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DOI:10.2214/AJR.06.5004-1
AJR 2006; 186:268
© American Roentgen Ray Society

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Tamar Sella, Svetlana Mironov and Hedvig Hricak

Memorial Sloan-Kettering Cancer Center New York, NY
Hadassah University Medical Center Jerusalem, Israel
Memorial Sloan -Kettering Cancer Center New York, NY

We thank Drs. Zissin and Even-Sapir for their important insight into the possible physiologic uptake of 18F-FDG in normal ovaries during certain phases of the menstrual cycle. Indeed, 18F-FDG uptake has been described in various physiologic and benign lesions in the ovaries and elsewhere. These physiologic and benign lesions have been recognized as a potential source of error when interpreting 18F-FDG PET studies in oncology patients [1, 2].

As in the normal ovary, in a functioning transposed ovary of a premenopausal woman, physiologic uptake may theoretically be encountered. However, ovarian and peritoneal metastases are not rare in cervical cancer patients. Evaluation of the amount of uptake, and correlation with clinical factors and other imaging techniques, are necessary to distinguish physiologic from pathologic uptake. Such a case is presented in figures 9 and 11 of our article [3], with a transposed left ovary showing strong uptake of 18F-FDG (standardized uptake value, 20) and correlating with a predominantly solid mass on CT. Surgical pathology proved this lesion to be a metastasis of cervical cancer.

Thus, although a physiologic process may be considered in a premenopausal patient with a transposed ovary, careful assessment of the PET/CT characteristics and correlation with clinical parameters and other imaging findings are necessary to exclude a metastasis.


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  1. Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996; 26:308 -314[CrossRef][Medline]
  2. 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]
  3. Sella T, Mironov S, Hricak H. Imaging of transposed ovaries in patients with cervical carcinoma. AJR2005; 184:1602 -1610[Abstract/Free Full Text]

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