DOI:10.2214/AJR.06.5004
AJR 2006; 186:267-268
© American Roentgen Ray Society
18F-FDG Uptake on PET/CT in Transposed Ovaries
R. Zissin and
E. Even-Sapir
Sapir Medical Center Kfar Saba 44281, Israel and Tel-Aviv University
Tel-Aviv, Israel
Tel-Aviv Sourasky Medical Center affiliated with the Sackler Faculty
of Medicine and Tel-Aviv University Tel-Aviv, Israel
We read with interest the pictorial essay by Sella et al.
[1] regarding the imaging
features of the normal transposed ovaries and of a spectrum of associated
abnormalities. We have recently reported the PET/CT findings in surgically
transposed ovaries [2] and
would like to comment about physiologic uptake that can occasionally be seen
in these deviated, but otherwise normal, ovaries with preserved
functionality.
Currently, a hybrid composition of PET and CT systems has been introduced
in conjunction with conventional cross-sectional imaging methods in the
routine practice of staging oncologic patients, monitoring response to
treatment, and assessing recurrence. PET and CT data, acquired at the same
clinical setting and with the generation of fused PET/CT images, provide both
functional and anatomic information. A transposed ovary may show increased
18F-FDG uptake on the PET portion of the study that may be related
to its preserved functionality
[2]. Such uptake has been
reported in the ovaries of healthy premenopausal patients at mid menstrual
cycle as a result of functional changes
[3].
In a young woman with a history of cervical carcinoma, when the CT portion
of a PET/CT study shows surgical clips adjacent to a soft-tissue mass with
focal increased 18F-FDG uptake on the PET part of the study, these
findings may be a clue for the correct diagnosis and for preventing a
misdiagnosis of a tumoral implant. Directly interviewing the patient may help
because the information of ovarian transposition may unfortunately be missing
from the referral letter. In menstruating patients, the physiologic cause of
uptake may then be found by asking about the menstruation history of the
patient. In posthysterectomy patients, however, the phase of the menstrual
cycle cannot be determined by history alone.
To conclude, physicians interpreting PET/CT scans should be aware of a
functioning transposed ovary to avoid, in the proper clinical setting, its
misinterpretation as a neoplastic process.
References
- Sella T, Mironov S, Hricak H. Imaging of transposed ovaries in
patients with cervical carcinoma. AJR2005; 184:1602
-1610[Abstract/Free Full Text]
- Zissin R, Metser U, Lerman H, Lievshitz G, Safra T, Even-Sapir E.
PET-CT findings in surgically transposed ovaries. Br J
Radiol 2005; 78:1
-6[Free Full Text]
- Lerman H, Metser U, Grisaru D, Fishman A, Lievshitz G, Even-Sapir
E. Normal and abnormal 18F-FDG endometrial and ovarian uptake in
pre- and postmenopausal patients: assessment by PET/CT. J Nucl
Med 2004; 45:266
-271[Abstract/Free Full Text]
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