Interesting images
Visualizations of metastatic ovarian carcinoma on a bone scintigraphy and SPECT/CT
Cáncer de ovario metastásico visualizado en una gammagrafía ósea y SPECT/TC
M. Pudis
, J.J. Martín-Marcuartu, A. Feu-Llauradó, J.G. Reyes-Junca, C. Soldevila-Lozano, M. Cortés-Romera
Corresponding author
Nuclear Medicine-PET (IDI) department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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(b) Focal hypermetabolic uptake cranial to the iliac bifurcation due to an active infectious process already described in previous studies. (c) Hypodense lesions with peripheral contrast uptake and increased metabolism in the left iliac muscle, approximately 6.7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.4<span class="elsevierStyleHsp" style=""></span>cm, and in the subcutaneous cellular tissue in the gluteus medius region, approximately 6.4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.2<span class="elsevierStyleHsp" style=""></span>cm, compatible with abscesses. (d) Focal hypermetabolic lesions located in the middle third of the right femur, the middle third of the left femur, soft tissue of the left knee’s lateral side that associates skin thickening and on the anteromedial face of the right tibia compatible with septic embolisms.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Sabater Sancho, J. Orozco Cortés, T. Mut Dólera, Á. Badenes Romero, E. Casula, B. Cueto Cañadas" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sabater Sancho" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Orozco Cortés" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Mut Dólera" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Badenes Romero" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Casula" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Cueto Cañadas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921000525?idApp=UINPBA00004N" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808921000525/v1_202205140730/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2253808921000549" "issn" => "22538089" "doi" => "10.1016/j.remnie.2021.03.012" "estado" => "S300" "fechaPublicacion" => "2022-05-01" "aid" => "1260" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2022;41:190-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Early diagnosis of cardiac sarcoidosis in inflammatory stage on cardiac [<span class="elsevierStyleSup">18</span>F]FDG PET/MRI. A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "190" "paginaFinal" => "191" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico precoz de sarcoidosis cardiaca en fase inflamatoria mediante cardio PET/RM con [<span class="elsevierStyleSup">18</span>F]FDG. A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 437 "Ancho" => 1500 "Tamanyo" => 55566 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient preparation: 72 h previous to the procedure patient was placed on a high-fat diet with carbohydrates restriction, and fasted for 12 h. Fifty units/Kg of SC heparin were injected 15 min prior to the [<span class="elsevierStyleSup">18</span>F]FDG injection.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Synchronous PET/CMR acquisition:</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• PET: 1 beds/10 min. Cardiac/breath gating.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• CMR: anatomical sequences; cine; phase contrast; STIR; gadolinium administration (first-pass perfusion, late gadolinium enhancement).</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CMR: Left ventricle is mildly dilated, with slight concentric hypertrophy; basal inferolateral segmental akinesia and diffuse hypokinesia; systolic function is moderately depressed (LVEF 40%).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Integrated [<span class="elsevierStyleSup">18</span>F]FDG PET/CMR axial images obtained with a GE Signa 3T equipment:</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• [<span class="elsevierStyleSup">18</span>F]FDG PET: Adequate myocardial suppression with segmental radiotracer uptake seen on basal inferolateral territory.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• Post-gadolinium MRI: Late myocardial enhancement with gadolinium, especially in inframyocardial area, which suggested fibrosis on basal inferolateral segment, spreading to basal anterolateral segment, with minimum subendocardial involvement.</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleHsp" style=""></span>• Hybrid PET/CMR imaging: Image matching is seen between segmental [<span class="elsevierStyleSup">18</span>F]FDG uptake and late gadolinium enhancement on basal inferolateral territory, which corresponded to an active sarcoidosis pattern.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Olivero, J.R. Garcia, P. Bassa, P. Garcia, E. Riera, A. Maceira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Olivero" ] 1 => array:2 [ "nombre" => "J.R." "apellidos" => "Garcia" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Bassa" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Garcia" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Riera" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Maceira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921000549?idApp=UINPBA00004N" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808921000549/v1_202205140730/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Visualizations of metastatic ovarian carcinoma on a bone scintigraphy and SPECT/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "193" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Pudis, J.J. Martín-Marcuartu, A. Feu-Llauradó, J.G. Reyes-Junca, C. Soldevila-Lozano, M. Cortés-Romera" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Pudis" "email" => array:1 [ 0 => "michalpudis@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.J." "apellidos" => "Martín-Marcuartu" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Feu-Llauradó" ] 3 => array:2 [ "nombre" => "J.G." "apellidos" => "Reyes-Junca" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Soldevila-Lozano" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Cortés-Romera" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Nuclear Medicine-PET (IDI) department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cáncer de ovario metastásico visualizado en una gammagrafía ósea y SPECT/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1119 "Ancho" => 705 "Tamanyo" => 28366 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bone scan with [99mTc] Tc-HMDP performed 2 h after the injection of the radiopharmaceutical, showing an increase in osteoblastic activity in the right chest wall.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 57-year-old woman with a clinical history of an ovarian cancer in complete remission for 2 years who consulted her physician for a lump in her right breast. A physical examination confirmed a rounded nodule of about 7 cm in diameter in the upper-inner quadrant of the right breast, painless and partially fixed to the underlying chest wall. Given the suspicion of a disseminated breast cancer, mammography and bone scintigraphy were requested as initial tests from her Primary Health Care Center.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A bone scan was performed with technetium-99m ([99mTc] Tc HMDP), which showed an uptake of the radiopharmaceutical between some costal arches (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In hybrid SPECT/CT images, these were correlated with solid lesions, some with discrete calcifications in their interior, which were located in the right pectoral muscle, right subphrenic region and a right subhepatic nodular lesion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A biopsy of the lesion located in the right pectoral muscle was suggested, which was later confirmed as a metastasis from the low-grade serous ovarian carcinoma. The images from pathology showed an infiltration by neoplastic cells and abundant psammoma bodies (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The [99mTc]Tc-HMDP scan is primarily used to document skeletal pathology. However, an abnormal extraosseous accumulation of bone-affinity radiopharmaceuticals has been documented previously in many conditions, both benign and malignant. These deposits may be explained by the affinity of 99mTc-marked diphosphonates for hydroxyapatite crystals and calcium precipitates in soft tissue.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Tissue calcifications can be microscopic and beyond the resolution of conventional imaging techniques, so diphosphonate scintigraphy allows an early diagnosis of these lesions. Zhang et al. observed that extraosseous uptake on bone scintigraphy exists in 0.6% of neoplasms.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The complementary acquisition of hybrid images with SPECT/CT equipment allows a more precise localization and characterization and enables the selection of the most accessible lesion for biopsy, thus increasing its cost-effectiveness.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The psammoma bodies are concentrically laminated calcifications that are observed in a multitude of malignant tumors including the papillary serous adenocarcinoma. Soft tissue metastases from ovarian papillary serous adenocarcinoma show a high affinity for [99mTc]Tc-HMDP, due to the high calcium content in psammoma bodies, allowing their visualization in scintigraphic studies with bisphosphonates.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-23" "fechaAceptado" => "2020-12-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pudis M, Martín-Marcuartu JJ, Feu-Llauradó A, Reyes-Junca JG, Soldevila-Lozano C, Cortés-Romera M. Cáncer de ovario metastásico visualizado en una gammagrafía ósea y SPECT/TC. Rev Esp Med Nucl Imagen Mol. 2022;41:192–193.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1119 "Ancho" => 705 "Tamanyo" => 28366 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bone scan with [99mTc] Tc-HMDP performed 2 h after the injection of the radiopharmaceutical, showing an increase in osteoblastic activity in the right chest wall.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1252 "Ancho" => 1505 "Tamanyo" => 118595 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hybrid SPECT/CT and tomographic images show that these pathological uptakes correspond to solid lesions located in the right pectoral muscles, right subhepatic and subphrenic regions.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 973 "Ancho" => 1510 "Tamanyo" => 309267 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Images from pathology of a metastasis from a low-grade serous ovarian carcinoma. Core needle biopsy (CNB) of soft tissues with infiltration by neoplastic cells and abundant psammoma bodies in the image on the left (H&E ×100). The image on the right shows the concentric plates of the psammoma bodies seen at higher magnification (H&E ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soft tissue uptake on <span class="elsevierStyleSup">99m</span>Tc methylene diphosphonate bone scan imaging: pictorial review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Kaye" 1 => "M. Hayward" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1440-1673.2001.00989.x" "Revista" => array:6 [ "tituloSerie" => "Australas Radiol" "fecha" => "2002" "volumen" => "46" "paginaInicial" => "13" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11966582" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accurate characterization of <span class="elsevierStyleSup">99m</span>Tc-MDP uptake in extraosseous neoplasm mimicking bone metastasis on whole-body bone scan: contribution of SPECT/CT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Zhang" 1 => "Q. He" 2 => "T. Zhou" 3 => "B. Zhang" 4 => "W. Li" 5 => "H. Peng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12880-019-0345-1" "Revista" => array:5 [ "tituloSerie" => "BMC Med Imaging" "fecha" => "2019" "volumen" => "19" "paginaInicial" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31146746" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accumulation of <span class="elsevierStyleSup">99m</span>Tc-HMDP in ovarian serous papillary adenocarcinoma reflecting ongoing calcification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Kikuchi" 1 => "Y. Sugawara" 2 => "M. Kajihara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00003072-200110000-00026" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "886" "paginaFinal" => "887" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11564940" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004100000003/v1_202205140730/S2253808921000537/v1_202205140730/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/22538089/0000004100000003/v1_202205140730/S2253808921000537/v1_202205140730/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921000537?idApp=UINPBA00004N" ]
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