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Year : 2016  |  Volume : 31  |  Issue : 2  |  Page : 152-153  

Calcified peritoneal metastasis identified on 18F-fluoride positron emission tomography/computed tomography: Importance of extraosseous uptake of F-18 fluoride


Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication9-Mar-2016

Correspondence Address:
Venkatesh Rangarajan
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.178333

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   Abstract 

F-18 NaF positron emission tomography/computed tomography (PET/CT) is used for the evaluation of malignant and nonmalignant osseous disease. Extraosseous uptake of 18 fluoride-NaF has been observed in the arterial vasculature, gastrointestinal tract, and genitourinary tract. We describe a case of a woman with carcinoma of unknown primary in whom F-18 NaF PET/CT showed tracer uptake in the calcified peritoneal metastasis. Extraosseous findings on F-18 NaF PET/CT, though rare, may be visualized and may result in important management changes.

Keywords: 18F-fluoride positron emission tomography/computed tomography, bone scintigraphy, calcified soft tissue metastasis, extraosseous finding


How to cite this article:
Verma P, Chandra P, Agrawal A, Purandare N, Shah S, Rangarajan V. Calcified peritoneal metastasis identified on 18F-fluoride positron emission tomography/computed tomography: Importance of extraosseous uptake of F-18 fluoride. Indian J Nucl Med 2016;31:152-3

How to cite this URL:
Verma P, Chandra P, Agrawal A, Purandare N, Shah S, Rangarajan V. Calcified peritoneal metastasis identified on 18F-fluoride positron emission tomography/computed tomography: Importance of extraosseous uptake of F-18 fluoride. Indian J Nucl Med [serial online] 2016 [cited 2019 Nov 15];31:152-3. Available from: http://www.ijnm.in/text.asp?2016/31/2/152/178333

F-18 NaF positron emission tomography/computed tomography (PET/CT) is used routinely for bone imaging for the detection of malignant and nonmalignant osseous disease. [1],[2] Extraosseous uptake of 18F-NaF (18 fluoride NaF) has been observed in structures such as the arterial vasculature, gastrointestinal tract, and genitourinary tract. [3],[4],[5],[6] As a bone-seeking radiopharmaceutical, 18F-NaF can localize in extraosseous calcifying lesions. Lesions containing dystrophic or microscopic calcification or calcified visceral metastases can show focal uptake of 18F-NaF. [7],[8],[9],[10] Tc-99m methylene diphosphonate uptake has been reported in ovarian carcinoma and its soft tissue metastases. [11] In literature, there is one case report of F-18 fluoride uptake in calcified extraosseous metastases from ovarian papillary serous adenocarcinoma. [12] We describe a case of a 73-year-old woman with carcinoma of unknown primary in whom F-18 NAF PET/CT showed tracer uptake in the calcified peritoneal metastasis. She presented with abdominal distension, and ascitic fluid cytology was positive for malignant cells, suggestive of metastatic adenocarcinoma. She underwent F-18F bone scan for evaluation of skeletal metastases. Whole body F-18F PET/CT maximum intensity projection (MIP) [Figure 1] showed focal increased tracer uptake in the right iliac fossa. Axial PET/CT fused [Figure 2] showed increased tracer uptake corresponding to calcified soft tissue peritoneal metastasis. No evidence of skeletal metastases was seen. [Figure 3] shows the coronal and sagittal images of the same patient. Contrast-enhanced CT scan [Figure 4] was done, which demonstrated the presence of calcified peritoneal metastasis. However, the primary site could not be identified. The patient was given a diagnosis of peritoneal metastases with an unknown primary and was referred for chemotherapy. Extraosseous findings on F-18 NaF PET/CT, like the one described here, though rare, may be visualized and may result in important management changes, if it is a metastatic site as in our case. However, confirmation with histology or other imaging modality should be made.
Figure 1: Whole body 18-F fluoride positron emission tomography/computed tomography maximum intensity projection image shows focal increased tracer uptake tracer uptake in the right iliac fossa. No evidence of skeletal metastases was seen

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Figure 2: Axial positron emission tomography/computed tomography fused image shows increased tracer uptake corresponding to calcified soft tissue peritoneal metastasis

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Figure 3: The coronal and sagittal images of the same patient

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Figure 4: The axial and coronal contrast-enhanced computed tomography images showing the calcified soft tissue peritoneal metastasis

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Zuckier LS, Freeman LM. Nonosseous, nonurologic uptake on bone scintigraphy: Atlas and analysis. Semin Nucl Med 2010;40:242-56.  Back to cited text no. 6
    
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Grant FD, Fahey FH, Packard AB, Davis RT, Alavi A, Treves ST. Skeletal PET with 18F-fluoride: Applying new technology to an old tracer. J Nucl Med 2008;49:68-78.  Back to cited text no. 7
    
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Kuyumcu S, Adalet I, Isik EG, Unal SN. Impact of nonosseous findings on (18) F-NaF PET/CT in a patient with ductal breast carcinoma. Nucl Med Mol Imaging 2014;48:72-4.  Back to cited text no. 9
    
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Swietaszczyk C, Prasad V, Baum RP. Intense 18F-fluoride accumulation in liver metastases from a neuroendocrine tumor after peptide receptor radionuclide therapy. Clin Nucl Med 2012;37:e82-3.  Back to cited text no. 10
    
11.
Beres RA, Patel N, Krasnow AZ, Isitman AT, Hellman RS, Veluvolu P, et al. Concentration of Tc-99m MDP in ovarian carcinoma and its soft tissue metastases. Clin Nucl Med 1991;16:550-2.  Back to cited text no. 11
    
12.
Agrawal K, Bhattacharya A, Harisankar CN, Abrar ML, Dhaliwal LK, Mittal BR. F-18 fluoride uptake in calcified extraosseous metastases from ovarian papillary serous adenocarcinoma. Clin Nucl Med 2012;37:e22-3.  Back to cited text no. 12
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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