thoracic Medicine, Sanlıurfa Viransehir State Hospital, Sanlıurfa, Turkey
d Department of Radiology, Karaman State Hospital, Karaman, Turkey
e Department of Thoracic Medicine, Agrı State Hospital, Agrı, Turkey
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Upper side. Initial PET, CT and PET/CT axial views (a, a′, a″) of a suspected brain lesion with high tracer uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (b, c) show vascular lesion with blood–brain-barrier disruption and haemorrhagic transformation in the same side. Bottom side. Post-treatment PET, CT and PET/CT axial views (d, d′, d″) show reduction of the uptake in the right temporal lobe. Corresponding MR T1-weighted post-contrast and T2-FLAIR axial views (e, f) show a lacunar area, confirming the diagnosis of a vascular haemorrhagic lesion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G.L. Cascini, A. Restuccia, T. De Vincenti, F. Manti, F. Calabria" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G.L." "apellidos" => "Cascini" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Restuccia" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "De Vincenti" ] 3 => array:2 [ "nombre" => "F." 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The <span class="elsevierStyleSup">11</span>C-methionine PET showed cortico-subcortical lesion on the right parieto-temporal lobe without abnormal activity of the tracer, features suggestive of benign lesion. The stereotactic biopsy confirmed the existence of a DNET.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. García, M. Baquero, E. Llinares, M. Soler, M. Moragas, E. Riera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "García" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Baquero" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Llinares" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Soler" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Moragas" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Riera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X15000128" "doi" => "10.1016/j.remn.2015.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X15000128?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000762?idApp=UINPBA00004N" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000762/v1_201508130058/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Bilateral multiple pulmonary <span class="elsevierStyleSup">18</span>F-FDG microembolisms demonstrated on PET/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "334" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Gungor, M. Mazican, I. Koc, H. Bal, N. Mazican" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Gungor" "email" => array:1 [ 0 => "dr.serkan81@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Mazican" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Koc" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "H." "apellidos" => "Bal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "N." "apellidos" => "Mazican" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Nuclear Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Radiology, Agrı State Hospital, Agrı, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Thoracic Medicine, Sanlıurfa Viransehir State Hospital, Sanlıurfa, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Radiology, Karaman State Hospital, Karaman, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Thoracic Medicine, Agrı State Hospital, Agrı, Turkey" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Múltiples microembolismos pulmonares bilaterales en <span class="elsevierStyleSup">18</span>F-FDG PET/TAC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2457 "Ancho" => 3250 "Tamanyo" => 593447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection (A), transaxial slices of CT and fusion PET/CT images of thorax demonstrated bilateral multiple pulmonary focal FDG uptakes in the right upper lobes (B and C), right lower lobe (D) and left upper lobe (E) without any anatomical correlation on CT.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 51-year-old female patient presented with a history of mastectomy and chemotherapy because of breast cancer. <span class="elsevierStyleSup">18</span>F-FDG PET/CT was performed to assess treatment response and revealed partial regression of the lung and liver metastases (data not shown). In addition to these lesions, maximum intensity projection, transaxial slices of CT and fusion PET/CT images of thorax demonstrated bilateral multiple pulmonary focal FDG uptakes in the right upper lobe, right lower lobe and left upper lobe without any anatomical correlation on CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This artifact is well known in the literature and most likely explained by the migration of <span class="elsevierStyleSup">18</span>F-FDG containing blood clot that produced during injection process from injection site to small vascular structures of the lung parenchyma.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> Blood clots may exist when vascular endothelium is damaged by paravenous injection, high flow of materials, location of needle tip, or aspiration of blood.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Paravenous injection is known as the most appropriate mechanism for FDG microembolism. Although <span class="elsevierStyleSup">18</span>F-FDG is generally injected into a vein in the forearm, in our case it is administered into the dorsal vein of right foot due to invisible and impalpable forearm veins. At sites of endothelial injury, platelets are activated and adhere to the subendothelium, rapidly change their shape and subsequently aggregate, releasing the contents of the a-cytoplasmic granules by exocytosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Although anaerobic glycolysis is the major energy source for platelets at rest, all steps of the activation process are highly dependent on extracellular glucose. The most active glucose transporter, GLUT-3, has been shown to be the major agent responsible for glucose uptake by activated platelets.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a> The activation of platelets by thrombin induces a three- to five-fold increase in glucose transport via GLUT-3.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Activated platelets and fibrin are the major constituents of blood clots and this may account for the high <span class="elsevierStyleSup">18</span>F-FDG uptake of the focal lesions observed on PET images. To our knowledge, this is the first report of bilateral multiple microembolisms in the lung following paravenous <span class="elsevierStyleSup">18</span>F-FDG radiotracer injection at the dorsum of the foot. Our hypothesis is that lower extremity injection and the degree of endothelium injury may account for bilateral multiple FDG microembolisms.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">All the authors state that there were no conflicts of interests when the manuscript was written.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2457 "Ancho" => 3250 "Tamanyo" => 593447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum intensity projection (A), transaxial slices of CT and fusion PET/CT images of thorax demonstrated bilateral multiple pulmonary focal FDG uptakes in the right upper lobes (B and C), right lower lobe (D) and left upper lobe (E) without any anatomical correlation on CT.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary <span class="elsevierStyleSup">18</span>F FDG microembolism detected on only delayed image in a PET/CT study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.D. Gorur" 1 => "E. Ciftci" 2 => "S. Isgoren" 3 => "H. Demir" 4 => "C. Haksal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0000000000000585" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2015" "volumen" => "40" "paginaInicial" => "253" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25243945" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombin stimulates glucose transport in human platelets via the translocation of the glucose transporter GLUT-3 from alpha-granules to the cell surface" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.F. Heijnen" 1 => "V. Oorschot" 2 => "J.J. Sixma" 3 => "J.W. Slot" 4 => "D.E. James" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cell Biol" "fecha" => "1997" "volumen" => "138" "paginaInicial" => "323" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9230074" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombin-induced translocation of GLUT3 glucose transporters in human platelets" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.R. Sorbara" 1 => "T.M. Davies-Hill" 2 => "E.M. Koehler-Stec" 3 => "S.J. Vannucci" 4 => "M.K. Horne" 5 => "I.A. Simpson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biochem J" "fecha" => "1997" "volumen" => "328" "paginaInicial" => "511" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9371709" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003400000005/v1_201508130058/S2253808915000877/v1_201508130058/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003400000005/v1_201508130058/S2253808915000877/v1_201508130058/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808915000877?idApp=UINPBA00004N" ]
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