Author/Authors :
Ho, Kung-Chu Department of Nuclear Medicine - Chang Gung Memorial Hospital and Chang Gung University - Keelung, Taiwan , Dean Fang, Yu-Hua Department of Biomedical Engineering - National Cheng Kung University - Tainan, Taiwan , Lin, Gigin Department of Medical Imaging and Intervention - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Ueng, Shir-Hwa Department of Pathology - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Wu, Tzu-I Department of Obstetrics and Gynecology - Wan Fang Hospital - Taipei Medical University - Taipei, Taiwan , Lai, Chyong-Huey Department of Obstetrics and Gynecology - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Chueh, Ho-Yen Department of Obstetrics and Gynecology - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Chao, Angel Department of Obstetrics and Gynecology - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Chang, Ting-Chang Department of Obstetrics and Gynecology - Chang Gung Memorial Hospital and Chang Gung University - Taoyuan, Taiwan , Yen, Tzu-Chen Department of Nuclear Medicine - Xiamen Chang Gung Hospital - Fujian, China
Abstract :
The unidentified presence of uterine smooth muscle malignancies poses a tremendous risk in women planning surgery for
presumed benign leiomyomas. We sought to investigate whether preoperative FDG PET may be useful to identify leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP). Methods. We investigated patients with
rapidly growing uterine masses which were suspected of being malignant on ultrasound or MRI. Among the 21 patients who
underwent FDG PET, we identified 7 LMS, 1 STUMP, and 13 leiomyomas. PET-derived parameters and FDG uptake patterns
were analyzed retrospectively. Results. The SUVmax values of LMS/STUMP (range: 3.7–11.8) were significantly higher than those
observed in leiomyomas (range: 2.0–9.4; P = 0.003) despite a significant overlap. The metabolic tumor/necrosis ratio was
significantly higher in LMS/STUMP than in leiomyomas (P < 0.001), with no significant intergroup overlaps. All LMS/STUMP
revealed a characteristic pattern of FDG uptake, identifying a specific “hollow ball” sign (corresponding to areas of coagulative
tumor necrosis). In contrast, this sign was invariably absent in patients with leiomyomas. Conclusion. The characteristic FDG
uptake pattern instead of SUV on PET images allows identifying LMS/STUMP in patients with rapidly growing uterine masses,
avoiding the deleterious consequences of regular surgery for presumed benign leiomyomas.
Keywords :
Malignancies , FDG , PET , LMS
