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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.
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